Using virtual reality to identify the effects of safety-seeking behaviours and self-focused attention in social situations : pilot study

Background: Social anxiety disorder (SAD) is the most common anxiety disorder in adults with lifetime prevalence estimated around 10.3% (Kessler et al., 2012). Individuals with SAD either avoid social situations or endure them with high levels of distress (American Psychiatric Association, 2013). Two prominent maintaining factors of SAD are safety-seeking behaviours and self-focused attention (Clark & Wells, 1995). The present pilot study examines whether a single session of a behavioural experiment in virtual reality (VR) can reduce symptoms of social anxiety by targeting safety-seeking behaviours and self-focused attention. Method: Seven socially anxious people (Mage = 26.33, SD = 7.74) participated in this study, two male and five female. A VR environment was created for this research in collaboration with the Reykjavik University. The VR environment was a lecture hall with an audience of virtual people. The participants delivered two speeches in VR, once with safety-seeking behaviours and self-focused attention and then once without. Participants rated symptoms of social anxiety at two time points and completed ratings for Liebowitz Social Anxiety Scale, Social Cognitions Questionnaire, Social Behaviours Questionnaire, and Social Phobia Weekly Summary Scale. Results: When dropping safety-seeking behaviours and self-focused attention the participants rated themselves less anxious, their appearance less anxious, their feared outcomes came less true, and their overall performance better than when using safety-seeking behaviours and self-focused attention. There was a significant decrease in the avoidance subscale of LSAS and for the SPWSS. Conclusions: These findings give evidence that VR can be a good tool to use to identify the effects of safety-seeking behaviours and self-focused attention. Given that this research has few participants and is the first of its kind there is a high need for more research before any assumptions can be made about VR being useful in therapy for social anxiety disorder. Keywords: social anxiety disorder, virtual reality, self-focused attention, safety-seeking behaviour, safety behaviour, social phobi