Virtual Reality-Assisted, Single-Session Exposure for Public Speaking Anxiety: Improved Self-Reports and Heart Rate but No Significant Change in Heart Rate Variability

Introduction: This study examines the combined use of objective physiological measures (heart rate [HR], heart rate variability [HRV]) and subjective self-reports to gain a comprehensive understanding of anxiety reduction mechanisms—specifically, habituation—in the context of Virtual Reality Exposure (VRE) for public speaking anxiety (PSA). The present study evaluated whether a single-session, personalized VRE intervention could effectively reduce PSA. Methods: A total of 39 university students (mean age = 20.97, SD = 3.05) with clinically significant PSA were randomly assigned to a VRE group or a control group. Participants completed a 2 min speech task before and after the intervention and reported subjective distress (Subjective Units of Distress, SUDs), public speaking confidence (Personal Report of Confidence as a Speaker, PRCS), and willingness to speak in public. Heart rate (HR) and heart rate variability (HRV; RMSSD) were recorded at baseline and during speech tasks. The VRE protocol used personalized, hierarchical exposure to virtual audiences, with repeated trials until a criterion reduction in SUDs was achieved. Non-parametric analyses assessed group and time effects. Results: VRE participants showed significant reductions in subjective distress (p < 0.001) and HR (p < 0.001), with HR returning to baseline post-intervention. No such reductions were observed in the control group. Willingness to speak improved significantly only in the VRE group (p = 0.001). HRV did not differ significantly across time or groups. Conclusions: A single, personalized VRE session can produce measurable reductions in PSA, particularly in subjective distress and autonomic arousal, supporting habituation as a primary mechanism of change, even after one session. The lack of HRV change suggests that emotion regulation may require more prolonged interventions. These findings support VRE’s potential as an efficient and scalable treatment option for PSA.