Integrating Creativity into Exposure Therapy: A Pilot Randomized Study of a VR-Based Serious Game for Adolescent Social Anxiety

Social Anxiety Disorder (SAD) is common among adolescents and often results in long-term impairment. Cognitive Behavioral Therapy (CBT) remains the gold-standard treatment, yet delivering consistent exposure exercises in real-world settings can be difficult. This study evaluated SAVIRE (Social Anxiety – Virtual Reality – Serious Game), a VR-based tool designed to enhance CBT through immersive social scenarios and real-time behavioral feedback. Twenty participants aged 17–24 with SAD were randomly assigned to CBT alone or CBT combined with SAVIRE over ten weeks. Outcomes were assessed with standardized anxiety scales, in-game behavioral responses, and usability ratings. Results indicated that the CBT+SAVIRE group showed significantly greater reductions in social anxiety symptoms than CBT alone. Adaptive in-game responses correlated strongly with clinical improvement, while usability ratings were high across participants and clinicians. Findings suggest that SAVIRE offers a creative, practical, and scalable approach to strengthening exposure therapy for adolescent social anxiety.