Testing Mechanisms of Virtual Reality Exposure Therapy for Social Anxiety

The purpose of this study is to test mechanisms and processes of virtual reality and augmented reality exposure therapy for social anxiety. There is substantial evidence that virtual reality exposure therapy is an effective treatment for social anxiety. However, it can be difficult to access treatment that needs to be conducted in person. Tests of self-guided (without therapist assistance) virtual reality exposure therapy have had mixed efficacy and tests of augmentation offer an important method to optimize brief interventions. The study objectives are to test a wide range of possible mechanisms and approaches (ranging from single sessions in person to remotely conducted virtual reality exposure therapy) in order to advance the field. The broadness of the proposed research is to provide multiple avenues for inquiry per discussion with IRB chair Dr. Kuo. Depending on the specific line of inquiry some variations will be documented (e.g., multiple consent forms for answering different sub questions of the primary questions listed below).

Study Overview

• Status: Recruiting
• Conditions: no Interaction VRET; Scripted Interactions VRET; Fully Customized Interactions VRET
• Intervention / Treatment: Behavioral: ExpandXR

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Palo Alto, California, United States, 94304
      • Recruiting
      • Palo Alto University Mountain View Campus
      • Contact: Mikael Rubin, PhD; Phone Number: 650-433-3805; Email: mrubin@paloaltou.edu
      • Principal Investigator: Mikael Rubin, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Individuals at least 18 years of age
• Located in the U.S. with sufficient proximity to Mountain View Campus to attend in person visit(s).
• Able to give consent
• Social Anxiety Disorder based on Structured Clinical Interview AND/OR self-report score cutoff (LSAS > 47).

Exclusion Criteria:

• Current Alcohol or Substance Use Disorder (based on self-report)
• Current or prior psychotic related or bipolar disorder (based on self-report)
• Unstable psychotropic medication (starting/stopping medication in past 6 weeks based on selfreport)
• Current cognitive behavioral therapy for social anxiety
• Impaired vision such that cannot see in VR headset without glasses (contacts okay)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: no interaction Virtual Reality Exposure Therapy	Behavioral: ExpandXR; An Mixed Reality Exposure Therapy platform for the Apple Vision Pro
Experimental: structured interaction Virtual Reality Exposure Therapy	Behavioral: ExpandXR; An Mixed Reality Exposure Therapy platform for the Apple Vision Pro
Experimental: personalized interaction Virtual Reality Exposure Therapy	Behavioral: ExpandXR; An Mixed Reality Exposure Therapy platform for the Apple Vision Pro

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Liebowitz Social Anxiety Scale Self Report Version	The Liebowitz Social Anxiety Scale Self Report Version is a 48-item self-report measure of fear and avoidance concerning social interactions and performance situations (e.g., telephoning in public, talking to people in authority). The range of scores is 0-144; higher scores are worse.	21 days
Liebowitz Social Anxiety Scale Self Report Version	The Liebowitz Social Anxiety Scale Self Report Version is a 48-item self-report measure of fear and avoidance concerning social interactions and performance situations (e.g., telephoning in public, talking to people in authority). The range of scores is 0-144; higher scores are worse.	51 days
Liebowitz Social Anxiety Scale Self Report Version	The Liebowitz Social Anxiety Scale Self Report Version is a 48-item self-report measure of fear and avoidance concerning social interactions and performance situations (e.g., telephoning in public, talking to people in authority). The range of scores is 0-144; higher scores are worse.	111 days
Personal Report of Communication Apprehension (PRCA)	The Personal Report of Communication Apprehension is a 24-item that assesses anxiety related to speaking in a variety of situation. The range of scores is 24-120; higher scores are worse.	21 days
Personal Report of Communication Apprehension (PRCA)	The Personal Report of Communication Apprehension is a 24-item that assesses anxiety related to speaking in a variety of situation. The range of scores is 24-120; higher scores are worse.	51 days
Personal Report of Communication Apprehension (PRCA)	The Personal Report of Communication Apprehension is a 24-item that assesses anxiety related to speaking in a variety of situation. The range of scores is 24-120; higher scores are worse.	111 days
Liebowitz Social Anxiety Scale Self Report Version	The Liebowitz Social Anxiety Scale Self Report Version is a 48-item self-report measure of fear and avoidance concerning social interactions and performance situations (e.g., telephoning in public, talking to people in authority). The range of scores is 0-144; higher scores are worse.	Baseline
Personal Report of Communication Apprehension (PRCA)	The Personal Report of Communication Apprehension is a 24-item that assesses anxiety related to speaking in a variety of situation. The range of scores is 24-120; higher scores are worse.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Speech Anxiety Thoughts Inventory	The Speech Anxiety Thoughts Inventory is a 23-item self-report measure of assessing the intensity of belief in maladaptive, negative thoughts categorized into two main factors: prediction of poor performance and fear of negative evaluation by the audience. The range of scores is 23-115 with higher scores reflecting greater endorsement of maladaptive thoughts.	21 days
Speech Anxiety Thoughts Inventory	The Speech Anxiety Thoughts Inventory is a 23-item self-report measure of assessing the intensity of belief in maladaptive, negative thoughts categorized into two main factors: prediction of poor performance and fear of negative evaluation by the audience. The range of scores is 23-115 with higher scores reflecting greater endorsement of maladaptive thoughts.	51 days
Speech Anxiety Thoughts Inventory	The Speech Anxiety Thoughts Inventory is a 23-item self-report measure of assessing the intensity of belief in maladaptive, negative thoughts categorized into two main factors: prediction of poor performance and fear of negative evaluation by the audience. The range of scores is 23-115 with higher scores reflecting greater endorsement of maladaptive thoughts.	111 days
Speech Anxiety Thoughts Inventory	The Speech Anxiety Thoughts Inventory is a 23-item self-report measure of assessing the intensity of belief in maladaptive, negative thoughts categorized into two main factors: prediction of poor performance and fear of negative evaluation by the audience. The range of scores is 23-115 with higher scores reflecting greater endorsement of maladaptive thoughts.	Baseline

Collaborators and Investigators

• Sponsor: Palo Alto University

Study record dates

Study Major Dates

• Study Start (Estimated): February 24, 2026
• Primary Completion (Estimated): February 1, 2028
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: February 20, 2026
• First Submitted That Met QC Criteria: February 20, 2026
• First Posted (Actual): February 27, 2026

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 2, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 2025-077-PAU

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No