Design and evaluation of a VR-based experience constructed with acceptance and commitment therapy (ACT) principles

Abstract

Background:
Public speaking anxiety (PSA) is a common manifestation of social anxiety disorder, particularly among university students, and can impair academic and professional performance. Virtual reality exposure therapy (VRET) offers immersive, controllable environments with high ecological validity but often lacks personalised interaction and does not explicitly target psychological flexibility—a key factor in PSA. Acceptance and Commitment Therapy (ACT) can enhance psychological flexibility, while gamification may boost user engagement; however, the combined effects of ACT, VR, and gamification remain under explored.

Objective:
This study evaluated the individual and combined effects of ACT mechanisms and gamified design elements within a VR-based intervention for PSA. Specifically, it compared baseline VR, ACT-enhanced VR, and gamified ACT-enhanced VR to examine their impacts on psychological outcomes (anxiety reduction, self-confidence, psychological flexibility) and user experience (immersion, engagement, perceived usability).

Method:
A between-subjects controlled experiment was conducted with 27 university students randomly assigned to one of three groups: baseline VR, ACT-enhanced VR, or gamified ACT-enhanced VR. Each participant completed a single-session public speaking task in a VR environment. Psychological flexibility (AAQ-II) and public speaking anxiety (PRCA-PS) were measured pre- and post-intervention; system usability (SUS), technology acceptance (TAM), and immersion (IPQ) were assessed post-intervention. Semi-structured interviews provided qualitative insights into user experience and design features.

Conclusion:
The ACT-enhanced VR group showed the greatest improvements in psychological flexibility (p = .001) and reduced PSA (p = .006), outperforming the VR-only and gamified ACT-enhanced VR groups. VR-only produced moderate, marginally significant benefits, while gamified ACT-enhanced VR achieved the highest engagement, usability, and immersion scores but no measurable psychological gains. Gamification enhanced perceived realism (p = .084) without yielding significant therapeutic effects.

Date of Award	15 Jul 2026
Original language	English
Awarding Institution	University of Nottingham
Supervisor	Bingjian Liu (Supervisor) & Xu Sun (Supervisor)