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.

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

A total of 31 participants who reported social anxiety were recruited online and engaged in a simulated videoconference task, where they interacted with multiple audience members’ emotional faces on a 3 × 3 split screen. Their video recordings were analysed using imaging photoplethysmography 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, and Social Phobia Scale.

Pearson correlation analysis revealed that STAI-X1 scores negatively correlated with high-frequency normalised units (HFnu) changes and positively correlated with low-frequency high-frequency (LF–HF) ratio and low-frequency normalised 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 videoconferencing.

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