Speaking AnxietySocial CommunicationEcological Validity

Can VR elicit SAD-typical distress? In 21 SAD adults + 24 non-anxious controls, VR public-speaking task elicited significant physiological + subjective distress over baseline - but less than the in-vivo task; no SAD-vs-control group differences on physiology

Owens ME, Beidel DC · 2015 · Journal of Psychopathology and Behavioral Assessment · Experimental · n = 45 · Adults with social anxiety disorder (n=21) and non-anxious controls (n=24) · DOI
Evidence certainty: Moderate certainty
How this was rated

Within-subjects design with both SAD (n=21) and non-anxious control (n=24) groups, all completing both VR and in-vivo speech tasks. Strong physiological measurement (HR, EDA, RSA) alongside self-report distress. Peer-reviewed in Journal of Psychopathology and Behavioral Assessment (Springer, established peer-reviewed clinical-psychology venue). Limitations: VR hardware was era-appropriate research-grade (2014-2015), not contemporary consumer hardware. The null physiological finding between SAD and control groups in VR may reflect the attenuated VR response rather than true equivalence between groups - a power-and-paradigm caveat. The realism-and-validity framing is the contribution; clinical-efficacy claims are not part of this study's design.

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Twenty-one adults with social anxiety disorder (SAD) and 24 non-anxious controls each gave an impromptu speech in front of an in-vivo (live) audience AND in front of a virtual reality audience. Outcomes: heart rate, electrodermal activity, respiratory sinus arrhythmia, and self-reported distress, plus sense of presence ratings. Results: VR significantly increased heart rate, electrodermal activity, RSA, and subjective distress over baseline - but less than the in-vivo task. Participants reported moderate presence in VR, but significantly less than in-vivo. NO significant SAD-vs-control group differences on physiological measures. The study addresses VR's realism-and-validity for SAD clinical work.

Clinical bottom line

An important realism-and-validity study comparing VR public-speaking to in-vivo public-speaking in 21 SAD adults + 24 controls. VR DOES elicit physiological and subjective distress over baseline - a prerequisite for using VR clinically with SAD - but the response is ATTENUATED compared to in-vivo public-speaking, and presence is moderate rather than high. Critically, NO SAD-vs-control physiological differences emerged in this paradigm - a finding that complicates the assumption that VR can fully substitute for in-vivo exposure assessment. For clinicians using VR with SAD clients, the takeaway is that VR is a workable but partial substitute for in-vivo exposure - useful for graded exposure and engagement, less reliable for full-intensity physiological elicitation.

Key findings

  • Within-subjects design with 21 SAD adults + 24 non-anxious controls; each participant gave an impromptu speech in front of both an in-vivo (live) audience AND a VR audience
  • VR task elicited SIGNIFICANT increases in heart rate, electrodermal activity, respiratory sinus arrhythmia, and self-reported distress OVER BASELINE - confirming that VR public-speaking generates measurable arousal
  • VR task was LESS anxiety-producing than the IN-VIVO task on physiological + subjective measures - in-vivo exposure produces a stronger response than VR exposure at matched task structure
  • Participants reported MODERATE presence in VR - but significantly LESS than in-vivo presence ratings - sense of being-there is partial, not complete
  • NO significant SAD-vs-control group differences emerged on physiological measures in VR - the expected pattern (greater arousal in SAD than controls) was NOT observed in this paradigm
  • The dissociation: VR can elicit distress at the within-subject level (above baseline) but does NOT discriminate SAD from non-anxious controls on physiology in this specific design
  • Pre-2015 era VR research-grade hardware; contemporary consumer HMDs may produce different presence and physiological profiles
  • Beidel co-author connection: also co-author of Wong Sarver 2014 (childhood SAD VR feasibility) - this is the Beidel-group's adult-SAD validity work

Background

By 2014-2015, VR was being widely proposed as a clinical exposure modality for social anxiety disorder, but a key validity question remained underexplored: does VR public-speaking actually elicit the physiological and subjective distress patterns that characterise SAD in vivo? Without this realism-and-validity foundation, claims about VR’s clinical utility for SAD assessment and treatment would rest on assumption rather than evidence.

What they did and found

Within-subjects design. 21 SAD adults + 24 non-anxious controls each gave an impromptu speech in front of both an in-vivo audience and a VR audience. Outcomes: HR, EDA, RSA, self-reported distress, sense of presence.

Why it matters + Limitations

VR is a workable but partial substitute for in-vivo exposure assessment in SAD. Useful for graded exposure / engagement-building; less reliable for full-intensity physiological elicitation or for discriminating clinical from non-clinical responders on physiology alone. Limitations: era-appropriate research-grade hardware (2014-2015); contemporary consumer HMDs may differ; the null SAD-vs-control finding may reflect power and paradigm rather than true equivalence.

Implications for practice

For clinicians using or considering VR with SAD clients, this study delivers an important nuance: VR DOES elicit distress over baseline (a prerequisite for clinical use) but the response is attenuated relative to in-vivo public speaking. VR is a workable but PARTIAL substitute for in-vivo exposure. For graded exposure and engagement-building, VR offers a controlled lower-intensity environment that may be useful early in a treatment hierarchy. For full-intensity physiological elicitation (e.g., where the goal is maximally activating the fear network), in-vivo exposure remains the gold standard. For PWS with SAD comorbidity, this study's findings argue for blended VR + in-vivo protocols rather than VR-only substitution. The null SAD-vs-control physiology finding is worth flagging as a discriminant-validity caution: VR may not reliably differentiate clinical from non-clinical responders on physiology alone.

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Cite this study

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

APA 7th
Owens, M. E., & Beidel, D. C. (2015). Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?. Journal of Psychopathology and Behavioral Assessment. https://doi.org/10.1007/s10862-014-9454-x.
AMA 11th
Owens ME, Beidel DC. Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?. Journal of Psychopathology and Behavioral Assessment. 2015. doi:10.1007/s10862-014-9454-x.
BibTeX
@article{owens2015,
  author = {Owens, M. E. and Beidel, D. C.},
  title = {Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?},
  journal = {Journal of Psychopathology and Behavioral Assessment},
  year = {2015},
  doi = {10.1007/s10862-014-9454-x},
  url = {https://withvr.app/evidence/studies/owens-2015}
}
RIS
TY  - JOUR
AU  - Owens, M. E.
AU  - Beidel, D. C.
TI  - Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?
JO  - Journal of Psychopathology and Behavioral Assessment
PY  - 2015
DO  - 10.1007/s10862-014-9454-x
UR  - https://withvr.app/evidence/studies/owens-2015
ER  -

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Funding & independence

Affiliations: lead authors Owens and Beidel at University of Central Florida (Beidel is established SAD/anxiety researcher and co-author of Wong Sarver 2014). Specific funding sources reported in published article. Peer-reviewed in Journal of Psychopathology and Behavioral Assessment (Springer). No withVR BV involvement. Summary prepared independently by withVR. The VR system used was era-appropriate research configuration, NOT Therapy withVR or Research withVR.

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