Background: Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective: We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods: We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality–based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results: Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality–based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions: These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

中文翻译：

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基于虚拟现实的社交焦虑症心理治疗：使用自我推荐任务的fMRI研究

背景：尽管已经充分证明，虚拟现实疗法对社交焦虑症的疗效与传统的认知行为疗法相当，但对于虚拟现实对社交焦虑症患者病理性自我指称过程的影响知之甚少。目的：我们旨在确定虚拟现实治疗后自我参照过程的变化及其神经机制。方法：我们招募了具有或没有对社交焦虑症进行主要诊断的参与者，以进行临床评估（社交恐惧症量表和事后反刍量表）和功能磁共振成像（fMRI）扫描。患有社交焦虑症的参与者在基线测试后立即接受了基于虚拟现实的暴露治疗，共进行了6次疗程。第六届会议之后，患有社交焦虑症的参与者完成了后续扫描，在此期间，他们被要求判断一系列单词（正，负，中性）是否与他们相关。结果：在参加该研究的25名社交焦虑症患者中，有21名完成了会议并进行了随访。22名控制人员也参加了会议。年龄没有显着差异（P = .36），性别（P = .71）或惯用性（P= .51）之间。全脑分析显示，与对照组相比，社交焦虑症组的参与者在颞叶内侧和额叶皮质的积极自我指涉过程中神经反应增强。社交焦虑症组的参与者在负自我参照过程中也显示出左岛岛激活增加和右中额回回激活减少。接受基于虚拟现实的治疗后，社交焦虑症参与者的总体症状得到缓解，这些参与者在负责自我参照和自传体记忆过程的大脑区域表现出更大的活动能力，同时在干预后功能磁共振成像扫描中查看阳性单词。有趣的是，与正自我参照处理相关的血氧水平依赖性变化越大，在虚拟事件之后对负面事件进行反省的趋势越小，社交焦虑也越低。与基线时相比，在社交现实障碍患者的虚拟自我治疗后的负面自我参照过程中，在广泛的躯体感觉区域内也发现了更高的激活。结论：这些功能磁共振成像的发现可能反映了社交焦虑症患者对自我指称信息的反应增强了其生理和认知过程。他们还提供了虚拟现实暴露疗法对社交焦虑和自我克减效果的神经证据。