{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:13:02Z","timestamp":1787065982512,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":144,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Depression and Anxiety"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The purpose of the present study was to investigate the relative effectiveness of cognitive\u2013behavioral therapy (CBT) with imaginal exposure (CBT\u2009+\u2009IE) and CBT combined with virtual reality exposure (CBT\u2009+\u2009VRE) for symptoms of social anxiety disorder (SAD) and fear of negative evaluation (FNE) in adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a three\u2010armed randomized controlled trial (RCT), a total of 51 adolescents who met the DSM\u20105 criteria for SAD were randomly assigned to either CBT\u2009+\u2009IE (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200917;\n                      <jats:italic>M<\/jats:italic>\n                      <jats:sub>age<\/jats:sub>\n                      \u2009=\u200916.41;\n                      <jats:italic>SD<\/jats:italic>\n                      \u2009=\u20090.61), CBT\u2009+\u2009VRE (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200917;\n                      <jats:italic>M<\/jats:italic>\n                      <jats:sub>age<\/jats:sub>\n                      \u2009=\u200916.35;\n                      <jats:italic>SD<\/jats:italic>\n                      \u2009=\u20090.70), or a waitlist control condition (WLCC;\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200917;\n                      <jats:italic>M<\/jats:italic>\n                      <jats:sub>age<\/jats:sub>\n                      \u2009=\u200916.00;\n                      <jats:italic>SD<\/jats:italic>\n                      \u2009=\u20090.70). Participants were assessed pre and posttreatment and followed up 3 months after the last treatment session regarding symptoms of social phobia, measured with the social phobia inventory (SPIN), and FNE, measured with the FNE Questionnaire.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A linear mixed model (LMM) analysis revealed significant differences between the treatment groups and WLCC in interaction with the three assessment times in SAD and FNE. A significant reduction of both CBT\u2009+\u2009VRE and CBT\u2009+\u2009IE treatments on symptoms of SAD from pretreatment to posttreatment and 3 months follow\u2010up (\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre\u2013post<\/jats:sub>\n                      \u2009=\u20091.31 and\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre-fu<\/jats:sub>\n                      \u2009=\u20091.43 in CBT\u2009+\u2009VRE group;\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre\u2013post<\/jats:sub>\n                      \u2009=\u20091.90 and\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre-fu<\/jats:sub>\n                      \u2009=\u20092.04 in CBT\u2009+\u2009IE group) and FNE (\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre\u2013post<\/jats:sub>\n                      \u2009=\u20091.35 and\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre-fu<\/jats:sub>\n                      \u2009=\u20091.68 in the CBT\u2009+\u2009VRE group;\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre\u2013post<\/jats:sub>\n                      \u2009=\u20091.95 and\n                      <jats:italic>d<\/jats:italic>\n                      <jats:sub>pre-fu<\/jats:sub>\n                      \u2009=\u20091.59 in the CBT\u2009+\u2009IE group) compared to the WLCC was observed. No significant differences were observed between the VRE\u2009+\u2009CBT and CBT\u2009+\u2009IE groups on FNE. With respect to SAD, statistically significant between\u2010group differences emerged in favour of the CBT\u2009+\u2009IE group, accompanied by substantial effect sizes at posttreatment (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.87) and follow\u2010up (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.73).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results support the effectiveness of CBT\u2009+\u2009IE and CBT\u2009+\u2009VRE in reducing the symptoms of SAD and FNE, which were maintained 3 months after treatment. Future research should focus on optimizing VRE protocols, exploring long\u2010term outcomes, and investigating its applicability across diverse populations. Further exploration of the cost\u2010effectiveness and accessibility of VR technology in clinical settings is required.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      ClinicalTrials.gov identifier: IRCT20210213050343N2\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/da\/9956436","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:24:14Z","timestamp":1779769454000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual Reality Exposure\u2010Enhanced Cognitive Behavioral Therapy (CBT\u2009+\u2009VRE) vs. CBT With Imaginal Exposure (CBT\u2009+\u2009IE) for Adolescent Patients Treatment of Social Anxiety Disorder Symptoms: A Pilot Randomized Controlled 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