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Background: Public speaking anxiety (PSA) is a prevalent social anxiety affecting up to 30% of the population. Individuals with PSA often express fear of being evaluated by others and avoid eye contact. Despite this behavioral characteristic, the potential of gaze avoidance reduction as a therapeutic intervention to alleviate PSA-related anxiety remains unexplored. Methods: We designed a standalone virtual reality (VR) gaze exposure treatment focused on enhancing eye contact in public speaking contexts and evaluated its effectiveness in reducing state anxiety during public speaking. In a single-blind, randomized controlled trial, 89 participants with subclinical PSA were assigned to either a gaze exposure treatment or a control group. Assessments occurred at baseline, following a one-hour intervention, and after nine additional 20-minute home interventions. The primary outcome was state anxiety, assessed using the Subjective Units of Distress Scale during a real-life public speaking test. Results: Repeated, but not acute VR gaze exposure reduced state anxiety during public speaking compared to the control group (treatment: baseline 48.95 [SD 19.52], post-intervention 2: 26.60 [SD 19.23]; control: baseline 48.92 [SD 18.43], post-intervention 2: 56.34 [SD 28.15]; adjusted mean group difference: -29.82, 95% CI: -41.77 to -17.87; Cohen's d = -1.07, p < 0.0001). Limitations: Our study design does not allow conclusions regarding the effective component (i.e., gaze exposure vs. social context) of the intervention. Conclusions: Our findings indicate that repeated VR gaze exposure treatment in public speaking contexts can effectively reduce state anxiety during public speaking among individuals with subclinical PSA. These promising results call for further investigations in clinical populations.

BackgroundIn the early stages of the COVID-19 pandemic, mental-health experts called attention to a possible deterioration of obsessive-compulsive symptoms (OCSs). In particular, people suffering from a fear of contamination were considered a vulnerable population.AimThe aim of this study was to investigate the change in OCSs from before to during the pandemic within the Swiss general population, and to examine a possible relationship of OCSs to stress and anxiety.MethodsThis cross-sectional study was implemented as an anonymized online survey (N = 3,486). The Obsessive-Compulsive Inventory-Revised (OCI-R) was used to assess global OCS severity (range: 0–72, clinical cut-off > 18) and specific OCS dimensions (range: 0–12) during the second wave of the pandemic and retrospectively for before the pandemic. Participants were asked to report stress and anxiety in the previous 2 weeks before the survey.ResultsParticipants reported significantly higher OCI-R total scores during (12.73) compared to before the pandemic (9.04, mean delta increase: 3.69). Significantly more individuals reported an OCI-R total score exceeding the clinical cut-off during (24%) than before the pandemic (13%). OCS severity increased on all symptom dimensions, but was most pronounced on the washing dimension (all with p < 0.001). Self-reported stress and anxiety were weakly associated with differences in severity in total score and symptom dimensions (with R2 < 0.1 and p < 0.001).ConclusionOur results indicate that the full spectrum of people with OCS should be considered as risk groups for symptom deterioration during a pandemic and when assessing its possible long-term effects of such.

Abstract Smartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app—Easy Heights—and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18–60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen’s d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights.

Background: To assess the psychological consequences of changes during the coronavirus 2019 (COVID-19) pandemic in the Iranian population. Methods: We performed an anonymous online survey in the first 3 weeks of March 2020. Individuals older than 14 who could read Persian, and lived in Iran, were eligible for the study. The participants had to rate their stress levels and depressive symptoms (using a nine-item Patient Health Questionnaire PHQ-9) during the last 2 weeks and before the pandemic retrospectively. The changes in the psychological measurements and their association with the sociodemographic factors and burdens due to confinement were assessed. Results: Overall, among the 3,210 subjects who participated in our study, both the stress levels and average depression scores increased. However, about 23% of the subjects reported a decrease in their stress levels. The burden of childcare, restrictions in private life, and thoughts about the future were positively correlated with the changes in the stress levels and depression scores (|r| > 0.15). However, feeling relieved in the pandemic condition, and enjoying more family time were associated with less change in the stress and depression scores. Being religious (odds ratio [OR] [CI]: 1.5 [1.3-1-8]) and older age (OR [CI]: 2.9 [1.8–4.6] for >55 years old) were identified as the resilience factors, whereas being a student (OR [CI]: 2.1 [1.6;2.7]), seeking a job (OR [CI]: 2.6 [1.8;3.9]), and history of a psychiatric disorder (OR [CI]: 3.2 [2.6;4]) were identified as the risk factors for depression. Conclusions: The stress levels and depressive symptoms have increased during the COVID-19 pandemic and this increase is related to different social and personal burdens due to the confinement conditions.