This study used an open clinical trial to test a cognitive‐behavioral treatment for public‐speaking anxiety that utilized virtual reality as a tool for exposure therapy. Treatment was completed by participants (n=10) meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV criteria for social phobia, or panic disorder with agoraphobia in which public speaking was the predominantly feared stimulus. Treatment was conducted by a licensed psychologist in an outpatient clinic. Treatment consisted of eight individual therapy sessions, including four sessions of anxiety management training and four sessions of exposure therapy using a virtual audience, according to a standardized treatment manual. Participants completed standardized self‐report questionnaires assessing public‐speaking anxiety at pre‐treatment, post‐treatment, and 3‐month follow‐up. Participants were asked to give a speech to an actual audience at pre‐ and post‐treatment. Results showed decreases on all self‐report measures of public‐speaking anxiety from pre‐ to post‐treatment, which were maintained at follow‐up (n=8; all P<.05). Participants were no more likely to complete a speech post‐treatment than at pre‐treatment. This study provides preliminary evidence that a cognitive‐behavioral treatment using virtual reality for exposure to public speaking may reduce public‐speaking anxiety and suggests that further research with a controlled design is needed. Depression and Anxiety 22:156–158, 2005.

Digital mental health interventions (DMHIs) are typically designed as "one-size fits all" which may perpetuate health disparities for racialized minorities. This systematic review identified culturally adapted DMHIs and examined their efficacy and acceptability among racial and ethnic minorities. PsycINFO, Web of Science, and Pubmed databases were searched between 2000 and 2021. Studies that examined the development or impact of a culturally adapted DMHI for racial or ethnic minority populations using quantitative and/or qualitative methodologies were included. Meta-analyses explored the efficacy of DMHIs, and moderator analyses were used to identify differences in effect sizes due to study quality, clinical outcomes, therapist support, and attrition. Thirty-two studies met inclusion criteria and were reviewed. DMHIs were deemed acceptable and feasible in most studies (n = 24). Among eligible randomized controlled studies (n = 12) comprising 653 participants, results indicated that culturally adapted DMHIs produced a large, positive, significant effect (g = 0.90) across a range of outcomes when compared to wait-list and treatment as usual control conditions. The average attrition rate per study was 42%, and most participants did not complete all modules despite reporting high satisfaction. Culturally adapted DMHIs are efficacious and acceptable. Such interventions represent a powerful opportunity to circumvent barriers to mental health treatment and improve mental health equity among racially and ethnically minoritized communities. However, the prevalence of feasibility studies, lack of active comparison treatments-and limited research for Black and Indigenous populations-indicate that more research is needed to achieve this purpose. Recommendations are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).