Fear Not: Combining Digital and Virtual Reality Interventions for the Treatment of Social Anxiety Disorder – A Randomized Controlled Trial

Social anxiety disorder (SAD) poses a significant mental health challenge. Despite cognitive behavior therapy being the first-line treatment for SAD, its accessibility remains limited. Internet- and mobile-based interventions (IMIs) offer approaches to enhance accessibility and reduce waiting times. As part of this, some recent approaches have incorporated virtual reality (VR) to enable behavioral experiments and exposure. This pilot study aimed to explore the efficacy of an IMI, including CBT interventions via smartphone apps and VR to alleviate the severity of SAD symptoms. Thirty-two patients diagnosed with SAD were randomly assigned to either an experimental group (n = 16) receiving the IMI or an active control group (n = 16). The number of therapeutic appointments was held constant across conditions to account for unspecific treatment effects. The primary outcome was SAD severity, obtained at baseline, interim, post-treatment, and follow-up assessments. The secondary outcome remission was evaluated through a diagnostic interview at follow-up. The trial was registered with ISRCTN (ID: ISRCTN18013983). Regarding the differential effectiveness between the active control condition and the IMI, two different results were found: There was a higher remission rate in the experimental group compared to the control group, while no significant differences in SAD severity were found. While SAD severity showed a comparable reduction in both groups, significantly fewer patients in the experimental group were still diagnosed with SAD at follow-up. This suggested a difference between self-report and clinical evaluation. Despite the mixed results, IMIs provide a low-barrier intervention and could be used to increase access to therapy and reduce waiting times.