For people who stutter, dysfluent speech is central to social experiences. Stuttering often elicits social reactions which can become embedded in thoughts and expectations about social interaction, laying the foundation for heightened social anxiety. People who stutter are at a greater risk of developing heightened social anxiety which often reaches clinical levels. However, there are few social anxiety interventions which consider the unique social experience of stuttering. The growing use of digital mental health interventions opens up several opportunities for effective and accessible social anxiety treatments for people who stutter. In this thesis we explore the adaption of one such approach, Virtual Reality Exposure Therapy (VRET).
This thesis documents the process of designing, developing, and evaluating VRET tailored to stuttering-related social anxiety. First, we review existing VRET protocols to examine the comparative value of different VRET techniques and how they may be suitably applied in stuttering. These insights are combined with user feedback and small-scale pilot trial findings in the participatory design of VRET. This holistic approach to treatment design balances evidence-based techniques with relevance to the stuttering experience. VRET is designed with speech therapy integration in mind. It is remotely delivered using a smartphone and guided by a virtual therapist. Exercises also target stuttering-specific fears and behaviours. Thereafter, VRET efficacy is examined in a randomised controlled pilot trial. Findings failed to demonstrate a reduction in social anxiety symptoms, though showed promise for longer-term learning. In a subsequent study, we explore wider user experience and treatment mechanisms that are theorised to underlie successful treatment outcomes in VRET. A mixed set of findings suggest design issues related to novel treatment techniques may have hampered users’ engagement with therapeutic strategies.
Despite mixed findings, this research is a useful resource for designing future iterations of stuttering-specific VRET and other digital mental health interventions.