Speaking AnxietySocial Communication

Feasibility study (n=41 adolescents ages 13-18) showing that VR environments differentiate socially reactive from neutral scenarios AND distinguish youth with social anxiety disorder from non-anxious peers via SUDS during exposure

Parrish DE et al. · 2016 · Research on Social Work Practice · Experimental · n = 41 · Adolescents aged 13-18 with and without social anxiety · DOI
Evidence certainty: Low certainty
How this was rated

Cross-sectional feasibility design with known-groups and discriminant validity tests - appropriate for the research question but does not establish treatment efficacy. Sample size n=41 (20 SAD + 21 non-anxious) is reasonable for feasibility and validity but small for subgroup analyzes. Peer-reviewed in Research on Social Work Practice (SAGE, established peer-reviewed journal). Hardware (VFX-3D Interactive Imagining Systems HMD with Emagin z800 optics) is early-mid 2010s era - generalization to current consumer HMDs (Meta Quest 2/3) requires assumption. Community-recruited sample with majority female (65.9%) and ethnic-diversity reporting. Diagnostic stratification used LSAS-CA cutoff 29.5 (the conservative threshold) rather than full ADIS-style diagnostic interview.

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.

Forty-one adolescents aged 13-18 (20 with social anxiety disorder by LSAS-CA cutoff 29.5; 21 non-anxious) were exposed to four VR environments: a party scenario, a public speaking scenario, and two neutral scenarios. All participants reported significantly higher Subjective Units of Distress Scale (SUDS) ratings during party and public speaking scenarios versus neutral environments - establishing the system's discriminant validity. Critically, youth with SAD reported significantly higher SUDS in the social environments than non-anxious peers - establishing known-groups validity. Adolescents demonstrated acceptable levels of presence and immersion. The study supports VR exposure as feasible for adolescent SAD.

Clinical bottom line

A feasibility study with strong known-groups + discriminant-validity design in adolescents with social anxiety disorder. VR environments differentiated socially reactive from neutral scenarios in all youth, AND differentiated SAD youth from non-anxious peers on SUDS during exposure - the two validity pieces that need to hold before VR can be used clinically with adolescents. For clinicians working with adolescents (and SLPs working with PWS adolescents with social anxiety comorbidity), this study is foundational adolescent-population evidence. Does NOT establish efficacy - this is feasibility and assessment-validity work, with future research called for on treatment outcomes.

Key findings

  • Community-recruited sample of 41 adolescents aged 13-18, mean age 16 (SD 1.65), 65.9% female, ethnically diverse (42% Caucasian, 37% Black or African American, 10.5% Asian American, 5.3% Native Hawaiian/Pacific Islander, 5.3% Hispanic/Latino)
  • Group assignment by Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA), conservative cutoff 29.5: 20 youth identified as socially anxious, 21 non-anxious
  • Four VR environments: party scenario (social), public speaking scenario (social), and two neutral environments (control)
  • All participants reported SIGNIFICANTLY HIGHER SUDS ratings during party and public-speaking scenarios versus neutral environments - establishes that VR socially reactive environments are differentially anxiety-inducing in the expected direction
  • Youth with SAD reported SIGNIFICANTLY HIGHER SUDS in social environments than non-anxious peers - establishes known-groups validity of VR exposure as an assessment modality for adolescent SAD
  • Adolescents demonstrated ACCEPTABLE LEVELS OF PRESENCE AND IMMERSION - critical feasibility evidence for using VR with this age group
  • Hardware: VFX-3D Interactive Imagining Systems HMD customized with Emagin z800 optics (era-appropriate research-grade)
  • Procedure: 5-minute VR exposures with SUDS sampled at four equally spaced timepoints (~75 sec intervals); average SUDS across timepoints used in analysis

Background

Social anxiety disorder (SAD) typically onsets around 15.5 years - in mid-adolescence - and adolescents with SAD have fewer friends, school attendance difficulties, and elevated risk for substance-use disorders. Despite the developmental significance of adolescent SAD, virtually all VRET research at the time of this study had been conducted in adults. Whether VR exposure environments are feasible, acceptable, and validity-supportive in the adolescent population - and whether they can be used both for assessment and as a future treatment modality - had not been established.

What the researchers did

Forty-one adolescents aged 13-18 were recruited from the community (via flyers, social-networking sites, a community agency, online listings). The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) was used to stratify participants into SAD (cutoff 29.5; n=20) vs non-anxious (n=21) groups.

Each participant was exposed in randomised order to four VR environments:

Hardware was a VFX-3D Interactive Imagining Systems HMD customized with Emagin z800 optics. Each exposure lasted 5 minutes; SUDS ratings were sampled at four equally spaced timepoints (~75 sec intervals). The average SUDS across timepoints was the primary outcome.

Two hypotheses were tested:

  1. The VR Exposure System differentiates socially reactive from neutral environments (discriminant validity).
  2. The system differentiates SAD from non-anxious youth on SUDS during socially reactive exposure (known-groups validity).

What they found

Why this matters

This study fills a clinically important gap: prior VRET research was adult-focused, but adolescence is the developmental window where SAD onsets and consolidates. The validity findings support using VR exposure both for assessment (distinguishing anxious from non-anxious adolescents) and as a foundation for future treatment-outcome research in this age group. For SLPs working with adolescent PWS who present with social-anxiety comorbidity, this is the foundational adolescent-population evidence base.

Limitations

Implications for practice

For clinicians using or considering VR exposure with adolescents - including SLPs working with adolescent PWS who present with social-anxiety comorbidity - this study provides foundational validity and feasibility evidence specifically in the 13-18 age range. The known-groups validity (VR-elicited SUDS differentiates SAD youth from non-anxious peers) supports using VR as an assessment adjunct alongside standard self-report instruments. The 5-minute exposure-with-SUDS-sampling protocol is a clinically efficient model for in-session VR work. For Therapy withVR users targeting adolescent populations, this supports using social scenarios (party, public speaking) with SUDS sampling during exposure. Treatment efficacy not established here - this is feasibility and assessment-validity work.

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Cite this study

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

APA 7th
Parrish, D. E., Oxhandler, H. K., Duron, J. F., Swank, P., & Bordnick, P. (2016). Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder. Research on Social Work Practice. https://doi.org/10.1177/1049731515579204.
AMA 11th
Parrish DE, Oxhandler HK, Duron JF, Swank P, Bordnick P. Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder. Research on Social Work Practice. 2016. doi:10.1177/1049731515579204.
BibTeX
@article{parrish2016,
  author = {Parrish, D. E. and Oxhandler, H. K. and Duron, J. F. and Swank, P. and Bordnick, P.},
  title = {Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder},
  journal = {Research on Social Work Practice},
  year = {2016},
  doi = {10.1177/1049731515579204},
  url = {https://withvr.app/evidence/studies/parrish-2016}
}
RIS
TY  - JOUR
AU  - Parrish, D. E.
AU  - Oxhandler, H. K.
AU  - Duron, J. F.
AU  - Swank, P.
AU  - Bordnick, P.
TI  - Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder
JO  - Research on Social Work Practice
PY  - 2016
DO  - 10.1177/1049731515579204
UR  - https://withvr.app/evidence/studies/parrish-2016
ER  -

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Funding & independence

Affiliations: lead author Parrish, Oxhandler, Duron, Swank, Bordnick - University of Houston Graduate College of Social Work (Texas); subsequent author affiliations may differ. Funding sources not extracted in detail. Peer-reviewed in Research on Social Work Practice (SAGE). No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published peer-reviewed paper. The VR system was an 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