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August 6, 2003


Emory Pilot Study Tests Virtual Reality Therapy For People With Fear of Public Speaking

ATLANTA -- The thought of public speaking can cause students or even business professionals to tremble. The fear of public speaking is common in up to 88 percent of individuals with social phobia, and 34 percent of people in the general population. The stares of an awaiting audience may evoke sweaty hands, shortness of breath, and memory loss for people who suffer from this social anxiety that is the most common phobia.

A new pilot study is exploring the first attempt at virtual reality therapy (VRT) for people with a fear of public speaking. The computer-based self-help program is based on the research of Barbara O. Rothbaum, PhD, associate professor of psychiatry and behavioral sciences at Emory University School of Medicine and Director of the Trauma and Anxiety Recovery Program, and Larry Hodges, PhD, former associate director of the Graphics, Visualization and Usability Center at the Georgia Institute of Technology, and now the professor and chairman in the Department of Computer Science at the University of North Carolina at Charlotte.

Drs. Rothbaumís and Hodgesí work includes using virtual reality as a medium for exposure therapy for people with anxiety disorders. They first used VRT in 1995 to treat patients with a fear of heights. Since then, they have also conducted studies for persons with fears of flying, thunderstorms, and post-traumatic stress disorder for Vietnam veterans. In 1996, Drs. Rothbaum and Hodges formed the start-up company Virtually Better, Inc. to market their virtual reality systems.

"Using virtual reality therapy is an easier way to treat the fear of public speaking for logistical reasons," Dr. Rothbaum says. "Itís difficult for most therapists to assemble enough people on a regular basis and at a specific time, to use a real audience for someone with fear of public speaking. But with VRT, participants give a speech to their virtual audience and tape themselves to use it for feedback."

Therapists at Virtually Better are looking to enroll participants in the first phase of the pilot study. To be considered for the study, participants must be between the ages of 18-65, read and speak English, and public speaking must be their primary fear.

Following a telephone screening, eligible persons may be asked to visit the Virtually Better center for additional screening and for a therapist to better assess the need for diagnostic treatment. If accepted into the study, participants will complete a total of eight sessions. The first four sessions, facilitated by a therapist, will introduce anxiety management techniques. The sessions include education on breathing relaxation, speaking tips, cognitive therapy (ability to identify and analyze anxious thoughts) and finally, a videotaped speech performed by the participant in front of the centerís staff.

During the next four sessions, called exposure therapy, the participants will use the self-help module using different computer-generated environments that appear on the computer monitor. The computer programs are designed to allow the participant to slowly get used to public speaking. Depending on their level of anxiety, participants can choose different situations, such as speaking to different audience sizes, using different delivery styles for their speech, and responding to different audience reactions.

Elana Zimand, PhD, is director of clinical services at Virtually Better. Dr. Zimand works with Libby Tannenbaum, PhD, an Emory post-doctoral fellow, to conduct the pilot study at the center.

"We advise the participants to first choose the situations that produce the least anxiety, and then gradually build up to more anxiety-producing situations," Dr. Zimand says. "This approach allows for a more therapeutic exposure to the environment."

The pre-set computer options allow the participant to choose audience size (small or large), involvement, and type of speech delivery. Audience reactions include choices of a friendly, neutral, bored or a difficult audience. Study participants practicing with the difficult audience, for example, experience distractions such as a cell phone ringing, a person reading the newspaper, and someone leaving the room in a noisy fashion. The delivery style options include a prepared speech delivered with notes, a memorized speech, or a spontaneous speech on a topic selected by the therapist.

Currently, the therapy is conducted by viewing a computer screen, but in the near future, Dr. Zimand says, a three-dimensional component will be introduced for the study. With the use of a head-mount display that covers the eyes and ears, the computer-generated environment will create a sense of immersion into the environment. The virtual reality experience integrates real-time computer graphics, body tracking devices, visual displays and other sensory input devices to assist the patient in having an experience as close to real life as possible.

The study allows for flexibility so participants can set their own schedule; however, all sessions must be completed at the Virtually Better center so a therapist can perform a follow-up assessment after each session. This is helpful, Dr. Zimand says, because the follow-up meetings allow for the participantís input that will help revise aspects of future studies.

People interested in the study may call Virtually Better at (404) 634-3400.

Under an agreement between Virtually Better, Inc. and Emory University, Dr. Barbara Rothbaum is entitled to a share of sales royalty received by the University from Virtually Better, Inc. Under that agreement, Emory University and Dr. Rothbaum have received Virtually Better, Inc. equity interests. The terms of this arrangement have been reviewed and approved by the University in accordance with its conflict of interest policies.

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