ARTICLE REVIEW - NATASHA - WEEK 6

Virtual Reality Exposure versus Cognitive Restructuring for Treatment of Public Speaking Anxiety: A Pilot Study

Helene S. Wallach, PhD, 1 Marilyn P. Safir, PhD, 1 and Margalit Bar-Zvi, MD2

Isr J Psychiatry Relat Sci - Vol. 48 - No. 2 (2011)

With reference to:

Use of virtual reality as therapeutic tool for behavioural exposure in the ambit of social anxiety disorder treatment

H Grillon, F Riquier, B Herbelin, and D Thalmann, 2006

AIM OF THE STUDY:

To determine the utility of Virtual Reality Exposure Therapy (VRE) in comparison with Cognitive Therapy (CT) and with Cognitive-Behavior Therapy (CBT). Usually phobias are treated with CBT, recently VRE has been employed to conduct the BT (exposure) component of CBT. The researchers wanted to find out the relative efficiency of each component individually as well as comparatively with the combined treatment.

METHODOLOGY:

20 subjects suffering from public speaking anxiety (PSA) were randomly allocated to VRE and CT, and received 12 therapy sessions, employing standardized treatment manuals. Outcome (questionnaires, observer and self-ratings of a behavioural task) was compared to results of subjects in a previous study CBT and Wait List Controls who were not significantly different on demographic data.

The virtual simulator included scenes in which the subject is required to read from text, which appears on a podium in the virtual world, in front of a large audience in various situations (audience clapping, asking questions, appearing hostile, etc.).

 The subjects provided the text, but the scenes were controlled by the therapist, according to the hierarchy which was developed for each subject prior to exposure

Upon completion of the VR experience, the researchers studied their materials buy using:

Liebowitz Social Anxiety Scale: includes 24 questions where the participant rates the amount of fear experiences and the amount of avoidance experience. This scale has a high reliability and validity.

Self-statements during public speaking which assesses fearful thoughts during public speaking judging on positive and negative self-statements. This also has high reliability and validity.

Fear of negative evaluation which consists of 30 close ended questions. These questions relate to cognitive aspects of the phobic experience (fear of criticism or negative evaluation)

Behavioural task: after the VRE treatment, participants gave a ten minute talk on a topic of their choice (standing, without notes) in front of a small live audience (4-5 people). Participants were rated on 10 anxiety indicators

Prior to rating the subjects, all observers underwent a brief training session in order to insure high inter-rater reliability. In addition, subjects rated their anxiety at various points (waiting outside the room, giving the lecture, etc.)

FINDINGS:

CT was not superior to VRE on cognitive measures, but was superior to VRE on one behavioural measure (LSAS fear). VRE was superior to CT on one behavioural measure (fear reduction on a behavioural task). No differences were found between either CT, or VRE, and CBT and all were superior to WL.

Limitations: Subject group was small and homogeneous. It appeared advisable to increase number of therapy sessions.

Conclusions: VRE and CT proved to be equally effective to CBT in reducing PSA relative to a control group, with minimal differential effects between them. Therefore, employing either one may be satisfactory and sufficient.

Even though each methods of treatment are effective, the use of VR is still beneficial in this field as VR can offer (anxiety) provoking scenarios which are difficult to access and are not easily available in real life. As an example, it would be extremely difficult for a therapist to fill his/her office with spiders in order to treat a patient. Equally, it would be extremely expensive and time consuming to repeatedly take a patient on an airplane in order to treat him/her against fear of flights. VR also allows repeating exposures without limitations. For example, a job interview is an accessible but exceptional situation. It would be difficult to have to do a job interview every week, as a habituation exercise (Grillon, 2006).