New virtual imaging technology may become a useful addition to therapy for social anxiety, according to researchers at the University of East Anglia (UEA).
A study published by UEA investigated whether people with social anxiety could benefit from seeing themselves interact in everyday social situations through video-capture virtual environments. For the first time, researchers tested whether viewing a life-size recorded image of oneself interacting in scripted social scenes could help reduce anxious behaviours and improve confidence.
Researchers led by Dr Lina Gega from UEA’s Norwich Medical School and MHCO’s Northumberland Talking Therapies collaborated with Xenodu Virtual Environments to build more than 100 different social scenarios. These included everyday situations such as using public transport, buying a drink at a bar, attending a party, shopping, and speaking with a stranger in an art gallery.
The study explored whether this form of exposure could be integrated into Cognitive Behavioural Therapy (CBT). Participants attended a standard 12-week CBT course with one hour-long virtual environment session introduced midway through treatment. The virtual session allowed participants to observe and rehearse social interactions while seeing their own life-size image projected into scripted, digitally edited video scenes.
Unlike immersive head-mounted displays, the Xenodu system employs video capture to project an out-of-body perspective: users watch themselves interact with filmed characters and can simultaneously engage with those characters. This approach aims to be less intrusive for people who find wearable devices uncomfortable while still providing realistic social exposure.
The pilot project focused on six young men with psychosis who also experienced severe social anxiety. Scenarios were tailored to address common fears—small talk, maintaining eye contact, fears of saying the wrong thing, and the use of safety behaviours such as avoiding eye contact or scanning the room for threats. Some scenes intentionally included rude or hostile characters so participants could practice responding assertively and test negative beliefs about social rejection.
Results from the pilot indicated several advantages to using video-capture virtual environments as a therapeutic tool. Participants reported increased awareness of anxious behaviours and were able to experiment with alternative, less avoidant responses in a controlled and repeatable setting. Over the course of the intervention, patients reduced safety behaviours and began taking greater social risks. The semi-staged nature of the scenarios also helped participants reinterpret ambiguous social cues, making it easier to consider less threatening explanations for others’ behaviour.
Dr Gega noted that the artificial or “surreal” quality of the staged scenarios could itself be beneficial: by recognizing the scenarios as constructed, participants found it easier to re-evaluate their initial interpretations of social interactions. She also pointed out that the system can be tailored to target specific fears—such as performance anxiety, discomfort with intimacy, or fear of crowds—making it a flexible adjunct to standard CBT.
Paul Strickland of Xenodu highlighted the practical strengths of the technology: it does not require specialist technical skills to set up, the system avoids uncomfortable headsets, and libraries of scenes can be expanded to reflect the variety of social exposures needed in everyday clinical practice.
While these early findings are promising, the researchers emphasize that this study explored feasibility and preliminary benefits rather than providing definitive proof of clinical superiority. The next step recommended by the team is a randomized controlled trial comparing CBT with and without the virtual environment tool to determine whether adding virtual exposure improves symptom reduction or speeds recovery.
Notes about this research
Contact: Press Office – University of East Anglia
Source: University of East Anglia press release
Image Source: The image is a still taken from the Xenodu video associated with this research.
Video Source: The research team used a video entitled “Virtual Phobia Therapy” produced by Xenodu Virtual Environments.
Original Research: The study titled “Virtual Environments Using Video Capture for Social Phobia with Psychosis” was conducted by Lina Gega, Richard White, Timothy Clarke, Ruth Turner, and David Fowler and published in Cyberpsychology, Behaviour and Social Networking in June 2013.