Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study

Abstract

Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking.

Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of "being there," during VR exposure with anxiety measures and treatment response was examined.

Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured.

Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η²=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response.

Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents.

Keywords: VR; VRET; adolescents; autonomic arousal; digital health; exposure therapy; posttreatment; school anxiety; simulation; social anxiety; virtual reality; virtual reality exposure therapy.

Figure 1

Virtual reality scenario. The upper pictures are from the experimenter’s perspective, and the lower pictures are from the participants’ perspective. Panels (A; schoolyard) and (B; school corridor) are examples of the phase “exploration.” The lower pictures are related to the phases “introduction,” “math,” and “event.”.

Figure 2

Mean trajectory of SUD (A) and HR (B) in the first and the final session. Note that n=10 for SUD and n=4 for HR. Acc: acclimatization; Exp: exploration; HR: heart rate; Intro: introduction; SUD: Subjective Units of Distress (state anxiety); Means and standard errors.

Figure 3

Association between presence and Subjective Units of Distress (state anxiety) in the first session and between mean presence across sessions and pre to post change in school reluctance (N=10). The graph represents the regression line with standard error. (B) Change was calculated as a Post-pre-difference , so that negative values represent a reduction from pre to post-VRET. IPQ: Igroup Presence Questionnaire; SUD: Subjective Units of Distress; VRET: virtual reality exposure therapy.