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Updated: Sep 13, 2025

Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure
Published on: January 18, 2021
Enhancing the efficacy and user experience of virtual reality exposure therapy for social anxiety disorder: A pilot
Warut Aunjitsakul1, Kanthee Anantapong1, Pakawat Wiwattanaworaset1
1Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Abstract:
BackgroundSocial anxiety disorder (SAD) significantly impairs social functioning. Virtual reality exposure therapy (VRET) offers a promising treatment by providing a controlled, customizable environment. This study aimed to develop and evaluate the efficacy and user experience of a VRET program.MethodsThe study was conducted in two phases: Phase I with the general population and Phase II with individuals diagnosed with SAD at a university hospital. Social anxiety, depression, anxiety, and stress were measured using the Social Interaction Anxiety Scale and the Depression Anxiety and Stress Scale at three time points: before, immediately after, and two weeks post-VRET. The Virtual Reality Neuroscience Questionnaire assessed user experience, game mechanics, in-game assistance, and any VR-induced symptoms. Our VRET program utilized graded exposure techniques within culturally relevant social scenarios.ResultsBoth groups exhibited significant reductions in social anxiety levels following VRET sessions (ps < 0.01) compared to pre-VRET levels. However, individuals with SAD reported increased social anxiety at the two-week follow-up, while the general population maintained their improvement. The VR software received satisfactory ratings for usability, safety, and acceptability.ConclusionThis program demonstrates potential for reducing social anxiety and provides a satisfactory VR experience, supporting its feasibility for individuals with SAD in a developing country. Given the pilot nature and limited sample size, these findings should be interpreted cautiously. Future research with larger samples and repeated sessions is needed to enhance efficacy and ensure long-term benefits. Comprehensive treatment protocols, including tutorials, relaxation techniques, and stress monitoring, are recommended for optimal outcomes.
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