Virtual reality exposure using three-dimensional images for the treatment of social phobia

Gebara, Cristiane M.; Barros-Neto, Tito P. de; Gertsenchtein, Leticia; Lotufo-Neto, Francisco

doi:10.1590/1516-4446-2014-1560

Cristiane M. Gebara

Programa Ansiedade (AMBAN), Departamento de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

Tito P. de Barros-Neto

Programa Ansiedade (AMBAN), Departamento de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

Leticia Gertsenchtein

Programa Ansiedade (AMBAN), Departamento de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

Francisco Lotufo-Neto

Programa Ansiedade (AMBAN), Departamento de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

Correspondence: Cristiane Maluhy Gebara, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-010, São Paulo, SP, Brazil. E-mail: crisgebara@gmail.com

Disclosure The authors report no conflicts of interest.

Panel A - Demographic profile of the sample
	Gender		Educational attainment				Phobia
	Female	Male	Graduate (completed)	Undergraduate (completed)	Undergraduate (ongoing)	High school (completed)	Social phobia	Performance anxiety
n (%)	10 (47.6)	11 (52.4)	2 (9.5)	13 (61.9)	1 (4.8)	5 (23.8)	13 (61.9)	8 (38.1)

Panel B - Age, number of sessions, and duration of exposure
	Mean ± SD	Median (range)
Age (years)	39.62±11.14	38.00 (19.00-63.00)
Number of sessions	5.00±1.60	5.00 (2.00-7.00)
Duration of exposure (minutes)	21.29±8.72	20.00 (5.00-45.00)

Technique presentation session	Psychoeducation with the necessary explanations of the nature of the procedures: exposure and virtual reality exposure. Anxiety hierarchy (from low- to high-anxiety scenes).
Sessions 1 and 2	Scene 1: Go for a walk on the street. The therapist asks the participant to walk down a street, where he/she will be observed by passersby.
Sessions 3 and 4	Scene 2: Approached on the street. The therapist asks the participant to walk down a street and asks a stranger for information, e.g., where the nearest pharmacy is. He or she thanks the stranger and repeats the same question to another. The therapist pushes the button on the auxiliary keyboard, and each character replies the same way: “Go straight ahead and turn right.” The characters are a teenager, a man, a woman, and, finally, a small group.
Sessions 5 and 6	Scene 3: Entering a party. The therapist asks the participant to enter a house where a party is taking place and be observed by the guests.
Sessions 7 and 8	Scene 4: Dialog at the party. The therapist tells the participant he/she is at a friend’s party. He/she is then introduced by one of the characters to a stranger at the party, who initiates a conversation. The questions regard the subject’s acquaintance with a supposed friend of the party’s host/hostess, previously set before the start of virtual exposure. The therapist pushes the button on the auxiliary keyboard to insert the character’s questions, e.g., “how long have you guys known each other?”.
Sessions 9 and 10	Scene 5: Guest reception. The therapist says the participant is the host/hostess and must welcome the guests.
Sessions 11 and 12	Scene 6: Speech at the party. The therapist says the participant is the host/hostess and has to give a speech thanking the guests. Depending on the feared situation, the participant may eat, drink, or write in front of the guests. One of the characters takes a cell phone call, another coughs, and another whispers to the person next to him/her and laughs out loud.

	Baseline			Final			Mean diff.	Follow-up			Mean diff.
	Mean ± SD	Median	Range	Mean ± SD	Median	Range	(final - baseline)	Mean ± SD	Median	Range	(follow-up - baseline)
Sheehan 3 family life/home responsibilities^* * ≤ 0.01;	3.24±3.02	3.00	0.00-10.00	0.86±1.49	0.00	0.00-5.00	-2.38	1.29±1.85	0.50	0.00-7.00	-2.38
SF-36 functional capacity	89.05±18.95	95.00	20.00-100.00	89.76±14.27	95.00	45.00-100.00	0.71	80.00±23.66	85.00	0.00-100.00	0.71
SF-36 physical aspects	76.19±35.77	100.00	0.00-100.00	85.71±25.7	100.00	0.00-100.00	9.52	75.00±40.31	100.00	0.00-100.00	9.52
SF-36 emotional aspects^† † ≤ 0.001.	33.33±40.82	0.00	0.00-100.00	85.71±29.00	100.00	0.00-100.00	52.38	63.49±44.60	83.33	0.00-100.00	52.38

	F	Baseline Mean ± SD	Final Mean ± SD	Mean diff. (final - baseline)	Follow-up Mean ± SD	Mean diff. (follow-up - baseline)
LSAS fear	50.63^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	37.33±15.24	17.43±13.41	-19.90^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	20.10±13.73	-17.24^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
LSAS avoidance	28.81^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	36.62±14.73	15.57±14.78	-21.05^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	21.38±14.41	-15.24^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
LSAS total	42.12^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	73.95±28.32	33.00±27.42	-40.95^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	41.48±26.89	-32.48^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
ATQ automatic thoughts	21.64^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	85.19±26.33	55.57±20.92	-29.62^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	61.19±22.99	-24.00^† § p ≤ 0.05.
Sheehan 1 work/school	32.55^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	5.95±2.60	1.95±2.16	-4.00^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	1.57±1.89	-4.38^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
Sheehan 2 social life	29.72^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	6.14±3.07	2.48±2.18	-3.67^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	2.24±2.00	-3.90^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
SF-36 pain	2.87	83.48±20.02	83.71±15.84	0.24	72.80±26.29	-11.19
SF-36 general health	2.07	71.52±17.24	79.19±20.11	7.67	75.52±21.78	4.00
SF-36 vitality	12.59^† § p ≤ 0.05.	42.86±22.28	65.95±16.25	23.09^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	51.43±24.86	8.57
SF-36 social aspects	6.04	55.36±28.11	79.17±17.82	23.81^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	60.12±31.03	4.76
SF-36 mental health	9.83^† * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	49.52±21.11	70.10±16.81	20.57^* * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	61.90±22.83	12.38
DAS	11.60^† § p ≤ 0.05.	107.76±29.69	133.00±25.84	25.24^† * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	131.38±31.61	23.62^† * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;
BDI	5.37^§ § p ≤ 0.05.	12.62±6.74	7.00±5.80	-5.61^† * p ≤ 0.0001; †p ≤ 0.001; †p ≤ 0.01;	11.33±9.35	-1.29

	Mean ± SD	Range
Realistic	4.19±0.69	2.5-5.0
Resembled own life	4.24±0.55	3.0-5.0
Maximum degree of anxiety	3.23±0.45	2.3-3.8

[1] Correspondence: Cristiane Maluhy Gebara, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-010, São Paulo, SP, Brazil. E-mail: crisgebara@gmail.com

Brasil

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Virtual reality exposure using three-dimensional images for the treatment of social phobia

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