All articles in NSAC’s social anxiety blog are written by actual human beings, not artificial intelligence. Our authors are all mental health clinicians who have expertise in evidence-based treatment for social anxiety disorder, and who are affiliated with NSAC Regional Clinics and Associates.


People are inherently social. We band together in social groups at work or in school, we pair up in relationships and bond with friends over sports games. We even go out of our way to join online games or social media groups themed around a common interest. This bonding is deeply ingrained in our psyche – it’s the connection that allows us to help others in times of trouble or reach out if we need support. For people who suffer with social anxiety, though, communal gatherings aren’t about connecting with others. Instead, they are a source of apprehension, fears of being judged, and stress over having to interact with others. This is where virtual reality therapy can make a huge difference.

The typical method of social anxiety treatment is a combination of Cognitive Behavioral Therapy (CBT) and in-vivo exposure therapy. Through these two modalities, an individual with social anxiety is slowly exposed to small doses of social interaction over time. This will help them gradually build up their tolerances and confidence while desensitizing them to their fears. During treatment, the person also participates in role playing with their therapist to acquire social skills and practices these new abilities in a safe, non-threatening environment.

The drawback to this treatment comes when someone finds that being physically present in an anxiety-laden situation is too traumatic. It can also be problematic for those who have to travel to a physical location, such as for someone who lives in a more rural area.

Enter virtual reality exposure therapy (VRET). Now, people with social anxiety can challenge their fears non-physically, in a realistic, safe, comfortable setting – and in situations they can control.

Social Anxiety Disorder Takes Many Forms

People with social anxiety worry constantly that they’ll embarrass themselves in social settings or that they’re always being watched and judged for even the smallest actions. Often, they realize they might be making a bigger deal out of a situation than is warranted, but they can’t help how they feel or change their emotional reactions.

As with anything, social anxiety can be all-consuming or may simply be confined to certain areas of a person’s life. For example, one person might have a hard time participating on a team project at work or find it difficult to give a presentation to their peers. Another individual may feel so traumatized about social interaction that they can’t leave the safety of their home to go to work, shop at a mall, or eat at a restaurant.

How Does Virtual Reality Exposure Therapy Help Social Anxiety?

Just as with Cognitive Behavioral Therapy and in-vivo exposure, virtual reality exposure therapy helps people with social anxiety learn to effectively cope with fearful situations, but it does so in a high-tech, non-physical way. During a VRET session, the person wears a virtual reality headset similar to the type used by video gamers or the ones that let you view movies on your phone. On-screen avatars move through simulations of common social situations and the individual participates via their own avatar. By learning to guide their avatar through anxiety-laden circumstances, they become better prepared for real life interactions.

With virtual reality exposure therapy, people feel as if they’re actually in the setting, but with the benefit of having more control. If you become too anxious, the therapist can stop the program, instantly removing you from the perceived threat. Although it seems hard to believe, the experience of guiding an avatar through a fearful experience does trigger an emotional response, even if you know you aren’t in a real setting. This is similar to watching a horror movie and jumping involuntarily when the killer leaps out at the person on the screen, despite knowing that the movie is fake.

VR therapy programs begin with a low anxiety stimulus and increase gradually as the person becomes desensitized and learns coping skills. The therapist monitors the session to give feedback and help with relaxation methods, as well as to provide coaching during the simulation.

Is VRET Effective for Social Anxiety?

A study was done in 2013 to find out if virtual reality therapy was truly effective. During the study, participants who had an official diagnosis of social anxiety disorder took part in a randomized trial comparing in-vivo exposure therapy with VR therapy. Study participants were directed to give a speech in front of their peers.

Before the speeches, some people went through eight sessions of in-vivo exposure therapy, some participants completed eight sessions of virtual reality therapy, and some individuals were required to give the speech without taking part in either therapy modality. After completing the assigned treatment, the two therapy groups demonstrated reduced anxiety levels and significant improvement in symptoms as compared with the group who received no treatment. Additionally, both therapy groups were able to maintain this improvement at their 12-month reassessment.

While more studies will be done in the future, the findings from this one show that both physical and virtual therapies offer similar results. The conclusion is that VRET is as effective a treatment for social anxiety as therapy done in a physical setting, without the added stress of being in an actual social environment. In fact, nearly 83 percent of people who have tried virtual reality therapy have managed to put their fears behind them.

Article by Andrew Rosen PH.D., ABPP, FAACP
Board Certified Psychologist
Founder and Director of NSAC South Florida:  The Center for the Treatment of Anxiety and Mood Disorders, in Delray Beach, Florida.


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