# Effects of change in dysfunctional beliefs and self-esteem in avatar-based cognitive therapy for symptoms of social anxiety disorder: a randomized parallel trial

## TL;DR

A remote avatar-based therapy reduced social anxiety symptoms more effectively than a control method, with changes in self-esteem and beliefs playing a role.

## Contribution

This study demonstrates avatar-based cognitive restructuring as an effective method for reducing subclinical social anxiety disorder symptoms.

## Key findings

- Avatar-based intervention led to greater social anxiety symptom reduction compared to a control group.
- Increased self-esteem was significantly associated with reduced social anxiety symptoms.
- Changes in dysfunctional beliefs about social phobia correlated with symptom changes.

## Abstract

Social anxiety is both highly prevalent and debilitating, with dysfunctional beliefs playing a crucial role in its persistence. This randomized controlled trial examined whether a remote avatar-based intervention for restructuring dysfunctional beliefs was associated with changes in social anxiety symptoms in a sample with subclinical social anxiety disorder (SAD). Data from N = 235 participants who completed all study stages were included in the analyses. While participants in the intervention group were tasked with contradicting their personal dysfunctional beliefs verbalized by the avatar, participants in the control group contradicted nonsense statements uttered by the avatar. Three sessions took place over three consecutive days. Data collection occurred pre-, post-intervention, and at a 14-days-follow-up. A significant group x time interaction effect (F(1, 233) = 4.106, p < .05) indicates a stronger SAD symptom reduction within the intervention group in comparison to the control group. Post-hoc analysis revealed a medium effect size for symptom reduction in the intervention group (d = 0.57) and a small effect size for the control group (d = 0.34). An additional linear multiple regression analysis identified that increased self-esteem (B = − 0.56, p < .001) was associated with reductions in SAD symptoms. An increase in dysfunctional social phobia cognitions was associated with an increase in SAD symptoms (B = 0.175, p = .021). Avatar-based cognitive restructuring was associated with reductions in SAD symptoms in a subclinical sample. Changes in self-esteem and social phobia-related cognitions were also associated with symptom changes, but causal relationships cannot be inferred from this study design.

The online version contains supplementary material available at 10.1038/s41598-026-39641-x.