Virtual Reality Exposure in Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Qualitative Evaluation Based on Patients' and Therapists' Experiences

Social anxiety disorder (SAD) is a highly prevalent and impairing disorder. Current best practice is cognitive behavioral therapy (CBT), but there are several challenges associated with performing exposure therapy. Virtual reality exposure (VRE) may improve treatment efficacy of SAD in a group therapy context, because it allows for greater control, flexibility, and individualization of the exposure stimuli. However, to date no study has investigated the use of VRE for SAD in a group context. In the present study, nine patients who had undergone group CBT with VRE for SAD and three therapists responsible for the treatment were interviewed about their experiences. The objective of the study was to investigate the practical and therapeutic challenges of using VRE in a group therapy context. Thematic analysis was used to analyze the data. The results showed that it was difficult for the patients to engage with the VRE in a group therapy context and that there were several practical challenges. However, all participants found the VRE exercises to be meaningful, because it gave them a medium to practice and understand typically avoided social situations. The latter has not previously been described as a treatment mechanism for anxiety through virtual reality. However, the appropriateness of VRE in group therapy remains unclear. Implications are discussed. What is the significance of this article for the general public? Anxiety disorders are increasingly common and represent a growing economic burden in most developed countries. Group therapy that focuses on building skills, facing fears, and changing unhelpful habits is an often used and efficacious treatment. Virtual reality has been used to help people with anxiety face their fears in a safe and flexible environment. However, it has never been investigated if virtual reality can be used in group therapy. The present study is the first to examine the use of virtual reality in group therapy, by interviewing patients and therapists. Several challenges to the treatment format were discovered and recommendations to meet them are proposed. It remains uncertain if virtual reality is a meaningful addition to group therapy.