The Effects of Virtual Reality (VR) Treatment on Prefrontal Cortex Activity in Patients with Social Anxiety Disorder: fNIRS measurement for VR-derived video exposure (Preprint)

BACKGROUND Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been recently, and many researchers identified the effects of VR in psychiatric disorders. There have been research reports that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. OBJECTIVE The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in SAD patients using a portable functional near-infrared spectroscopy (fNIRS). METHODS The patients with SAD (n=28) were provided with a total of six sessions of VR treatment solution that was developed for exposure to social situations with recording system of participant's self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of participant's self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while seeing video 1 and 2 with cognitive task, before and after whole VR treatment sessions, and after first session of VR treatment. We compared the data of fNIRS between SAD patients and healthy controls (HC) (n=27). RESULTS We found that reduction of activities of right frontopolar prefrontal cortex (FPPFC) in HC was greater than in SAD group in baseline (t=-2.01, p=0.049). Comparing the frontal cortex activation before and after VR treatment sessions in SAD group, there were significant differences in activities of FPPFC (right: t=-2.93, p<0.001, left: t=-2.25, p=0.033) and orbitofrontal cortex (OFC) (right: t=-2.10, p=0.045, left: t=-2.21, p=0.035) while seeing video 2. CONCLUSIONS Activities of FPPFC and OFC were associated with symptom reduction after the VR treatment for SAD. Our study findings might provide a clue to understand the mechanisms of VR treatment for SAD. CLINICALTRIAL CRIS Registration Number-KCT0003854.