172 Rapee, 2005.) CBT treatment packages typically include exposure to the feared situation(s), social skills training and cognitive-restructuring. One significant limitation of the traditional in vivo exposure is the difficulty for the therapist to provide adequate and controlled social interactions (e.g., audience to conduct the exposure, control on people’s reactions, variety of social situations appropriate for exposure) in order to make progress in a continuous and non-threatening way for the participant. Virtual reality (VR) overcomes many of the shortcomings of in vivo exposure, in addition to providing a treatment that is more readily accepted by clients (Garcia-Palacios, Botella, Hoffman, Villa, & Fabregat, 2004; Garcia-Palacio, Hoffman, See, Tsai, & Botella, 2001) and allows the client to interact with a phobic scenario in the safety and confidentiality of the office. Outcome studies for VR and SAD are more recent than those on specific phobias, the latter having repeatedly confirmed the efficacy of in virtuo exposure (Wiederhold & Wiederhold, 2004). Few studies have been published so far, and mostly concentrating on fear a public speaking, a less severe form of SAD (North, North, & Coble, 1998). Also, a previous study conducted by Klinger and colleagues (2005) showed a significant effect of VR on SAD. Despite the limitations of that early study (Klinger et al., 2005), we can safely propose that using virtual humans to conduct in virtuo exposure would be a useful alternative to traditional CBT in the treatment of SAD. This present study aims to compare very similar CBT treatments that differ only by the use, or absence of, of in virtuo exposure versus a waiting list control condition. Our hypothesis is that both treatments will be superior to the waiting list. method Forty-five adults (mean age 34.9 years old; 71% female) receiving a DSM-IV-TR diagnosis of social anxiety have completed the study and were randomly assigned to one of these three conditions – traditional individual CBT treatment (CBT; n=16), individual CBT combined with in virtuo exposure (CBT-VR; n=14) and waiting list (WL; n=15). CBT group and CBT-VR group participants received 16 individual sessions of therapy. WL group participants were measured “pre and post” and, for ethical reasons, were later treated for their condition. Both treatment groups had individual exposure sessions every week that were done in various public speaking and social situations (virtual or not, depending on the participant group condition). For the CBT-VR group, the software used for ex- Abstracts from CT15 posure were created by E. Klinger in the European VEPSY Updated project or by Virtually Better Inc. The hardware used was a HP xw4600 Workstation Intel® Core™2 Duo CPU E6850 @ 3.00 GHz, 3.48 GB of RAM, with a NVidia GeForce 8800 GTX graphic card, running on Windows XP Professional (version 2002). An eMagin z800 3D Visor was used as the virtual helmet. results This study compared 16 individual therapy sessions of traditional CBT with in vivo exposure, CBT with in virtuo exposure and a waiting list control condition. Results on anxiety rated scales and self-report questionnaires showed a significant improvement in both treatment conditions comparing the waiting-list (see Table 1). The ANOVAs revealed significant time effects on all measures (p< .001) and no significant group main effects. Most importantly, statistically significant group by time interactions were found, confirming that treatments were superior to the waiting list. Further analyses of treatment X contrast interactions revealed that both active treatments were superior to the waiting list. First, for those receiving CBT with in vivo exposure, the interactions contrasts between traditional CBT and the WL have been found to be significant on the Liebowitz scale (F= -2.53, p<0.05), the Social Phobia Scale (F= -3.07, p<0.01), the Appraisal of Social Concerns (probability F= -2.53, p<0.05; consequence F= -2.54, p<0.05), the Fear of Negative Evaluation (F= -2.42, p<0.05), a Self-efficacy single-item measure (F=2.34, p<0.05), the Beck Depression Inventory II (F=-2.97 p<0.01) and the Trait-anxiety subscale of the STAI (F= -2.56, p<0.05). Significant interaction contrast were also found for the CBTVR Group and WL Group on the Liebowitz Scale (F= -4.06, p<0.001), the Social Phobia Scale (F= -5.12, p<0.001), the Appraisal of Social Concerns (probability F= -3.67, p<0.001; consequence F= -3.38, p=0.001), Fear of Negative Evaluation (F= -3.36, p=0.001), the Self-efficacy single-item measure (F= 2.59, p<0.05), the Beck Depression Inventory II (F=3.17, p<0.01) and the Trait-anxiety Inventory (F= -4.44, p<0.001). These significant interaction contrasts confirmed our hypothesis that both treatment conditions were superior to the waiting list. This is the first randomized controlled study that includes a large sample of people suffering from severe social anxiety (DSM-IV-TR criteria) using CBT treatment combined with in virtuo exposure and compared to a waiting list. This study is part of a broader project that will determine whether the effects of the two treatments are sufficiently similar to be considered equivalent and exploratory analyses will JCR

Journal of CyberTherapy and Rehabilitation, 3 (2), 2010