Virtual Reality: A viable strategy for public speaking anxiety in university students and graduates (Realidad Virtual: Una estrategia viable para la ansiedad a hablar en público en estudiantes universitarios y egresados)

Contenido principal del artículo

Gabriela P. Ayala-Almarza
Vanetza E. Quezada-Scholz
Maria Consuelo San Martín
Mario A. Laborda
Gonzalo Miguez
Matias F. Silva
Gressley A. Valdés
Carolina C. Salazar
Sarai A. Espinoza
Jorge E. Fuentealba-Valdés
Sebastián Ibacache-Ramírez
Luis Pardo-Garrido

Resumen

Abstract: Public speaking anxiety is a frequent manifestation of social anxiety among university students and recent graduates, with significant implications for well-being, academic performance, and professional development. Given the high prevalence of anxiety disorders in Chile, accessible and cost-effective interventions are needed. This research evaluated the feasibility and preliminary effects of a brief virtual reality exposure therapy protocol delivered in both face-to-face and remote modalities. Two non-randomized single-group pretest–posttest studies with repeated measures were conducted. Study 1 (n = 9), delivered in person over five sessions, showed a significant reduction in negative self-verbalizations and an increase in confidence for public speaking, along with changes consistent with the expected direction in other variables. Study 2 (n = 5), remote and using a flexible 6–8-session protocol, showed full adherence, a significant increase in positive self-verbalizations, a relevant decrease in negative ones, and a significant improvement in public speaking confidence. In addition, a clinically significant decrease was observed in the CORE-OM subscales of Problems/Symptoms and Functioning. Taken together, the results indicate that this intervention is feasible and potentially effective, with flexibility for implementation in either face-to-face or remote modalities. Its relevance for university settings establishes it as a promising tool within mental health promotion and preventive efforts, providing preliminary evidence to improve access to and the quality of psychological care in higher education.


Keywords: social anxiety; fear of public speaking; cognitive behavioral therapy; exposure therapy; emerging technologies; student mental health.


Resumen: La ansiedad al hablar en público es una manifestación frecuente de ansiedad social en estudiantes y egresados universitarios, con efectos en el bienestar, el rendimiento académico y la proyección profesional. Dada la alta prevalencia de los trastornos ansiosos en Chile, se requieren intervenciones accesibles y costo-efectivas. Esta investigación evaluó la viabilidad y los efectos preliminares de un protocolo breve de terapia de exposición mediante realidad virtual, aplicado en modalidad presencial y remota. Se realizaron dos estudios pretest–postest de un solo grupo, con medidas repetidas y sin asignación aleatoria. El Estudio 1 (n = 9), presencial y de cinco sesiones, mostró una reducción significativa de las autoverbalizaciones negativas y un aumento de la confianza para hablar en público, junto con cambios coherentes en la dirección esperada en otras variables. El Estudio 2 (n = 5), remoto y con un protocolo flexible de 6 a 8 sesiones, presentó adherencia total, un aumento significativo de autoverbalizaciones positivas, una disminución relevante de las negativas y una mejora significativa en la confianza para hablar en público. Además, se observó una disminución clínicamente significativa en las subescalas de Problemas/Síntomas y Funcionamiento del CORE-OM. En conjunto, los resultados indican que esta intervención es viable y potencialmente eficaz, con flexibilidad para ser implementada en modalidad presencial o remota. Su pertinencia para contextos universitarios la posiciona como una herramienta prometedora en estrategias de promoción y prevención en salud mental, aportando evidencia preliminar relevante para mejorar el acceso y la calidad de la atención psicológica en educación superior.


Palabras clave: ansiedad social; miedo al hablar en público; terapia cognitivo conductual; terapia de exposición; tecnologías emergentes; salud mental estudiantil.


Resumo: A ansiedade de falar em público é uma manifestação frequente da ansiedade social em estudantes e egressos universitários com efeitos sobre o bem-estar, o desempenho acadêmico e a projeção profissional. Dada a alta prevalência dos transtornos ansiosos no Chile, são necessárias intervenções acessíveis e custo-efetivas. Esta pesquisa avaliou a viabilidade e os efeitos preliminares de um protocolo breve de terapia de exposição por meio de realidade virtual, aplicado nas modalidades presencial e remota. Foram realizados dois estudos pré-teste–pós-teste de grupo único, com medidas repetidas e sem alocação aleatória. O Estudo 1 (n = 9), presencial e com cinco sessões, mostrou uma redução significativa das autoverbalizações negativas e um aumento da confiança para falar em público, juntamente com mudanças coerentes com a direção esperada em outras variáveis. O Estudo 2 (n = 5), remoto e com um protocolo flexível de 6 a 8 sessões, apresentou adesão total, um aumento significativo das autoverbalizações positivas, uma diminuição relevante das negativas e uma melhora significativa na confiança para falar em público. Além disso, observou-se uma diminuição clinicamente significativa nas subescalas de Problemas/Sintomas e Funcionamento do CORE-OM. Em conjunto, os resultados indicam que essa intervenção é viável e potencialmente eficaz, com flexibilidade para ser implementada de forma presencial ou remota. Sua pertinência para contextos universitários a posiciona como uma ferramenta promissora em estratégias de promoção e prevenção em saúde mental, oferecendo evidências preliminares relevantes para melhorar o acesso e a qualidade da atenção psicológica no ensino superior.


Palavras-chave: ansiedade social; medo de falar em público; terapia cognitivo-comportamental; terapia de exposição; tecnologias emergentes; saúde mental dos estudantes.

Descargas

Los datos de descargas todavía no están disponibles.

Detalles del artículo

Cómo citar
Ayala-Almarza, G. P., Quezada-Scholz, V. E., San Martín, M. C., Laborda, M. A., Miguez, G., Silva, M. F., … Pardo-Garrido, L. (2026). Virtual Reality: A viable strategy for public speaking anxiety in university students and graduates (Realidad Virtual: Una estrategia viable para la ansiedad a hablar en público en estudiantes universitarios y egresados). Ibero-American Journal of Psychology and Public Policy, 3(1), 107–142. https://doi.org/10.56754/2810-6598.2026.0044
Sección
Artículos

Citas

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Baker, S., Heinrichs, N., Kim, H., & Hofmann, S. (2002). The Liebowitz Social Anxiety Scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy, 40(6), 701–715. https://doi.org/10.1016/S0005-7967(01)00060-2

Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Latin, H. M., Ellard, K. K., Bullis, J. R., Bentley, K. H., Boettcher, H. T., Casiello-Robbins, C. (2019). Protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales. Manual del Terapeuta. Alianza Editorial.

Bobes, J., Badía, X., Luque, A., García, M., González, M., & Dal-Re, R. (1999). Validación de las versiones en español de los cuestionarios Liebowitz Social Anxiety Scale. Social Anxiety and Distres Scale y Sheehan Disability Inventory para la evaluación de la fobia social. Medicina Clínica, 112, 14-16. https://www.unioviedo.es/psiquiatria/wpcontent/uploads/2017/03/1999_Bobes_Validaci on_MedClinicaBCN.pdf

Centro UC. (2024). Novena Ronda del Termómetro de la Salud Mental Achs-UC: Salud mental mejora en Chile pero aún hay más de un millón de personas con síntomas que dice no necesitar tratamiento. https://encuestas.uc.cl/?p=2358

Chard I., & van Zalk N. (2022). Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering. Frontiers in Digital Health, 4. https://doi.org/10.3389/fdgth.2022.842460

Chesham, R., Malouff, J., & Schutte, N. (2018). Meta-Analysis of the Efficacy of Virtual Reality Exposure Therapy for Social Anxiety. Behaviour Change, 35(3), pp.152- 166. https://doi.org/10.1017/bec.2018.15

Chowdhury, N., & Khandoker, A. H. (2023). The gold-standard treatment for social anxiety disorder: A roadmap for the future. Frontiers in Psychology, 13, 1070975. https://doi.org/10.3389/fpsyg.2022.1070975

Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006

Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022). Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy, 152, 104069. https://doi.org/10.1016/j.brat.2022.104069

de la Rubia, J., Antona, C., & García, C. (2012). Validación del inventario de ansiedad y fobia social en una muestra de estudiantes universitarios mexicanos. Salud & Sociedad, 3(3), 313–331. https://doi.org/10.22199/S07187475.2012.0003.00006

Derogatis, L. R. (1975). The SCL-90-R. Clinical psychometric research.

Dwivedi, A. K., Mallawaarachchi, I., & Alvarado, L. A. (2017). Analysis of small sample size studies using nonparametric bootstrap test with pooled resampling method. Statistics in Medicine, 36(14), 2187-2205. https://doi.org/10.1002/sim.7263

Echeverría, G. (2005). Análisis cualitativo por categorías. Universidad Academia de Humanismo Cristiano. Escuela de Psicología. Santiago.

Elliott, R., & Rodgers, B. (2008). Client Change Interview Schedule (v5). University of Strathclyde, Glasgow.

Emmelkamp P. M. G., Meyerbröker K., & Morina N. (2020). Virtual Reality Therapy in Social Anxiety Disorder. Current Psychiatry Reports, 22(32). https://doi.org/10.1007/s11920-020-01156-1

Espinoza, S. A., Salazar, C. C., Valdés, G. A., Silva, M. F., Varas, F. I., Ayala, G., Munro, G., Laborda, M. A., Miguez, G., & Quezada-Scholz, V. E. (2025). Efficacy of a Virtual Reality Exposure Therapy Protocol for Fear of Public Speaking: A Randomized Controlled Pilot Study. Behavioral Psychology, 33(3), 49436. https://doi.org/10.31083/BP49436

Estrada, E., Ferrer, E., & Pardo, A. (2019). Statistics for evaluating pre-post change: Relation between change in the distribution center and change in the individual scores. Frontiers in Psychology, 9, 1–12. https://doi.org/10.3389/fpsyg.2018.02696

Feixas, G., Evans, C., Trujillo, A., Saúl, L., Botella, L., Corbella, S., González, E., Bados, A., García-Grau, E., & López-González, M. (2012). La versión española del CORE-OM: Clinical Outcomes in Routine Evaluation - Outcome Measure. Revista de Psicoterapia, 23(89), 109–135. https://doi.org/10.33898/rdp.v23i89.641

Ferrer, R., & Pardo, A. (2014). Clinically meaningful change: False positives in the estimation of individual change. Psychological Assessment, 26(2), 370–383. https://doi.org/10.1037/a0035419

Gadelha, M. J., Silva, L. R., Oliveira, A. P., Cavalcante, N. A., Araújo, V. S., Lopes, R. T., & Silva, N. G. (2021). Internet Cognitive Behavioral Therapy for social anxiety disorder: a systematic review. Revista Brasileira de Terapias Cognitivas, 17(2), 96-104. https://doi.org/10.5935/1808-5687.20210022

Girondini, M., Stefanova, M., Pillan, M., & Gallace, A. (2023). Speaking in front of cartoon avatars: A behavioral and psychophysiological study on how audience design impacts on public speaking anxiety in virtual environments. International Journal of Human-Computer Studies, 179. https://doi.org/10.1016/j.ijhcs.2023.103106

González, G. & Quezada V. E. (2016). A brief cognitive-behavioral intervention for stress, anxiety and depressive symptoms in dental students. Research in Psychotherapy: Psychopathology, Process and Outcome, 19, 68-78. https://doi.org/10.4081/ripppo.2016.192

Hall, M., Luo, A., Bhullar, N., Moses, K., & Wootton, B. M. (2024). Cognitive behaviour therapy for social anxiety disorder: A systematic review and meta-analysis investigating different treatment formats. Australian Psychologist, 59(1), 1–12. https://doi.org/10.1080/00050067.2024.2356804

Hofmann, S. G., & DiBartolo, P. M. (2000). An instrument to assess self-statements during public speaking: Scale development and preliminary psychometric properties. Behavior Therapy, 31(3), 499–515. https://doi.org/10.1016/s0005-7894(00)80027-1

Hook, J. N., Smith, C. A., & Valentiner, D. P. (2008). Personal Report of Confidence as a Speaker--Short Form (PRCS-12) [Database record]. APA PsycTests. https://doi.org/10.1037/t20159-000

Ibacache-Ramírez, S., Quezada-Scholz, V., Laborda-Rojas, M., San Martín, M. C., Alfaro, F., & Miguez-Cavieres, G., (2025). Estudio psicométrico del Inventario de Ansiedad Estado-Rasgo en adultos de Santiago. Terapia Psicológica, 43(3), 303-322.

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337-346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Keller, F., & Alexandrowicz, R. W. (2024). Assessing Individual Change: A Comparison of Reliable Change Indices Based on Classical Test Theory and Various Item Response Theory Models. In: Stemmler, M., Wiedermann, W., Huang, F.L. (Eds.) Dependent Data in Social Sciences Research. Springer, Cham. https://doi.org/10.1007/978-3-031-56318-8_28

Kindred, R., Bates, G. W., & McBride, N. L. (2022). Long-term outcomes of cognitive behavioural therapy for social anxiety disorder: A meta-analysis of randomised controlled trials. Journal of Anxiety Disorders, 92, 102640. https://doi.org/10.1016/j.janxdis.2022.102640

Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173. https://doi.org/10.1159/000414022

Lindner, P., Dagöö, J., Hamilton, W., Miloff, A., Andersson, G., Schill, A., & Carlbring, P. (2021). Virtual Reality exposure therapy for public speaking anxiety in routine care: A single-subject effectiveness trial. Cognitive Behaviour Therapy, 50(1), 67–87. https://doi.org/10.1080/16506073.2020.1795240

Lindner, P., Miloff, A., Fagernäs, S., Andersen, J., Sigeman, M., Andersson, G., Furmark, T., & Carlbring, P. (2019). Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial. Journal of Anxiety Disorders, 61, 45-54. https://doi.org/10.1016/j.janxdis.2018.07.003

Löchner, J., Carlbring, P., Schuller, B., Torous, J., & Bosse Sander, L. (2025). Digital interventions in mental health: An overview and future perspectives. Internet Interventions, 40. https://doi.org/10.1016/j.invent.2025.100824

Martinez-Pecino, R., & Durán, M. (2013). Social communication fears: factor analysis and gender invariance of the short-form of the personal report of confidence as a speaker in Spain. Personality and Individual Differences, 55(6), 680–684. https://doi.org/10.1016/j.paid.2013.05.017

Méndez, F. X., Inglés, C. J., & Hidalgo, M. D. (2004). La versión española abreviada del “cuestionario de confianza para hablar en público” (Personal Report of Confidence as Speaker): Fiabilidad y validez en población adolescente. Psicología Conductual: Revista Internacional de Psicología Clínica de la Salud, 12(1), 25–42.

Ministerio de Salud. (2017). Plan Nacional de Salud Mental 2017-2025. Gobierno de Chile. https://www.minsal.cl/wp-content/uploads/2017/12/Plan-Nacional-Salud-Mental-2017-2025.pdf

Ministerio de Salud. (2022). Estrategia Nacional de Salud para el cumplimiento de los Objetivos Sanitarios de la Década 2021-2030. Gobierno de Chile. https://www.minsal.cl/wp-content/uploads/2022/07/Estrategia-Nacional-de-Salud-2021-2030.pdf

Ncube, M. (2024). npboottprm (Version 0.3.2) [R package]. Comprehensive R Archive Network. https://doi.org/10.32614/CRAN.package.npboottprm

Pedram, S., & Piatkowski, T. (2025). Exploring the potential of virtual reality (VR) in mental healthcare: a systematic literature review. Virtual Reality, 29, 135 (2025). https://doi.org/10.1007/s10055-025-01181-6

Quezada-Scholz, V. E., Laborda, M. A., San Martín, C., Miguez, G., Alfaro, F., Mallea, J., & Díaz, F. (2022). Cued fear conditioning in humans using immersive Virtual Reality. Learning and Motivation, 78. https://doi.org/10.1016/j.lmot.2022.101803

Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical psychology review, 24(7), 883-908. https://doi.org/10.1016/j.cpr.2004.07.007

Santoyo, A., Ayala, A., Laborda, M., Miguez, G., San Martin, C., Alfaro, F., Diaz, F., & Quezada-Scholz, V. E. (2021). Uso de realidad virtual en la investigación e intervención en miedo y ansiedad: una revisión sistemática breve [Undergraduate Thesis, Universidad de Chile]. Repositorio Académico de la Universidad de Chile. https://repositorio.uchile.cl/handle/2250/195048

Tan, Y. L., Chang, V. Y. X., Ang, W. H. D., Ang, W. W., & Lau, Y. (2025). Virtual reality exposure therapy for social anxiety disorders: a meta-analysis and meta-regression of randomized controlled trials. Anxiety, Stress & Coping, 38(2), 141–160. https://doi.org/10.1080/10615806.2024.2392195

Trujillo, A., Feixas, G., Bados, A., García-Grau, E., Salla, M., Medina, J. C., Montesano, A., Soriano, J., Medeiros-Ferreira, L., Cañete, J., Corbella, S., Grau, A., Lana, F., & Evans, C. (2016). Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure. Neuropsychiatric Disease and Treatment, 16, 1457-1466. https://doi.org/10.2147/NDT.S103079

Whaibeh, E., Mahmoud, H., & Naal, H. (2020). Telemental health in the context of a pandemic: The COVID-19 experience. Current Treatment Options in Psychiatry, 7(2), 198–202. https://doi.org/10.1007/s40501-020-00210-2

Wolpe, J. (1969). Subjective Units of Distress Scale (SUDS) [Database record]. APA PsycTests. https://doi.org/10.1037/t05183-000

World Health Organization (2023). 2023 Emerging technologies and scientific innovations: A global public health perspective. World Health Organization. https://iris.who.int/bitstream/handle/10665/370365/9789240073876-eng.pdf?sequence=1

Wright, D. B., London, K., & Field, A. P. (2011). Using bootstrap estimation and the plug-in principle for clinical psychology data. Journal of Experimental Psychopathology, 2(2), 252-270. https://doi.org/10.5127/jep.013611

Zeka, F., Clemmensen, L., Valmaggia, L., Veling, W., Hjorthøj, C., & Glenthøj, L. B. (2024). The effectiveness of immersive virtual reality‐based treatment for mental disorders: A systematic review with meta‐analysis. Acta Psychiatrica Scandinavica, 151(3), 210–230. https://doi.org/10.1111/acps.13777

Zeng, W., Xu, J., Yu, J., & Chu, X. (2025). Effectiveness of virtual reality therapy in the treatment of anxiety disorders in adolescents and adults: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Psychiatry, 16, 1553290. https://doi.org/10.3389/fpsyt.2025.1553290