Adaptive exposure therapy for Social Anxiety Disorder: a preliminary validation in virtual reality

Abstract

Social Anxiety Disorder (SAD) represents an increasingly prevalent challenge for healthcare. Exposure therapy is the elective treatment that has undergone significant development over last decades thanks to Virtual Reality (VR): its last frontier is represented by adaptive scenarios changing in real time to maximize efficacy and tolerability of the exposure. In the present study, 15 volunteers with clinical SAD symptomatology were immersed in two versions of the same virtual waiting room and asked to continuously report their anxiety in real time using the VR controller. One scenario gradually filled with avatars interacting with the participant in a fixed progression independent of the participant’s responses; the other automatically adapted the avatars’ number and behavior to induce more-or-less anxiety. Participants were not aware that, in the latter scenario, their ratings modulated the environment to maintain participants within an optimal range of social anxiety: sufficiently elevated to promote therapeutic habituation, yet low enough to minimize dropout. The current findings indicate that the adaptive condition successfully constrained anxiety within this target range: while preliminary, these results encourage further investigation to fully establish therapeutic efficacy.