Beyond exposure: a feasibility and validity study of virtual reality-based cognitive therapy for social anxiety disorder

Abstract

Background Social Anxiety Disorder (SAD) is maintained by maladaptive cognitive patterns, yet most virtual reality (VR) interventions focus on exposure-based strategies, neglecting cognitive restructuring. To address this gap, we developed VR CHANGE, a mobile-based virtual reality cognitive therapy (VRCT) program targeting cognitive distortions in SAD. The program guides users through structured training tasks, including identifying automatic thoughts, recognizing cognitive distortions, and modifying maladaptive thinking. This study examined the program's feasibility and validity.Methods Twenty-four individuals with SAD completed the VRCT program, consisting of Theoretical Learning, Basic Training (beginner, intermediate, and advanced), and Applied Training, in two sessions spaced 1 week apart. Data collected for analysis included automatically recorded performance on behavioral tasks within the program, measures of social anxiety symptoms and cognitive distortions before and after the program, and a post-program user experience evaluation.Results Participants showed significant reductions in social anxiety and cognitive distortion scores post-intervention. Treatment satisfaction and content comprehension were high, and user experience ratings fell within an acceptable range. Behavioral data supported the program's construct, content, and convergent validity. In detail, error rates in cognitive distortion identification decreased with progression through training levels, and thought modification ability was associated with baseline cognitive distortion levels. Social anxiety-related scenario-induced distress increased appropriately across stages and correlated with social anxiety scales. Content validity was supported by differentiated task difficulty across cognitive distortion types.Conclusion VR CHANGE demonstrated strong feasibility and validity as a cognitive therapy intervention for SAD, suggesting that its structured, multimedia-supported format reduced cognitive load and facilitated therapeutic learning. The findings support its value as a subject for a large-scale randomized controlled trial to determine whether VRCT can be effectively used to treat SAD.