The Effects of Virtual Audience Size on Social Anxiety during Public Speaking

Prior studies have explored the possibility of inducing social anxiety (SA) in virtual reality (VR). Among various existing protocols for this purpose, the Trier Social Stress Test (TSST) has been proven to be robust in evoking SA in the majority of participants in both in vivo as well as VR conditions. The TSST consists of giving a speech and performing mental arithmetic calculations each for five minutes in front of three persons. In this paper, we present an adaptation of TSST to investigate the effects of different numbers of virtual humans (VHs) (i.e., three, six, or fifteen) on perceived SA. In addition, we compare the results with an in vivo TSST with three real persons in the audience. Twenty four participants took part in this experiment. As a result, physiological arousal could be observed with VR inducing SA yet less than in vivo TSST. Furthermore, some of the subjective measures showed a high state of anxiety experienced during the experiment. An effect of the virtual audience size could be observed only in heart rate (HR) as a virtual audience size of three VHs induced the highest HR responses which was significantly different from an audience of size six and fifteen.

[1]  J. Russell A circumplex model of affect. , 1980 .

[2]  Marian Joëls,et al.  Learning under stress: how does it work? , 2006, Trends in Cognitive Sciences.

[3]  Brenda K. Wiederhold,et al.  A Randomized, Controlled Trial of Virtual Reality-Graded Exposure Therapy for Post-Traumatic Stress Disorder in Active Duty Service Members with Combat-Related Post-Traumatic Stress Disorder , 2011, Cyberpsychology Behav. Soc. Netw..

[4]  S. Dickerson,et al.  Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. , 2004, Psychological bulletin.

[5]  Mel Slater,et al.  Public Speaking in Virtual Reality: Facing an Audience of Avatars , 1999, IEEE Computer Graphics and Applications.

[6]  B. Rothbaum,et al.  A controlled study of virtual reality exposure therapy for the fear of flying. , 2000, Journal of consulting and clinical psychology.

[7]  M. Krijn,et al.  Treatment of acrophobia in virtual reality: the role of immersion and presence. , 2004, Behaviour research and therapy.

[8]  Albert A. Rizzo,et al.  Is clinical virtual reality ready for primetime? , 2017, Neuropsychology.

[9]  Victor R. Preedy,et al.  Spielberger State-Trait Anxiety Inventory , 2010 .

[10]  Helmut Hlavacs,et al.  Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment , 2016, Comput. Hum. Behav..

[11]  S. Bilgin,et al.  State and Trait Anxiety Scores of Patients Receiving Intravitreal Injections , 2017, Biomedicine Hub.

[12]  Stéphane Bouchard,et al.  Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial , 2017, British Journal of Psychiatry.

[13]  M. Bradley,et al.  Measuring emotion: the Self-Assessment Manikin and the Semantic Differential. , 1994, Journal of behavior therapy and experimental psychiatry.

[14]  Nicolas Rohleder,et al.  Chronic Interpersonal Stress Predicts Activation of Pro- and Anti-Inflammatory Signaling Pathways 6 Months Later , 2009, Psychosomatic medicine.

[15]  William K. Goodman,et al.  Meta-analytical assessment of the effects of protocol variations on cortisol responses to the Trier Social Stress Test , 2017, Psychoneuroendocrinology.

[16]  Chris Barker,et al.  An Experimental Study on Fear of Public Speaking Using a Virtual Environment , 2006, Cyberpsychology Behav. Soc. Netw..

[17]  M. Newman,et al.  The Social Phobia Diagnostic Questionnaire: preliminary validation of a new self-report diagnostic measure of social phobia , 2003, Psychological Medicine.

[18]  M. Muñoz,et al.  adapTaTion of The Trier soCial sTress TesT To VirTual realiTy : psyCho-phsyiologiCal and neuroendoCrine modulaTion , 2011 .

[19]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. , 2019, Journal of anxiety disorders.

[20]  E. Hall,et al.  Proxemics [and Comments and Replies] , 1968, Current Anthropology.

[21]  Matthew Price,et al.  Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. , 2011, Journal of anxiety disorders.

[22]  B. Herbelin,et al.  Virtual reality exposure therapy for social phobia , 2005 .

[23]  D. Lykken,et al.  Correcting psychophysiological measures for individual differences in range. , 1966, Psychological bulletin.

[24]  G. Johansson,et al.  Cardiovascular and cortisol reactivity and habituation to a virtual reality version of the Trier Social Stress Test: A pilot study , 2010, Psychoneuroendocrinology.

[25]  Gerard Jounghyun Kim,et al.  A SWOT Analysis of the Field of Virtual Reality Rehabilitation and Therapy , 2005, Presence: Teleoperators & Virtual Environments.

[26]  Marian Joëls,et al.  Implications of psychosocial stress on memory formation in a typical male versus female student sample , 2011, Psychoneuroendocrinology.

[27]  Steven Taylor,et al.  Psychological and Pharmacological Treatments of Social Phobia: A Meta-Analysis , 2001, Journal of clinical psychopharmacology.

[28]  Mattias Wallergård,et al.  A Virtual Reality Version of the Trier Social Stress Test: A Pilot Study , 2011, PRESENCE: Teleoperators and Virtual Environments.

[29]  Alberto Oliverio,et al.  Psychobiology of stress , 1990 .

[30]  C. Kirschbaum,et al.  The Reaction to Social Stress in Social Phobia: Discordance between Physiological and Subjective Parameters , 2014, PloS one.

[31]  I. Lucki,et al.  Abnormal salivary cortisol levels in social phobic patients in response to acute psychological but not physical stress , 2001, Biological Psychiatry.

[32]  J. Angst,et al.  Social phobia. , 1995, European archives of psychiatry and clinical neuroscience.

[33]  Azucena García-Palacios,et al.  The Effectiveness of VR Exposure Therapy for PTSD in Returning Warfighters , 2012, Annual Review of Cybertherapy and Telemedicine.

[34]  M. Safir,et al.  Virtual Reality Cognitive Behavior Therapy for Public Speaking Anxiety , 2009, Behavior modification.

[35]  S. Asch Effects of Group Pressure Upon the Modification and Distortion of Judgments , 1951 .

[36]  Poul Henning Kirkegaard,et al.  Can architectural design alter the physiological reaction to psychosocial stress? A virtual TSST experiment , 2014, Physiology & Behavior.

[37]  B. Kudielka,et al.  Acute HPA axis responses, heart rate, and mood changes to psychosocial stress (TSST) in humans at different times of day , 2004, Psychoneuroendocrinology.

[38]  G. Robillard,et al.  Using virtual humans to alleviate social anxiety: preliminary report from a comparative outcome study. , 2010, Studies in health technology and informatics.

[39]  Chris Barker,et al.  An Experiment on Public Speaking Anxiety in Response to Three Different Types of Virtual Audience , 2002, Presence: Teleoperators & Virtual Environments.

[40]  Max M. North,et al.  Brief Virtual Reality Therapy for Public Speaking Anxiety , 2002, Cyberpsychology Behav. Soc. Netw..

[41]  Larry Cahill,et al.  Children's and adults’ salivary cortisol responses to an identical psychosocial laboratory stressor , 2010, Psychoneuroendocrinology.

[42]  Beat Meier,et al.  Stress Effects on Working Memory, Explicit Memory, and Implicit Memory for Neutral and Emotional Stimuli in Healthy Men , 2008, Frontiers in behavioral neuroscience.

[43]  Kevin M. Holloway,et al.  Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). , 2016, Journal of consulting and clinical psychology.

[44]  Robert S. Kennedy,et al.  Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. , 1993 .

[45]  S. Asch Opinions and Social Pressure , 1955, Nature.

[46]  C. Kirschbaum,et al.  Human hypothalamus–pituitary–adrenal axis responses to acute psychosocial stress in laboratory settings , 2010, Neuroscience & Biobehavioral Reviews.

[47]  Ulrike Ehlert,et al.  Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? , 2012, Psychoneuroendocrinology.

[48]  B. Kudielka,et al.  HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender , 2004, Psychoneuroendocrinology.

[49]  Barbara O. Rothbaum,et al.  Comparing Virtual Reality Exposure Therapy to Present-Centered Therapy with 11 U.S. Vietnam Veterans with PTSD , 2010, Cyberpsychology Behav. Soc. Netw..

[50]  C. Kirschbaum,et al.  Neuroendocrine and psychometric evaluation of a placebo version of the ‘Trier Social Stress Test’ , 2009, Psychoneuroendocrinology.

[51]  C. Kirschbaum,et al.  The 'Trier Social Stress Test'--a tool for investigating psychobiological stress responses in a laboratory setting. , 1993, Neuropsychobiology.

[52]  Oliver T. Wolf,et al.  Cortisol broadens memory of a non-stressful social interaction , 2015, Psychopharmacology.

[53]  Jennifer A. Healey,et al.  Wearable and automotive systems for affect recognition from physiology , 2000 .

[54]  P. Anderson,et al.  Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. , 2013, Journal of consulting and clinical psychology.

[55]  Philip Spinhoven,et al.  Hypothalamus–Pituitary–Adrenal Axis Hyperresponsiveness Is Associated with Increased Social Avoidance Behavior in Social Phobia , 2009, Biological Psychiatry.

[56]  Steven D. Penrod,et al.  Social Influence Model: A formal integration of research on majority and minority influence processes. , 1984 .

[57]  Dong Pyo Jang,et al.  The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy , 2002, IEEE Transactions on Information Technology in Biomedicine.

[58]  Cristina Botella,et al.  Redefining Therapeutic Success with Virtual Reality Exposure Therapy , 2001, Cyberpsychology Behav. Soc. Netw..

[59]  Dan J Stein,et al.  Social Anxiety Disorder , 1999, CNS Spectrums.

[60]  B. Latané The psychology of social impact. , 1981 .

[61]  Betty Pfefferbaum,et al.  Guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder , 2004 .

[62]  Josiane Bissonnette,et al.  Virtual Reality Exposure Training for Musicians: Its Effect on Performance Anxiety and Quality. , 2015, Medical problems of performing artists.

[63]  Robert J. Ursano,et al.  Guideline Watch (March 2009): Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder , 2009 .

[64]  E. Foa,et al.  Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence , 2015, Dialogues in clinical neuroscience.

[65]  O. Wolf,et al.  Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia , 2012, Journal of abnormal child psychology.

[66]  Robert J. Gatchel,et al.  The Effects of Audience Size on High and Low Speech-Anxious Subjects During an Actual Speaking Task , 1983 .

[67]  Eva Walther,et al.  Virtually stressed? A refined virtual reality adaptation of the Trier Social Stress Test (TSST) induces robust endocrine responses , 2019, Psychoneuroendocrinology.

[68]  M. Krijn,et al.  Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. , 2002, Behaviour research and therapy.

[69]  Sandra Poeschl,et al.  Measuring Co-Presence and Social Presence in Virtual Environments - Psychometric Construction of a German Scale for a Fear of Public Speaking Scenario. , 2015, Studies in health technology and informatics.

[70]  Isabel L. Kampmann,et al.  Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. , 2016, Behaviour research and therapy.

[71]  M. Pérez-García,et al.  A virtual reality approach to the Trier Social Stress Test: Contrasting two distinct protocols , 2016, Behavior research methods.

[72]  Cristina Botella,et al.  Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias , 2007, Cyberpsychology Behav. Soc. Netw..

[73]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[74]  Holger Regenbrecht,et al.  The Experience of Presence: Factor Analytic Insights , 2001, Presence: Teleoperators & Virtual Environments.

[75]  福田 博一 State-Trait Anxiety Inventoryによるペインクリニック外来患者の不安の評価 , 1994 .

[76]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[77]  R. Bond,et al.  Group Size and Conformity , 2005 .

[78]  Stéphane Bouchard,et al.  Virtual Reality Therapy Versus Cognitive Behavior Therapy for Social Phobia: A Preliminary Controlled Study , 2005, Cyberpsychology Behav. Soc. Netw..

[79]  A. Mühlberger,et al.  Trier Social Stress Test in vivo and in virtual reality: Dissociation of response domains. , 2016, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[80]  C. Kirschbaum,et al.  Consistent sex differences in cortisol responses to psychological stress. , 1992, Psychosomatic medicine.

[81]  J. Lobmaier,et al.  Gaze perception in social anxiety and social anxiety disorder , 2013, Front. Hum. Neurosci..