People with social anxiety disorder show improved symptoms and changes in brain activity after virtual reality therapy

In an experiment published in JMIR Mental Health, people with social anxiety disorder showed reduced social anxiety and less negative rumination after virtual reality-based exposure therapy. In addition, this reduction in symptoms was associated with changes in brain activity when participants judged whether positive words were self-relevant.

People with social anxiety disorder (SAD) experience an intense fear of negative evaluation during social situations that greatly interferes with their quality of life. In researching possible treatments for the disorder, psychology scholars have identified virtual reality (VR) therapy as an effective intervention to teach adaptive skills to people with SAD.

A team of researchers led by Ji-Won Hur devised a study to explore the effectiveness of VR therapy in addressing a particular aspect of SAD that is believed to be key to the development and maintenance of the disorder. Self-referential processing, which refers to the processing of self-related information, appears to be skewed among people with social anxiety. Using neuroimaging, the researchers tested whether virtual reality therapy would affect areas of the brain responsible for self-referential processing.

First, a sample of 25 individuals diagnosed with SAD and 22 healthy control subjects participated in an initial evaluation. All participants performed a self-referential processing task while undergoing a functional magnetic resonance imaging (MRI). During the assignment, subjects were presented with a series of words that were neutral, positive, or negative and asked to select whether each word was relevant to them, somewhat relevant to them, or not relevant to them.

Next, 21 of the participants with SAD participated in six VR sessions during several laboratory visits. Virtual reality situations varied in difficulty, but each showed a scenario of social anxiety in which participants had to introduce themselves to strangers. After completing treatment, participants with SAD underwent another RMF while participating again in a self-referential processing task.

When the researchers analyzed the baseline data, they found that people with SAD showed greater activation in certain parts of the brain during the task of self-referential processing compared to controls.

After VR therapy, participants with SAD showed increased activity in various parts of the brain, including the frontal, temporal, and occipital lobes. In addition, they showed strong decreases in negative rumination and lower scores on the social phobia scale (SPS). In fact, SPS scores fell below severity levels.

In addition, the more participants showed changes in activity on the lingual turn during positive word processing, the lower the social anxiety and the less they participated in the negative rumination after VR therapy. Hur and colleagues point out that, according to previous research, lingual twist may be involved in self-referential processing. They say that RV therapy may have helped patients with SAD to accept positive words as self-referential.

Participants also showed increased activity in the brain areas involved in the processing of autobiographical memories, the construction of self-images, and the integration of sensory information.

“To our knowledge,” the researchers report, “this is the first neuroimaging study to specify changes in psychophysiological responses to self-referential information in social anxiety disorder in response to VR therapy. We believe that our findings may contribute to a better understanding of the therapeutic effects of RV-based interventions, which could be included in the routine treatment of social anxiety disorder. “

Since the control group did not participate in the VR sessions, it is not known whether the neural changes observed in patients with SAD were caused directly by therapy treatment. However, the study authors emphasize that SAD participants showed significant changes in brain activity during self-referential processing after completing therapy.

The study, “Virtual Reality-Based Psychotherapy in Social Anxiety Disorder: An fMRI Study Using a Self-Referential Task,” was written by Ji-Won Hur, Hyemin Shin, Dooyoung Jung, Heon-Jeong Lee, Sungkil Lee, Gerard J Kim, Chung-Yean Cho, Seungmoon Choi, Seung-Moo Lee and Chul-Hyun Cho.

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