Virtual Reality Overexposure Therapy for Speech Anxiety
Treatment plan
Prerequisites
• written and memorised a presentation (or at least part of a presentation)
• viewed the relevant VR tutorial and tested your device
Treatment overview
To overcome speech anxiety as quickly as possible, the treatment plan will combine overexposure therapy with cognitive reframing and the latest neuroscience tools. Accordingly, in addition to increasingly challenging virtual reality training environments, you will be given facts to consider and tools to use. The plan is presented as a week-long course of treatment. However, it can be adapted to fit the time you have available to you - for example, you could do two days in one.
DAY 01
Fact to consider: You are about to access the most effective treatment for speech anxiety and you will learn the most effective science-based tools. Exposure therapy, for example, is highly effective. It has been shown to be more effective than medication, it has been successfully used for decades, it is the gold standard treatment, and it typically works for 90% of patients. As part of exposure therapy for speech anxiety, a patient is often encouraged to present to a range of increasingly challenging audiences - which results in desensitisation. Typically, this starts with an audience of zero and scales up to an audience size of around twenty or so people. To increase the efficacy further, a patient could subsequently partake in 'overexposure therapy': practising in extreme scenarios that one is unlikely to encounter in real life, such as hyper-distracting stadiums with 1000s of spectators (made possible with the latest advancements in virtual reality). Accordingly, overexposure therapy provides the psychological equivalent of running with weights or at high altitudes; it builds extra confidence, adaptability, and resilience. To increase the efficacy further still, a patient could incorporate additional science-based tools, such as cognitive reframing techniques to reduce anticipatory anxiety or neuroscience tools to reduce their heart rate quicker. The treatment plan outlined on this page provides you with all of this for free. As a result, you can begin this process with a positive mindset knowing that you are about to access a highly effective, evidence-based hybrid treatment plan that will provide you with a wide range of experiences, perspectives, and tools.
Tool to use: Prolonged exhalations. You may have heard that deep breathing can calm your nerves however, with regard to the most powerful immediate effects, this advice isn't precise enough. Technically, the types of breathing that will calm you the quickest involve emphasised and/or prolonged exhalations as these trigger an automatic response that slows your heart rate. One method of applying this is using what is known as ‘4-7-8’: breathing in through the nose for a count of 4, holding one’s breath for a count of 7, and exhaling from the mouth for a count of 8.
Task: Prior to practising in the VR training environment, complete 5 rounds of 4-7-8. Then complete three practice runs of your presentation in the VR training environment (note - if your presentation is longer than 5 minutes, you may wish to practice parts of it).
VR training environment: Audience of 0
DAY 02
Fact to consider: You can go 'off script'. When presenting, it is important to remember that the audience doesn't know your script so don't feel obliged to present it word for word; if you go slightly off script, it doesn't matter. Just continue and don't call attention to it. The knowledge that it doesn't matter if you don't remember every word is an important component of reducing anxiety.
Tool to use: Slowing things down. Talking too fast is one of the most common public speaking mistakes. And not only does it make it harder for the audience to understand you, but it also speeds up your heart rate and can make you feel more anxious. By contrast, if you slow things down, not only will you be more clearly understood, you will give yourself the time to fully exhale and therefore, slow your heart rate down.
Task: Prior to practising in the VR training environment, complete 5 rounds of 4-7-8. Then, in your practice session, try to insert some pauses to fully exhale. And remember, don't be concerned if you don't recall your script word for word. Complete three practice runs of your presentation in the VR training environment.
VR training environment: Audience of 16
DAY 03
Fact to consider: The majority of people fear public speaking so you are not on your own. The latest studies state that around 70 to 80% of people fear public speaking. Furthermore, as these are based on survey responses rather than biometric data, the fear is likely underreported. Also, it does not take into consideration the people who feared public speaking but through repetition built resilience. If the question was, "Have you ever feared public speaking?" the results would be closer to a 100% yes. So it is important to know that you are not 'strange' or 'different' if you have speech anxiety. You are part of the vast majority. And you can be proud of the fact that you have acknowledged it is something you want to overcome and that you are now following the most evidenced and most effective treatment.
Task: Complete 5 rounds of 4-7-8 and then complete three practice runs of your presentation in the VR training environment.
VR training environment: Audience of 25
DAY 04
Fact to consider: You will not look as nervous as you may feel. Often presenters self-report feeling a 7 or 8 out of 10 with regard to their levels of anxiety. However, their audience reports them as appearing around 2 or 3. In psychology, this is known as the 'illusion of transparency': the tendency for people to overestimate the degree to which their personal mental state is known by others. It is an important phenomena to be aware of as if we feel as though we look nervous that can take us further away from the message and towards self-critique, a sense of judgement, and ultimately even more anxiety. It is important to remember that, given that most people are anxious when public speaking, it would be perfectly normal to appear nervous - and it is important to know that if you do feel nervous, you won't look as nervous as you feel. Ultimately, don't focus on your nerves. Just focus on, and continue with, your message.
*Note - many people will shake when presenting and so you may feel more comfortable not holding notes. If you feel you need notes, try holding a heavy book or clipboard rather than a loose page.
Task: Complete 5 rounds of 4-7-8 and then complete three practice runs of your presentation in the VR training environment.
VR training environment: Audience of 50
DAY 05
Fact to consider: Practice is key. Public speaking can be a highly misleading spectacle. When we see a stand-up comedian captivating an audience of hundreds of people, it can appear like an impromptu effortless conversation. And yet, with some reflection, we can understand that in reality, that one-hour comedy special is the result of thousands of hours of practice. Not only the hundreds of repetitions to learn that one-hour monologue but the year plus that went into developing the script - and the prior decade that went into becoming comfortable in front of increasingly larger audiences. Indeed there is something that appears innate about public speaking and perhaps this is why a lack of preparation is often number one on the list of the most common public speaking mistakes. And failing to make time for sufficient practice can lead to many other common mistakes: starting with an apology, reading not delivering, forgetting key pieces of information, rambling, and not sticking to the time limit. But perhaps most of all, a lack of practice will likely make you more self-aware, self-critical, and therefore, more anxious. It is ultimately through repetitions that we become more comfortable. If you keep lifting a heavy weight, it will eventually become light. When someone first learns how to drive, it can be highly stressful but after enough trips, it becomes just another way to move yourself around. And so, when it comes to public speaking, if you practice enough, you will feel much more confident. Ideally, you would practice at least ten times, and ideally in front of a range of audiences. And the great news is, not only have you already done that, but you now have the technology to do it as much as you like.
Tool to use: Distant lateral eye movement. When speaking to larger audiences, often looking at faces can raise levels of anxiety and so you can look slightly above their heads and towards the back of the room and thus increasing your field of view which can further help to calm the brain. You can add to this calming effect by introducing lateral eye movements, moving your gaze slowly from left to right, as this suppresses brain activity in the amygdala and therefore suppresses our fear response resulting in a profound calming effect.
Task: Complete 5 rounds of 4-7-8 and then complete three practice runs of your presentation in the VR training environment. On your first practice round, look at someone in the front row. In the second and third practice rounds, implement distant lateral eye movements (look at the back left and right corners of the room) and notice how it helps to further reduce anxiety.
VR training environment: Audience of 100
DAY 06
Fact to consider: Most people practice to an 'audience' of zero. Prior to a presentation, most students tend to practice on their own, in a highly-controlled environment—normally in their bedrooms to an ‘audience’ of zero. As a result, it will feel like a significant ‘step up’ when they present to even a small group of people—and even a subtle audience gesture can throw them off. By contrast, you have been practising in a wide range of venues to a wide range of distracting audiences. This process is proven to build extra confidence, resilience, and adaptability.
Tool to use: Projection. Another very common public speaking mistake is to speak too quietly. And just like speaking too fast, speaking too quietly can be a double-edged sword: not only does it make it harder for the audience to understand you, but it also speeds up your heart rate and can make you feel more anxious. By contrast, by speaking louder, not only will you be more clearly understood, you will give better emphasis on your exhales and therefore, slow your heart rate down. Speaking louder provides an instant calming effect. Just as 'looking nervous', speakers report their volume levels as being much higher than the audience members report. Therefore, try to project much louder than you think you need to. Speak to those at the back of the room.
Task: Complete 5 rounds of 4-7-8 and then complete three practice runs of your presentation in the VR training environment. When practising, stand up tall and project your voice. Emphasise projecting from your diaphragm with good volume and notice how it helps to calm you. Complete three practice rounds focusing on speaking loudly.
VR training environment: Audience of 100s
DAY 07
Tool to use: Positive framing. Negative self-talk is a common driver of anxiety. And it can be self-fulfilling. Fortunately, however, positive self-talk can also become self-fulfilling.
Task: Complete 5 rounds of 4-7-8. In your practice session, bring it all together. And remember that speaking with confidence involves getting things out: getting the air out of your lungs, getting the words out of your mouth, and getting your focus out into the room. So stand up tall, look to the back of the room, and project your voice nice and loud. You have put in the work and so you can provide yourself with the following positive self-talk: "I have practised to a diverse range of audiences. I can and I will deliver my presentation with confidence." Complete three practice rounds (speaking loudly).
VR training environment: Audience of 1000s
Congratulations! You did it!
Now go out there and seize, or better yet, create the opportunities to practice in real life. You have presented confidently and competently in front of increasingly larger audiences. And, you have a range of additional specialised resources at your disposal to prepare for any scenario. And so, get out there, and start speaking.