Moderating Role of State and Trait Positive Affect in Virtual Reality Exposure for Public Speaking Anxiety: Protocol for a Multisite Experimental Study

TL;DR

This study explores how state and trait positive affect influence the effectiveness of virtual reality exposure therapy for public speaking anxiety.

Contribution

The study introduces a multisite experimental design to clarify the moderating role of positive affect in exposure therapy outcomes.

Findings

State and trait positive affect will be tested as predictors of virtual reality exposure outcomes for public speaking anxiety.

The study will examine optimism, hopefulness, and mental health self-efficacy as potential explanatory constructs for trait positive affect.

Findings will inform strategies to improve exposure therapy efficacy through better understanding of positive affect.

Abstract

The identification of moderators of exposure-based cognitive behavioral therapy (EXCBT) outcomes has the potential to (1) guide the judicious application of the limited resource that is EXCBT and (2) identify additional treatment targets for ameliorating the deleterious effects of an identified moderator, thereby enhancing clinical response. Experimental and clinical studies have yielded intriguing findings for the moderating influence of positive affect on EXCBT outcomes. Mixed findings for state positive affect (at the time of extinction or exposure trials) as a predictor of EXCBT outcomes stand in contrast to evidence that baseline levels of trait positive affect may be a more effective predictor. As such, questions remain about the best way to assess positive affect as a potential treatment moderator.

This study was designed to investigate (1) the relative value of state and trait positive affect for predicting the outcome of a single-session virtual reality exposure intervention for public speaking anxiety in adults attending college and (2) the role of 3 related constructs—optimism, hopefulness, and mental health self-efficacy—that may explain the predictive significance of trait positive affect.

State affect will be manipulated at an experimental level using affect induction procedures; trait positive affect will be measured at baseline. Three dependent measures—a primary outcome of public speaking anxiety and secondary outcomes of social phobia and self-reported valence—will be examined. This study relies on a team science approach and is being conducted across 12 collaborating sites through the Exposure Therapy Consortium, allowing for replication of all findings across diverse study sites worldwide.

Data collection for this study began in October 2024 and ended in August 2025. We expect to complete data analysis and submit results for publication in approximately November 2025.

This study will help clarify the relationship among positive affect (state and trait), exposure learning, and 3 related constructs (optimism, hopefulness, and mental health self-efficacy). These findings will illuminate strategies for future treatment improvement and enhanced efficacy.