Virtual Reality and Mindful Strategies: Enhancing Metaemotional Awareness and Social Efficacy in Socially Anxious Youth

Abstract

Background: Social anxiety disorder (SAD) significantly impairs adolescents' (aged 15 - 18 years) social and academic functioning, often maintained by maladaptive metacognitive beliefs about emotions and deficient social self-efficacy. Objectives: This study aimed to compare the effectiveness of mindfulness-based cognitive therapy (MBCT) and virtual reality-based worry exposure therapy (VR-WET) on metacognitive beliefs about emotions (positive and negative subscales) and social self-efficacy in adolescents diagnosed with SAD. Methods: This study utilized a clinical trial design with pre-test, post-test, and three-month follow-up assessments. The population comprised adolescents with SAD referred to counseling centers in Ahvaz (2024). A purposive sample of 45 adolescents, diagnosed via clinical interview and scoring ≥ 50 on the Social Anxiety Scale, was randomly allocated to three groups (n = 15 each): Mindfulness-based cognitive therapy, VR-WET, and a waiting-list control; simple randomization was employed, assessors were blinded to allocation, and sample size was powered (α = 0.05, power = 0.80) to detect medium effects. Both interventions consisted of 8 sessions of 90 minutes each, delivered twice weekly. Data, collected using the Metaemotions Questionnaire and Self-efficacy Scale for social situations, were analyzed via repeated measures analysis of variance (ANOVA) to evaluate within- and between-group differences. Results: The findings indicated that both MBCT and VR-WET significantly improved metacognitive beliefs about emotions and social self-efficacy compared to the control group in both the post-test and follow-up stages (P < 0.001). Crucially, the comparative analysis between the two intervention groups revealed a statistically significant superior effectiveness for VR-WET over MBCT in enhancing both outcomes, with larger mean differences (e.g., Δ = 3.73 - 4.20) and effect sizes (ηp² = 0.57 - 0.78 for interactions). Conclusions: Both VR-WET and MBCT effectively enhanced metacognitive beliefs about emotions and social self-efficacy in adolescents with social anxiety. However, VR-WET showed greater efficacy, particularly in improving positive and negative metacognitive beliefs about emotions subscales and social confidence. These results advocate for integrating virtual reality (VR) into exposure protocols for effective cognitive restructuring.