{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:33:58Z","timestamp":1786484038576,"version":"build-2736575974"},"reference-count":28,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Youth social anxiety is rising; however, evidence for therapist-guided virtual reality (VR) exposure remains sparse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This randomized controlled trial will test whether such a VR program is associated with reductions in social-anxiety symptoms in youth aged 15 to 25 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants will be recruited from schools, tertiary institutions, and community centers in Hong Kong and screened for eligibility. Youth aged 15 to 25 years who score 25 or higher on the Social Phobia Inventory (SPIN) will be randomly allocated to either the VR intervention group or the waitlist control group in a 1:1 ratio. The VR group will receive a 6-session therapist-facilitated VR intervention, focusing on exposure to realistic social scenarios, real-time physiological monitoring, and AI-driven adaptive support. The control group will not receive the VR intervention during the primary assessment period but will be offered access after the 3-month follow-up assessment. Both groups will be assessed at baseline, 1 month (postintervention), and 3 months for the primary outcome of social anxiety (SPIN) and the secondary outcome of depression (Patient Health Questionnaire-9). An exploratory cost analysis will estimate the cost per unit reduction in SPIN scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 90 participants (45 in each group) will be recruited. Participant enrollment began in March 2026, and data collection will continue until the required sample size is reached. The primary findings are expected to be published in late 2027. Outcome analyses will use a linear mixed effects model under the intention-to-treat principle, with missing data accounted for under the assumption of missing-at-random.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This trial will provide preliminary evidence on the efficacy, feasibility, and acceptability of a therapist-facilitated VR intervention for youth social anxiety in Hong Kong. Given the waitlist comparator and 3-month follow-up period, findings will not establish VR-specific effects, long-term effectiveness, or implementation-level cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/86937","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:15:31Z","timestamp":1786482931000},"page":"e86937-e86937","source":"Crossref","is-referenced-by-count":0,"title":["Therapist-Facilitated Virtual Reality Intervention for Social Anxiety Among Youth: Protocol for a Randomized Controlled Trial"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9407-4195","authenticated-orcid":false,"given":"Yi Zhou","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5662-921X","authenticated-orcid":false,"given":"Ming Tak","family":"Hue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4896-264X","authenticated-orcid":false,"given":"Kung Wong","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8771-5348","authenticated-orcid":false,"given":"De Hui","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8255-7459","authenticated-orcid":false,"given":"Siu Man","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9564-4284","authenticated-orcid":false,"given":"Xue","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"R1","unstructured":"International statistical classification of diseases and related health problems 10th revision (ICD-10) version: 2019. World Health Organization. URL: https:\/\/icd.who.int\/browse10\/2019\/en#F40.0 [Accessed 14-07-2026]"},{"key":"R2","unstructured":"DSM-5 changes: implications for child serious emotional disturbance. Substance Abuse and Mental Health Services Administration (US); 2016. URL: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519708\/pdf\/Bookshelf_NBK519708.pdf [Accessed 14-07-2026]"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2165\/00148581-200709040-00004","article-title":"Social anxiety disorder in children and adolescents: epidemiology, diagnosis, and treatment","volume":"9","author":"Khalid-Khan","journal-title":"Paediatr Drugs"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s10802-007-9099-2","article-title":"Social anxiety and peer relations in early adolescence: behavioral and cognitive factors","volume":"35","author":"Erath","journal-title":"J Abnorm Child Psychol"},{"key":"R5","doi-asserted-by":"crossref","unstructured":"Alden LE Regambal MJ Plasencia L . Relational processes in social anxiety disorder. In: Weeks JW , editor. The Wiley Blackwell Handbook of Social Anxiety Disorder. Wiley Blackwell; 2014:159-178. [doi: 10.1002\/9781118653920.ch8]","DOI":"10.1002\/9781118653920.ch8"},{"issue":"6","key":"R6","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00127-015-1062-x","article-title":"The 'Early Developmental Stages of Psychopathology (EDSP) study': a 20-year review of methods and findings","volume":"50","author":"Beesdo-Baum","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1146\/annurev-clinpsy-081219-115923","article-title":"Virtual reality therapy in mental health","volume":"17","author":"Emmelkamp","journal-title":"Annu Rev Clin Psychol"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2018.08.003","article-title":"Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials","volume":"61","author":"Carl","journal-title":"J Anxiety Disord"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s40211-020-00349-7","article-title":"Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents: a systematic review","volume":"35","author":"Kothgassner","journal-title":"Neuropsychiatry"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2015.08.010","article-title":"Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments","volume":"74","author":"Morina","journal-title":"Behav Res Ther"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s10567-018-0258-5","article-title":"Understanding social anxiety disorder in adolescents and improving treatment outcomes: applying the cognitive model of Clark and Wells (1995)","volume":"21","author":"Leigh","journal-title":"Clin Child Fam Psychol Rev"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1037\/0022-006X.74.3.568","article-title":"Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial","volume":"74","author":"Clark","journal-title":"J Consult Clin Psychol"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11920-017-0788-4","article-title":"Recent progress in virtual reality exposure therapy for phobias: a systematic review","volume":"19","author":"Botella","journal-title":"Curr Psychiatry Rep"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1038\/s44220-023-00042-y","article-title":"The coming global economic downturn and suicide: a call to action","volume":"1","author":"Sinyor","journal-title":"Nat Mental Health"},{"issue":"10372","key":"R15","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/S0140-6736(22)02368-6","article-title":"Global investments to optimise the health and wellbeing of children with disabilities: a call to action","volume":"401","author":"Olusanya","journal-title":"Lancet"},{"issue":"11","key":"R16","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1016\/S2215-0366(23)00257-2","article-title":"Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses","volume":"10","author":"Freeman","journal-title":"Lancet Psychiatry"},{"issue":"8","key":"R17","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1097\/DBP.0000000000000213","article-title":"Brief measures to screen for social anxiety in adolescents","volume":"36","author":"Garcia-Lopez","journal-title":"J Dev Behav Pediatr"},{"key":"R18","unstructured":"Furmark T . Social phobia. From epidemiology to brain function [Dissertation]. Acta Universitatis Upsaliensis; 2000. URL: https:\/\/swepub.kb.se\/bib\/swepub%3Aoai%3ADiVA.org%3Auu-546?language=en&tab2=abs [Accessed 14-07-2026]"},{"key":"R19","unstructured":"Heimberg RG Liebowitz MR Hope DA Schneier FR , editors. Social Phobia: Diagnosis, Assessment, and Treatment. Guilford Press; 1995. ISBN: 9781572300125"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jbtep.2006.12.002","article-title":"Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor","volume":"39","author":"McManus","journal-title":"J Behav Ther Exp Psychiatry"},{"issue":"7","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/23683","article-title":"The effects of immersive virtual reality in reducing public stigma of mental illness in the university population of Hong Kong: randomized controlled trial","volume":"23","author":"Yuen","journal-title":"J Med Internet Res"},{"issue":"4","key":"R22","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1192\/bjp.176.4.379","article-title":"Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale","volume":"176","author":"Connor","journal-title":"Br J Psychiatry"},{"issue":"8","key":"R23","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1016\/j.brat.2005.08.013","article-title":"Psychometric properties of the social phobia inventory: further evaluation","volume":"44","author":"Antony","journal-title":"Behav Res Ther"},{"issue":"11","key":"R24","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/S1726-4901(09)70430-7","article-title":"Screening for social phobia: psychometric evaluation of Chinese Social Phobia Inventory (SPIN)","volume":"72","author":"Chen","journal-title":"J Chin Med Assoc"},{"issue":"5","key":"R25","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1016\/j.genhosppsych.2014.05.021","article-title":"Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population","volume":"36","author":"Wang","journal-title":"Gen Hosp Psychiatry"},{"issue":"15","key":"R26","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1017\/S0033291720003785","article-title":"Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis","volume":"50","author":"Horigome","journal-title":"Psychol Med"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1080\/10615806.2024.2392195","article-title":"Virtual reality exposure therapy for social anxiety disorders: a meta-analysis and meta-regression of randomized controlled trials","volume":"38","author":"Tan","journal-title":"Anxiety Stress Coping"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1111\/acps.12275","article-title":"Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis","volume":"130","author":"Furukawa","journal-title":"Acta Psychiatr Scand"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:15:39Z","timestamp":1786482939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e86937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":28,"URL":"https:\/\/doi.org\/10.2196\/86937","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"v15i4e86937"}}