VR-Counseling to Reduce Public Speaking Anxiety

NCT07351409 | Not Yet Recruiting

• 1 other identifier: RV-PSI_13/03/2023_n. 318
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Public Speaking Anxiety (PSA) is a common manifestation of social anxiety among university students that can negatively impact academic performance and psychological well-being. Virtual Reality (VR) based interventions combined with Cognitive Behavioral Therapy (CBT) represent a promising approach to address PSA by enabling controlled, gradual exposure to feared social situations through realistic simulations of audiences and settings. This randomized controlled trial will evaluate whether integrating VR sessions into standard psychological counseling provided by the University Psychological Counseling Service (UPCS) improves anxiety and PSA outcomes in university students compared with counseling alone. Participants will be randomized to one of two groups: (1) a control group receiving standard psychological counseling intervention, or (2) an experimental group receiving psychological counseling supplemented with VR interventions delivered via immersive 360° video scenarios. The VR-based intervention includes a VR-Exposure and Response Prevention (ERP) module offering graded exposure to anxiety-provoking public speaking contexts, and a VR-Acceptance and Commitment Training (ACT) module aimed at enhancing mindfulness and psychological flexibility through guided experiential exercises. Psychological outcomes and physiological responses recorded during sessions will be analyzed to compare the effectiveness of VR-integrated counseling versus standard counseling alone. This study addresses the limited evidence on CBT combined with 360° video-based VR exposure for PSA in university students and introduces a novel VR-based ERP and ACT protocol tailored to a university counseling setting.

Conditions

Anxiety and Distress; Anxiety; Anxiety Disease; Public Speaking Anxiety

Keywords

Public speaking anxiety; university counseling; Virtual Reality

Outcome Measures

Primary Outcomes (1)

• Change From Baseline in Public Speaking Anxiety at VR Post-Treatment

  Change from baseline to post-treatment in public speaking anxiety as assessed by the Personal Report of Public Speaking Anxiety (PRPSA), comparing the experimental arm with the control arm. The PRPSA is a self-report questionnaire designed to measure anxiety specifically related to speaking in front of an audience. It assesses cognitive, physiological, and behavioral components of public speaking anxiety, capturing both anticipatory anxiety and anxiety experienced during performance. The scale consists of 34 items rated on a 5-point Likert scale, with response options ranging from 1 = strongly disagree to 5 = strongly agree. Items reflect feelings of tension and nervousness, physiological arousal, negative self-appraisal, and fear of audience evaluation. Total scores range from 34 to 170, with higher scores indicating greater levels of public speaking anx

  Baseline (T0) and end of VR intervention sessions (T1, at the end of the 4-week intervention period).

Secondary Outcomes (6)

• Heart Rate During Intervention Sessions

  During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

• Heart Rate Variability During Intervention Sessions

  During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

• Electrodermal Activity During Intervention Sessions

  During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

• Skin Temperature During Intervention Sessions

  During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

• Movement and Activity Levels During Intervention Sessions

  During intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

Other Outcomes (1)

• Change From Baseline in Public Speaking Anxiety at 3-Month Follow-Up

  Baseline (T0) and 3-month follow-up (T2) (approximately 3 months after treatment completion).

Study Arms (2)

Experimental Arm: VR (360°) Modules (VR-ERP + VR-ACT) + Standard Counseling

EXPERIMENTAL

The experimental intervention includes two distinct VR-based training scenarios: (A) VR-ERP, designed to gradually expose students to anxiety-provoking situations to prevent avoidance responses, and (B) VR-ACT training, a consistent mindfulness training aimed at enhancing psychological flexibility and value-oriented behaviors. Participants in the experimental group, after VR-ACT training, go to standard counseling intervention.

Device: Exposure and Response Prevention (ERP); Device: Acceptance and Commitment Therapy (ACT) training

Control Arm: Standard Counseling (No VR)

ACTIVE COMPARATOR

Standard counseling sessions will be conducted by one psychotherapist for 6 consecutive weeks in 60-minute sessions.

Behavioral: Counseling program

Interventions

Acceptance and Commitment Therapy (ACT) training DEVICE

to provide an ACT-consistent mindfulness training targeting psychological flexibility processes, such as contact with the present moment, cognitive defusion, and acceptance, aimed at eliciting a grounding response within a digitally generated, safe environment.

Experimental Arm: VR (360°) Modules (VR-ERP + VR-ACT) + Standard Counseling

Exposure and Response Prevention (ERP) DEVICE

to simulate feared-anxiety-evoking scenarios, allowing both assessment and training for situationally induced anxiety to progressively promote desensitization to the anxiety-provoking stimuli

Experimental Arm: VR (360°) Modules (VR-ERP + VR-ACT) + Standard Counseling

Counseling program BEHAVIORAL

Standard counseling sessions will be conducted by one psychotherapist for 6 consecutive weeks in 60-minute sessions.

Control Arm: Standard Counseling (No VR)

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• current enrollment at the university;
• request for psychological counseling at the UPCS;
• fluency in Italian;
• provision of written informed consent;
• the presence of at least moderate levels of anxiety and perceived stress, as indicated by scores on standardized assessment instruments. Specifically, scores between STAI scores from 35 to 50 and PRPSA scores from 85 to 110.

You may not qualify if:

• current psychotic disorder;
• acute suicidality;
• severe substance dependence;
• severe sensory or motor impairments that would prevent safe use of VR equipment;
• inability to attend the planned sessions;
• concurrent participation in other specialized psychotherapy programs.

Sponsors & Collaborators

• University of Calabria: lead

Study Sites (1)

University of Calabria

Rende, CS, 87036, Italy

Location

Related Publications (12)

• Reeves R, Curran D, Gleeson A, Hanna D. A Meta-Analysis of the Efficacy of Virtual Reality and In Vivo Exposure Therapy as Psychological Interventions for Public Speaking Anxiety. Behav Modif. 2022 Jul;46(4):937-965. doi: 10.1177/0145445521991102. Epub 2021 Feb 3.

  PMID: 33533265 RESULT

• Kampmann IL, Emmelkamp PM, Morina N. Meta-analysis of technology-assisted interventions for social anxiety disorder. J Anxiety Disord. 2016 Aug;42:71-84. doi: 10.1016/j.janxdis.2016.06.007. Epub 2016 Jun 18.

  PMID: 27376634 RESULT

• Kampmann IL, Emmelkamp PM, Hartanto D, Brinkman WP, Zijlstra BJ, Morina N. Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. Behav Res Ther. 2016 Feb;77:147-56. doi: 10.1016/j.brat.2015.12.016. Epub 2015 Dec 29.

  PMID: 26752328 RESULT

• Kahlon S, Lindner P, Nordgreen T. Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study. Child Adolesc Psychiatry Ment Health. 2019 Dec 27;13:47. doi: 10.1186/s13034-019-0307-y. eCollection 2019.

  PMID: 31890004 RESULT

• Huang J, Nigatu YT, Smail-Crevier R, Zhang X, Wang J. Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res. 2018 Dec;107:1-10. doi: 10.1016/j.jpsychires.2018.09.018. Epub 2018 Sep 29.

  PMID: 30300732 RESULT

• Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev. 2024 Jul 8;7(7):CD007674. doi: 10.1002/14651858.CD007674.pub3.

  PMID: 38973756 RESULT

• Donnelly MR, Reinberg R, Ito KL, Saldana D, Neureither M, Schmiesing A, Jahng E, Liew SL. Virtual Reality for the Treatment of Anxiety Disorders: A Scoping Review. Am J Occup Ther. 2021 Nov 1;75(6):7506205040. doi: 10.5014/ajot.2021.046169.

  PMID: 34817595 RESULT

• Craig F, Colella GM, Tenuta F, Mauti M, Gravina A, Calomino ML, Plastina R, Polito A, Costabile A. From psychological wellbeing to distress: the role of psychological counseling interventions in university students. Front Psychol. 2025 Aug 8;16:1602009. doi: 10.3389/fpsyg.2025.1602009. eCollection 2025.

  PMID: 40861352 RESULT

• Copeland WE, McGinnis E, Bai Y, Adams Z, Nardone H, Devadanam V, Rettew J, Hudziak JJ. Impact of COVID-19 Pandemic on College Student Mental Health and Wellness. J Am Acad Child Adolesc Psychiatry. 2021 Jan;60(1):134-141.e2. doi: 10.1016/j.jaac.2020.08.466. Epub 2020 Oct 19.

  PMID: 33091568 RESULT

• Cerolini S, Zagaria A, Franchini C, Maniaci VG, Fortunato A, Petrocchi C, Speranza AM, Lombardo C. Psychological Counseling among University Students Worldwide: A Systematic Review. Eur J Investig Health Psychol Educ. 2023 Sep 14;13(9):1831-1849. doi: 10.3390/ejihpe13090133.

  PMID: 37754472 RESULT

• Gallego A, McHugh L, Penttonen M, Lappalainen R. Measuring Public Speaking Anxiety: Self-report, behavioral, and physiological. Behav Modif. 2022 Jul;46(4):782-798. doi: 10.1177/0145445521994308. Epub 2021 Feb 16.

  PMID: 33593107 RESULT

• Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Demyttenaere K, Ebert DD, Green JG, Hasking P, Murray E, Nock MK, Pinder-Amaker S, Sampson NA, Stein DJ, Vilagut G, Zaslavsky AM, Kessler RC; WHO WMH-ICS Collaborators. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018 Oct;127(7):623-638. doi: 10.1037/abn0000362. Epub 2018 Sep 13.

  PMID: 30211576 RESULT

Related Links

• Related Info

MeSH Terms

Conditions

Anxiety Disorders

Condition Hierarchy (Ancestors)

Mental Disorders

Central Study Contacts

FRANCESCO CRAIG, PhD

CONTACT

+39 3274432477; francesco.craig@unical.it

Fabio Bruno, PhD

CONTACT

0984/494623; fabio.bruno@unical.it

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor

Model Details: This is a randomized controlled, parallel-group interventional study with two independent arms (1:1 allocation): (1) an experimental group and (2) a control group. Both groups receive a brief standard counseling program consisting of six individual sessions delivered by trained clinicians within the University Psychological Counseling Service (UPCS). The experimental group receives the same counseling program plus two immersive VR modules delivered via 360° video scenarios: (a) VR-Exposure and Response Prevention (VR-ERP) for graded, controlled exposure to public-speaking situations, and (b) VR-Acceptance and Commitment Training (VR-ACT) providing ACT-consistent mindfulness and psychological flexibility exercises aimed at reducing arousal and enhancing coping. The control group receives counseling only (no VR). Outcomes are assessed at baseline (T0), post-treatment (T1), and follow-up (T2) to evaluate changes over time and between-group differences.

Study Record Dates

• First Submitted: December 22, 2025
• First Posted: January 20, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): October 12, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: January 20, 2026

Record last verified: 2025-10

Locations

IT (1)