Enhancing Generalization of Virtual Reality Exposure for Public Speaking Anxiety

NCT ID: NCT07323498

Last Updated: 2026-01-09

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 48 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-11-26
• Study Completion Date: 2026-12-31

Brief Summary

This randomized controlled trial examines whether imagery-based extinction memory updating following a standardized virtual reality (VR) exposure session improves the generalization of exposure effects to novel public speaking contexts. Individuals with elevated public speaking anxiety will complete a single-session VR speech exposure. Participants are randomized to (a) standard mental rehearsal of the exposure experience or (b) mental rehearsal plus guided imagery that updates the extinction memory with novel, non-exposed contexts. Generalization is assessed 7-14 days later using a multi-context behavioral approach test (BAT) in vivo and in VR.

Detailed Description

Exposure-based interventions are highly effective in the treatment of anxiety disorders; however, fear reduction achieved during exposure is often limited to the specific situations and stimuli encountered during treatment. As a result, fear may re-emerge when individuals face novel situations, a phenomenon commonly referred to as return of fear. This limited generalization is assumed to reflect the context- and stimulus-specific nature of extinction learning. While increasing variability across exposure contexts can enhance generalization, this approach typically requires longer treatment duration and increased therapeutic burden. Therefore, strategies that promote extinction generalization without increasing exposure time are of high clinical relevance.

Experimental laboratory research has demonstrated that extinction generalization can be enhanced by updating the extinction memory through mental imagery. Specifically, retrieving a recently acquired extinction memory and integrating novel, non-experienced stimuli or situations through imagination has been shown to reduce fear responses to both imagined and previously unencountered stimuli. This process is thought to increase the accessibility and robustness of inhibitory extinction memories by integrating new information into the existing memory network. The present study aims to translate this experimentally established mechanism into a clinically relevant intervention.

In this randomized controlled trial, individuals with elevated public speaking anxiety complete a standardized, single-session virtual reality (VR) speech exposure consisting of repeated short oral presentations across different VR contexts. Following exposure, participants are randomized to one of two imagery-based post-exposure procedures. In the control condition, participants engage in guided mental rehearsal of the previously experienced VR exposure situations. In the experimental condition, participants additionally update the extinction memory by vividly imagining having the same successful exposure experience in two novel public speaking situations: (1) giving a speech in front of a small real audience and (2) giving a speech in a VR environment with a substantially larger audience than experienced during exposure. These imagined situations are not directly experienced during the intervention but are intended to be integrated into the existing extinction memory through guided imagery.

Generalization of exposure effects is assessed 7-14 days after the intervention using a multi-context behavioral approach test (BAT). The BAT includes oral presentations in (a) situations that were directly experienced during VR exposure, (b) situations that were previously imagined during the extinction memory updating procedure, and (c) novel situations that were neither experienced nor imagined before. This design allows for the differentiation between responses to previously experienced, imagined, and entirely new public speaking contexts, thereby providing a stringent test of extinction generalization.

Primary outcomes include public speaking anxiety at follow-up as well as subjective fear ratings during each behavioral approach test, with a focus on differences between study groups across the different BAT contexts. Secondary outcomes include anticipatory anxiety prior to each BAT and behavioral performance indexed by speech duration. Baseline measures of anhedonia and positive emotionality are assessed to examine individual differences in treatment response.

Conditions

Public Speaking Anxiety; Public Speaking Fear

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

VR Exposure + Standard Mental Rehearsal

Single-session VR exposure intervention: 6 VR speech exposure trials \& Post-exposure standard mental rehearsal

Group Type: ACTIVE_COMPARATOR

VR Exposure

Intervention Type: BEHAVIORAL

6 VR speech exposure trials (3 min each; topic: "something you are proud of")

Standard Mental Rehearsal

Intervention Type: BEHAVIORAL

Post-exposure guided imagery: vivid mental rehearsal of the same exposure experience in the same VR contexts (brief, ≤30s each)

VR Exposure + Mental Rehearsal With Extinction Memory Updating

Single-session VR exposure intervention: 6 VR speech exposure trials \& Post-exposure mental rehearsal with updating the extinction memory with novel, non-exposed contexts

Group Type: EXPERIMENTAL

VR Exposure

Intervention Type: BEHAVIORAL

6 VR speech exposure trials (3 min each; topic: "something you are proud of")

Mental Rehearsal With Extinction Memory Updating

Intervention Type: BEHAVIORAL

Post-exposure guided imagery: vivid rehearsal of the exposure experience while updating the extinction memory with novel, non-exposed contexts (e.g., speaking to three real listeners; speaking in a new VR context with a larger audience). Brief, ≤30s each

Interventions

VR Exposure

6 VR speech exposure trials (3 min each; topic: "something you are proud of")

Intervention Type: BEHAVIORAL

Standard Mental Rehearsal

Post-exposure guided imagery: vivid mental rehearsal of the same exposure experience in the same VR contexts (brief, ≤30s each)

Intervention Type: BEHAVIORAL

Mental Rehearsal With Extinction Memory Updating

Post-exposure guided imagery: vivid rehearsal of the exposure experience while updating the extinction memory with novel, non-exposed contexts (e.g., speaking to three real listeners; speaking in a new VR context with a larger audience). Brief, ≤30s each

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• speech anxiety scale score of ≥ 18 on the Personal Report of Communication Apprehension, Public Speaking Subscale (PRCA-PS)
• Self-report of 18 - 70 years of age

Exclusion Criteria

-

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Philipps University Marburg

OTHER

Sponsor Role: lead

Responsible Party

Christoph Benke

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Christoph Benke, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Philiips-University of Marburg

Locations

Department of Psychology, Philipps-University of Marburg

Marburg, Hesse, Germany

Site Status: RECRUITING

Countries

Germany

Central Contacts

Christoph Benke, Ph.D.

Role: CONTACT

christoph.benke@uni-marburg.de

+49 6421 28-24091

Facility Contacts

Christoph Benke, Ph.D.

Role: primary

christoph.benke@uni-marburg.de

+49 6421 28-24091

Other Identifiers

VREX2.0

Identifier Type: -

Identifier Source: org_study_id