Biased attention to social threats has been implicated in social anxiety disorder. Modifying visual attention during exposure therapy offers a direct test of this mechanism. We developed and tested a brief virtual reality exposure therapy (VRET) protocol using 360°-video and eye tracking. Participants (N = 21) were randomized to either standard VRET or VRET + attention guidance training (AGT). Multilevel Bayesian models were used to test (1) whether there was an effect of condition over time and (2) whether post-treatment changes in gaze patterns mediated the effect of condition at follow-up. There was a large overall effect of the intervention on symptoms of social anxiety, as well as an effect of the AGT augmentation on changes in visual attention to audience members. There was weak evidence against an effect of condition on fear of public speaking and weak evidence supporting a mediation effect, however these estimates were strongly influenced by model priors. Taken together, our findings suggest that attention can be modified within and during VRET and that modification of visual gaze avoidance may be casually linked to reductions in social anxiety. Replication with a larger sample size is needed.

中文翻译：

---

虚拟现实暴露疗法治疗社交焦虑症的注意力引导增强：一项随机对照试验。

对社会威胁的偏见关注与社交焦虑症有关。在暴露疗法期间改变视觉注意力可以直接测试这种机制。我们使用 360° 视频和眼动追踪开发并测试了一个简短的虚拟现实暴露疗法 (VRET) 方案。参与者 (N = 21) 被随机分配接受标准 VRET 或 VRET + 注意力指导训练 (AGT)。使用多级贝叶斯模型来测试（1）随着时间的推移，病情是否会产生影响；（2）治疗后凝视模式的变化是否会介导随访时病情的影响。干预对社交焦虑症状有很大的总体影响，并且 AGT 增强对观众视觉注意力的变化也有影响。有微弱的证据表明条件对公开演讲的恐惧有影响，也有微弱的证据支持中介效应，但这些估计受到模型先验的强烈影响。综上所述，我们的研究结果表明，在 VRET 期间和期间可以改变注意力，并且视觉凝视回避的改变可能与社交焦虑的减少有偶然的联系。需要用更大的样本量进行复制。