VR-Counseling to Reduce Public Speaking Anxiety (VR-Counseling)

January 9, 2026 updated by: Francesco Craig, University of Calabria

Immersive Virtual Reality as a Tool for Reducing Public Speaking Anxiety in Students Accessing the University Psychological Counseling Service: A Randomized Controlled Trial

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

72

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental Arm: VR (360°) Modules (VR-ERP + VR-ACT) + Standard Counseling
The experimental intervention includes two distinct VR-based training scenarios: (A) VR-ERP, designed to gradually expose students to anxiety-provoking situations to prevent avoidance responses, and (B) VR-ACT training, a consistent mindfulness training aimed at enhancing psychological flexibility and value-oriented behaviors. Participants in the experimental group, after VR-ACT training, go to standard counseling intervention.
Device: Exposure and Response Prevention (ERP)
to simulate feared-anxiety-evoking scenarios, allowing both assessment and training for situationally induced anxiety to progressively promote desensitization to the anxiety-provoking stimuli
Device: Acceptance 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.
Active Comparator: Control Arm: Standard Counseling (No VR)
Standard counseling sessions will be conducted by one psychotherapist for 6 consecutive weeks in 60-minute sessions.
Behavioral: Counseling program
Standard counseling sessions will be conducted by one psychotherapist for 6 consecutive weeks in 60-minute sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change From Baseline in Public Speaking Anxiety at VR Post-Treatment
Time Frame: 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
Baseline (T0) and end of VR intervention sessions (T1, at the end of the 4-week intervention period).

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Heart Rate During Intervention Sessions
Time Frame: 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.
During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)
Heart Rate Variability During Intervention Sessions
Time Frame: 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.
During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)
Electrodermal Activity During Intervention Sessions
Time Frame: 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.
During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)
Skin Temperature During Intervention Sessions
Time Frame: 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.
During VR intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)
Movement and Activity Levels During Intervention Sessions
Time Frame: 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.
During intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)
Change From Baseline in Anxiety at VR Post-Treatment
Time Frame: 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.
During intervention sessions, from session 1 (T0) through session 4 (T1 - end of the 4-week intervention period)

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change From Baseline in Public Speaking Anxiety at 3-Month Follow-Up
Time Frame: Baseline (T0) and 3-month follow-up (T2) (approximately 3 months after treatment completion).
Change from baseline (T0) to the 3-month follow-up (T2) in public speaking anxiety (PSA). The experimental arm (VR intervention sessions) is expected to show greater sustained improvements at T2 compared with the control arm (brief standard counseling only).
Baseline (T0) and 3-month follow-up (T2) (approximately 3 months after treatment completion).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Calabria

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 1, 2026

Primary Completion (Estimated)

October 12, 2026

Study Completion (Estimated)

December 31, 2026

Study Registration Dates

First Submitted

December 22, 2025

First Submitted That Met QC Criteria

January 9, 2026

First Posted (Actual)

January 20, 2026

Study Record Updates

Last Update Posted (Actual)

January 20, 2026

Last Update Submitted That Met QC Criteria

January 9, 2026

Last Verified

October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • RV-PSI_13/03/2023_n. 318

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

De-identified individual participant data (IPD) underlying the results reported in publications will be made available upon reasonable request. Data will be shared in a de-identified format in accordance with applicable privacy regulations (e.g., GDPR).

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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