Speaking AnxietySocial Communication

Non-randomized feasibility and pilot study of one-session 90-minute VRET for 27 Norwegian adolescents (ages 13-16) with public speaking anxiety: large effect (Cohen's d = 1.53) maintained at 3-month follow-up with low-cost consumer VR hardware

Kahlon S et al. · 2019 · Child and Adolescent Psychiatry and Mental Health · Experimental · n = 27 · Norwegian adolescents aged 13-16 with public speaking anxiety · DOI
Evidence certainty: Moderate certainty
How this was rated

Non-randomized feasibility and pilot design - the absence of randomization limits causal inference relative to RCTs (Parrish 2016 has the validity-design strength; Kahlon 2019 has the treatment-effect-magnitude strength). Linear mixed effects modeling is appropriate for the pre-post-follow-up structure. n=27 is modest but consistent with pilot scale. Peer-reviewed in Child and Adolescent Psychiatry and Mental Health (BMC, open access, peer-reviewed). Consumer-hardware focus and one-session protocol are the major contributions; longer-term follow-up beyond 3 months and replication with full RCT design are obvious next steps.

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Twenty-seven Norwegian adolescents aged 13-16 with public speaking anxiety received a one-session (90 minutes) VR exposure therapy intervention using a low-cost consumer head-mounted display with custom-built VR stimuli depicting a cultural and age-appropriate classroom and audience. Pre/post and follow-up self-report measures plus heart-rate recording during the session. Linear mixed effects modeling showed a LARGE pre-to-post effect (Cohen's d = 1.53) on PSA symptoms, maintained at 1- and 3-month follow-up. Heart rate increased modestly during exposure tasks. Feasibility improvements were iterated during the trial based on adolescent feedback.

Clinical bottom line

A non-randomized feasibility and pilot study showing that ONE 90-MINUTE session of consumer-hardware VRET produces a LARGE (d=1.53) durable reduction in adolescent public speaking anxiety, maintained at 3 months. Critical companion to Lindner 2019 (which established consumer hardware works for adult PSA) and Parrish 2016 (adolescent SAD feasibility). Together, the three studies establish the consumer-VR + one-session protocol as workable for adolescent PSA. For school SLPs and adolescent mental-health services, this is the strongest pilot evidence available for an extremely brief, scalable, school-deliverable PSA intervention.

Key findings

  • n=27 Norwegian adolescents (ages 13-16) recruited from high schools, all with elevated self-reported public speaking anxiety
  • TREATMENT FORMAT: ONE 90-minute session of VRET, followed by no further intervention - extremely brief by clinical standards
  • Hardware: LOW-COST CONSUMER head-mounted VR display - establishing that effective adolescent PSA treatment does not require research-grade equipment
  • VR stimuli: custom-built CULTURAL AND AGE-APPROPRIATE classroom and audience - the contextual fit to Norwegian adolescents was deliberate
  • Linear mixed effects modeling revealed SIGNIFICANT pre-to-post decrease in PSA symptoms with LARGE effect size: Cohen's d = 1.53
  • Improvements MAINTAINED at 1-month AND 3-month follow-up - durable, not transient
  • Heart rate recorded during exposure tasks revealed a SMALL increase - consistent with mild physiological engagement without overwhelming arousal
  • Iterative feasibility improvements based on adolescent feedback during the trial - the protocol was refined to better fit this developmental age group
  • Lindner is co-author - this paper extends the Lindner 2019 adult consumer-hardware VRET work to adolescents

Background

Public speaking anxiety (PSA) typically onsets in adolescence and early adulthood. Prior VRET research had established efficacy in adults (Lindner 2019, Bouchard 2017, Wallach 2009) and validity for adolescent populations (Parrish 2016, Wong Sarver 2014), but the question of whether the consumer-hardware one-session VRET format that works for adults also works for ADOLESCENTS specifically was not yet directly tested.

What they did and found

27 Norwegian adolescents (13-16) received one 90-minute VRET session using a low-cost consumer HMD with culturally appropriate VR stimuli. Pre/post and 1+3 month follow-up self-report measures plus heart-rate recording during exposure. Linear mixed effects modeling.

Why it matters + Limitations

For school-based SLP and adolescent mental-health services, this is the strongest pilot evidence for a brief, scalable, consumer-hardware PSA intervention deliverable in a single 90-minute slot. Limitations: non-randomized; n=27 is modest; 3-month follow-up is moderate. RCT replication is the obvious next step.

Implications for practice

For school SLPs and adolescent mental-health services, this is the strongest pilot evidence for an extremely brief, scalable, school-deliverable PSA intervention. The one-session 90-minute format using consumer hardware suggests a delivery model that could fit within a single school visit or appointment slot. For PWS adolescents with PSA comorbidity, this study supports the use of consumer VRET as a brief adjunct alongside stuttering therapy. Caveats: non-randomized design limits causal claims; replication with a true RCT is the obvious next step. The Lindner-group lineage (Kahlon 2019 + Lindner 2019 + Mimerse-era Swedish consumer-VRET work) is now the most coherent consumer-hardware PSA evidence cluster in the literature.

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Lindner P et al. · 2019 Read Summary
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Cite this study

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

APA 7th
Kahlon, S., Lindner, P., & Nordgreen, T. (2019). Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study. Child and Adolescent Psychiatry and Mental Health. https://doi.org/10.1186/s13034-019-0307-y.
AMA 11th
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 and Adolescent Psychiatry and Mental Health. 2019. doi:10.1186/s13034-019-0307-y.
BibTeX
@article{kahlon2019,
  author = {Kahlon, S. and Lindner, P. and Nordgreen, T.},
  title = {Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study},
  journal = {Child and Adolescent Psychiatry and Mental Health},
  year = {2019},
  doi = {10.1186/s13034-019-0307-y},
  url = {https://withvr.app/evidence/studies/kahlon-2019}
}
RIS
TY  - JOUR
AU  - Kahlon, S.
AU  - Lindner, P.
AU  - Nordgreen, T.
TI  - Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study
JO  - Child and Adolescent Psychiatry and Mental Health
PY  - 2019
DO  - 10.1186/s13034-019-0307-y
UR  - https://withvr.app/evidence/studies/kahlon-2019
ER  -

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Funding & independence

Affiliations: lead author Kahlon and corresponding-author Nordgreen at University of Bergen / Bergen-related Norwegian psychiatric services; Lindner at Stockholm University and Karolinska Institutet. Open access via BMC. Funding sources reported in the published article. No withVR BV involvement. Summary prepared independently by withVR. The VR system was custom-built low-cost consumer hardware, NOT Therapy withVR or Research withVR.

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