In an experiment published in JMIR Mental Health, people with social anxiety disorder showed reduced social anxiety and less negative rumination following a virtual reality based exposure therapy. Moreover, this reduction in symptoms was associated with changes in brain activity when participants judged whether positive words were self-relevant.
People with social anxiety disorder (SAD) experience an intense fear of negative evaluation during social situations that greatly interferes with their quality of life. In investigating potential treatments for the disorder, psychology scholars have pinpointed virtual reality (VR) therapy as an effective intervention for teaching coping skills to individuals with SAD.
A team of researchers led by Ji-Won Hur devised a study to explore the efficacy of VR therapy in targeting a particular aspect of SAD that is believed to be key to the development and maintenance of the disorder. Self-referential processing — which refers to the processing of information related to oneself — appears to be biased among people with social anxiety. Using neuroimaging, the researchers tested whether VR therapy would affect areas of the brain responsible for self-referential processing.
First, a sample of 25 individuals diagnosed with SAD and 22 healthy control subjects took part in a baseline assessment. All participants completed a self-referential processing task while undergoing functional magnetic resonance imaging (fMRI). During the task, the subjects were presented with a series of words that were either neutral, positive, or negative and were asked to select whether each word was relevant to them, somewhat relevant to them, or not relevant to them.
Next, 21 of the participants with SAD took part in six VR sessions over several lab visits. The VR situations varied in difficulty, but each one depicted a social anxiety scenario where participants had to introduce themselves to strangers. After completing the treatment, the participants with SAD underwent another fMRI while again partaking in a self-referential processing task.
When the researchers analyzed the baseline data, they found that people with SAD showed increased activation in certain parts of the brain during the self-referential processing task when compared to the controls.
Following the VR therapy, the participants with SAD showed increased activity in various parts of the brain, including the frontal, temporal, and occipital lobes. In addition, they showed robust decreases in negative rumination and lower scores on the Social Phobia Scale (SPS). In fact, SPS scores actually dropped below severity levels.
Moreover, the more participants showed changes in activity in the lingual gyrus during positive word processing, the lower their social anxiety and the less they partook in negative rumination following the VR therapy. Hur and colleagues note that, according to previous research, the lingual gyrus may be implicated in self-referential processing. They say that the VR therapy may have assisted the SAD patients in accepting the positive words as self-relevant.
The participants also showed increased activity in brain areas implicated in processing autobiographical memories, constructing self-image, and integrating sensory information.
“To our knowledge,” the researchers report, “this is the first neuroimaging study to specify the changes in the psychophysiological responses to self-referential information in social anxiety disorder in response to VR therapy. We believe that our findings may contribute to a better understanding of the therapeutic effects of VR-based interventions, which could be included in the routine treatment of social anxiety disorder.”
Since the control group did not partake in the VR sessions, it is uncertain whether the neural changes observed in patients with SAD were directly caused by the therapy treatment. However, the study authors emphasize that the SAD participants did show significant changes in brain activity during self-referential processing after completing the therapy.
The study, “Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task”, was authored by Ji-Won Hur, Hyemin Shin, Dooyoung Jung, Heon-Jeong Lee, Sungkil Lee, Gerard J Kim, Chung-Yean Cho, Seungmoon Choi, Seung-Moo Lee, and Chul-Hyun Cho.