Therapist-Facilitated Virtual Reality Intervention for Social Anxiety Among Youth: Protocol for a Randomized Controlled Trial.

BACKGROUND: Youth social anxiety is rising; however, evidence for therapist-guided virtual reality (VR) exposure remains sparse. OBJECTIVE: This randomized controlled trial will test whether such a VR program is associated with reductions in social-anxiety symptoms in youth aged 15 to 25 years. METHODS: Participants will be recruited from schools, tertiary institutions, and community centers in Hong Kong and screened for eligibility. Youth aged 15 to 25 years who score 25 or higher on the Social Phobia Inventory (SPIN) will be randomly allocated to either the VR intervention group or the waitlist control group in a 1:1 ratio. The VR group will receive a 6-session therapist-facilitated VR intervention, focusing on exposure to realistic social scenarios, real-time physiological monitoring, and AI-driven adaptive support. The control group will not receive the VR intervention during the primary assessment period but will be offered access after the 3-month follow-up assessment. Both groups will be assessed at baseline, 1 month (postintervention), and 3 months for the primary outcome of social anxiety (SPIN) and the secondary outcome of depression (Patient Health Questionnaire-9). An exploratory cost analysis will estimate the cost per unit reduction in SPIN scores. RESULTS: A total of 90 participants (45 in each group) will be recruited. Participant enrollment began in March 2026, and data collection will continue until the required sample size is reached. The primary findings are expected to be published in late 2027. Outcome analyses will use a linear mixed effects model under the intention-to-treat principle, with missing data accounted for under the assumption of missing-at-random. CONCLUSIONS: This trial will provide preliminary evidence on the efficacy, feasibility, and acceptability of a therapist-facilitated VR intervention for youth social anxiety in Hong Kong. Given the waitlist comparator and 3-month follow-up period, findings will not establish VR-specific effects, long-term effectiveness, or implementation-level cost-effectiveness.