VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial

Abstract While virtual reality exposure (VRE) has shown effectiveness in treating social anxiety in adults, research on its efficacy for adolescents remains limited. Given that adolescence is a critical period for early intervention, this study aims to address this gap by evaluating the efficacy and...

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Main Authors: Elizabeth S. Uduwa Vidanalage, Jella De Lee, Dirk Hermans, Iris M. Engelhard, Sara Scheveneels, Katharina Meyerbröker
Format: Article
Language:English
Published: BMC 2025-04-01
Series:BMC Psychiatry
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Online Access:https://doi.org/10.1186/s12888-025-06756-w
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author Elizabeth S. Uduwa Vidanalage
Jella De Lee
Dirk Hermans
Iris M. Engelhard
Sara Scheveneels
Katharina Meyerbröker
author_facet Elizabeth S. Uduwa Vidanalage
Jella De Lee
Dirk Hermans
Iris M. Engelhard
Sara Scheveneels
Katharina Meyerbröker
author_sort Elizabeth S. Uduwa Vidanalage
collection DOAJ
description Abstract While virtual reality exposure (VRE) has shown effectiveness in treating social anxiety in adults, research on its efficacy for adolescents remains limited. Given that adolescence is a critical period for early intervention, this study aims to address this gap by evaluating the efficacy and acceptability of VRE compared to in vivo exposure (IVE) in a non-referred sample of socially anxious adolescents. Additionally, we seek to identify mechanisms of change—such as expectancy violation, habituation, and self-efficacy—as well as predictors of treatment response, including clinical, personality, and VR-related factors. Using a randomized controlled trial (RCT), 120 adolescents (ages 12–16) with subclinical to moderate social anxiety will be assigned to one of three conditions: VRE, IVE, or a waitlist control (WL). Participants in the active conditions will undergo a seven-session exposure-based intervention (either in VR or in vivo). Primary (SPAI-18, LSAS-avoidance) and secondary (SPWSS) measures of social anxiety, along with general well-being indicators (e.g., resilience, depression, psychosocial functioning), will be assessed at baseline, post-treatment, and 3- and 6-month follow-ups. A series of linear mixed model (LMM) analyses will be used to examine and compare the effects of the interventions. We hypothesize that both VRE and IVE will significantly reduce social anxiety symptoms compared to WL at post-assessment, with comparable long-term efficacy between the two exposure methods. Additionally, thematic analyses will be conducted to explore participants’ experiences and acceptance of VRE and IVE through qualitative interviews. The findings of this study aim to advance digital mental health research by evaluating the potential of VRE as an early intervention and identifying mechanisms and predictors to inform personalized treatments for socially anxious youth. Trial registration Clinicaltrials.gov: NCT06379633, registered on April, 23, 2024.
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spelling doaj-art-7e5e1282b9904ce7b51b457211712b362025-08-20T02:28:10ZengBMCBMC Psychiatry1471-244X2025-04-0125112010.1186/s12888-025-06756-wVIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trialElizabeth S. Uduwa Vidanalage0Jella De Lee1Dirk Hermans2Iris M. Engelhard3Sara Scheveneels4Katharina Meyerbröker5Utrecht UniversityKU LeuvenKU LeuvenUtrecht UniversityMaastricht UniversityUtrecht UniversityAbstract While virtual reality exposure (VRE) has shown effectiveness in treating social anxiety in adults, research on its efficacy for adolescents remains limited. Given that adolescence is a critical period for early intervention, this study aims to address this gap by evaluating the efficacy and acceptability of VRE compared to in vivo exposure (IVE) in a non-referred sample of socially anxious adolescents. Additionally, we seek to identify mechanisms of change—such as expectancy violation, habituation, and self-efficacy—as well as predictors of treatment response, including clinical, personality, and VR-related factors. Using a randomized controlled trial (RCT), 120 adolescents (ages 12–16) with subclinical to moderate social anxiety will be assigned to one of three conditions: VRE, IVE, or a waitlist control (WL). Participants in the active conditions will undergo a seven-session exposure-based intervention (either in VR or in vivo). Primary (SPAI-18, LSAS-avoidance) and secondary (SPWSS) measures of social anxiety, along with general well-being indicators (e.g., resilience, depression, psychosocial functioning), will be assessed at baseline, post-treatment, and 3- and 6-month follow-ups. A series of linear mixed model (LMM) analyses will be used to examine and compare the effects of the interventions. We hypothesize that both VRE and IVE will significantly reduce social anxiety symptoms compared to WL at post-assessment, with comparable long-term efficacy between the two exposure methods. Additionally, thematic analyses will be conducted to explore participants’ experiences and acceptance of VRE and IVE through qualitative interviews. The findings of this study aim to advance digital mental health research by evaluating the potential of VRE as an early intervention and identifying mechanisms and predictors to inform personalized treatments for socially anxious youth. Trial registration Clinicaltrials.gov: NCT06379633, registered on April, 23, 2024.https://doi.org/10.1186/s12888-025-06756-wVirtual reality exposureSocial anxietyAdolescenceRandomized controlled trialTreatment mechanismsPredictors
spellingShingle Elizabeth S. Uduwa Vidanalage
Jella De Lee
Dirk Hermans
Iris M. Engelhard
Sara Scheveneels
Katharina Meyerbröker
VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
BMC Psychiatry
Virtual reality exposure
Social anxiety
Adolescence
Randomized controlled trial
Treatment mechanisms
Predictors
title VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
title_full VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
title_fullStr VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
title_full_unstemmed VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
title_short VIRTUS: virtual reality exposure training for adolescents with social anxiety – a randomized controlled trial
title_sort virtus virtual reality exposure training for adolescents with social anxiety a randomized controlled trial
topic Virtual reality exposure
Social anxiety
Adolescence
Randomized controlled trial
Treatment mechanisms
Predictors
url https://doi.org/10.1186/s12888-025-06756-w
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