Second Life is a free online program created by Linden Research, Inc., and has over 15 million users. Users create avatars (graphical characters) to represent themselves. Users can make their avatars travel to various locations, which include islands, stores, art galleries, business centers, and classrooms. In each location, users may encounter other avatars controlled by actual people. Users can speak to each other through voice-over-IP (VoIP) headsets (similar to talking on the telephone), or by typing messages. Users can make friends, engage in conversations, join organizations, attend meetings, and participate in an economy that involves buying and selling merchandise or services. A number of universities, corporations, government agencies, and non-profit organizations utilize Second Life to distribute information, advertise services, hold educational or fundraising events, and to serve as an easily accessible online meeting place. 15 adults in the United States diagnosed with social anxiety disorder according to the SCID-IV Age: ranges from 21 to 64 years old (M=35.1; SD =12.1) Gender: 60% female, 40% male Ethnicity: 86% Caucasian, 7% Black or African American, 7% Asian Marital Status: 60% single, 33% married, 7% separated Prior Second Life experience: 66% never used Second Life prior to treatment, 27% had limited prior experience, and 7% had extensive prior experience Pre-Treatment scores indicate participants are highly socially anxious : SPAI-SP: M=137.9 ( SD =28.6) LSAS-Fear: M=43.5 ( SD =12.9) LSAS-Avoidance: 41.2 ( SD =14.5) Erica K. Yuen, James D. Herbert, Ph.D., Evan M. Forman, Ph.D., Ronald Comer, DSW, Jean-Claude Bradley, Ph.D., Jennie A. Park, & Elizabeth M. Goetter SECOND LIFE PROCEDURE PARTICIPANTS Social anxiety disorder (SAD) is one of the most common psychiatric disorders in the United States. SAD has a chronic, unremitting course, and is associated with high personal costs including decreased quality of life, work productivity, quality of social relationships, and financial independence. Despite solid empirical support for the effectiveness of various exposure-based CBT programs for SAD, over 80% of people with SAD do not receive any type of treatment whatsoever. Individuals living in non-metropolitan areas of the country have limited access to CBT therapists competent in the treatment of SAD. Due to the nature of social anxiety, a significant number of socially anxious adults are unwilling or reluctant to seek psychological treatment in person. Second Life is a free online virtual world that potentially holds great promise in the widespread delivery of CBT to individuals who are unable or unwilling to obtain in-person treatment. This pilot study assesses the feasibility, acceptability, and initial efficacy of an acceptance-based CBT intervention in Second Life to treat adults with generalized SAD. Study Design: 1 treatment group with assessments conducted at multiple time-points: pre-treatment, mid-treatment (6 weeks), post-treatment (12 weeks), and follow-up (24 weeks). Participants were recruited through online anxiety message boards and the Drexel Social Anxiety Treatment Program website. Treatment consists of 12 individual therapy sessions that include the following components: psychoeducation, exposure exercises, acceptance-based coping strategies, and social skills training. Therapists and clients meet in a private secure virtual therapy room and speak to each other through headsets with attached microphones. The virtual environment is utilized to conduct in-session exposure exercises. For example, the therapist, client, and confederates may travel to a virtual conference room where the client practices delivering a business presentation to an audience. Data collection is in progress. Preliminary observations include: Most participants are easily able to learn how to use Second Life. Technical difficulties encountered by therapists and participants include occasional poor sound quality, and slow computers or internet connection. If sound quality is problematic during a session, the therapist and participant will speak through the telephone (instead of headsets) while still logged into Second Life. Therapists report a greater reliance on observing participants’ vocal tonality to ascertain response to treatment, as therapists are unable to observe body language and facial expressions. Participants report experiencing high levels of anxiety during in-session exposure exercises in the virtual environment. Participants also report experiencing reductions in anxiety and increases in acceptance as social scenarios are practiced repeatedly in the virtual environment. Clients appear more engaged in the virtual exposure exercises when the simulated environment is more realistic, for example, when confederates make their avatars use body language and hand gestures.

Second Life is a free online program created by Linden Research, Inc., and has over 15 million users.

Users create avatars (graphical characters) to represent themselves.

Users can make their avatars travel to various locations, which include islands, stores, art galleries, business centers, and classrooms. In each location, users may encounter other avatars controlled by actual people.

Users can speak to each other through voice-over-IP (VoIP) headsets (similar to talking on the telephone), or by typing messages.

Users can make friends, engage in conversations, join organizations, attend meetings, and participate in an economy that involves buying and selling merchandise or services.

A number of universities, corporations, government agencies, and non-profit organizations utilize Second Life to distribute information, advertise services, hold educational or fundraising events, and to serve as an easily accessible online meeting place.

15 adults in the United States diagnosed with social anxiety disorder according to the SCID-IV

Age: ranges from 21 to 64 years old (M=35.1; SD =12.1)

Gender: 60% female, 40% male

Ethnicity: 86% Caucasian, 7% Black or African American, 7% Asian

Marital Status: 60% single, 33% married, 7% separated

Prior Second Life experience: 66% never used Second Life prior to treatment, 27% had limited prior experience, and 7% had extensive prior experience

Pre-Treatment scores indicate participants are highly socially anxious :

SPAI-SP: M=137.9 ( SD =28.6)

LSAS-Fear: M=43.5 ( SD =12.9)

LSAS-Avoidance: 41.2 ( SD =14.5)

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in the United States. SAD has a chronic, unremitting course, and is associated with high personal costs including decreased quality of life, work productivity, quality of social relationships, and financial independence.

Despite solid empirical support for the effectiveness of various exposure-based CBT programs for SAD, over 80% of people with SAD do not receive any type of treatment whatsoever.

Individuals living in non-metropolitan areas of the country have limited access to CBT therapists competent in the treatment of SAD.

Due to the nature of social anxiety, a significant number of socially anxious adults are unwilling or reluctant to seek psychological treatment in person.

Second Life is a free online virtual world that potentially holds great promise in the widespread delivery of CBT to individuals who are unable or unwilling to obtain in-person treatment.

This pilot study assesses the feasibility, acceptability, and initial efficacy of an acceptance-based CBT intervention in Second Life to treat adults with generalized SAD.

Study Design: 1 treatment group with assessments conducted at multiple time-points: pre-treatment, mid-treatment (6 weeks), post-treatment (12 weeks), and follow-up (24 weeks).

Participants were recruited through online anxiety message boards and the Drexel Social Anxiety Treatment Program website.

Treatment consists of 12 individual therapy sessions that include the following components: psychoeducation, exposure exercises, acceptance-based coping strategies, and social skills training.

Therapists and clients meet in a private secure virtual therapy room and speak to each other through headsets with attached microphones.

The virtual environment is utilized to conduct in-session exposure exercises. For example, the therapist, client, and confederates may travel to a virtual conference room where the client practices delivering a business presentation to an audience.

Data collection is in progress. Preliminary observations include:

Most participants are easily able to learn how to use Second Life.

Technical difficulties encountered by therapists and participants include occasional poor sound quality, and slow computers or internet connection.

If sound quality is problematic during a session, the therapist and participant will speak through the telephone (instead of headsets) while still logged into Second Life.

Therapists report a greater reliance on observing participants’ vocal tonality to ascertain response to treatment, as therapists are unable to observe body language and facial expressions.

Participants report experiencing high levels of anxiety during in-session exposure exercises in the virtual environment.

Participants also report experiencing reductions in anxiety and increases in acceptance as social scenarios are practiced repeatedly in the virtual environment.

Clients appear more engaged in the virtual exposure exercises when the simulated environment is more realistic, for example, when confederates make their avatars use body language and hand gestures.