Virtual Reality Helps Teens and Young Adults with Social Anxiety

Many teens and young adults find social situations challenging, like attending a party or asking someone on a date. But for those with social anxiety disorder, everyday interactions are so anxiety-producing they often lead to panic or avoidance, which can have an impact on work, school, and relationships and interferes with quality of life.

At the Columbia University Clinic for Anxiety and Related Disorders (CUCARD), clinic founder and director Anne Marie Albano, PhD, and Lauren Hoffman, PsyD, are building an innovative program using virtual reality therapy, which enables people to engage with and navigate social situations that trigger anxiety without having to experience it in real life.

“We are excited about the potential of virtual reality-based therapy to improve social skills and ease the distress that teens and young adults encounter daily,” says Dr. Hoffman, who is an assistant professor of medical psychology (Psychiatry) at Columbia. “We look forward to seeing VR reach young people who might not otherwise have access to evidence-based treatment.” 

Columbia Psychiatry spoke with Dr. Hoffman about social anxiety disorder, how virtual reality therapy works, and why VR treatment is a promising option for teens and young adults who struggle with this mental health condition.

Social anxiety seems like a rite of passage for many adolescents. What are the signs that anxiety in social situations goes beyond shyness or unease? 

Youth with social anxiety disorder (SAD) have tremendous difficulty interacting with peers and adults in everyday social situations. They are persistently worried about judgement from others and can experience intense distress (including panic) when faced with situations that could elicit embarrassment. In many instances, youth with SAD choose to avoid (or leave early from) situations that prompt anxiety, and their lives become “smaller” and often less enjoyable as a result. This can include limited participation in class, saying no to birthday parties or school events, withdrawing from extracurricular activities, and relying more heavily on parents to complete tasks, such as ordering at a restaurant or sending an email to a teacher. Over time, youth with significant social anxiety can struggle with other anxiety symptoms, depressed mood, loneliness, and difficulties at school or work. 

How common is social anxiety disorder?

Social anxiety disorder is the most frequently occurring anxiety disorder among young people. Based on interview data from a national survey of more than 10,000 adolescents, an estimated 8.6% of adolescents (13–18) had social anxiety disorder, and up to 25% were considered severe cases. The lifetime prevalence was even higher (13.6%) for young adults ages 18 to 29.

What is the typical treatment for SAD?

Cognitive behavioral therapy (CBT) is the “gold standard” treatment for both youth and adults. CBT traditionally involves education about anxiety and skills for relaxation, problem solving, and recognizing and reframing anxious self-talk. Most importantly, treatment for social anxiety disorder involves exposure therapy in which youth repeatedly confront feared situations with the support of a therapist to learn that worst-case outcomes typically don’t occur—everyone probably won’t laugh at you—and that they can reduce or tolerate anxious feelings. For SAD, exposure exercises may include joining a group conversation, public speaking, making mistakes in front of others, asserting one’s needs, and interview for job situations, among others. These exposures usually occur in the therapist’s office, often via role-play with the therapist, and when possible, using other clinic personnel or neighborhood spaces.

What makes VR a promising intervention?

We know that exposure therapy is most effective, especially for adolescents and young adults, when the stimuli used represent real-life situations. While we therapists can put on our best teen performance, role play with your therapist surely doesn’t feel the same as interacting with a same-aged peer! Also, it’s impractical for most clinicians to travel to other locations or find peers for practice. VR is a potential solution to these problems because VR can bring anxiety-provoking situations into treatment without leaving the office. VR allows for the use of realistic exposure stimuli—introducing yourself in a classroom, meeting peers at a party—enhancing the likelihood that anxiety will be activated, and that treatment will ultimately be successful. In addition, VR therapy is appealing to youth who are interested in technology or gaming and may reduce stigma about attending traditional therapy. 

How does the technology work? 

VR therapy typically involves the use of a head-mounted display (VR goggles), headphones, and sensors that track an individual’s eye movement and position in space. The software presents immersive, 3-D environments that transport individuals to a range of settings. Our program at CUCARD-Midtown makes use of classroom, dorm room, and party settings and allows for interaction with avatars that can respond to the user with pre-programmed responses depending on the scenario. This permits individualized, gradual exposure, as the therapist can select “easier” or “harder” responses based on the youth’s goals and needs. For example, in the public speaking scene, the therapist can prompt laughter or interruptions from the audience if that challenge is appropriate. 

Is VR therapy effective?

Yes. VR has been successfully and safely used for decades in the treatment of anxiety disorders in adults, including fear of flying, fear of heights, PTSD, and public speaking fears. Research on the use of VR exposure therapy for youth and adolescents is more limited, but recent studies show promising effects. Importantly, VR is practical and cost-efficient for clinicians and often preferred by patients when compared to traditional exposure. This is exciting, as VR can be a tool for improving the reach and accessibility of mental health treatments. 

Is VR treatment available for me/my teen?

VR exposure therapy is available and offered as part of anxiety treatment at many clinics throughout New York City. Most of these programs are geared toward adults (18+), although I expect we’ll see more youth programs as research in this area expands. There is lots of growth on the horizon for VR. Technology is rapidly advancing. VR headsets are becoming increasingly affordable, and interest is increasing.