Effectiveness of virtual reality and in vivo exposure combined with Acceptance and Commitment Therapy for public speaking anxiety: a randomized clinical trial

Fear of public speaking (PSF) is one of the primary manifestations of social phobia and is highly prevalent among university students. In vivo (IV) exposure from Acceptance and Commitment Therapy (ACT) has proven effective for treating PSF. Exposure through virtual reality (VR) offers practical advantages over IV exposure, although its effectiveness still needs to be demonstrated. This study aims to provide evidence for ACT-based VR in treating PSF. This randomized clinical trial involved thirty-seven university students with significant levels of social phobia and PSF. Participants were randomly assigned to ACT-based IV exposure, ACT-based VR, or a waiting list. Those on the waiting list were later allocated to either IV or ACT conditions. A five-session ACT-based individual treatment protocol was administered. Measures were collected using standardized questionnaires and subjective scales before and after treatment, as well as at a three-month follow-up. Both IV and VR ACT-based interventions were found to be feasible in a university setting, with most participants showing excellent adherence. Results demonstrated the interventions’ impact on PSF, social anxiety, cognitive fusion, and self-efficacy levels, with moderate to large effect sizes. ACT-based interventions were more successful in reducing PSF compared to non-intervention. Exposure aimed at psychological acceptance proved effective, and the practical advantages of VR were confirmed. This study provides evidence for delivering ACT-based exposure through VR for treating PSF in a university context. Future research should aim to provide additional evidence with broader and more diverse samples.