Speaking AnxietySocial Communication

Preliminary 2010 report from Bouchard's group on using virtual humans to alleviate social anxiety - the lineage anchor for the Bouchard 2017 BJP RCT that compared VRET to in-vivo exposure in CBT-integrated treatment of SAD

Robillard G et al. · 2010 · Studies in Health Technology and Informatics · Experimental 0 · Adults with social anxiety (small preliminary sample) · DOI
Evidence certainty: Very low certainty
How this was rated

Preliminary report (4-page conference proceedings paper) in Studies in Health Technology and Informatics (IOS Press peer-reviewed conference series). Small early-stage sample. Methodology consistent with the broader Bouchard-group program (later definitive in the BJP 2017 RCT). The contribution is methodological-lineage rather than clinical-evidence; use Bouchard 2017 for clinical inference.

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A preliminary report from Bouchard's Université du Québec en Outaouais group describing early findings on using virtual humans to alleviate social anxiety in a comparative outcome study. Published as a short conference proceedings entry in Studies in Health Technology and Informatics. This is the lineage precursor to the Bouchard et al. 2017 British Journal of Psychiatry three-arm RCT (CBT+VRET vs CBT+in-vivo vs waitlist; in our Hub as bouchard-2017) - documenting the methodological development that led to the later definitive RCT.

Clinical bottom line

An early-stage preliminary report from Bouchard's group establishing the methodological foundations for what became the Bouchard et al. 2017 three-arm BJP RCT (in our Hub). Useful as historical and lineage context for the In-Virtuo platform's clinical development trajectory. Not standalone clinical evidence - the larger Bouchard 2017 RCT supersedes this preliminary report for clinical decision-making. For researchers tracking the Bouchard-group lineage, this is the documented precursor.

Key findings

  • Short (4-page) preliminary report from Bouchard's Université du Québec en Outaouais group, published in Studies in Health Technology and Informatics (IOS Press conference proceedings)
  • Early-stage comparative outcome study using virtual humans (avatars) to alleviate social anxiety - the methodological precursor to the larger Bouchard et al. 2017 three-arm BJP RCT (CBT+VRET vs CBT+in-vivo vs waitlist; in our Hub as bouchard-2017)
  • Author lineage: Robillard, Bouchard, Dumoulin, Guitard, Klinger - the core team that later published the definitive BJP 2017 RCT (which added Forget, Loranger, Roucaut as co-authors)
  • Klinger as co-author connects this work to the earlier Klinger et al. 2005 VRT vs CBT social phobia preliminary controlled study (in our Hub as klinger-2005)
  • Affiliation: the In-Virtuo / Cliniques d'In-Virtuo platform development tradition (Quebec, Canada)
  • Useful as historical / lineage context; clinical inference should rely on the larger downstream Bouchard 2017 RCT

Background

The Bouchard-group at Université du Québec en Outaouais (UQO) has been a leading clinical-VRET research lineage since the early 2000s. Their published trajectory includes the Klinger et al. 2005 preliminary VRT vs CBT for social phobia paper (in our Hub) and culminated in the Bouchard et al. 2017 British Journal of Psychiatry three-arm RCT comparing CBT+VRET vs CBT+in-vivo vs waitlist (also in our Hub).

Between Klinger 2005 and Bouchard 2017, the group published methodological developments in conference proceedings - including this 2010 preliminary report.

What they did and what they reported

A short (4-page) preliminary report on the comparative outcome study using virtual humans to alleviate social anxiety. The paper documents early findings and methodological development. As a conference proceedings entry, it does not provide the full statistical synthesis that would be in a journal RCT report - the definitive analysis came later in Bouchard 2017.

Why this matters + Limitations

This paper’s contribution is lineage and methodological-history rather than standalone clinical evidence. Limitations: small preliminary sample; short conference-proceedings format; superseded by Bouchard 2017 for clinical decision-making. Useful for completeness; not appropriate as a primary citation for VRET-for-SAD efficacy claims.

Implications for practice

For clinicians making clinical decisions about VRET for SAD, this paper is NOT the appropriate citation - use Bouchard et al. 2017 (in our Hub as bouchard-2017), the three-arm BJP RCT that this preliminary report led to. For researchers writing about the development of clinical VRET, this paper is the documented lineage anchor for the Bouchard-group's contributions. For Hub completeness, this paper closes a citation gap: it is referenced in subsequent reviews (Chesham 2018, Kampmann 2016 Meta) and adds historical depth to our SAD-VRET coverage.

Related Studies

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Pre-registered three-arm RCT: CBT with VR exposure was superior to in-vivo exposure on the primary social-anxiety outcome - and more practical for therapists

A pre-registered three-arm RCT randomized 59 adults with DSM-5 social anxiety disorder to 14 weekly sessions of CBT with VR exposure (n=17), CBT with in-vivo exposure (n=22), or waitlist (n=20). The pre-specified superiority hypothesis was confirmed: VR exposure was significantly more effective than in-vivo exposure on the LSAS-SR primary outcome at post-treatment and at 6-month follow-up, and significantly less cumbersome for therapists (SWEAT: 15.24 vs 24.46). Reliable change: 76.5% VR, 68.3% in vivo, 30.0% waitlist.

Bouchard S et al. · 2017 Read Summary
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Two meta-analyzes of VRET for social anxiety: (1) 6 studies (n=233) confirmed VRET more effective than waitlist; (2) 7 studies (n=340) showed essentially no difference between VRET and in-vivo/imaginal exposure - supporting VRET as a non-inferior alternative to standard treatment

Two complementary meta-analyzes of VRET for social anxiety published in Behavior Change. The first compared VRET to waitlist control across 6 studies (n=233), showing a significant overall effect favoring VRET - confirming VRET reduces social anxiety better than no treatment. The second compared VRET to the standard treatment (in-vivo or imaginal exposure) across 7 studies (n=340), showing essentially no difference in effect sizes between VRET and in-vivo/imaginal exposure - supporting VRET as a non-inferior alternative. Together, the two meta-analyzes establish VRET as both effective in absolute terms AND clinically equivalent to the gold-standard exposure modality.

Chesham RK et al. · 2018 Read Summary
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PROSPERO-registered systematic review + meta-analysis (22 studies, n=703) in Psychological Medicine: VRET for social anxiety disorder is efficacious with durable effects, and treatment-discontinuation rates are comparable to in-vivo exposure

A PROSPERO-registered (CRD42019121097) systematic review and meta-analysis of VRET for social anxiety disorder, published in Psychological Medicine. Inclusion criteria: SAD or related phobias; at least three VRET sessions; minimum 10 participants. 22 studies met criteria (total n=703). Primary outcome: social anxiety evaluation score change synthesized with Hedges' g random-effects modeling. Secondary outcome: risk ratio for treatment discontinuation. The review evaluates VRET's magnitude of efficacy, duration of efficacy, and dropout rates against in-vivo exposure and against passive controls.

Horigome T et al. · 2020 Read Summary
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Three-arm RCT (n=60) of stand-alone VR exposure therapy vs in-vivo exposure vs waiting-list for social anxiety disorder: in-vivo exposure was superior to VRET on multiple secondary outcomes - the opposite pattern to Bouchard 2017

Sixty participants diagnosed with social anxiety disorder were randomly assigned to individual virtual reality exposure therapy (VRET), individual in-vivo exposure therapy (iVET), or a waiting-list control. Both treatments improved social anxiety symptoms, speech duration, perceived stress, and avoidant-personality-disorder beliefs versus waitlist. However, iVET (but NOT VRET) also improved fear of negative evaluation, speech performance, general anxiety, depression, and quality of life. iVET was superior to VRET on social anxiety symptoms at post and follow-up and on avoidant-PD beliefs at follow-up. At follow-up, almost all improvements remained significant for iVET; for VRET only the perceived-stress effect held.

Kampmann IL et al. · 2016 Read Summary
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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
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PRISMA systematic review + meta-analysis of RCTs comparing VRET to in-vivo exposure in agoraphobia, specific phobia, and social phobia - with equivalent exposure dose in both arms

A pre-registered, PRISMA-compliant systematic review and quantitative meta-analysis of randomized controlled trials specifically comparing VR exposure therapy (VRET) to gold-standard in-vivo exposure for agoraphobia, specific phobia, and social phobia - with the critical inclusion criterion that the AMOUNT of exposure be equivalent in both arms. By controlling for exposure dose, the authors directly test whether the delivery modality (VR vs in-vivo) itself drives any outcome difference. The review covers literature through June 2019. Hedges' g effect-size synthesis is performed across the phobia disorders, with subgroup analysis by disorder.

Wechsler TF et al. · 2019 Read Summary

Cite this study

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

APA 7th
Robillard, G., Bouchard, S., Dumoulin, S., Guitard, T., & Klinger, E. (2010). Using virtual humans to alleviate social anxiety: Preliminary report from a comparative outcome study. Studies in Health Technology and Informatics. https://doi.org/10.3233/978-1-60750-561-7-57.
AMA 11th
Robillard G, Bouchard S, Dumoulin S, Guitard T, Klinger E. Using virtual humans to alleviate social anxiety: Preliminary report from a comparative outcome study. Studies in Health Technology and Informatics. 2010. doi:10.3233/978-1-60750-561-7-57.
BibTeX
@article{robillard2010,
  author = {Robillard, G. and Bouchard, S. and Dumoulin, S. and Guitard, T. and Klinger, E.},
  title = {Using virtual humans to alleviate social anxiety: Preliminary report from a comparative outcome study},
  journal = {Studies in Health Technology and Informatics},
  year = {2010},
  doi = {10.3233/978-1-60750-561-7-57},
  url = {https://withvr.app/evidence/studies/robillard-2010}
}
RIS
TY  - JOUR
AU  - Robillard, G.
AU  - Bouchard, S.
AU  - Dumoulin, S.
AU  - Guitard, T.
AU  - Klinger, E.
TI  - Using virtual humans to alleviate social anxiety: Preliminary report from a comparative outcome study
JO  - Studies in Health Technology and Informatics
PY  - 2010
DO  - 10.3233/978-1-60750-561-7-57
UR  - https://withvr.app/evidence/studies/robillard-2010
ER  -

Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.

Funding & independence

Affiliations: Robillard, Bouchard, Dumoulin, Guitard at Université du Québec en Outaouais (UQO); Klinger at Université d'Angers (France). Specific funding sources not extracted in detail. Peer-reviewed conference proceedings paper in Studies in Health Technology and Informatics (IOS Press). No withVR BV involvement. Summary prepared independently by withVR. The VR system used was an early version of the In-Virtuo platform developed by Bouchard's group, NOT Therapy withVR or Research withVR.

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