Fear, psychophysiological arousal, and cognitions during a virtual social skills training in social anxiety disorder while manipulating gaze duration.

The use of virtual reality (VR) is an option for social skills training and exposure in Social Anxiety Disorder (SAD). In addition, virtual social situations are an ideal tool to study the influence of a counterpart's social behavior, e. g. eye contact. We developed two scenarios in VR that enable users to practice to assert their rights. The participants' tasks were to ask a passenger to release their reserved seat in a virtual train and to cancel a trip in a virtual travel agency. In a randomized, crossover design, we compared the effect of a large (during 80% of the conversation time) and a small (20%) amount of direct gaze by the virtual conversational partners in 41 patients with SAD and 21 healthy controls (HCs). We expected fear and psychophysiological arousal to be higher in patients than in HCs and higher in the 80% eye contact condition. The scenarios provoked an increase of fear and psychophysiological arousal over baseline in patients and in HCs. Gaze duration of the virtual agent had no influence on fear and psychophysiological arousal, but affected the experience of presence. Our results suggest a suitability of our scenarios for social skills training and exposure therapy in SAD. The lack of influence of gaze duration on parameters of fear might be explained by the fact that participants did not consciously detect the differences in gaze duration. However, the impact on some parameters (e. g. presence) suggests that participants noticed differences in gaze duration on a subliminal level.