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Accepted manuscript

Physiological Responses to Video Conferencing Exposure in Individuals with Social Anxiety: An iPPG-Based HRV Analysis

Published online by Cambridge University Press:  07 July 2025

Hye-Min Kim
Affiliation:
Department of Psychiatry, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
June Christoph Kang
Affiliation:
Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, Republic of Korea.
Young-Hoon Ko
Affiliation:
Department of Psychiatry, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
Cheolmin Shin
Affiliation:
Department of Psychiatry, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
Ho-Kyoung Yoon*
Affiliation:
Department of Psychiatry, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
*
*Corresponding author: Ho-Kyoung Yoon, MD, PhD, Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea. E-mail address: hkhkgogo@korea.ac.kr (H.-K. Yoon)
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Abstract

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Background:

Although social anxiety remains prevalent, conventional exposure therapy faces limitations such as limited accessibility, high cost, and low ecological validity. These barriers highlight the need for alternative, scalable methods that can effectively simulate social evaluative contexts.

Objective:

This study aims to evaluate the anxiety-inducing effects of video conferencing exposure, measured through heart rate variability (HRV), using a fully online-based methodology.

Methods:

A total of 31 participants who reported social anxiety were recruited online and engaged in a simulated video conference task, where they interacted with multiple audience members’ emotional faces on a 3×3 split screen. Their video recordings were analyzed using imaging photoplethysmography (iPPG) to obtain HRV data. Baseline anxiety levels were assessed using validated self-report questionnaires, including the State Anxiety Scale (STAI-X1), Trait Anxiety Scale (STAI-X2), Social Interaction Anxiety Scale (SIAS), and Social Phobia Scale (SPS).

Results:

Pearson correlation analysis revealed that STAI-X1 scores negatively correlated with high-frequency normalized units (HFnu) changes and positively correlated with low-frequency high-frequency (LF–HF) ratio and low-frequency normalized units (LFnu) changes. Similar patterns were observed for STAI-X2. These findings suggest that higher levels of trait and state anxiety are associated with greater reductions in parasympathetic activity and increased sympathetic activation during online video conferencing.

Conclusions:

This study underscores the clinical potential of online video conferencing as a scalable and accessible exposure therapy for the digital era, eliminating spatial and logistical constraints associated with traditional in-person exposure therapy.

Information

Type
Original Article
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

Footnotes

These authors contributed equally to this work