{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:32:52Z","timestamp":1753893172808,"version":"3.41.2"},"reference-count":72,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Virtual Real."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Social anxiety disorder (SAD) has a high prevalence and an early onset. It often persists well into adulthood, turning into a chronic disorder. Cognitive behavioral therapy (CBT) is effective in treating SAD, but real-life exposure conducted as part of CBT is often costly and time-consuming, and imaginary exposure might lack realism and intensity. Virtual reality (VR)-based exposure using 360\u00b0 video offers a promising way to deliver exposure therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop a complete psychotherapeutic treatment program including CBT with VR-based exposure using 360\u00b0 videos (CBT-ExpVR) for adult patients with SAD and to test the treatment effect using the Social Interaction Anxiety Scale (SIAS) as the primary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This three-arm randomized controlled trial involved 51 participants who were recruited through self-referral. The interventions took place at Center for Digital Psychiatry in Denmark. Participants were randomized via computer program to CBT-ExpVR, CBT with <jats:italic>in vivo<\/jats:italic> exposure (CBT-Exp), or an active control group offered VR relaxation (RlxVR). Afterwards, participants assigned to RlxVR were re-randomized to one of the two CBT interventions. Allocation was not blinded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intention-to-treat analysis showed that participants receiving CBT-ExpVR reported significantly fewer symptoms of social anxiety at post-treatment compared to pre-treatment, \u03b2 = \u221214.89, 95% CI (\u221218.64, \u221211.14), <jats:italic>p<\/jats:italic> &amp;lt; 0.0001. At post-treatment, no difference in treatment effect was found between CBT-ExpVR and CBT-Exp, \u03b2 = 3.643, 95% CI (\u22121.727, 9.013), <jats:italic>p<\/jats:italic> = 0.1839. However, CBT-ExpVR was more effective than RlxVR, \u03b2 = \u221211.537, 95% CI (\u221216.163, \u22126.911), <jats:italic>p<\/jats:italic> &amp;lt; 0.0001. Dropout rates post-treatment were 16% (CBT-ExpVR), 38% (CBT-Exp), and 20% (RlxVR). No harms were registered during the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CBT-ExpVR represents an effective treatment for SAD comparable to standard CBT treatment. CBT-ExpVR was reported as less costly and requiring less effort by the therapist compared to CBT-Exp. Thus, VR-based exposure might pave the way for a broader implementation of exposure in psychotherapeutic interventions for social anxiety by providing easy and low-cost access to exposure scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trials Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/clinicaltrials.gov\/study\/NCT03973541<\/jats:ext-link>, identifier NCT03973541.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frvir.2025.1588181","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T05:28:40Z","timestamp":1750138120000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual reality-based exposure with 360\u00b0 video as part of cognitive behavioral therapy for social anxiety disorder: a three-arm randomized controlled trial"],"prefix":"10.3389","volume":"6","author":[{"given":"Per Trads","family":"\u00d8rskov","sequence":"first","affiliation":[]},{"given":"Eik","family":"Runge","sequence":"additional","affiliation":[]},{"given":"Trine Theresa Holmberg","family":"Sainte-Marie","sequence":"additional","affiliation":[]},{"given":"Mathias Torp","family":"Ernst","sequence":"additional","affiliation":[]},{"given":"Lars","family":"Clemmensen","sequence":"additional","affiliation":[]},{"given":"Caroline H\u00f8ier","family":"Dalsgaard","sequence":"additional","affiliation":[]},{"given":"Mia Beck","family":"Lichtenstein","sequence":"additional","affiliation":[]},{"given":"St\u00e9phane","family":"Bouchard","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1080\/10401230600801077","article-title":"Validity of pilot adult ADHD self- report scale (ASRS) to rate adult ADHD symptoms","volume":"18","author":"Adler","year":"2006","journal-title":"Ann. 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