Background:

Virtual reality (VR) is a promising tool for diagnostics and treatment in Social Anxiety Disorder (SAD) and its subtypes. In VR, controlled environments for the activation of social fears and anxiety can be provided, making them valuable to measure and modify SAD. While research on both is expanding, the range of VR environments currently in use remains unclear. Therefore, this work systematically examines virtual environments and tasks for self or therapist-guided assessment and intervention of Social Anxiety in children, adolescents, and adults, focusing on technical implementation, feasibility, usability, and effectiveness in anxiety activation.

Methods:

We conducted a preregistered systematic scoping review of original research published until January 2025 in English or German targeting interactive, immersive VR systems for the assessment and/or intervention in Social Anxiety. Included studies cover children, adolescents, or adults samples with a DSM/ICD diagnosis of SAD, or high Social Anxiety based on validated instruments. We extracted and summarized qualitative data on study and sample characteristics, VR environment design, technical realization, feasibility, usability, and presence. Furthermore, we descriptively summarized quantitative data on presence and anxiety activation during VR sessions.

Results:

A total of 31 studies were included, eleven providing quantitative data for summary. Public speaking tasks dominated VR scenarios, while other subtypes, such as fear of blushing, were not addressed. VR scenarios for children and adolescents remained a substantial research gap. Immersive systems typically involved HMDs with head-tracking, and in part, motion- or eye-tracking. Effect sizes for anxiety activation were lacking; among the few studies reporting them, moderate to high effects were observed. Presence was sufficient to elicit anxiety responses, although social presence was underreported. Feasibility was assessed via dropout and adherence rates; usability reporting focused primarily on cybersickness, supplemented by user-friendliness, time- and cost-efficiency, and user satisfaction.

Conclusion:

This review presents the wide range of VR environments and tasks for assessment and intervention in Social Anxiety, with promising anxiety-activating effects. However, improvements in technical features, usability, and presence are needed. Future research should focus on expanding VR scenarios to address individual fears, enhance dialogues and social interactions, and provide applications targeting children and adolescents.