Anxiety, Anxiety and Distress, Anxiety Disease, Public Speaking Anxiety
Conditions
Keywords
Public speaking anxiety, university counseling, Virtual Reality
Brief summary
Public Speaking Anxiety (PSA) is a common manifestation of social anxiety among university students that can negatively impact academic performance and psychological well-being. Virtual Reality (VR) based interventions combined with Cognitive Behavioral Therapy (CBT) represent a promising approach to address PSA by enabling controlled, gradual exposure to feared social situations through realistic simulations of audiences and settings. This randomized controlled trial will evaluate whether integrating VR sessions into standard psychological counseling provided by the University Psychological Counseling Service (UPCS) improves anxiety and PSA outcomes in university students compared with counseling alone. Participants will be randomized to one of two groups: (1) a control group receiving standard psychological counseling intervention, or (2) an experimental group receiving psychological counseling supplemented with VR interventions delivered via immersive 360° video scenarios. The VR-based intervention includes a VR-Exposure and Response Prevention (ERP) module offering graded exposure to anxiety-provoking public speaking contexts, and a VR-Acceptance and Commitment Training (ACT) module aimed at enhancing mindfulness and psychological flexibility through guided experiential exercises. Psychological outcomes and physiological responses recorded during sessions will be analyzed to compare the effectiveness of VR-integrated counseling versus standard counseling alone. This study addresses the limited evidence on CBT combined with 360° video-based VR exposure for PSA in university students and introduces a novel VR-based ERP and ACT protocol tailored to a university counseling setting.
Interventions
to simulate feared-anxiety-evoking scenarios, allowing both assessment and training for situationally induced anxiety to progressively promote desensitization to the anxiety-provoking stimuli
DEVICEAcceptance and Commitment Therapy (ACT) training
to provide an ACT-consistent mindfulness training targeting psychological flexibility processes, such as contact with the present moment, cognitive defusion, and acceptance, aimed at eliciting a grounding response within a digitally generated, safe environment.
BEHAVIORALCounseling program
Standard counseling sessions will be conducted by one psychotherapist for 6 consecutive weeks in 60-minute sessions.
Sponsors
University of Calabria
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Caregiver)
Intervention model description
This is a randomized controlled, parallel-group interventional study with two independent arms (1:1 allocation): (1) an experimental group and (2) a control group. Both groups receive a brief standard counseling program consisting of six individual sessions delivered by trained clinicians within the University Psychological Counseling Service (UPCS). The experimental group receives the same counseling program plus two immersive VR modules delivered via 360° video scenarios: (a) VR-Exposure and Response Prevention (VR-ERP) for graded, controlled exposure to public-speaking situations, and (b) VR-Acceptance and Commitment Training (VR-ACT) providing ACT-consistent mindfulness and psychological flexibility exercises aimed at reducing arousal and enhancing coping. The control group receives counseling only (no VR). Outcomes are assessed at baseline (T0), post-treatment (T1), and follow-up (T2) to evaluate changes over time and between-group differences.
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
are: 1. current enrollment at the university; 2. request for psychological counseling at the UPCS; 3. fluency in Italian; 4. provision of written informed consent; 5. the presence of at least moderate levels of anxiety and perceived stress, as indicated by scores on standardized assessment instruments. Specifically, scores between STAI scores from 35 to 50 and PRPSA scores from 85 to 110.
Exclusion criteria
are: 1. current psychotic disorder; 2. acute suicidality; 3. severe substance dependence; 4. severe sensory or motor impairments that would prevent safe use of VR equipment; 5. inability to attend the planned sessions; 6. concurrent participation in other specialized psychotherapy programs.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Public Speaking Anxiety at VR Post-Treatment | Baseline (T0) and end of VR intervention sessions (T1, at the end of the 4-week intervention period). | Change from baseline to post-treatment in public speaking anxiety as assessed by the Personal Report of Public Speaking Anxiety (PRPSA), comparing the experimental arm with the control arm. The PRPSA is a self-report questionnaire designed to measure anxiety specifically related to speaking in front of an audience. It assesses cognitive, physiological, and behavioral components of public speaking anxiety, capturing both anticipatory anxiety and anxiety experienced during performance. The scale consists of 34 items rated on a 5-point Likert scale, with response options ranging from 1 = strongly disagree to 5 = strongly agree. Items reflect feelings of tension and nervousness, physiological arousal, negative self-appraisal, and fear of audience evaluation. Total scores range from 34 to 170, with higher scores indicating greater levels of public speaking anx |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart Rate During Intervention Sessions | During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Heart rate is continuously recorded during each intervention session to assess physiological arousal and recovery and to examine whether VR-supported counseling is associated with different within-session heart rate responses compared with counseling alone. |
| Heart Rate Variability During Intervention Sessions | During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Heart rate variability is continuously recorded during each intervention session as an index of autonomic regulation and physiological recovery, and to compare within-session variability between VR-supported counseling and counseling alone. |
| Electrodermal Activity During Intervention Sessions | During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Electrodermal activity is continuously recorded during each intervention session to assess sympathetic nervous system activation and physiological arousal during counseling, and to compare responses between treatment arms. |
| Skin Temperature During Intervention Sessions | During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Skin temperature is continuously recorded during each intervention session as an indicator of peripheral physiological responses associated with stress and recovery, and to evaluate differences between VR-supported counseling and counseling alone. |
| Movement and Activity Levels During Intervention Sessions | During intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Movement and activity levels are continuously recorded during each intervention session to quantify physical activity and motion-related physiological responses and to compare within-session patterns between treatment arms. |
| Change From Baseline in Anxiety at VR Post-Treatment | During intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period) | Change from baseline in anxiety assessed with the State-Trait Anxiety Inventory (STAI), Form Y, a widely used self-report questionnaire designed to measure two distinct dimensions of anxiety: (i) State Anxiety, a temporary emotional condition characterized by feelings of tension, apprehension, and heightened autonomic nervous system activity, reflecting how the respondent feels "right now, at this moment"; and (ii) Trait Anxiety, a relatively stable disposition to perceive situations as threatening and to respond with anxiety across time and contexts. Each subscale consists of 20 items rated on a 4-point Likert scale. Response options range from 1 = not at all to 4 = very much so for the State Anxiety subscale, and from 1 = almost never to 4 = almost always for the Trait Anxiety subscale. Total scores for each subscale range from 20 to 80, with higher scores indicating greater levels of anxiety. |
Countries
Italy
Contacts
CONTACTFRANCESCO CRAIG, PhD
CONTACTFabio Bruno, PhD
Outcome results
None listed