Virtual Reality Overexposure Therapy for Speech Anxiety
TREATMENT PLAN 2.0
Prerequisites
• written and memorised 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 10 sessions. This can be adapted to fit the time you have available to you - for example, you could do it over a week, and perhaps do multiple sessions in a day - you could spread it out over a couple of weeks and repeat sessions.
SESSION 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, and it is widely considered the gold standard treatment. 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 could be thought of as psychological weight training; 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 (you can read more about the science behind this here). One practical 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 first VR training environment, complete 5 rounds of 4-7-8. Then complete three practice runs (speaking out loud) 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). This discrete breathing pattern can be used in the moments leading up to a presentation. And so, if you start to worry in the moments prior to a presentation, instead focus on this breathing technique.
VR training environment: Audience of 0
SESSION 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. A common mistake is to forget a small part and start getting frustrated and apologising. Instead, 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 (using the same underlying mechanism as described in session one).
Task: Have a look over your script and find some good moments for pauses (e.g., after a key point). It might help to literally write the work pause on your script. Prior to practising in the VR training environment, complete 5 rounds of 4-7-8. Then, in your practice session, use those 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 9
SESSION 03
Fact to consider: Your brain calms down once you start speaking. Once you start talking, your prefrontal cortex starts to take over to focus on the task, giving you a sense of control. In other words, as soon as you get into your speech, nerves will begin to settle. In short, anticipation fuels anxiety; action reduces it. And so, rather than thinking, "I don't want to start", instead think, "I can't wait to start as starting will help". And so, you can focus on your breathing leading up to a presentation, and then get excited about starting as you are walking up to the stage.
Tool to use: Island hopping. A tool to consider to help you get more comfortable with going off script is to think of your script like a set of 'islands' rather than a long series of words that must be used. And so, rather than moving from one word to another, think broader and move from one section to another. Moving between the key points ('island hopping') rather than focusing on each specific word will help to reduce anxiety as it becomes clearer that forgetting a word is not catastrophic, it is merely a slightly different route to the next island. There is no fixed road.
Task: Prior to practising, write down the main 'islands' of your presentation. When presenting, try to not use the exact same words each time. Just make sure you visit each island. This is a great exercise to get even more comfortable with going off script. Prior to practising in the VR training environment, complete 5 rounds of 4-7-8. Complete three practice runs of your presentation in the VR training environment - and remember, going off script is totally fine.
VR training environment: Audience of 16
SESSION 04
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 and/ or have speech anxiety. Furthermore, as these are often 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.
Tool to use: Lateral eye movement. Looking side to side has a powerful two-pronged calming effect: it directly calms the brain's fear centre (amygdala deactivation), and it simultaneously helps to calm the body's stress response (parasympathetic stimulation). Furthermore, social anxiety increases self-focused attention and directing attention outward disrupts this loop. Wide-field attention engages the dorsal attention network (outward attention) rather than the default mode network (self-evaluation, rumination). This shift improves cognitive flexibility and reduces performance disruption under stress. And so, when speaking, broaden your field of view, and gently move your gaze from left to right.
Task: Complete 5 rounds of 4-7-8, and then complete three practice runs of your presentation in the VR training environment. When presenting, be sure to broaden your visual field as this will reduce physiological threat responses, interrupt self-focused anxiety loops, and activate attentional and neural systems associated with calm, control, and effective performance.
VR training environment: Audience of 25
SESSION 05
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 phenomenon 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.
Tool to use: Progressive Muscle Relaxation (PMR). The technique involves systematically tensing a muscle group for 5-10 seconds before releasing it, allowing you to notice the profound difference between tension and relaxation. A key 2024 systematic review examined 46 separate studies involving over 3,000 adults. The conclusion was: PMR is effective in significantly reducing symptoms of stress and anxiety.
Task: Complete a PMR routine. Simply work through your body clenching for 10 seconds and then releasing: clench your fists, then release. Tense your arms, then release. Scrunch your face, then release. Continue this for your shoulders, legs, and feet. This conscious release of physical stress directly calms the mind. Afterwards, complete three practice runs of your presentation in the VR training environment.
VR training environment: Audience of 50
SESSION 06
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: Lateral eye movement (again). 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. Try to look at the back corners 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. 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
Audience sound track: Quiet crowd
SESSION 07
Fact to consider: Most people practise to an 'audience' of zero. Prior to a presentation, most people practise 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. 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 (it will provide an instant calming effect).
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 200
Audience sound track: Loud crowd
SESSION 08
Fact to consider: Motor rehearsal lowers anxiety. Your brain creates auditory pathways that it can recall on presentation day. In short, practising out loud increases prefrontal control and lowers anxiety through predictability.
Tool to use: Projection. Yes, this was the same tool to focus on as last time but it is one that most people forget so it is well worth focusing on again.
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 500
Audience sound track: Louder crowd
SESSION 09
Fact to consider: Being positive has a profoundly positive impact. There is a lot of fun science we could get stuck into here: self-regulation signals maturity and competence, predictability creates psychological safety, emotional contagion (your positivity literally spreads to other brains), positive people get “reward pathway” credits (positivity activates the brain’s dopamine and oxytocin systems), low-drama behaviour enhances social status, etc, etc. So, if something bad or negative happens during your presentation, if you remain positive (e.g., just smiling and continuing) there will be multiple benefits. In fact, the positive result of not negatively reacting to something unexpected happening is so profound that you can reframe the whole concept of "what happens if things go wrong?". It becomes less of what you will 'have to do', and more, what you 'get to do'. You get to show people that you can maintain positivity when it is challenging to do so. And that will create a cascade of positive ripple effects beyond demonstration of integrity. In short, you are not just “being positive”, you are calming yourself, others, and your are optimising yourself for social bonding at a neurobiological level.
Tool to use: Go with the flow. Wanting to be in full control of each component is not possible and will only fuel anxiety. Instead, embrace the unexpected elements. Simply, smile, be positive, and continue as best you can. The audience will only like you more for it. For example, this next audience are stood up. This might not be what you were expecting but if you think about it, it doesn't really change anything. Some of them might leave. You could choose to dwell on that and think that it is something you have said, but perhaps they simply needed to go somewhere. Either way, it is out of your control, so don't focus on it. Just smile and 'go with the flow'. People might interrupt in the next VR training scenario, phones may go off. Some people might interrupt and say things like "What did you say?". In which case, you can simply calmly repeat and continue. Some people might say "Speak louder". In which case, you can simply do so, and continue.
Task: Complete 5 rounds of 4-7-8, and then complete three practice runs of your presentation in the VR training environments. Train twice with the "standing audience" and once with the "challenging audience" (note that the challenging audience has its own audio so you don't need to play the additional audience sound track). 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. If something unexpected happens, just go with the flow.
VR training environment 1: The standing audience
Audience sound track (for environment 1): Interrupting crowd
VR training environment 2: The challenging audience (has its own audio)
SESSION 10
Fact to consider: Perfect is not perfect. It is important to reframe the goal from flawless delivery to human delivery. Not only will this take unnecessary pressure off of yourself, it can help you build rapport. This is directly supported by a classic social psychology finding known as the Pratfall Effect, first studied by Elliot Aronson. His research, published in the late 1960s, demonstrated that highly competent individuals were rated as more likeable after making a small, clumsy mistake (a "pratfall") than if they were perfect. This effect has been replicated in various contexts. It works because vulnerability and the ability to handle imperfection gracefully can humanise a speaker, breaking down the barrier between them and the audience.
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. Research shows that repetitive self-critical negative thoughts activate the brain’s threat-detection systems and heighten stress responses. Because the brain tends to confirm what it expects. Fortunately, the same mechanism works in the opposite direction: practicing positive or compassionate self-talk can shift cognitive biases, reduce physiological stress, and reinforce more adaptive emotional patterns—making those expectations self-fulfilling as well.
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." If anything goes wrong, you get to show the audience how you can remain positive and go with the flow. Complete three practice rounds (speaking loudly).
VR training environment: Audience of 1000s
Audience sound track: Louder crowd
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 distracting 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 up.