Enabling accessible social anxiety care: a pilot study of a virtual reality serious game in a resource-constrained public health setting

Purpose This study evaluates whether a custom-built Virtual Reality (VR) Serious Game – SAVIRE – can serve as an enabling technology to overcome barriers in traditional exposure therapy for adolescents with social anxiety disorder (SAD). It specifically examines the system's usability and clinical efficacy in a resource-constrained public health context. Design/methodology/approach A randomized pilot trial (N = 20) was conducted using a mixed-methods approach. Participants were assigned to either standard CBT or VR-supported CBT. Efficacy was measured via LSAS and SPIN scales, alongside MEEGA + usability metrics and objective in-game behavioral tracking. Findings The VR-supported intervention yielded significantly greater symptom reduction than standard care for both LSAS (p < 0.001, η2 = 0.75) and SPIN (p = 0.004, η2 = 0.40). Regression analysis confirmed that in-game engagement significantly predicted clinical gains (p = 0.047). Usability testing (MEEGA+) verified high accessibility and relevance for the target demographic. Research limitations/implications The study is limited by its small sample size (N = 20) and single-site context. As a pilot trial, these results provide preliminary validation, but larger multi-site studies are required to confirm broad scalability. Practical implications The system offers an objective clinical tracking tool and a cost-effective implementation model via consumer-grade hardware, effectively overcoming logistical barriers in public health settings. Social implications By aligning with the digital habits of adolescents, the intervention reduces stigma and demonstrates how immersive technology can bridge the digital divide in regions with mental health professional shortages. Originality/value This research validates a framework for operationalizing complex therapeutic tasks using Social Learning Theory and Bloom's Revised Taxonomy into a user-friendly format, enabling standardized care delivery in resource-limited settings.