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Goal-Directed Exposure: Building Checklists and Concrete Milestones with Clients

Exposure therapy can be challenging for clients — and for clinicians too. One of the most effective ways to maintain structure, motivation, and clarity is through goal-directed exposure. Using concrete checklists and milestones transforms the process from something abstract (“face your fears”) into something measurable, encouraging, and collaborative.


Why Goal-Setting Matters

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Goals give exposure therapy direction. They help clients see progress, sustain motivation, and reduce avoidance. We know that specific, measurable goals are strongly linked to better adherence and greater therapeutic outcomes [1, 2].


Without clear goals, exposure can feel like endless repetition. With goals, each step has purpose — and each success, no matter how small, becomes tangible evidence of growth.


Turning Goals into Action

Effective goal-setting involves three elements:

  1. Specificity: “Hold a spider for 10 seconds” is more effective than “Work on spider fear.”

  2. Measurement: Using SUDs (Subjective Units of Distress) or exposure hierarchies helps both client and clinician track progress.

  3. Feedback: Reflecting on achievements reinforces confidence and strengthens therapeutic alliance.


Using Checklists in VR Exposure

oVRcome allows clinicians to build customised exposure hierarchies for each client, breaking large goals into achievable steps. For example:


Fear of Flying Hierarchy:

  • Look at a plane parked on the runway.

  • Sit in an airplane cabin during take-off simulation.

  • Experience turbulence at cruising altitude.


Each step is linked with a measurable distress rating, allowing clients to see their tolerance improve over time. This sense of visible progress can be highly motivating.


Milestones and Meaning

Progress is not only about distress reduction. It’s about meaning. Encourage clients to identify what each goal represents — “being able to visit family,” or “feeling calm on a business trip.” This helps shift focus from fear reduction to value-driven living, a key factor in long-term outcomes.


In oVRcome, milestone tracking allows clinicians to mark achievements and celebrate them collaboratively. Clients can see how far they’ve come, turning what once felt impossible into something measurable and shared.


Practical Tips for Clinicians

  • Collaboratively design exposure hierarchies: Let clients co-create the steps — it increases ownership and confidence.

  • Integrate visual progress tracking: Use apps or simple charts to show improvement in SUDs over time.

  • Anchor each goal to personal values: “Why does this matter to you?” helps connect therapy to real-life meaning.

  • Celebrate small wins: Recognising micro-achievements (e.g., reduced tension, improved breathing) builds positive reinforcement.

  • Review and revise: Goals should evolve as the client grows — adjust exposure difficulty based on tolerance and success.


Bringing It Together

Goal-directed exposure helps turn fear into forward motion. It provides clarity, accountability, and encouragement — all essential ingredients for lasting change.


At oVRcome, clinicians can use built-in hierarchy tools, progress tracking, and milestone feedback to keep clients engaged and motivated throughout their journey. Together, you can turn exposure therapy into a structured, value-based process that feels not just doable — but deeply rewarding.


References

[1] Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303–315.[2] Kraft, D., & Kraft, T. (2021). Goal setting in psychotherapy: A review and implications for practice. J Contemp Psychother, 51, 75–84.


[2] Kraft, D., & Kraft, T. (2021). Goal setting in psychotherapy: A review and implications for practice. J Contemp Psychother, 51, 75–84.


 
 
 
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