The feasibility of verbal and virtual reality exposure for youth with academic performance worry

•Imaginal exposure was tested without other anxiety management strategies in youth.•Verbal and virtual reality imaginal exposure were effective in reducing anxiety.•Both formats of standalone imaginal exposure were found to be tolerable by youth.•Youth preferred virtual reality but it did not outperform verbal imaginal exposure.•Enhanced realism in virtual reality may improve performance over verbal exposure. With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.