Immersive virtual reality for reducing public speaking anxiety in students accessing a university psychological counseling service: protocol for a randomized controlled trial

Background Public Speaking Anxiety (PSA) is a form of social anxiety spread among university students, negatively affecting both academic performance and overall psychological well-being. Virtual Reality (VR)-based interventions combined with Cognitive Behavioral Therapy (CBT) represent a promising approach for treating PSA, as they enable gradual and controlled exposure to feared social situations by simulating realistic audiences and environments. The primary aim of this study is to evaluate whether the use of VR as a support to standard psychotherapy is effective in managing anxiety and PSA in university students who access the University Psychological Counseling Service (UPCS). Methods This article outlines the study protocol for a randomized controlled trial (RCT). Participants will be divided into two groups: (1) a control group receiving psychological counseling, and (2) an experimental group that receives psychological counseling integrated with VR interventions based on 360 degrees video scenarios. The intervention will include two VR-based modules: a VR-Exposure and Response Prevention (ERP) module, designed to provide graded immersive exposure to anxiety-provoking scenarios, and a VR-Acceptance and Commitment Training (ACT) module, aimed at enhancing mindfulness and psychological flexibility through guided experiential practice. Psychological and physiological data collected during the sessions will be analyzed to compare the effectiveness ofVR-integrated psychotherapy with traditional counseling alone. Discussion This study will introduce a novel VR-based ERP and ACTtraining protocol designed to reduce public speaking anxiety in university students by integrating innovative, immersive VR scenarios within a psychological counseling context. The proposed approach may be particularly relevant for university settings, as it offers a scalable, standardized, and controllable VR-supported counseling protocol aimed at reducing PSA, enhancing students ' academic functioning (e.g., oral exams and presentations), and strengthening the overall effectiveness of university psychological counseling services.