Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking.

BACKGROUND: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. OBJECTIVE: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. METHODS: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. RESULTS: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. CONCLUSIONS: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients.

Voice Handicap and Public Speaking Anxiety in Self-Assessment among Children with and without Vocal Fold Nodules.

PURPOSE: Vocal fold (VF) nodules are very common laryngeal lesion that affects people, including children as well. However, it has a negative impact on the communication and voice quality which is why it is important to study and measure it. Unfortunately, there may be factors which disturb examining process especially during questionnaire self-assessment. This study aimed to investigate whether public speaking anxiety (stage fright) correlates with scores on the Children's Voice Handicap Index-10 (CVHI-10) and to determine if children with VF nodules assess their voice similarly to those without such lesions. METHOD: Thirty-seven respondents at age 8-12 participated in the study. It was conducted the surveys: Children Voice Handicap Index-10 (CVHI-10), Stage Fright Scale - Children & Youth (SFS-CY), and Neuroticism subscale of the Big Five Questionnaire - Children (BFQ-C-Neu) and endoscopy laryngeal examination. The text describes the reliability analysis, means comparison, and correlation analysis. RESULTS: The measures used achieved a high level of reliability. There were no statistically significant differences in voice self-assessment scores between groups with and without VF nodules. Significant relationships were found between the CVHI-10 scores and all factors of the SFS-CY. CONCLUSIONS: The results reveal that children with VF nodules assess their voice similarly to those without laryngeal lesions. Correlation analysis shows significant relationships between voice handicap in self-assessment and stage fright factors. This may explain the lack of differences in CVHI-10 scores among groups; however, further research is needed to clarify this phenomenon.

Um, so, like, do speech disfluencies matter? A parametric evaluation of filler sounds and words.

This study evaluated how speech disfluencies affect perceived speaker effectiveness. Speeches with filler sounds and filler words at different rates of disfluencies (i.e., 0, 2, 5, and 12 per minute) were created and evaluated by a crowdsourcing service for survey-based research for the speaker's public speaking performance. Increased disfluencies, particularly filler sounds, significantly affected perceptions across most categories, notably at higher rates of filler sounds (i.e., 12 per minute). A low, but nonzero, rate of disfluencies (5 per minute) did not adversely affect perceived effectiveness. These findings suggest that although reducing filler sounds is crucial for optimizing perceived speaking effectiveness, a rate of five or fewer disfluencies per minute may be acceptable.

The perception and passage of time during public speaking.

Several studies have shown that anxious individuals experience a slower passage of time under threat conditioning. Anxiety-evoking situations have also been proposed to elevate arousal levels, which, in turn, alter one's time percept. However, the effect of social stressors on time perception remains significantly neglected. The current research aimed to investigate the impact of anxiety levels on time estimation and passage of time judgments during public speaking in healthy adults. Participants were recruited from a pool of students that had to give a presentation as part of a university course or their teaching duties. Following the presentation, they were asked to make retrospective time estimations on the duration of the latter, as well as to provide passage of time judgments. Self-reported questionnaires related to affective states, public speaking anxiety, and performance were also administered. Analysis showed that higher levels of public speaking anxiety predicted temporal overestimation and slower "feel" duration and passage of time. Moreover, the relationship between public speaking anxiety and passage of time was mediated by participants' mood states, which remained significant after -indirectly- controlling for fear of evaluation. Overall, our observations suggest that anxiety levels during public presentation significantly predict altered perception and experience of time. The latter can be explained by the speaker's mood status. Identifying the mechanisms that modulate timing under psychological stressors could complement our understanding regarding their impact on educational and social settings, as well as set the ground towards the development of early intervention and prevention strategies for those who suffer from stress-related disorders.

Let's talk posters: a novel role-playing activity to prepare undergraduate researchers for poster presentations.

Calls to increase undergraduate involvement in research have led to a significant increase in student participation via course-based undergraduate research experiences (CUREs). These CUREs provide students an authentic research experience, which often involves dissemination of research by public speaking. For instance, the First-year Research Immersion (FRI) program at Binghamton University is a three-semester CURE sequence that prepares students for scientific research and effective communication of their findings. After one semester of research, students from the FRI program are tasked with presenting their research to hundreds of faculty members, staff, friends, and family at the annual FRI poster session. However, our students, and undergraduates in general, report high anxiety and fear around public speaking such as this. To better prepare our students for public speaking at a research poster session, we developed a workshop that includes a novel role-play activity to mimic a fast-paced poster session or conference in order to address students' fears and increase confidence levels. The role-play activity gives students iterative practice such that they are prepared for the realities of a poster session including variation of poster attendees. During the activity, students switch roles between presenter and audience member. In the role of an audience member, students are given Pokèmon-like role-playing cards that explain the traits and abilities of various types of poster-goers that students might come across (faculty in and out of discipline, staff, family, friends, etc.). Students improvise and enact their card-assigned role as they engage with their classmates who are practicing their poster presentations. To assess student outcomes, students were given three surveys: pre-activity, post-activity, and post-poster presentation. Immediately following the activity, 64% of students reported the highest level of confidence, and following the poster session, 93% of students reported extreme confidence in their poster presentation abilities. These data show that this role-play activity can help address student confidence and better prepare students to communicate their research.

Fear of public speaking: the effects of a communicational improvement training on physiological parameters and the perception of communication.

Presentations to audiences are often seen as challenging by university students, causing physiological reactivity on cortisol levels and heart rate, for example. Many students perceive that they have difficulties expressing themselves or do not consider themselves to be good communicators. With the thought that efficient communication is able to bring well-being and more confidence, it is understood that a communication skills training could mitigate adverse effects on the body during public speaking. This study aimed to verify whether a communicational improvement training can improve physiological parameters and perception when speaking in public among university students. This was a prospective, blinded, controlled, and randomized trial. Students from colleges and universities were recruited for this study. Invitations were either in person or via social networks and/or e-mail. There were 39 university students who completed the tasks, ages between 18 and 30. There were two groups: the intervention group (IG) and control group (CG). The intervention group participated in a communicational improvement program for six weeks to work on breathing, articulation, speech rhythm, pneumophonoarticulatory coordination, expressiveness and non-verbal communication. Data of heart rate measures, salivary cortisol analysis, self-perception of public speaking, and presentation ratings were collected. The intervention group presented with lower heart rates and cortisol levels, better presentation ratings, and higher self-perception of public speaking than the control group after participating in the communication improvement training. In this study it was possible to verify the efficiency of a communicational improvement training, being able to improve cortisol levels, heart rate, and perception when speaking in public in university students. Based on the results presented, new studies are suggested: (a) measuring the individual effect of the workshops demonstrated here and (b) comparing this type of intervention with other types of treatment used in the health area (medication, psychotherapeutic, holistic, etc.).

Perfectionism as a predictor of change in digital self-guided interventions for public speaking anxiety in adolescents: A secondary analysis of a four-armed randomized controlled trial.

Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions.

The efficacy of remote video-based behavioral skills training and awareness training on public speaking performance.

This study evaluated the efficacy of (a) remote video-based behavioral skills training (BST) with added speech outlines on teaching public speaking behaviors and (b) remote video-based awareness training (AT) on speech-disfluency rates. A multiple-baseline design across speech behaviors was used to evaluate the training. Remote video-based BST and AT were effective at teaching public speaking behaviors and reducing speech disfluencies, respectively, for both participants. In addition, performance generalized to increased audience size. Although expert ratings of perceived public speaking effectiveness improved following BST, the ratings did not improve and some worsened following AT. Both participants reported satisfaction with video-based BST and AT. One participant reported greater comfort, confidence, overall ability, and less anxiety as a public speaker following BST. Both participants reported greater improvements in those categories following AT. Our results suggest that public speaking behaviors can be taught using remote video-based BST and speech disfluencies can be reduced using remote video-based AT.

Relationships Among English Language Proficiency, Self-efficacy, Motivation, Motivational Intensity, and Achievement in an ESP/EAP Context.

This study, the first of the kind in the field of English for specific purposes, examined direct and indirect relationships among English language proficiency, English public speaking (EPS) motivation, motivational intensity, self-efficacy, and EPS achievement. The sample consisted of 189 non-English-major students. The final structural equation model yielded an acceptable fit to the data and explained 23.4% of the variance in EPS achievement. English language proficiency and EPS self-efficacy had both direct and indirect (via, respectively, self-efficacy and motivational intensity) impacts on EPS performance. Ought-to self emerged as the strongest contributor to explaining motivation (R2 = .90), followed by learning experience (R2 = .57), and ideal self (R2 = .32). Implications are discussed.

Interventions That Target or Affect Voice or Speech Production During Public Speaking: A Scoping Review.

OBJECTIVES: Public speaking (PS) is frequently necessary in many professional, educational, and personal settings. Mastering this communication skill is particularly important in today's society. Training techniques for PS have been described in the literature. Given that PS anxiety affects performance, especially voice characteristics and speech fluency, the purpose of this scoping review is to examine, map, and narratively summarize the available evidence on PS interventions that target or affect voice or speech. METHODS: An extensive literature search was conducted in three bibliographic databases: Medline ALL/Ovid, PsycINFO/Ovid, and Eric/Ovid. Of the 850 studies identified, 22 met the eligibility criteria, and one was added from the reference lists of the included studies. RESULTS: A total of 23 studies were included. The interventions identified aim to improve speaking skills either by explicitly targeting the voice or speech (direct intervention, n = 15) or by targeting the cognitive, behavioral, psychological, or physical environment impacting the speaker's production (indirect intervention, n = 8). CONCLUSIONS: This scoping review provides the first published methodological summary of the characteristics of existing PS interventions that target or affect voice and speech. Heterogeneous characteristics were observed. Further studies are needed to determine which interventions are most effective.

[Public speaking in the service of the IPA profession]. / L'art oratoire au service de la profession d'IPA.

Public speaking is fashionable. Yet, as a discipline of performers with its own technique, it has only one purpose: to serve authors in order to enrich the world with their ideas. Advanced practice nurses could also use it to develop their ability to communicate their ideas.

Associations between Autonomic and Endocrine Reactivity to Stress in Adolescence: Related to the Development of Anxiety?

Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional-neurobiological development, particularly with respect to the development of stress management skills.

The Effect of Previous Exposure on Virtual Reality Induced Public Speaking Anxiety: A Physiological and Behavioral Study.

Public speaking anxiety (PSA) is defined as a strong distress when performing a speech in front of an audience, causing impairment in terms of work possibilities and social relationships. Audience behavior and feedback received during a speech are a crucial variable to induce PSA, affecting performance and perception. In this study, two different virtual reality public speaking scenarios were developed to investigate the impact of positive (more assertive) versus negative (more hostile) audience behavior regarding perceived anxiety and physiological arousal during performance. Moreover, the presence of any carry-over effect based on first experiences (positive vs. negative) was investigated by using a within-between design. Both explicit (questionnaires) and implicit physiological measures (heart rate [HR]) were used to assess participants' experience. The results confirmed the influence of audience behavior on perceived anxiety. As expected, negative audience elicited greater anxiety and lower experience pleasantness. More interesting, the first experience influenced the perceived anxiety and arousal during performance, suggesting some sort of priming effect due to the valence of previous experience. In particular, starting with an encouraging feedback scenario did not increase the perceived anxiety and HR in front of a subsequent annoying audience. This modulation did not appear in the group who started with the annoying audience, which clearly reported higher HR and anxiety during the annoying exposure compared with the encouraging audience. These results are discussed considering previous evidence on the effect of feedback on performance. In addition, physiological results are interpreted considering the role of somatic marker theory in human performance.

Effective Communication for Child Advocacy: Getting the Message out Beyond Clinic Walls.

Clinicians who want to communicate child advocacy messages, stories, and arguments can draw on their clinical and scientific experience, but effective communication to wider--and nonmedical--audiences requires careful thought. We discuss choosing and honing the message, developing writing and speaking skills that fit both the exigencies of the chosen medium and format, including op-eds, essays, social media, public testimony, and speeches. We provide guidance on proposing articles, working with editors, shaping language and diction for a general audience, and drawing on clinical experiences while respecting confidentiality. all with the goal of effective communication, spoken and written, in the service of children and child advocacy.

Expanding Applicability of Presentations at Public Health Conferences.

As public health practitioners and program evaluators for a state health department, we look forward to public health conferences for the opportunity to hear from leaders in the field and inform our own practice. While we feel that most presentations describe the work and why it matters, many of us leave sessions thinking, "Now what?" In other words, how do we apply what we learned to public health practice? As American Public Health Association (APHA) looks to celebrate its 150th year in 2022, now is an ideal time to focus on expanding the impact of our work. We offer several suggestions for how conference presenters can make their work more applicable to public health practitioners. We ground our recommendations in John Driscoll's reflective model for health care practitioners. This framework guides the audience through three questions designed to move from a description of what happened ("what?") to the potential significance of their findings ("so what?") and finally to the actions we can take as a result ("now what?"). These strategies are meant to help presenters describe processes and implications in addition to outcomes and theory. We hope that public health professionals can continue to look to the APHA Annual Meeting and other public health conferences as not only sources of innovative research but also as forums for practitioners to share the practical applications of their work.

New Directions in L2 Self-efficacy Research: Comparing Bifactor and Second-Order Models in the English Public Speaking Domain.

Reflecting an alternative model comparison framework and grounded in Bandura's self-efficacy theory and in western and Chinese English Public Speaking (EPS) competences literature, we examine the possibility of a hierarchical structure of the EPS self-efficacy construct. In particular, we contrast an established first-order model of the EPS self-efficacy with two higher-order rival models, testing for subordinate (second-order model) versus nested (bifactor model) relationships in a sample of 203 Chinese EFL college students. From a theoretical perspective, the results supported the bifactor model as a strong conceptual foundation for understanding the EPS self-efficacy construct as nested. From a practical perspective, this conceptualization would allow for gauging EPS self-efficacy development both holistically and by subdomains. From a research methodology perspective, this study is among the first to bring the bifactor model into the broader field of L2 research. Other implications are discussed.

Concordance in salivary cortisol and subjective anxiety to the trier social stress test in social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is characterised by an excessive fear of negative social evaluation. There is a limited understanding of how individuals with SAD react physiologically and subjectively to social stress. METHOD: The Trier Social Stress Test (TSST), an acute social stress task, was completed by 40 SAD individuals (50% female) and 41 healthy controls (matched on age, sex, and education) to examine salivary cortisol and self-reported stress reactivity. Salivary cortisol concentrations and self-reported affect (anxiety, sadness, tiredness, withdrawal, and happiness) were assessed at baseline and across nine-time points during the TSST. RESULTS: Bayesian salivary cortisol analyses revealed no group differences in salivary cortisol levels at baseline or during the TSST, with results comparative after the removal of 17 cortisol non-responders (21%). Contrastingly, the groups significantly differed on self-reported affect. At baseline, the SAD group (vs. controls) reported heightened negative affect and diminished happiness. In response to the TSST, the SAD group (vs. controls) displayed greater negative affect reactivity and diminished happiness reactivity, and significantly higher rates of change in their anxiety and sadness over time. After accounting for differences in the temporal resolution of self-reported versus cortisol responses, a moderate positive association was found between salivary cortisol and anxiety reactivity to social stress that was comparable between the groups. CONCLUSIONS: Despite elevated subjective anxiety, our findings suggest concordance in psychobiological stress reactivity in SAD and healthy controls. We discuss the possibility of heightened subjective sensitivity to social evaluative stress as a core treatment target for SAD.

The effect of virtual reality therapy and counseling on students' public speaking anxiety.

Background and Aims: One of the barriers to effective communication between speaker and listeners is public speaking anxiety (PSA). Over recent years, PSA has become common among students as the most widespread social anxiety (SA). Virtual reality (VR) and counseling therapy help reduce PSA. Therefore, the present study aimed to investigate the effect of VR therapy and counseling on students' PSA and SA. Methods: This quasi-experimental study was conducted on 30 students at three levels of undergraduate, postgraduate, and PhD at Kerman University of Medical Sciences and Shiraz University of Medical Sciences (15 students in the intervention group and 15 in the control group). The intervention group observed four virtual classroom scenarios in a 30-min session, and the control group attended a 90-min group counseling session. Data were collected using by Personal Report of Public Speaking Anxiety, Liebowitz Social Anxiety Scale, and Igroup Presence Questionnaire. The data analysis was done using SPSS version 21. Descriptive analysis (frequency and percentage, mean, standard deviation, and quartiles) and analytical tests (paired t-test and independent t-test) were used to analyze the data. Results: The results showed that VR and counseling did not affect SA scores and statistical differences before and after the intervention were not statistically significant. However, VR and counseling reduced PSA. The mean of IPQ/IGP (physical presence) was 63.73. The participants' SA means (93.76) were higher than the mean PSA (73.4). Conclusions: VR and counseling did not affect students' SA, but they reduced PSA. If the intervention duration in future studies are longer, the effect of VR and counseling on reducing SA is likely to become more apparent.

We, um, have, like, a problem: excessive use of fillers in scientific speech.

A filler is any word or sound that interpolates (i.e., is inserted into) the main message of a speaker. Common fillers include "um", "ah," "like," "so," and "you know?" among others. Excessive use of fillers in scientific presentations can reduce the credibility of the speaker as well as impair the comprehension of the speaker's message by the audience. Primary causes of fillers include nervousness/speaking too quickly, inadequate preparation time, and infrequently used words that are difficult for the speaker to remember while presenting. Recommendations for reducing the use of fillers include self-awareness of the problem, reinforcing feedback, and active intervention to render pauses silent (instead of verbal) by "chunking" content, increasing preparation time, and slowing presentation pace. Excessive use of fillers is an obstacle to becoming an effective public speaker, and therefore, efforts to reduce filler use should be a goal of professional development.NEW & NOTEWORTHY Although many articles exist on the use of filler words during public speaking, to our knowledge this is the first comprehensive discussion of the issue in the context of scientific presentations and speech in biomedical research. This Personal View discusses the problem of excessive filler use, the underlying causes, and tips for reducing fillers based on a combination of available literature and personal advice from a laboratory with nearly 40 years of experience in mentoring.

Public speaking disfluencies: A review of habit reversal training and research.

From 2016 to 2022, the Journal of Applied Behavior Analysis published 7 studies that evaluated the effects of habit reversal training on speech disfluencies (filled pauses) during public speaking. This review summarizes the participants, dependent variables, procedures, experimental design, and outcomes from this research including practice implications and suggested areas of inquiry.