Skip to main content Skip to main navigation menu Skip to site footer
Research Articles
Published: 2020-05-04

The use of psycho-education based on the CBT protocol using a single-session virtual exposure within the psychological support of students with a fear of public speaking: results of a pilot study

Ukrainian Catholic University
Private practice
public speaking anxiety social anxiety disorder virtual reality exposure


Introduction. Anxiety and fear of public speaking are some of the common complaints of students during their studies. The prevalence and consequences for psychological well-being make it possible to discuss the fear of public speaking in the context of pathopsychological changes that contribute to or are a variant of a social anxiety disorder. At the same time, constant anxiety and emotional distress can contribute to the development of other comorbid pathologies such as depressive disorder, other anxiety disorders, or substance abuse as a way of coping anxiety. The development and implementation of effective psychological/psychotherapeutic interventions for self-help and psychological support with using a virtual environment has already proven itself in dealing with specific phobias and other anxiety states and can be applied in preventative measures for social anxiety disorder among students.

Aim. Investigate the impact of psychoeducation based on CBT protocol with a one-session virtual exposure on the level of students' social anxiety before public speaking and the features of social interaction during education.

Methods. Social anxiety assessment using the Social Phobia Inventory (SPIN), and Social Phobia Rating Scale (SPRS), clinical semi-structured interview, observation, and assessment of changes in virtual exposure.

Results. Compared with the control group, there was a statistically significant decrease in all indicators on the SPIN (p <0.001) and SPRS (p <0.001) scales in the experimental group 1 month after virtual exposure. Decreases in social anxiety on the SPIN scale before the intervention and one month after were statistically different depending on belonging to the experimental group (F = 5.06, p = 0.035) and time (F = 5.46, p = 0.029), and significantly from a baseline level of social anxiety (F = 124.8, p = 0.000). The significance of changes in the experimental group as a whole on the SPIN scale is achieved by reducing the indicator in the subgroup with a high level of social anxiety, where statistical significance is significant p <0.001. Differences in changes in the level of social anxiety on the SPRS scale before the intervention and one month after, depending on belonging to the experimental group (F = 9.39, p = 0.006), time (F = 12.33, p = 0.002) and baseline level of social anxiety (F = 12.06, p = 0.000) are also significant. According to the SPRS method, a statistically significant decrease in the rate of exhaustion and overall restriction imposing social anxiety (p <0.001) was found in the experimental group and a statistically significant decrease in the using of part of strategies avoidance behaviors and the influence of typical unproductive beliefs (p <0.05, in accordance).

Conclusion. Using psychoeducation based on CBT protocol with a one-session virtual exposure has proven to be an effective way of reducing the fear of public speaking. After 1 month undergoing a psychoeducational session using virtual exposure, a significant decrease in the intensity of anxious feelings, the impact of unproductive beliefs, and changes in behavior that underpinned them were revealed. It was noted that the most significant effect was achieved in the subgroup of participants with high input levels of social anxiety and manifest traits corresponding to the criteria of social anxiety disorder. Such changes may be explained by the need and timeliness of providing psychological support to this category of participants. Given that our findings are incomplete, they require further research and expansion of the experimental base.

Full-text of the article is available for this locale: Українська.


  1. Avramchuk O. Social anxiety disorder: relevance and perspectives. Psychosomatic Medicine and General Practice. 2018;3(3). doi:
  2. Avramchuk O. Virtual exposure as an instrument to overcome student’s fear of public speaking and social interactions. Psychol J. 2020;6(1):9-17. doi:
  3. Allen M, Hunter J, Donohue W. Meta-Analysis of Self-Report Data on the Effectiveness of Public Speaking Anxiety Treatment Techniques. Commun Educ. 1998;38(1):54-77. doi:
  4. Anderson P, Price M, Edwards S, et al. Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. J Consult Clin Psychol. 2013;81(5):751-60. doi:
  5. Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008;43(8):667-72. doi:
  6. Bodie G. A Racing Heart, Rattling Knees, and Ruminative Thoughts: Defining, Explaining, and Treating Public Speaking Anxiety. Commun Educ. 2010;59(1):70-105. doi:
  7. Blöte A, Kint M, Miers A, Westenberg P. The relation between public speaking anxiety and social anxiety: A review. J Anxiety Disord. 2009;23(3):305-13. doi:
  8. Bögels S, Alden L, Beidel D, et al. Social anxiety disorder: Questions and answers for the DSM-V. Depress Anxiety. 2010;27(2):168-89. doi:
  9. Burnley M, Cross P, Spanos N. The effects of stress inoculation training and skills training on the treatment of speech anxiety. Imagination, Cognition and Personality. 1993;12(4):355-66. doi:
  10. Carl E, Stein A, Levihn-Coon A, et al. Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019;61:27-36. doi:
  11. Goberman A, Hughes S, Haydock T. Acoustic characteristics of public speaking: Anxiety and practice effects. Speech Commun. 2011;53(6):867-76. doi:
  12. Hancock A, Stone M, Brundage S, Zeigler M. Public speaking attitudes: does curriculum make a difference. J Voice. 2010;24(3):302-7. doi:
  13. Harris S, Kemmerling R, North M. Brief Virtual Reality Therapy for Public Speaking Anxiety. Cyberpsychology Behav. 2002;5(6):543-50. doi:
  14. Nordahl H, Wells A. Metacognitive Therapy for Social Anxiety Disorder: An A–B Replication Series Across Social Anxiety Subtypes. Front Psychol. 2018;9. doi:
  15. Hofmann S, Heinrichs N, Moscovitch D. The nature of social phobia: Toward a new classification. Clin Psychol Rev. 2004;24(7):769-97. doi:
  16. Hook J, Valentiner D. Are specific and generalized social phobias qualitatively distinct. Clin Psychol Sci Pract. 2002;9(4):379-95. doi:
  17. Kant L. Public Speaking Anxiety. University of Tennessee; 2000.
  18. Kampmann I, Emmelkamp P, Hartanto D, Brinkman W, Zijlstra B, Morina N. Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. Behav Res Ther. 2016;77:147-56.
  19. Lindner P, Miloff A, Hamilton W, et al. Creating state of the art, next-generation virtual reality exposure therapies for anxiety disorders using consumer hardware platforms: Design considerations and future directions. Cogn Behav Ther. 2017;46(5):404-420. doi:
  20. Lindner P, Miloff A, Fagernäs S, et al. Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial. J Anxiety Dis. 2019;61:45-54. doi:
  21. Merikangas K, He J, Burstein M, et al. Lifetime prevalence of mental disorders in U. S adolescents: Results from the national comorbidity survey replication–adolescent supplement (NCS-A) J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-9. doi:
  22. Miloff A, Lindner P, Hamilton W, Reuterskiöld L, Andersson G, Carlbring P. Single-session gamified virtual reality exposure therapy for spider phobia vs Traditional exposure therapy: Study protocol for a randomized controlled non-inferiority trial. Trials. 2016;17. doi:
  23. Moldovan R, David D. One session treatmet of cognitive and behavioral therapy and virtual reality for social and specific phobias, preliminary results from a randomized clinical trial. J Cogn Behav Psychot. 2014;14(1):67-83.
  24. Morina N, Brinkman W, Hartanto D, Kampmann I, Emmelkamp P. Social interactions in virtual reality exposure therapy: A proof-of-concept pilot study. Technol Health Care. 2015;23(5):581-9. doi:
  25. Pertaub D, Slater M, Barker C. An Experiment on Public Speaking Anxiety in Response to Three Different Types of Virtual Audience. Presence Teleop Virt. 2002;11(1):68-78. doi:
  26. Shri R. Anxiety: Causes and Management. JBS. 2010;5(1):100-18.
  27. Söyler E, Gunaratne C, Akbaş M. Towards a Comprehensive Simulator for Public Speaking Anxiety Treatment in Advances in Applied Digital Human Modeling and Simulation. Springer; 2017. doi:
  28. Spence S, Rapee R. The etiology of social anxiety disorder: An evidence-based model. Behav Res Ther. 2016;86:50-67. doi:
  29. Tillfors M, Carlbring P, Furmark T, et al. Treating university students with social phobia and public speaking fears: Internet delivered self-help with or without live group exposure sessions. Depress Anxiety. 2008;25(8):708-17. doi:
  30. Westenberg P, Drewes M, Goedhart A, Siebelink B, Treffers P. A developmental analysis of self-reported fears in late childhood through mid-adolescence: social-evaluative fears on the rise. J Child Psychol Psychiatry. 2004;45(3):481-95. doi:

How to Cite

Аврамчук О, Острижко Ю. The use of psycho-education based on the CBT protocol using a single-session virtual exposure within the psychological support of students with a fear of public speaking: results of a pilot study. PMGP [Internet]. 2020May4 [cited 2021Dec.9];5(1):e0501224. Available from: