Comparing the Effectiveness of Cognitive-Behavioral Therapy and Virtual Reality Exposure Therapy on Anxiety Sensitivity and Quality of Life Among High-School Students with Social Anxiety Disorder

Social anxiety disorder is a psychiatric condition in which the patient experiences anxiety in social interactions. Patients with social anxiety disorder experience high anxiety sensitivity and poorer quality of life than individuals without this disorder. Anxiety sensitivity is a multidimensional construct that consists of fears of somatic, social, and cognitive aspects of anxiety. Quality of life has been identified as an important outcome measure in research on treating social anxiety disorder. Considering the relationship between higher anxiety sensitivity and lower quality of life with social anxiety disorder, it was necessary to investigate the effective treatment of these psychological concepts in social anxiety disorder. Therefore, the present study aimed to compare the effects of Cognitive–Behavioral Therapy (CBT) and Virtual Reality Exposure Therapy (VRET) on anxiety sensitivity and quality of life in patients with social anxiety disorder.

The method of the present study was quasi–experimental with a pretest–posttest design and a 1–month follow–up with a control group. The statistical population included all high school students in Qaemshahr City, Iran, in the academic year 2022–2023 (450 people). A total of 51 eligible students were included in the study using a convenience sampling method and were randomly divided into 2 intervention groups and 1 control group (17 people in each group). The inclusion criteria were an age range of 15–17 years, a definite diagnosis of social anxiety disorder during at least the last 6 months based on DSM–5 diagnostic criteria using a structured clinical interview, not suffering from other clinical disorders at the same time, not dependent on alcohol or drugs, not receiving any other concurrent treatment, and completing the informed consent form to participate in the research. The exclusion criteria were having thoughts and ideas of suicide and absenting more than 2 sessions in therapy sessions. Patients in the first intervention group received 12 sessions (two sessions per week, each session lasting 60 minutes) of CBT. Patients in the second intervention group had 8 sessions (two sessions per week, each lasting for 60 minutes) of VRET. The control group did not receive any intervention. The data collection tools included the Anxiety Sensitivity Index–Revised (ASI–R) (Taylor & Cox, 1998) and the World Health Organization Quality of Life–BREF (WHOQOL–BREF) (1996). The obtained data were analyzed using descriptive statistics (frequency indices, mean, and standard deviation) and inferential statistics (1–way variance analysis test, analysis of variance with repeated measurements, and Tukey post hoc test) in SPSS 24 at a significance level of 0.05.

The results showed that the effects of time (p<0.001), group (p<0.001), and their interaction (p<0.001) on variables of anxiety sensitivity and quality of life were significant. In the posttest and follow–up stages, a significant difference was observed between CBT and VRET in the control group in reducing anxiety sensitivity and increasing quality of life (p<0.05). In the posttest, there was no significant difference between the effectiveness of CBT and VRET in reducing anxiety sensitivity scores (p=0.054). Still, there was a significant difference in increasing quality of life scores (p<0.001). In the follow–up, there was no significant difference between the two treatments in reducing anxiety sensitivity scores (p=0.265). Still, a significant difference was observed in increasing the quality of life scores (p<0.001).

According to the findings, CBT and VRET effectively reduce anxiety sensitivity and improve patients' quality of life, but CBT is more effective than VRET. As a result, both approaches can be used to reduce anxiety sensitivity and enhance the quality of life in patients with social anxiety disorder.