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Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study

  • Chris N.W. Geraets (a1), Wim Veling (a1), Maartje Witlox (a2), Anton B.P. Staring (a3), Suzy J.M.A. Matthijssen (a3) (a4) and Danielle Cath (a1) (a4) (a5)...

Patients with generalized social anxiety disorder (SAD) avoid various social situations and can be reluctant to engage in in vivo exposure therapy. Highly personalized practising can be required before patients are ready to perform in vivo exposure. Virtual reality-based therapy could be beneficial for this group.


To assess the feasibility and potential effect of virtual reality-based cognitive behavioural therapy (VR-CBT) for patients with severe generalized SAD.


Fifteen patients with generalized SAD attended up to 16 VR-CBT sessions. Questionnaires on clinical and functional outcomes, and diary assessments on social activity, social anxiety and paranoia were completed at baseline, post-treatment and at 6-months follow-up.


Two patients dropped out of treatment. Improvements in social anxiety and quality of life were found at post-treatment. At follow-up, depressive symptoms had decreased, and the effect on social anxiety was maintained. With respect to diary assessments, social anxiety in company and paranoia were significantly reduced by post-treatment. These improvements were maintained at follow-up. No increase was observed in social activity.


This uncontrolled pilot study demonstrates the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life.

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Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E. and Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1, 368376. doi: 10.1016/S2215-0366(14)70329-3
Pot-Kolder, R., Geraets, C. N. W., Veling, W., Staring, A. B. P., Gijsman, H. J., Delespaul, P. A. and van der Gaag, M. (2018). Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial. The Lancet Psychiatry, 5, 217226. doi: 10.1016/S2215-0366(18)30053-1
Valmaggia, L. R., Latif, L., Kempton, M. J. and Rus-Calafell, M. (2016). Virtual reality in the psychological treatment for mental health problems: an systematic review of recent evidence. Psychiatry Research, 236, 189195. doi: 10.1016/j.psychres.2016.01.015
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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