The Pennsylvania State University, USA.
Palo Alto University, USA.
Behav Res Ther. 2021 Dec;147:103984. doi: 10.1016/j.brat.2021.103984. Epub 2021 Oct 6.
Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD.
Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data.
VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = -0.54 to -1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36-0.45), whereas cybersickness decreased (g = -0.43).
Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.
虚拟现实暴露疗法（VRE）已显示出对治疗社交焦虑症（SAD）和相关共病的有前途的疗效。然而，迄今为止进行的大多数试验都是由治疗师主导的，对于自我指导的 VRE 的疗效知之甚少。因此，这项随机对照试验（RCT）旨在确定自我指导的 VRE 治疗 SAD 的疗效。
根据 Mini 国际神经精神访谈，将 44 名被诊断为 SAD 的社区居住或大学生被随机分配到 VRE 组（n=26）或等待名单组（WL；n=18）。自我报告的 SAD 严重程度（社交恐惧症诊断问卷和社交互动焦虑量表）、工作面试焦虑（选拔面试焦虑量表）、特质担忧（宾夕法尼亚州担忧问卷）和抑郁症状（患者健康问卷-9）在基线、治疗后、3 个月随访（3MFU）和 6 个月随访（6MFU）时进行评估。使用分段多层模型分析来管理数据聚类。
VRE 与 WL 相比，SAD 症状严重程度、工作面试恐惧和特质担忧的降低更为显著，治疗前后的效应量为中等至较大（Hedge's g=-0.54 至-1.11）。虽然在抑郁变化方面没有出现显著的组间差异，但 VRE 导致了抑郁的变化，而 WL 则没有。这些收益在 3MFU 和 6MFU 时仍保持不变。此外，在 VRE 过程中存在的各个方面增加（g=0.36-0.45），而网络病减少（g=-0.43）。
简短的、自我指导的 VRE 可能会改善年轻到中年成年人的 SAD 和共病担忧。还讨论了其他理论和实际意义。
