Virtual reality gaze exposure treatment reduces state anxiety during public speaking in individuals with public speaking anxiety: A randomized controlled trial

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.