Virtual Reality Exposure-Enhanced Cognitive Behavioral Therapy (CBT + VRE) vs. CBT With Imaginal Exposure (CBT + IE)...

The purpose of the present study was to investigate the relative effectiveness of cognitive-behavioral therapy (CBT) with imaginal exposure (CBT + IE) and CBT combined with virtual reality exposure (CBT + VRE) for symptoms of social anxiety disorder (SAD) and fear of negative evaluation (FNE) in adolescents.

In a three-armed randomized controlled trial (RCT), a total of 51 adolescents who met the DSM-5 criteria for SAD were randomly assigned to either CBT + IE (N = 17; M _age = 16.41; SD = 0.61), CBT + VRE (N = 17; M _age = 16.35; SD = 0.70), or a waitlist control condition (WLCC; N = 17; M _age = 16.00; SD = 0.70). Participants were assessed pre and posttreatment and followed up 3 months after the last treatment session regarding symptoms of social phobia, measured with the social phobia inventory (SPIN), and FNE, measured with the FNE Questionnaire.

A linear mixed model (LMM) analysis revealed significant differences between the treatment groups and WLCC in interaction with the three assessment times in SAD and FNE. A significant reduction of both CBT + VRE and CBT + IE treatments on symptoms of SAD from pretreatment to posttreatment and 3 months follow-up (d _pre-post = 1.31 and d _pre-fu = 1.43 in CBT + VRE group; d _pre-post = 1.90 and d _pre-fu = 2.04 in CBT + IE group) and FNE (d _pre-post = 1.35 and d _pre-fu = 1.68 in the CBT + VRE group; d _pre-post = 1.95 and d _pre-fu = 1.59 in the CBT + IE group) compared to the WLCC was observed. No significant differences were observed between the VRE + CBT and CBT + IE groups on FNE. With respect to SAD, statistically significant between-group differences emerged in favour of the CBT + IE group, accompanied by substantial effect sizes at posttreatment (d = 0.87) and follow-up (d = 0.73).

The results support the effectiveness of CBT + IE and CBT + VRE in reducing the symptoms of SAD and FNE, which were maintained 3 months after treatment. Future research should focus on optimizing VRE protocols, exploring long-term outcomes, and investigating its applicability across diverse populations. Further exploration of the cost-effectiveness and accessibility of VR technology in clinical settings is required. Trial Registration: ClinicalTrials.gov identifier: IRCT20210213050343N2.