Speaking AnxietySocial Communication

Pilot pre-post + waitlist study of four brief VR therapy sessions for public speaking anxiety in university students: reductions in self-report and heart-rate measures

Harris SR et al. · 2002 · CyberPsychology & Behavior · Experimental · n = 14 · University students with public speaking anxiety · DOI
Evidence certainty: Very low certainty
How this was rated

Small samples (8 treatment, 6 waitlist), early-era research-grade VR equipment (Virtual-I/0), single-site university recruitment, no formal randomisation reported. Peer-reviewed in CyberPsychology & Behavior (now Cyberpsychology, Behavior, and Social Networking - Mary Ann Liebert, established peer-reviewed venue). Treatment was 4 sessions of ~15 minutes each delivered by a single clinical psychologist therapist. The findings replicate the broader VRET-for-PSA pattern but should be interpreted in their historical context rather than as standalone efficacy evidence. Useful as a foundational citation; not useful as current clinical guidance.

Ratings use a simplified four-tier scheme (High, Moderate, Low, Very Low) informed by the GRADE working group. Learn more about how studies are rated.

Eight university students with public speaking anxiety completed four brief VR therapy sessions (~15 minutes each, weekly), with six waitlist-control students completing post-testing only. Self-report inventories, Subjective Units of Discomfort during exposure, and heart-rate measurements during speaking tasks were used. Results showed reductions on self-report measures and physiological indices for the VR group, supporting brief VRT as a workable PSA intervention. Small samples and pre-post-with-waitlist (not full RCT) design limit certainty - this is foundational pilot evidence rather than definitive efficacy data.

Clinical bottom line

An early-era pilot study (n=8 VR, n=6 waitlist) showing that four brief (~15-min) VR therapy sessions reduced public speaking anxiety on self-report inventories and heart-rate measurements during speaking tasks in university students. Foundational to the VRET-for-PSA literature - frequently cited in later reviews - but the small samples, the era of VR equipment (early-2000s research HMDs), and the pre-post-with-waitlist design (not a full RCT) make this historical evidence rather than current efficacy guidance. Stronger RCTs exist (Anderson 2013, Bouchard 2017, Wallach 2009, Lindner 2019) for clinicians evaluating current PSA-VRET options.

Key findings

  • Eight university students with public speaking anxiety completed four brief VR therapy sessions (~15 min each, weekly); six waitlist-control students completed post-testing only
  • Four self-report inventories used (specifics not fully extracted in this summary); plus Subjective Units of Discomfort (SUDS) ratings during VR exposure and heart-rate measurements during speaking tasks
  • Self-report measures of public speaking anxiety REDUCED in the VR group relative to baseline
  • Physiological measures (heart rate during speaking tasks) also showed reductions consistent with anxiety reduction
  • Treatment was delivered by the first author serving as therapist - a clinical psychologist. VRT was delivered as a standalone intervention (not integrated into a broader CBT package)
  • Hardware: research-grade Virtual-I/0 HMD - era-appropriate but limited compared to contemporary consumer HMDs
  • Authors framed PSA as a Social Phobia subtype per DSM-IV - aligning with subsequent VRET-for-SAD work (Anderson 2013, Bouchard 2017, Kampmann 2016)

Background

Public speaking anxiety is the most common subtype of Social Phobia, affecting up to 13% of individuals at some time in their lives and associated with moderate to severe functional impairment in education, employment, and social domains. In the early 2000s, exposure-based behavioral treatments were the gold-standard psychotherapy for specific phobias and social phobia, but in-vivo exposure for public speaking was difficult to deliver in a controlled, replicable way. Virtual reality offered a way to deliver exposure in a clinician-controlled environment, with the practical advantages of dosing, repetition, and confidentiality.

Prior to this study, only a small number of case studies had explored VRT for PSA, and no controlled-group data were available.

What the researchers did

Eight university students with public speaking anxiety completed four weekly VRT sessions of approximately 15 minutes each. Six waitlist-control students completed post-testing only (no treatment). Assessment measures included four self-report inventories (specifics not extracted in detail), Subjective Units of Discomfort (SUDS) ratings during VRT exposure, and heart-rate measurements during speaking tasks.

The hardware was a research-grade Virtual-I/0 HMD. Treatment was delivered by the first author, a clinical psychologist.

What they found

Why this matters

This was one of the first controlled-group demonstrations that brief VRT could reduce PSA in university students. It established that 4 sessions of ~15 minutes are workable as a protocol and that physiological as well as self-report change can be observed. The subsequent two decades have produced larger RCTs (Anderson 2013, Bouchard 2017, Wallach 2009, Lindner 2019) that supersede this study for current clinical decision-making, but Harris 2002 remains a foundational citation in any VRET-for-PSA literature review.

Limitations

Implications for practice

For current clinical decision-making about VRET for public speaking anxiety, this study is historical evidence rather than current efficacy data. Stronger and more recent RCTs are available (Anderson 2013, Bouchard 2017, Wallach 2009, Lindner 2019, Reeves 2021, Zainal 2021). Harris 2002 remains useful as (a) a foundational citation in any literature review of VRET-for-PSA, (b) evidence that brief 4-session protocols are workable - relevant for clinicians designing time-limited PSA interventions, and (c) a reminder that the field has advanced substantially in equipment, sample sizes, and study designs over the subsequent two decades.

Related Studies

Social CommunicationSpeaking AnxietyGeneralization

VR exposure is as effective as in vivo exposure group therapy for public-speaking-focused social anxiety, with lasting results

In a randomized controlled trial of 97 adults with social anxiety disorder whose primary fear was public speaking, eight sessions of virtual reality exposure were as effective as eight sessions of manualized in vivo exposure delivered in groups. Both active treatments outperformed waitlist on self-report and on a behavioral speech task, and improvements were maintained at 12-month follow-up.

Anderson PL et al. · 2013 Read Summary
Speaking AnxietySocial CommunicationGeneralization

First long-term (4-6 year) follow-up of VR exposure therapy and exposure group therapy for social anxiety disorder: durable gains, with 54% no longer meeting diagnostic criteria

Twenty-eight participants from the Anderson et al. 2013 RCT of VR exposure therapy (VRET) vs exposure group therapy for DSM-diagnosed social anxiety disorder were re-assessed a mean of 6 years (range 4-6) after treatment completion. Self-report measures, behavioral speech tasks, and diagnostic interviews all showed statistically significant improvement from pre-treatment to long-term follow-up. The majority (54%) no longer met diagnostic criteria for SAD; 68% rated themselves 'very much' or 'much' improved. With one exception, there were no differences between VRET and exposure group therapy at follow-up - both produce durable long-term benefits, consistent with the broader CBT-for-SAD evidence base.

Anderson PL et al. · 2017 Read Summary
Speaking AnxietySocial Communication

Preliminary controlled study comparing VR therapy versus group-CBT for social phobia (n=36): both treatments produced statistically and clinically significant improvement, with trivial differences between the two

Thirty-six participants diagnosed with social phobia were allocated to either virtual reality therapy (VRT) using four virtual environments (performance, intimacy, scrutiny, assertiveness situations) OR a control condition of group cognitive-behavioral therapy (CBT). Both treatments lasted 12 weeks and were delivered according to a treatment manual. Both produced statistically and clinically significant improvement. Effect-size comparisons revealed that the differences between VRT and the active group-CBT comparator were trivial - establishing VRT as a non-inferior alternative to evidence-based group-CBT for social phobia.

Klinger E et al. · 2005 Read Summary
Speaking AnxietyImplementation

First RCT (n=25+25) showing that consumer VR hardware and software can deliver effective one-session VRET for public speaking anxiety - both therapist-led (d=1.67) and self-led at home (d=1.35), with gains maintained at 6 and 12 months

Twenty-five participants were randomised to one-session therapist-led VR exposure therapy for public speaking anxiety using consumer VR hardware and software, followed by a 4-week internet-administered VR-to-in-vivo transition program; another 25 served as a waiting-list. Therapist-led VRET produced a very large effect on self-reported PSA (within Cohen's d = 1.67). The waiting-list then received internet-administered, SELF-LED VRET at home, followed by the same transition program - producing a large effect (d = 1.35). Results were maintained or improved at 6-month and 12-month follow-ups. This is the first published RCT demonstrating that off-the-shelf consumer VR hardware and software can deliver effective PSA exposure therapy in both clinician-supervised and home-based formats.

Lindner P et al. · 2019 Read Summary
Speaking AnxietyEcological Validity

Three-arm RCT (n=51) of stand-alone 360° video VR exposure therapy for public speaking anxiety: both audience-content and empty-room content produced significant pre-to-post reductions (partial η² up to .90) versus no-treatment control

Fifty-one participants with high public speaking anxiety were randomly allocated to one of three conditions: 360° video VRET incorporating audience stimuli (n=17), 360° video VRET incorporating empty-room stimuli (n=16), or no-treatment control (n=18). Outcomes measured at five timepoints. Mixed-ANOVA revealed a significant time × intervention-group interaction for PSA, social anxiety, and fear of negative evaluation (FNE). Both 360° VRET groups showed large pre-to-post reductions; for PSA, partial η² = .90 (audience) and .71 (empty room). Active intervention participants showed continued significant improvement out to 10-week follow-up. The study also addresses whether 360° video content (audience vs empty room) affects VRET outcomes - both worked.

Reeves R et al. · 2021 Read Summary
Speaking AnxietyGeneralization

VR exposure equals traditional CBT for public-speaking anxiety, with lower dropout

In an 88-person RCT, VR-based cognitive-behavioral therapy for public-speaking anxiety produced anxiety reductions equivalent to traditional CBT and significantly larger than waitlist, with notably fewer participants dropping out of the VR arm.

Wallach HS et al. · 2009 Read Summary

Cite this study

If you reference this study in your work, the canonical citation formats are:

APA 7th
Harris, S. R., Kemmerling, R. L., & North, M. M. (2002). Brief Virtual Reality Therapy for Public Speaking Anxiety. CyberPsychology & Behavior. https://doi.org/10.1089/109493102321018187.
AMA 11th
Harris SR, Kemmerling RL, North MM. Brief Virtual Reality Therapy for Public Speaking Anxiety. CyberPsychology & Behavior. 2002. doi:10.1089/109493102321018187.
BibTeX
@article{harris2002,
  author = {Harris, S. R. and Kemmerling, R. L. and North, M. M.},
  title = {Brief Virtual Reality Therapy for Public Speaking Anxiety},
  journal = {CyberPsychology & Behavior},
  year = {2002},
  doi = {10.1089/109493102321018187},
  url = {https://withvr.app/evidence/studies/harris-2002}
}
RIS
TY  - JOUR
AU  - Harris, S. R.
AU  - Kemmerling, R. L.
AU  - North, M. M.
TI  - Brief Virtual Reality Therapy for Public Speaking Anxiety
JO  - CyberPsychology & Behavior
PY  - 2002
DO  - 10.1089/109493102321018187
UR  - https://withvr.app/evidence/studies/harris-2002
ER  -

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Funding & independence

Affiliations not extracted in detail; lead author was a clinical psychologist serving as therapist for the trial. Published in CyberPsychology & Behavior (Mary Ann Liebert, established peer-reviewed venue). No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published peer-reviewed paper. The VR system used was era-appropriate research-grade equipment (Virtual-I/0 HMD), NOT Therapy withVR or Research withVR.

Last reviewed: 2026-05-17 Next review due: 2027-05-17 Reviewed by: Gareth Walkom