Social Anxiety Virtual Reality Study


This project aims to validate a virtual reality paradigm that assesses maladaptive avoidance behavior in social anxiety disorder. It also aims to generate a significant scientific advance by testing the hypothesis that maladaptive avoidance maintains anxiety through disruptions in safety learning.

Full Title of Study: “Maladaptive Avoidance and Fear Conditioning in Social Anxiety Disorder”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: January 31, 2021

Detailed Description

Although occasional mild social anxiety is a common human experience, social anxiety disorder has a devastating impact on patients' lives, leaving them vulnerable to medical, psychiatric, and socioeconomic complications. A key feature of social anxiety disorder is avoidance of social and/or performance situations in which judgment and evaluation from others might occur. Reducing avoidance is therefore an important treatment goal.

Despite the importance of avoidance, however, it is very difficult to assess a patient's tendency to avoid. Many prior assessments of avoidance measure adaptive (i.e., helpful) avoidance, in which an individual learns to avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, in which a relatively safe stimulus is avoided resulting in interference with the individual's goals. In this study, the first aim is to validate a virtual reality paradigm to measure maladaptive avoidance behavior in adults with social anxiety disorder. The second aim is to test whether maladaptive avoidance behavior relates to safety learning (measured by a fear extinction task).


  • Other: No intervention
    • There will be no intervention in this study. Adults with social anxiety disorder will complete research assessments related to fear and safety learning.

Arms, Groups and Cohorts

  • Social Anxiety Disorder
    • A group of adults with social anxiety disorder will be recruited for a psychological/behavioral research study.

Clinical Trial Outcome Measures

Primary Measures

  • Maladaptive Avoidance Behavior
    • Time Frame: Baseline
    • Latency (in milliseconds) to enter the quadrant of the avoidance task containing the image from the fear learning task

Secondary Measures

  • Maladaptive Avoidance Behavior (alternate measure)
    • Time Frame: Baseline
    • Amount of time (in milliseconds) spent in the quadrant of the avoidance task containing the image from the fear learning task
  • Maladaptive Avoidance Behavior (2nd alternate measure)
    • Time Frame: Baseline
    • Amount of time (in milliseconds) with center of gaze on the image from the fear learning task

Participating in This Clinical Trial

Inclusion Criteria

  • age 18+
  • primary diagnosis of social anxiety disorder
  • fluent spoken and written English
  • able to provide informed consent

Exclusion Criteria

  • history of manic episode, hypomanic episode, or psychosis
  • moderate or severe substance use disorder in the past 12 months
  • current major depressive episode greater than moderate severity (PHQ-9 score >14)
  • high risk for suicide (>8 on the MINI Suicidality section and/or clinician judgment that immediate medical attention is necessary)
  • general medical condition or impediment to vision, hearing, or motor function likely to interfere with assessments
  • benzodiazepine use in the past 2 weeks
  • cannabis use for anxiety management in the past 2 weeks

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Stanford University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Tali Manber Ball, PhD, Instructor – Stanford University
  • Overall Contact(s)
    • Meghana Nallajerla, BA, 650-498-1664,

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