Engagement and Adherence in VR therapy: Learning from Game Design Principles

One of the hardest parts of therapy isn’t just getting clients into sessions—it’s keeping them engaged between sessions, committed to homework, and consistent in their practice. This holds especially true in exposure-based treatments for phobias and anxiety: the more a client uses the tools and practices the exposures, the stronger the learning and the greater the chance of lasting change.

In the world of virtual reality exposure therapy (VRET), engagement and adherence aren’t simply nice extras—they’re crucial. What if we borrow from game design to boost these elements and help clients stay with change?

The First Step: Personalisation

Engagement is key to successful exposure. When clients feel a sense of control and relevance, they’re more likely to stay with the process long enough to experience lasting change. Research shows that perceived control reduces avoidance and improves treatment adherence [1]. In a virtual environment, that control can be built right into the design.

Instead of a rigid ladder of exposure tasks, personalised VRET allows clients and clinicians to shape the experience together. That means choosing scenes, adjusting difficulty, and tracking their emotional responses.

Studies have shown that customising exposure content to match the client’s specific fears significantly improves outcomes and reduces dropout [2]. VR technology takes that principle further by creating environments that respond to each client’s readiness and progress, moment by moment.

The Power of Game Design

The most effective digital mental health tools don’t just replicate therapy — they re-imagine it. Game design principles such as progress tracking, feedback loops, and reward milestones have been shown to enhance engagement and motivation in exposure therapy [3].

At oVRcome, we’ve taken inspiration from this evidence. Our platform allows clinicians to build tailored exposure hierarchies, while clients can see their own progress, mark key achievements, and even review earlier stages to see how far they’ve come.

This isn’t gamification for the sake of novelty — it’s a way to make therapy feel meaningful and rewarding. When clients see their courage quantified — perhaps through a fear rating dropping from 70% to 20%, or a once-avoided trigger becoming manageable — the data reinforces the emotional growth.

Personalisation Made Simple

oVRcome makes it easy to tailor therapy without adding extra workload. Clinicians can select from a wide library of immersive, real-life filmed environments — from airports and needles to social gatherings and enclosed spaces — and adapt the intensity of exposure to the client’s specific fear hierarchy.

The app also enables clients to practise between sessions, supporting a blended care model. They can record subjective units of distress (SUDs) ratings, track milestones, and revisit exercises when needed.

Meanwhile, clinicians can review this data to monitor progress, identify plateaus, and celebrate improvements — turning exposure therapy into an ongoing, collaborative process rather than a weekly appointment.

Engagement That Lasts

One of the most promising findings from recent research is that personalisation and presence work together to maintain engagement over time. Clients who feel both immersed in the environment and recognised as individuals show better emotional learning and stronger reductions in avoidance behaviours [4].

By combining custom exposure design with real-world visuals, oVRcome helps clients not only face their fears but stay with them long enough for meaningful change to occur.

The Future of VRET Is Personal

As digital mental health continues to evolve, the balance between technology and human connection becomes increasingly important. Clinicians bring the extensive expertise, empathy, and guidance — and platforms like oVRcome bring the tools to make that work more flexible, measurable, and tailored than ever.

Every step a client takes within oVRcome is unique to them — and every scene they face brings them one step closer to freedom from avoidance.

References

[1] Meuret, A. E., et al. (2012). Perceived control and exposure therapy for panic disorder: A mediational model of treatment change. Journal of Consulting and Clinical Psychology, 80(4), 625–638.

[2] Carl, E., et al. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 61, 27–36.

[3] Lindner, P., et al. (2019). Gamified smartphone-delivered, self-help intervention for social anxiety disorder: Randomized controlled trial. JMIR Mental Health, 6(5), e12259.

[4] Freeman, D., et al. (2022). Virtual reality in the treatment of mental health problems: A systematic review of recent evidence. Psychological Medicine, 52(6), 2310–2323.