One-Session Versus Three-Sessions of Virtual Reality Exposure Therapy for Public Speaking Anxiety: Protocol of a Randomized Controlled Trial.

Background: A 1-session virtual reality (VR) exposure for public speaking anxiety has been found to be effective in reducing public speaking anxiety. Previous meta-analyses comparing 1-session to several sessions of in vivo exposure for specific phobias did not find a difference in effectiveness. However, due to the specificity of VR exposure and public speaking anxiety, it is unclear how dividing the same amount of exposure tasks into 3 shorter sessions instead of one long session would affect the effectiveness of VR exposure for public speaking. Objective: The aim of this study is to compare the efficacy of a VR exposure-based intervention for public speaking anxiety and the level of VR presence between a 1-session treatment and an equal exposure time divided into 3 sessions, followed by 4 weeks of online intervention in both groups. Methods: This randomized controlled trial will aim to recruit 86 higher education students experiencing high levels of public speaking anxiety, who will be randomized into one of two conditions: either 1 or 3 sessions of VR exposure therapy, with the same total number of exposure exercises. Both conditions will be followed by the same 4-week online program to encourage in vivo exposure tasks for both conditions. The study will be an exploratory superiority trial testing whether one of the conditions is superior to the other. The primary outcome will be the Public Speaking Anxiety Scale. Assessments will take place pretreatment, at the beginning of the face-to-face session, during the face-to-face session, 1 week after the last VR exposure session, at the end of 4 weeks of the online program, and at two follow-ups at 3 and 12 months after finishing the online program, or equivalent time if the online program was discontinued. Repeated measures within-between ANOVA, the reliable change index (RCI), and effect sizes will be used as statistical analyses, and intention-to-treat will be the primary analysis approach; additional per-protocol analysis will be reported. Results: The study received funding from the Research Council of Lithuania (LMTLT) in April 2023. Recruitment for the study officially started in January 2024 and was still ongoing during the submission of this paper in December 2025. As of November 2025, a total of 101 participants have completed the initial screening. The final results of the study are expected to be prepared and submitted for publication in March 2026. Conclusions: This is the protocol of a study that will explore an understudied and clinically important question that could generate preliminary evidence comparing 1-session versus 3-session VR exposure for public speaking and inform further research. However, given the small and specific sample, results would have to be confirmed in larger and more diverse samples.