Virtual Reality Exposure Therapy for Fear of Public Speaking: A Randomised Trial and What Lasted

By Noam Shemla · The Studies

TL;DR Anderson and colleagues ran the first randomised trial comparing virtual-reality exposure therapy with real, in-person exposure for social anxiety. 97 people whose main fear was public speaking had eight sessions of speaking to a virtual audience, eight sessions of group exposure therapy, or waited. Both treatments worked about equally well, and a year later people were still better than when they started.

• Paper: Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(5), 751–760.
• Participants: 97 adults from the community with a diagnosis of social anxiety disorder whose main fear was public speaking; average age 39, 62% women, ethnically diverse.
• Arms: Eight sessions of virtual-reality exposure therapy, eight sessions of exposure group therapy, or a wait list, assigned at random.
• Measures: Standard questionnaires before, after and 12 months later; a standardised speech task before and after; diagnosis re-assessed 3 months after treatment.
• Analysis: Analysis of covariance, comparing groups after treatment while adjusting for where each person started.
• Access: Subscription-only. This summary uses the published abstract and the descriptions of the trial in a 2024 review and in its 4–6 year follow-up.

Fear of public speaking is the most common social fear there is, and the best-established treatment for it is exposure: speaking, repeatedly, in front of people, until the fear subsides. The problem is practical. Audiences are hard to assemble on demand. Page Anderson and colleagues at Georgia State University tested whether a virtual audience could do the same job.1

The trial

The virtual-reality group practised speeches in front of a virtual audience; the exposure group therapy arm did its exposure in a group, with real people. Outcomes included standard questionnaires about fear of public speaking and fear of negative evaluation, and a behavioural test: a standardised speech, given in the lab before and after treatment, including how long each person was willing to keep speaking.2

How the groups were compared

The trial used analysis of covariance. Each person's score after treatment is predicted from their score before it, plus which group they were in. That way a group is not credited with improvement simply because its members happened to start out more anxious.

What they found

What the trial found

Relative to waiting, both treatments improved people on all but one measure each: the virtual-reality group did not change significantly on self-reported fear of negative evaluation, and the group-therapy arm did not significantly lengthen its speeches. Directly compared, the two treatments did not differ on any measure at any time, nor in how many people reached partial or full remission. A year later, people in both treatments were still significantly better than before treatment on every measure.

The authors were careful about the last point. Finding no difference is not the same as proving the treatments equal; that needs a larger trial designed to test equivalence, which they called for.

Has it held up?

The trial's own long-term follow-up is the most direct answer. Four to six years later, 28 of the original participants were assessed again; their gains had been maintained, and according to a 2024 review of the field, 54.2% were in remission.32

The wider evidence points the same way. A 2025 meta-analysis of 17 randomised trials found virtual-reality exposure more effective than waiting lists at the end of treatment and at follow-up, and about as effective as other treatments, while calling for larger, longer trials.4

What this study cannot tell you

• Whether the two treatments are truly equal. The trial was not large enough to prove equivalence; the authors say so.
• What made them work. Both were exposure-based; the trial compares ways of delivering exposure, not exposure against something else active.
• How large the effects were. We could not read the full paper, and the abstract gives significance, not effect sizes.
• How it generalises. Participants had a diagnosed disorder; people with ordinary nerves may respond differently, and probably faster.

What a speaker can take from it

The active ingredient in both arms was the same: speaking, again and again, to an audience, in sessions structured so that the fear could rise and then fall. What this trial adds is that the audience does not have to be real for that to work, and that the gains last.

That is the principle behind every form of deliberate speaking practice, from a therapy room to a club night. The fear shrinks with exposure, not with advice about it, and the exposure has to be repeated to count.

This article summarises a subscription-only paper from its published abstract, with the trial’s measures and its long-term follow-up described from a 2024 review. No effect sizes are reported because we could not read them. The equation shows the general form of the analysis, not the paper’s exact model.

Measured

• Questionnaires on fear of public speaking and of negative evaluation, before, after and 12 months later
• A standardised speech task in the lab, before and after treatment
• Diagnostic status three months after treatment

Inferred, not measured

• Equivalence of the two treatments: not tested directly, as the authors note

References

1. Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(5), 751–760. https://doi.org/10.1037/a0033559
2. Seuling, P. D., Czernin, N. S., & Schiele, M. A. (2024). Virtual reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder. Neuroscience Applied, 3, 104074. https://doi.org/10.1016/j.nsa.2024.104074
3. Anderson, P. L., Edwards, S. M., & Goodnight, J. R. (2017). Virtual reality and exposure group therapy for social anxiety disorder: results from a 4–6 year follow-up. Cognitive Therapy and Research, 41(2), 230–236. https://doi.org/10.1007/s10608-016-9820-y
4. Tan, Y. L., Chang, V. Y. X., Ang, W. H. D., Ang, W. W., & Lau, Y. (2025). Virtual reality exposure therapy for social anxiety disorders: a meta-analysis and meta-regression of randomized controlled trials. Anxiety, Stress, & Coping, 38(2), 141–160. https://doi.org/10.1080/10615806.2024.2392195