Speaking AnxietySocial CommunicationImplementation

Meta-analysis of 37 RCTs (n=2,991) comparing three technology-assisted interventions for social anxiety disorder: internet-delivered CBT (21 trials), VR exposure therapy (3 trials), and cognitive bias modification (13 trials) - ICBT and VRET both produced large effects vs passive control (g=0.84 and 0.82)

Kampmann IL et al. · 2016 · Journal of Anxiety Disorders · Systematic Review · n = 2991 · 37 RCTs of technology-assisted interventions for social anxiety (pooled n=2,991) · DOI
Evidence certainty: High certainty
How this was rated

Systematic literature search across Medline, PsycInfo, and Web of Science. 37 RCTs, total n=2,991. Random-effects analysis. Three intervention categories analyzed separately with controlled effect-size estimates vs both passive and active controls, plus follow-up data where available. Peer-reviewed in Journal of Anxiety Disorders (Elsevier, established high-impact peer-reviewed clinical psychology venue). Authorship: Kampmann (first author of Kampmann 2016 RCT in our Hub), Emmelkamp (long-established VRET researcher), Morina (Amsterdam group). Limitations: only 3 VRET trials in the pool - the VRET conclusions are statistically modest; pre-2016 cutoff misses the consumer-hardware VRET trials (Lindner 2019, Reeves 2021, Zainal 2021).

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A systematic literature search of Medline, PsycInfo, and Web of Science identified 37 randomized controlled trials of technology-assisted interventions for social anxiety disorder, with total sample n=2,991 participants. Studies were grouped into internet-delivered cognitive behavior therapy (ICBT; 21 trials), virtual reality exposure therapy (VRET; 3 trials), and cognitive bias modification (CBM; 13 trials). Patients undergoing ICBT and VRET showed significantly less SAD symptoms at postassessment than passive control conditions (Hedges' g = 0.84 and 0.82 respectively). Compared to active control conditions, ICBT had a small advantage (g = 0.38); VRET showed comparable effects (p > 0.05). CBM was not more effective than passive control except in laboratory delivery (g = 0.35).

Clinical bottom line

A 2016 meta-analysis published in Journal of Anxiety Disorders comparing three technology-assisted SAD interventions: ICBT (21 trials), VRET (3 trials), and CBM (13 trials). Key finding: VRET produced a large effect (g=0.82) vs passive control, comparable to ICBT (g=0.84). Together with Carl 2019, Wechsler 2019, Horigome 2020, and Chesham 2018, this is part of the meta-analytic backbone for VRET in SAD - with the unique contribution of placing VRET alongside other technology-assisted SAD interventions for comparative context. Important methodological caveat: only 3 VRET trials are pooled here (the 2010-2015 era), so the VRET conclusions are preliminary relative to the more recent reviews.

Key findings

  • Systematic search of Medline, PsycInfo, Web of Science yielded 37 RCTs (n=2,991) of technology-assisted SAD interventions
  • Three intervention categories: ICBT (21 trials), VRET (3 trials), CBM (13 trials)
  • VRET vs PASSIVE CONTROL: large effect size, Hedges' g = 0.82 (CI 0.86-1.54 for the 2-study controlled effect-size at postassessment, large effect overall)
  • ICBT vs PASSIVE CONTROL: large effect, Hedges' g = 0.84
  • VRET vs ACTIVE CONTROL: comparable effects (p > 0.05) - VRET and active control produced similar outcomes
  • ICBT vs ACTIVE CONTROL: small advantage for ICBT (g = 0.38)
  • CBM was NOT more effective than passive control except in laboratory delivery (g = 0.35) - CBM has limited efficacy outside lab settings
  • Includes follow-up data where available - VRET follow-up was limited by the small number of trials
  • Cited in subsequent SAD-VRET meta-analyzes (Chesham 2018, Horigome 2020) as part of the field's foundation
  • Only 3 VRET trials in the pool - the VRET conclusions are preliminary relative to the larger ICBT pool; Horigome 2020 with 22 VRET trials supersedes for VRET-specific synthesis

Background

By 2016, three distinct technology-assisted interventions had developed for social anxiety disorder: internet-delivered CBT (ICBT, well-established), virtual reality exposure therapy (VRET, emerging), and cognitive bias modification (CBM, controversial). What was missing was a head-to-head meta-analytic comparison of the three.

What they did and found

Systematic search of Medline, PsycInfo, Web of Science. 37 RCTs (n=2,991). Three intervention categories: ICBT (21), VRET (3), CBM (13).

Why it matters + Limitations

Unique head-to-head comparison of technology-assisted SAD interventions. Limitations: only 3 VRET trials in the pool - VRET conclusions are preliminary relative to Horigome 2020 (22 VRET trials). Pre-2016 cutoff misses the consumer-hardware VRET trials (Lindner 2019, Reeves 2021, Zainal 2021).

Implications for practice

For clinicians comparing VRET against OTHER technology-assisted SAD interventions (ICBT, CBM), this is the unique meta-analytic synthesis. The finding that VRET and ICBT produced comparable large effects vs passive control suggests both are viable technology-delivered SAD treatments; the choice between them depends on accessibility, clinician training, and patient preference. CBM emerges as the weakest of the three categories. For PWS with SAD comorbidity, this paper supports both VRET (in-clinic or home) AND internet-CBT as viable adjuncts. For grant or procurement contexts where the question is 'which technology-assisted SAD intervention to invest in,' this paper provides head-to-head meta-analytic evidence.

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Cite this study

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

APA 7th
Kampmann, I. L., Emmelkamp, P. M. G., & Morina, N. (2016). Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders. https://doi.org/10.1016/j.janxdis.2016.06.007.
AMA 11th
Kampmann IL, Emmelkamp PMG, Morina N. Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders. 2016. doi:10.1016/j.janxdis.2016.06.007.
BibTeX
@article{kampmann2016,
  author = {Kampmann, I. L. and Emmelkamp, P. M. G. and Morina, N.},
  title = {Meta-analysis of technology-assisted interventions for social anxiety disorder},
  journal = {Journal of Anxiety Disorders},
  year = {2016},
  doi = {10.1016/j.janxdis.2016.06.007},
  url = {https://withvr.app/evidence/studies/kampmann-2016-meta}
}
RIS
TY  - JOUR
AU  - Kampmann, I. L.
AU  - Emmelkamp, P. M. G.
AU  - Morina, N.
TI  - Meta-analysis of technology-assisted interventions for social anxiety disorder
JO  - Journal of Anxiety Disorders
PY  - 2016
DO  - 10.1016/j.janxdis.2016.06.007
UR  - https://withvr.app/evidence/studies/kampmann-2016-meta
ER  -

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Funding & independence

Affiliations: Department of Clinical Psychology, University of Amsterdam; Amsterdam Brain and Cognition Center; Netherlands Institute for Advanced Study (Emmelkamp). Specific funding sources reported in published article. Peer-reviewed in Journal of Anxiety Disorders (Elsevier). No withVR BV involvement. Summary prepared independently by withVR.

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