Various Treatments for Public Speaking Anxiety: Including Virtual Reality Therapy, Desensitization,...

Running head: PUBLIC SPEAKING ANXIETY 1

Various Treatments for Public Speaking Anxiety:

Including Virtual Reality Therapy, Desensitization, and Exposure

Kayla Lord

Pennsylvania State University

PUBLIC SPEAKING ANXIETY 2

Various Treatments for Public Speaking Anxiety:

Including Virtual Reality Therapy, Desensitization, and Exposure

Public speaking anxiety is a specified form of social anxiety disorder (SAD), also known

as social phobia. SAD is a prevalent anxiety disorder that consists of extreme fear of

embarrassment, humiliation, and judgment by others in social situations. Most sufferers of SAD

fear certain social situations to the point that they will avoid the feared situation, such as public

speaking (Kashdan & Herbert, 2001). The fear of public speaking, formally known as

glossophobia, is a widespread condition. With a 6.8% 12-month prevalence rate in adults and a

5.5% lifetime prevalence rate in 13 to 18 year olds, SAD is the third most commonly diagnosed

psychiatric disorder in the United States (Kashdan & Herbert, 2001; Kessler, Chiu, Demler, &

Walters, 2005; Merikangas, He, Burstein, Swanson, Avenevoli, Cui, Benjet, Georgiades, &

Swendsen, 2010). Social phobia is more common in the female adolescent population and

prevalence rates increase with age from 13 to 18 years old (Merikangas et al., 2010). Social

phobia is especially common in adolescents who have less freedom to avoid social situations

than adults do for social and nonsocial purposes. Adolescents are typically students and students

have to participate in class, ask for help, and perform public speaking tasks. Being forced to

enter undesirable social situations leads to severe distress and impairment. The affects of social

phobia if left untreated are chronic and will continue into adulthood. Yet, most research on the

subject uses adult samples. It is pertinent to study and find the most affective treatment for

adolescents with social phobia because adolescent SAD is associated with various negative

outcomes such as lower perceived social support and close relationships, higher levels of

negative affect, social pessimism, and alcohol abuse (Kashdan & Herbert, 2001).


If treated with dosed exposure to public speaking situations accompanied by

psychotherapy, the negative physiological and psychological symptoms of speech anxiety will

decrease. The three research articles discussed in this paper used samples of college students in

late adolescence and early young adulthood. This is important because little research has been

done using adolescents in the sample. The following three experiments not only used adolescent

samples but also utilized three treatments that have been found to be exceptionally successful in

treating speaking anxiety. Virtual reality therapy is an important treatment to study because it is a

non-intrusive, less distressing way to treat speech anxiety than actually entering the participants

into public speaking situations (Harris, Kemmerling, & North, 2002). Exposure, when

accompanied with rhythmic eye movements, may be more effective than exposure alone, which

is why it is important to study eye movement desensitization (Foley & Spates, 1995). Finally,

studying continuous versus intermittent exposure builds upon the results of the earlier study on

eye movement desensitization. Additionally, the study is the first to examine behavioral indices

between dosed and prolonged exposures (Seim, Waller, & Spates, 2010). Together, all three

articles serve to transform my hypothesis into a logical extension of all three research articles’

hypotheses combined.

Virtual Reality Therapy

The primary research topic of this study is how virtual reality therapy (VRT) affects

public speaking anxiety in university students. VRT is “the treatment of phobias and other

psychiatric conditions by immersion into computer-generated virtual reality treatment

environments,” (Harris, Kemmerling, & North, 2002). A previous study utilizing VRT as the

independent variable, and acrophobia, the fear of heights, in college students as the dependent

variable found a significant decrease in levels of anxiety, avoidance, and distress six weeks post-


treatment. In comparison, the control group showed no change in levels of anxiety, avoidance,

and distress. Additionally, experimental group subjects’ heart rates and blood pressures

decreased over the duration of the experiment during exposure. Furthermore, 90% of the subjects

were capable of ascending 15 stories in a glass-enclosed elevator post-treatment, showing the

criterion validity of the experiment (Rothbaum, Hodges, Kooper et al., 1995). Similarly, VRT

has been successfully used to treat the fear of flying (North, North, & Coble, 1997A; Rothbaum,

Hodges, Watson, et al., 1996; Wiederhold, Gevirtz, & Spira, 2003). These comparison studies

show that VRT is successful in treating other phobias in college students and therefore, should be

successful in treating glossophobia in college students (Harris, Kemmerling, & North, 2002).

With technology constantly and consistently advancing in our society, it is important to

use all the resources available to try to decrease adolescent speech anxiety. Computer-based

therapy is a good option for college students with public speaking anxiety because they do not

have to enter undesirable social situations. Instead, they can receive treatment comfortably alone

without the stress of real social interaction. VRT is an up and coming treatment method for the

whole spectrum of anxiety, and in this study is utilized as the independent variable, while public

speaking anxiety is the dependent variable. The researchers hypothesize that completing VRT

treatment causes a reduction in public speaking anxiety (Harris, Kemmerling, & North, 2002).

This study consisted of eight students in the experimental group, and six students in the

control group. The control group was a Wait-List for treatment. Those in the control group

completed pre-testing and post-testing but received no treatment. Pre-testing consisted of various

self-report measures. First, students at a large state university filled out the Personal Report of

Confidence as a Speaker (PRCS) inventory (Paul, 1966). Those whose scores were higher than

16 were randomly assigned to the control or experimental group. All subjects attended initial


interviews in which they were surveyed using the Self-Evaluation Questionnaire, STAI form X-1

(STAI) (Spielberger, Gorsuch, & Lushene, 1970), the Liebowitz Social Anxiety Scale (LSAS)

(Liebowitz, 1987), and Attitudes Towards Public Speaking Questionnaire (ATPS) (North, North,

& Coble, 1997B). Additionally, physiological measures of heart rate, using a pulse oximeter,

were taken while the participants answered an open-ended question, read a paragraph, and

completed a brief relaxation exercise (Harris, Kemmerling, & North, 2002).

The independent variable, VRT, was operationalized into four sessions of VRT, 12-15

minutes in length, once per week, using software of an auditorium scene and a head-mounted

display with head-tracker. The dependent variable was operationalized into physiological

measures, such as heart rate, and various self-report measures of anxiety levels utilized during

pre-testing, post-testing, and throughout the experiment. Present during the sessions as the

therapist was Sandra R. Harris, Ph.D., the first author. Each session consisted of different

manipulations to the auditorium scene with heart rate measures taken throughout each session

and Subjective Units of Distress Scale (SUDS) ratings taken before, during, and after each

session. During Session 1, subjects viewed an empty auditorium scene and were asked to talk

about his or her anxiety experience while giving speeches. They were asked to prepare a two-

minute speech for Session 3. During Session 2, subjects said the Pledge of Allegiance twice,

while the therapist gradually filled the auditorium scene with people and used applause to

encourage during and at the end of the recitation to encourage the subjects. During Session 3, the

subjects read their two-minute speech twice while the therapist again gradually filled the

auditorium scene with people and added manipulations as follows: audience members talking to

each other, not paying attention, laughing, continuously asking the speaker to speak louder, and

applauding. During Session 4, the same manipulations were made as in Session 3 and the


subjects gave the same two-minute speech. Immediately after, the subjects completed post-

testing, which consisted of the same measures as pre-testing (Harris, Kemmerling, & North,

2002).

The researchers found that results on self-report and physiological measures indicated

that VRT was successful in reducing glossophobia in college students. Specifically, when pre-

and post-testing measures were compared, the experimental group’s scores significantly differed

on the PRCS, the ATPS, the heart rate during speaking tasks, and the resting heart rate after

Session 2 when compared to the heart rate after Session 4. Results approached significance on

the LSAS, but there were no significant differences on the STAI, nor on SUDS ratings at the end

of Session 2 as compared to at the end of Session 4. For the control group there was a significant

difference on the ATPS but no other differences on any other measures. When the control and

experimental groups were compared to each other, the results indicated significant increased on

the PRCS in the experimental group, as compared to the control group. Also, results approached

significance on the ATPS, on heart rate during speaking tasks, and on the LSAS between groups.

Overall, the subjects that completed four sessions of VRT showed a significant reduction in the

public speaking anxiety while the subjects of the control group did not (Harris, Kemmerling, &

North, 2002).

This study correlates with other studies on VRT in the respect that VRT in comparison

studies was also successful in treating anxiety, which makes the hypothesis plausible. However,

the results were not as significant as is necessary to make predictions based off of the research.

So, these results are not generalizable to all college students. They cannot be applied to those

from small universities, or even to those that receive a different VRT treatment than the one

described. However, if the sample size was bigger it is probable that there would be a much


greater significance in the results, aiding in the problem with generalizability. Furthermore, a

possible confounding variable exists: all of the participants were enrolled in an introductory

public speaking class during the study. For example, the control group showed a significant

difference on ATPS scores. This could have been caused by participating in class (exposure to

public speaking situations), which means that the results found in the experimental group could

have been influenced by participating in the class as well. Plus, the operationalization of the

independent and dependent variables could have been much simpler. The VRT treatment

contains many manipulations by the researcher that may be inconsistent between subjects and are

not easily replicable. The assessment measures consist of far too many measures that complicate

the results. If the researchers had used a program that was created to be manipulated equally for

each participant by the software instead of by the researcher, the research would be more valid.

Additionally, if the assessment measures consisted of less self-report measures, the results would

become more parsimonious. On top of that, the reliability and validity of the experimental

procedure were not reported in the article.

In the context of my hypothesis, this research shows me that exposure to a virtual

audience while speaking for 12-15 minutes, once a week, for four weeks may be enough to cause

a reduction in speaking anxiety. This gives me an idea of how many sessions are necessary and

how often those sessions should be scheduled. I cannot assume that a real audience will have the

same effect that a virtual audience did, but I can hypothesize that exposure leads to a reduction in

fear and avoidance. Additionally, I know that my participants cannot be enrolled in a speech

course during the experiment and that I need a larger sample than was used in this experiment.

Finally, I will measure my dependent variable in a similar way, by measuring physiological


measures, such as heart rate and blood pressure, as well as self-report scales, but I will use two

self-report scales instead of the multitude used in this study.

Eye Movement Desensitization

The primary purpose of this research study was to investigate the relevance of eye

movement desensitization (EMD) in regards to treating public speaking anxiety. The secondary

purpose was to discover if two alternatives to eye movement when compared to the standard

procedure are as effective. EMD was originally used to treat posttraumatic stress disorder but

shortness of the procedure and the successful outcomes led researchers to attempt to apply the

treatment to other disorders, such as social phobias (Shapiro, 1989). In this specific research

experiment, EMD is the independent variable and public speaking anxiety is the dependent

variable. Studying EMDs effectiveness in relation to treating public speaking anxiety is

important because it allows individuals to be treated without having to enter undesirable social

situations. Instead, they are treated alone and are desensitized to their social phobia before they

have to enter situations of public speaking. EMD in general consists of rhythmic eye movements

accompanied by concentrating on the feared situation. It has been theorized that the eye

movements are not necessary to the treatment and that it is the “dosed flooding” of the memory

to be desensitized that causes the outcomes of the treatment. This study reflects this “dosed

flooding” theory by having the subjects actively confront images of the feared situation for short

periods of time, followed by short periods of relief from images of the feared situation during

EMD treatment (Foley & Spates, 1995). The researchers hypothesized that EMD treatment will

cause a reduction in public speaking anxiety in college students (Foley & Spates, 1995).

The independent variable was operationalized into three separate treatments all applied

while focusing on a feared image or negative emotion in relation to public speaking. The


dependent variable was operationalized into various standardized self-report measures, such as

The Personal Report of Communication Anxiety-24 (PRCA-24) (McCroskey, 1982), the

Personal Report of Public Speaking Anxiety (PRPSA) (McCrosky, 1970), a behavioral measure

consisting of two trained observer scores on the Behavioral Assessment of Speech Anxiety

(BASA) (Mulac & Sherman, 1974), and a psycho-physiological measure consisting of measuring

pulse rate and blood pressure to determine heart rate. The three treatment groups were also

measured using Subjective Units of Discomfort (SUDs) and Validity of Cognition (VOC) scores

during treatment. Forty subjects were recruited form college classes by means of soliciting. They

were self-chosen in the event that they suffered from speech anxiety to the point that they

avoided public speaking at all costs or experienced extreme distress in public speaking situations

and only accepted as a participant if they scored higher than an 18 on the PRCA-24. They were

randomly assigned to four groups, three treatment groups, and one control group (Foley &

Spates, 1995).

During pre-testing and post-testing, all participants were surveyed using the PRCA-24,

and the PRPSA. Then, they gave a speech while being observed through a two-war mirror by the

two trained observers who scored their speech according to the BASA. Additionally, their heart

rates were measured while resting and while giving both speeches during pre- and post-testing.

The control group then received no treatment. Experimental subjects attended one or two

treatment sessions based upon whether or not treatment was considered completed. Treatment

was considered completed either when there was a significant change in SUDs or VOC, or after

two sessions. Initially, each experimental subject identified a specific image of public speaking

anxiety, a negative cognition in association with the image, a desired cognition, VOC rating in

relation to desired cognition, a specific emotion elicited by the public speaking anxiety image,


SUDs rating, and location of body sensation. The subjects were then instructed to think about the

specific image, emotion, and/or negative cognition they identified. While thinking of the

incident, Group 1 subjects were instructed to track the therapist’s fingers as they moved back and

forth across the field of vision at a rate of approximately one full cycle per second. While

thinking of the incident, Group 2 subjects were exposed to an audio stimulus (white noise) that

was manually manipulated at a rate of approximately one full left or right cycle per second.

While thinking of the incident, Group 3 subjects were instructed to rest their eyes on their hands

in their lap. Each set lasted 20-30 seconds and was followed by a brief period of “blanking out”

the image and deep breathing. After post-testing, subjects completed a final questionnaire about

their evaluation of the treatment (Foley & Spates, 1995).

All treatment groups showed a significant improvement on PRCA-24 scores, while the

control group showed no significant difference. There was an overall significant reduction in

SUDs and overall significant positive change in VOC for each treatment group. There was a

trend toward significant difference between the experimental and control groups on the PRPSA.

Additionally, there was a significant overall reduction in BASA scores for the treatment groups.

Finally, there was no significant difference in heart rate measures for any group. The results

overall, indicate that EMD (Group 1) and the alternative treatments (Groups 2 and 3) had

significant effects in treating public speaking anxiety in college students. However, EMD was

rated equally as effective as the resting eyes condition, while the audio stimulus condition was

rated the least effective (Foley & Spates, 1995).

Due to the fact that EMD was rated equally as effective as the resting eyes condition but

that there was a significant difference in all of the treatment groups, it seems that the eye

movement has little to do with the desensitization. Rather, it is due to the “dosed flooding” part


of the treatment that the subjects showed reduction in speech anxiety. So, a more logical primary

hypothesis would have been that “dosed flooding” causes a reduction in public speaking anxiety,

instead of EMD. This further justifies my hypothesis that exposure to public speaking will

reduce the negative effects of speech anxiety in adolescents. It helps justify my hypothesis

further by realizing that even being exposed to memory of a public speaking situation leads to

desensitization; therefore, being physically exposed to the stimulus will most likely cause an

even greater reduction of public speaking anxiety. Additionally, it informed me that my

experiment should include a pre- and post-testing behavioral measure for the sake of criterion

validity. A draw back of this research is the fact that the sample consisted of nine males and 31

females (Foley & Spates, 1995). The results may not be generalizable to males due to the fact

that less than a fourth of the participants were males. To test my hypothesis, it is necessary to

have an equally representative sample of males and females.

Continuous and Alternating Exposure

This research study serves to be the basis for further studies on the effectiveness of dosed

exposure treatment when compared to a prolonged exposure treatment. It has been found that

exposure, whether imagined or real, is effective at treating anxiety, fear, and avoidance reactions.

However, it has yet to be established what the most effective duration of exposure is. A previous

study compared 20-minute imagined exposure treatments on four subsequent days to 40-minute

imagined exposure treatments with intervals of four days between them. This study concluded

that shorter exposures were the most effective (Ramsay, Barends, Breuker, & Kruseman, 1966).

Another previous study compared 20-minute versus 40-minutes imagined exposure and 20-

minute versus 40-minute real life exposures for the treatment of agoraphobia. The conclusions of

the study were that only real life exposure was effective and that the longer exposures were the


most effective (Stern & Marks, 1973). So, there are mixed findings on which duration is the most

effective. What is interesting is that overall most of the studies that found dosed exposure to be

less effective considered “dosed” to mean ten minutes or more in length. While, the studies that

found dosed exposure to be more effective considered “dosed” to mean eight minutes or less, and

some treatments lasting under two minutes were considered effective. In this specific research

study, the independent variable is the length of exposure treatment, while the dependent variable

is public speaking anxiety. The researchers hypothesize that dosed exposures are more effective

than prolonged exposures in causing a reduction in public speaking anxiety in college students

(Seim, Waller, & Spates, 2010).

All participants attended a baseline and treatment session. During the baseline session

they were surveyed using State-Trait Anxiety Inventory – State subscale (STAI-State)

(Spielberger, Gorusch, Lushene, Vagg, & Jacobs, 1983), and the Personal Report of

Communication Apprehension (PRCA-24) (McCroskey, 1982), and were scored by trained

assessors on the Social Phobia subscale of the Anxiety Disorders Interviews Schedule (ADIS-IV)

(Brown, Dinardo, & Barlow, 1994). All participants met the criteria for public speaking anxiety.

One week after the baseline session, the subjects attended the treatment session. They were

surveyed again using the PRCA-24 and STAI-State measures. A baseline heart rate was

measured, and they completed a Behavioral Avoidance Test (BAT) measure according to the

Time Behavioral Checklist (TBCL) (Paul, 1966). During the BAT, Subjective Units of

Discomfort (SUDs) were also measured. Treatment began 15 to 45 minutes after the BAT. The

researchers conceptualized the independent variable into dosed exposure (DE) and prolonged

exposure (PE) respectively. They did not have a control group, but instead considered the

prolonged exposure group as the standard treatment. Then they operationalized the two


treatments. Those subjects randomly assigned to the PE treatment entered the lab individually

and were asked to choose three to five topics to speak on to an audience of three people he or she

did not know and the researcher. The participant cycled through these topics continuously until

either SUDs level fell to zero or dipped below 20 points during two subsequent measurements,

the participant spoke for three hours, or the participant refused to continue or exhibited signs of

extreme distress. Heart rate, SUDs, and behavioral indices of distress were measured every five

minutes. The DE group participants followed the same procedure but were instructed to speak

and rest in 30-second intervals, instead of speaking continuously (Seim, Waller, & Spates, 2010).

The researchers found that there was a significant increase in the DE groups mean score

on the BAT, while there was not a significant increase in the PE groups mean score. In regards to

heart rates during the pre- and post-treatment BAT measures, the heart rates of the PE group

increased, while the heart rates of the DE group decreased. However, there was no significant

change in heart rate between groups during the treatment. Additionally, though there were

significant decreases in SUDs for both groups, the difference in anxiety reduction between the

two treatment groups was not significant. Plus, participants in the PE group performed a greater

amount of behavioral indices of distress during treatment than did the DE group participants.

Scores on the PRCA-24 indicate that all participants in the DE group experienced reductions

while only some of the members of the PE group experienced reductions. In conclusion, though

the results are sporadic, they show that DE treatment is just as effective as PE treatment is. In

fact, some measures show that DE treatment is more effective (Seim, Waller, & Spates, 2010).

Though the hypothesis was not completely reliable, this research is important because it

serves as the first research done comparing behavioral indices of stress between different periods

of exposure. The researchers found mixed results that make it hard to render conclusions. This is


most likely due to the small sample size (six participants) (Seim, Waller, & Spates, 2010). If

there was a larger sample size then there may be more statically significant results and more

evident changes over the duration of the treatment. These results are not generalizable to all

college students because of the small sample size, and the less than conclusive results.

Additionally, while the subjects were “college students,” they were between the ages of 18 and

41 years old. I am less interested in studying adults, so this research serves as a reminder to set

age boundaries for my participants. I would like my participants to be typical college age,

meaning between 18 and 22 years old. This study helps me narrow my hypothesis by

understanding that duration and type of exposure does matter. Even an in vivo exposure of just

five minutes can successfully reduce public speaking anxiety. This made me consider how I will

actually expose participants to public speaking situations in vivo. Utilizing a small audience

seems to be the best option. It allows the audience interaction to be real, without overwhelming

the participant. My hypothesis will further investigate the claims made in this research article by

comparing dosed and prolonged exposure accompanied by psychotherapy.

Conclusion

Treating speech anxiety with frequent dosed exposure accompanied by sessions of

psychotherapy will cause a reduction in the negative symptoms of public speaking anxiety. My

two independent variables will be exposure and psychotherapy, while my independent variable

will be public speaking anxiety. Exposure as an independent variable will consist of three levels:

dosed exposure, prolonged exposure, and no treatment. Psychotherapy as an independent

variable will consist of two levels: treatment and no treatment. Indices of public speaking anxiety

will be measured using self-report scales, a behavioral measure, and physiological measures.

Instead of using virtual exposure, my experiment will utilize in vivo exposure. Though virtual


reality therapy is successful in treating glossophobia, real life exposure seems to cause greater

reduction than virtual exposure. Additionally, it is the exposure, not other circumstances, such as

EMD that cause a reduction in speech anxiety, which is why the participants will be treated with

exposure without any other manipulations. This is also to ensure that the differences between

groups, if any, are caused by the duration in exposure instead of other variables. This research

will serve to study what duration of exposure accompanied what certain duration of

psychotherapy will best treat speech anxiety by causing a decrease in the effects.


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