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<p>Social anxiety disorder is characterized by two core components: heightened social anxiety leading to avoidance of social situations, and a persistent fear of being negatively evaluated by others (fear of negative evaluation- FNE). Most trials of Virtual Reality-based Interventions, including exposure-focused component have focused narrowly on public speaking anxiety, limiting conclusions regarding broader forms of social interaction anxiety. The present systematic review and meta-analysis aimed to evaluate the efficacy of VRI for social anxiety beyond public speaking contexts, with a specific focus on interaction-based social anxiety and fear of negative evaluation. A systematic search of PubMed, Scopus, and ProQuest was conducted in accordance with PRISMA guidelines and a preregistered protocol. Randomized controlled trials involving participants with clinical or subclinical social anxiety were included. Primary outcomes were social anxiety symptom severity and fear of negative evaluation. Random-effects meta-analyses based on pre–post change scores were performed. Nine trials contributed to the primary meta-analysis of social anxiety symptom severity, showing a moderate reduction in symptoms favoring VRI compared with control conditions, particularly waitlist or no-treatment controls. However, heterogeneity was substantial and most studies were rated at high risk of bias, resulting in very low certainty of evidence. No significant overall effect was observed for fear of negative evaluation, with substantial variability across studies. Moderator analyses did not provide consistent evidence for a differential effect based on therapist involvement. Overall, VRI appears to be associated with reductions in social anxiety symptoms, particularly when compared with non-active controls, but the robustness and specificity of these effects remain insufficiently investigated. The findings highlight the need for methodologically rigorous trials targeting interaction-based social anxiety, with standardized outcome measures, active control conditions, and clearer specification of intervention components.</p><p><b>PROSPERO registration number</b>: CRD420251182945.</p>

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Efficacy of VR-based Interventions in Social Anxiety Disorder: a Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Antonella Cavallaro,
  • Alessandro Frolli,
  • Henning Romberg,
  • Ilaria La Penna,
  • Gianluca Posele,
  • Marco Romano,
  • Alessandro Gennaro

摘要

Social anxiety disorder is characterized by two core components: heightened social anxiety leading to avoidance of social situations, and a persistent fear of being negatively evaluated by others (fear of negative evaluation- FNE). Most trials of Virtual Reality-based Interventions, including exposure-focused component have focused narrowly on public speaking anxiety, limiting conclusions regarding broader forms of social interaction anxiety. The present systematic review and meta-analysis aimed to evaluate the efficacy of VRI for social anxiety beyond public speaking contexts, with a specific focus on interaction-based social anxiety and fear of negative evaluation. A systematic search of PubMed, Scopus, and ProQuest was conducted in accordance with PRISMA guidelines and a preregistered protocol. Randomized controlled trials involving participants with clinical or subclinical social anxiety were included. Primary outcomes were social anxiety symptom severity and fear of negative evaluation. Random-effects meta-analyses based on pre–post change scores were performed. Nine trials contributed to the primary meta-analysis of social anxiety symptom severity, showing a moderate reduction in symptoms favoring VRI compared with control conditions, particularly waitlist or no-treatment controls. However, heterogeneity was substantial and most studies were rated at high risk of bias, resulting in very low certainty of evidence. No significant overall effect was observed for fear of negative evaluation, with substantial variability across studies. Moderator analyses did not provide consistent evidence for a differential effect based on therapist involvement. Overall, VRI appears to be associated with reductions in social anxiety symptoms, particularly when compared with non-active controls, but the robustness and specificity of these effects remain insufficiently investigated. The findings highlight the need for methodologically rigorous trials targeting interaction-based social anxiety, with standardized outcome measures, active control conditions, and clearer specification of intervention components.

PROSPERO registration number: CRD420251182945.