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

Razaghivandi, Nazila; Jafari, Davood; Bahrami, Mohsen

Volume 13 - Articles-1402 MEJDS (2023) 13: 60 | Back to browse issues page

Research code: 162594438

Ethics code: IR.IAU.B.REC.1401.017

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Razaghivandi N, Jafari D, Bahrami M. 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. MEJDS 2023; 13 :60-60
URL: http://jdisabilstud.org/article-1-3157-en.html

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

Nazila Razaghivandi¹

, Davood Jafari ^*²

, Mohsen Bahrami³

1- PhD Student, Department of Psychology, Borujerd Branch, Islamic Azad University, Borujerd, Iran
2- Assistant Professor, Department of Psychology, Malayer Branch, Islamic Azad University, Malayer, Iran
3- Malayer Branch, Islamic Azad University, Malayer, Iran

Abstract: (963 Views)

Abstract
Background & Objectives: 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.
Methods: 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.
Results: 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).
Conclusion: 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.

Keywords: Social anxiety disorder, Anxiety sensitivity, Cognitive–behavioral therapy, Virtual reality exposure therapy, Quality of life

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Type of Study: Original Research Article | Subject: Psychology

References

1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593. [DOI]

2. Heimberg RG, Brozovich FA, Rapee RM. A cognitive-behavioral model of social anxiety disorder. In: Hofmann SG, DiBartolo PM; editors. Social anxiety. Elsevier; 2014. [DOI]

3. Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC. Social fears and social phobia in the USA: results from the national comorbidity survey replication. Psychol Med. 2008;38(1):15–28. [DOI]

4. Stein MB, Kean YM. Disability and quality of life in social phobia: epidemiologic findings. Am J Psychiatry. 2000;157(10):1606–13. [DOI]

5. Lochner C, Mogotsi M, Du Toit PL, Kaminer D, Niehaus DJ, Stein DJ. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology. 2003;36(5):255–62. [DOI]

6. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005;162(6):1171–8. [DOI]

7. Simon NM, Otto MW, Korbly NB, Peters PM, Nicolaou DC, Pollack MH. Quality of life in social anxiety disorder compared with panic disorder and the general population. Psychiatr Serv. 2002;53(6):714–8. [DOI]

8. Eng W, Coles ME, Heimberg RG, Safren SA. Domains of life satisfaction in social anxiety disorder: relation to symptoms and response to cognitive-behavioral therapy. J Anxiety Disord. 2005;19(2):143–56. [DOI]

9. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007;27(5):572–81. [DOI]

10. Frisch MB, Cornell J, Villanueva M, Retzlaff PJ. Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychol Assess. 1992;4(1):92–101. [DOI]

11. Barrera TL, Norton PJ. Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder. J Anxiety Disord. 2009;23(8):1086–90. [DOI]

12. Anderson ER, Hope DA. The relationship among social phobia, objective and perceived physiological reactivity, and anxiety sensitivity in an adolescent population. J Anxiety Disord. 2009;23(1):18–26. [DOI]

13. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8. [DOI]

14. Olatunji BO, Wolitzky-Taylor KB. Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychol Bull. 2009;135(6):974–99. [DOI]

15. Deacon B, Abramowitz J. Anxiety sensitivity and its dimensions across the anxiety disorders. J Anxiety Disord. 2006;20(7):837–57. [DOI]

16. Rector NA, Szacun-Shimizu K, Leybman M. Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behav Res Ther. 2007;45(8):1967–75. [DOI]

17. McWilliams LA, Stewart SH, MacPherson PSR. Does the social concerns component of the anxiety sensitivity index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity? Behav Res Ther. 2000;38(10):985–92. [DOI]

18. Rodriguez BF, Bruce SE, Pagano ME, Spencer MA, Keller MB. Factor structure and stability of the anxiety sensitivity index in a longitudinal study of anxiety disorder patients. Behav Res Ther. 2004;42(1):79–91. [DOI]

19. Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, Ades AE, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):368–76. [DOI]

20. Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, et al. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychol Med. 2020;50(15):2487–97. [DOI]

21. Freeman D, Reeve S, Robinson A, Ehlers A, Clark D, Spanlang B, et al. Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol Med. 2017;47(14):2393–400. [DOI]

22. Riva G, Serino S. Virtual reality in the assessment, understanding and treatment of mental health disorders. Journal of Clinical Medicine. 2020;9(11):3434. [DOI]

23. Valmaggia LR, Latif L, Kempton MJ, Rus-Calafell M. Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence. Psychiatry Res. 2016;236:189–95. [DOI]

24. Kampmann IL, Emmelkamp PMG, Hartanto D, Brinkman WP, Zijlstra BJH, Morina N. Exposure to virtual social interactions in the treatment of social anxiety disorder: a randomized controlled trial. Behav Res Ther. 2016;77:147–56. [DOI]

25. Bouchard S, Dumoulin S, Robillard G, Guitard T, Klinger É, Forget H, et al. Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. Br J Psychiatry. 2017;210(4):276–83. [DOI]

26. Connor KM, Davidson JRT, Churchill LE, Sherwood A, Weisler RH, Foa E. Psychometric properties of the Social Phobia Inventory (SPIN): new self-rating scale. Br J Psychiatry. 2000;176(4):379–86. [DOI]

27. Taylor S, Cox BJ. An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. J Anxiety Disord. 1998;12(5):463–83. [DOI]

28. World Health Organization. WHOQOL-BREF. introduction, administration, scoring and generic version of the assessment. field trial version. Program on mental health. WHO, Geneva; 1996. [Article]

29. Moradi Menesh F, Mirjafari SA, Goodarzi M, Mohammadi N. Barrasi vizhegi haye ravan sanji shakhes tajdid nazar shode hassasiat ezterabi (ASIR) [Investigating the psychometric properties of the revised anxiety sensitivity index (ASIR)]. Journal of Psychology. 2007;11(4):426–46. [Persian]

30. Skevington SM, Lotfy M, O'Connell KA; WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299-310. [DOI]

31. Nejat S, Montazeri A, Halakouie Naieni K, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of School of Public Health and Institute of Public Health Research. 2006;4(4):1–12. [Persian] [Article]

32. Tsitsas GD, Paschali AA. A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study. Health Psych Res. 2014;2(3):78–82. [DOI]

33. Scozzari S, Gamberini L. Virtual reality as a tool for cognitive behavioral therapy: a review. In: Brahnam S, Jain LC; editors. Advanced computational intelligence paradigms in healthcare 6 virtual reality in psychotherapy, rehabilitation, and assessment. Berlin, Heidelberg: Springer; 2011. [DOI]

34. Azimisefat P, De Jongh A, Rajabi S, Kanske P, Jamshidi F. Efficacy of virtual reality exposure therapy and eye movement desensitization and reprocessing therapy on symptoms of acrophobia and anxiety sensitivity in adolescent girls: a randomized controlled trial. Front Psychol. 2022;13:919148. [DOI]

35. Bahari S, Tozandehjani H, Taheri E. Effectiveness of modular cognitive behavioral therapy on the anxiety sensitivity, cognitive distortions of teen girls who has social anxiety disorder. Clinical Psychology. 2020;12(2):51–62. [Persian] [Article]

36. Asnaani A, Tyler J, McCann J, Brown L, Zang Y. Anxiety sensitivity and emotion regulation as mechanisms of successful CBT outcome for anxiety-related disorders in a naturalistic treatment setting. J Affect Disord. 2020;267:86–95. [DOI]

37. Nowakowski ME, Rowa K, Antony MM, McCabe R. Changes in anxiety sensitivity following group cognitive-behavior therapy for social anxiety disorder and panic disorder. Cogn Ther Res. 2016;40(4):468–78. [DOI]

38. Tavoli A, Sedighi Mornani N, Musa Al-Rezaei M, Aghaeipour M. Comparison of interpersonal therapy and cognitive behavior therapy for quality of life in Iranian people with social anxiety disorder. In: International Conference on the Culture of Psychopathology and Education [Internet]. Tehran: Alzahra University; 2016. [Persian]

39. Butler RM, O’Day EB, Swee MB, Horenstein A, Heimberg RG. Cognitive behavioral therapy for social anxiety disorder: predictors of treatment outcome in a quasi-naturalistic setting. Behavior Therapy. 2021;52(2):465–77. [DOI]

40. Hunt C, Campbell-Sills L, Chavira D, Craske M, Sherbourne C, Sullivan G, et al. Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: evidence from the coordinated anxiety learning management trial. Behav Res Ther. 2022;155:104119. [DOI]

41. Ledley DR, Huppert JD, Foa EB, Davidson JRT, Keefe FJ, Potts NLS. Impact of depressive symptoms on the treatment of generalized social anxiety disorder. Depress Anxiety. 2005;22(4):161–7. [DOI]

42. Beck AT, Steer RA, Ball R, Ciervo CA, Kabat M. Use of the beck anxiety and depression inventories for primary care with medical outpatients. Assessment. 1997;4(3):211–9. [DOI]

43. Abasi F, Farhadi H. The effectiveness of virtual reality package on improving the quality of work life and organizational vitality. Occupational Medicine. 2023;14(4):55-66. [Persian] [DOI]