How to Optimise VR Exposure Therapy: What Inhibitory Learning Looks Like in Practice

As VR becomes more common in clinical settings, the real question is no longer “Does VR work?” but “How do we use VR in the most effective way?”

Fortunately, decades of exposure-science research gives us clear, practical principles. When paired with VR, these strategies become even more flexible and accessible.

This article outlines how inhibitory learning research translates into day-to-day VR exposure, with no speculation beyond what has been established in empirical studies.

1. Expectancy Violation — creating moments that surprise the nervous system

What the research says: The biggest learning happens when clients expect something bad to happen… and reality proves them wrong. Baker et al. (2010) even showed that one exposure every two days produced long-term gains as long as expectancy violation was high [1].

Real-life example (acrophobia): A 20-year-old client is convinced that if they stand on a balcony, they'll “lose control and jump.” Instead of waiting for fear to drop, you ask:“What exactly do you expect will happen?” Then you design the exposure around disproving that expectation — maybe by having them stand near the railing for a set amount of time and noticing that the feared impulse doesn’t occur.

How VR helps: In VR, you can dial the balcony height to exactly the level needed to challenge the expectation. You can repeat the moment safely and tweak it until the client sees that their prediction is consistently wrong.

2. Deepened Extinction — combining cues to supercharge learning

What the research says: After extinguishing fears separately, combining them can reduce spontaneous recovery [2].

Real-life example (panic disorder): A client fears both:

• bodily sensations (e.g., dizziness)

• supermarkets

Traditionally you’d treat them separately. With deepened extinction, you might first complete some stand-alone interoceptive work (e.g., spinning in a chair), and some in-store exposures. Then you combine them:spinning + supermarket aisle.

For many clients, this is the exact moment when the therapy “clicks.”

How VR helps: Imagine creating a VR supermarket, then adding layers of interoceptive triggers — like an elevated heart-rate soundtrack or visual motion cues — in a single integrated environment. That’s where VR can take deepened extinction to the next level.

3. Safety Signal Reduction — removing the “just in case” hedges

What the research says: Safety behaviours often reduce short-term distress but weaken long-term learning, though the literature is mixed [3]. The general consensus: fade safety behaviours gradually, unless a client is ready for immediate removal.

Real-life example (social anxiety):Your client insists on texting a friend during exposures “just in case.” Instead of taking the phone on day one, you might say:“Today, it stays zipped in the bag. Next week, it stays at home.” You phrase it gently, but you’re working toward exposures where the client faces the feared outcome without backup.

How VR helps: VR can remove these signals automatically — no support person, no escape route, no phone in the virtual world. It creates clean exposure trials without relying on clinic logistics.

4. Variability — the big one for VR (and one of the strongest predictors of long-term success)

What the research says:Variable exposures (stimulus variability, timing variability, intensity variability) consistently produce better long-term outcomes than predictable, repeated exposures [3]. Importantly, fear often doesn’t habituate during variable exposures — and that’s fine.

Real-life example (spider phobia):Instead of repeating the same spider at the same distance until fear drops, you:

• show a small spider

• jump to a larger spider

• shift to one moving quickly

• move back to a medium one

• change lighting, distance, angle

Fear spikes and drops all over the place — and that’s exactly what strengthens inhibitory learning.

How VR helps:Here at oVRcome, we’re building a VR library with huge scenario variability — different environments, different stimuli, different intensities. If a clinician says, “My client needs a cluttered attic scenario, not a bedroom,” we can work with that. This variety means clients learn that they can handle fear across contexts, not just in one setup. VR makes variability effortless.

5. Retrieval Cues & Occasional Reinforced Trials

What the research says: Bringing retrieval cues into exposures helps reduce relapse after therapy [3].Occasionally allowing a feared outcome to “happen” (in a safe way) can also strengthen learning.

Real-life example (public speaking):Your client fears embarrassing themselves. On one trial, you deliberately introduce a minor stumble — a brief silence — and they see that the world doesn’t end. Then you give them a retrieval cue (e.g., a phrase or object) they can use later to reactivate the learning.

How VR helps:VR can intentionally build small, realistic “messy moments” — a cough from the audience, a microphone glitch — exactly the type of intermittent reinforcement that strengthens long-term learning.

Why This Matters for the Future of VR Exposure Therapy

There’s now an enormous body of research showing how exposure actually works — not through fear reduction, but through expectancy violation, variability, and learning that sticks across contexts. We understand these mechanisms more clearly than ever, and that means we can design exposure in a way that’s smarter, more targeted, and ultimately more effective for clients.

VR gives us the freedom to apply these principles with precision: shifting contexts, intensities, cues, and scenarios at the click of a button. It helps create the kinds of learning experiences that the inhibitory learning model predicts will lead to long-term change — memorable, surprising, varied, and deeply corrective moments.

And while no single method is a magic fix, the growing research base is showing that when we deliver exposure in this richer, more intentional way, outcomes improve. It’s an exciting time for the field and an exciting direction for VR-based treatment to continue developing in.

References

[1] Baker, A., Mystkowski, J., Culver, N., Yi, R., Mortazavi, A., & Craske, M. G. (2010). Does habituation matter? Emotional processing theory and exposure therapy for acrophobia. Behaviour research and therapy, 48(11), 1139-1143.

[2] Culver, N. C., Stoyanova, M., & Craske, M. G. (2011). Clinical relevance of retrieval cues for attenuating context renewal of fear. Journal of anxiety disorders, 25(2), 284-292.

[3] Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour research and therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006