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Neural Evidence of The Effect of Virtual Reality Exposure Therapy

At oVRcome, we’re big believers in virtual reality exposure therapy (VRET). We’ve invested in our own clinical trials, which demonstrated that the oVRcome app was effective at reducing the severity of specific phobia symptoms [1], and we’ve investigated the latest meta-analysis of VR in clinical practice in previous blogs.

But how exactly does VRET work to create sustained neurological adaptation in patients? Today, we’ll be diving into research from Korea University, Seoul, and published in the Journal of Medical Internet Research, that explored self-referential processing in individuals with social anxiety disorder (SAD) throughout their VRET treatment journey.

Social anxiety disorder affects an estimated 12.1% of U.S. adults at some point in their lives, and two-thirds of these individuals experience moderate or serious impairment. That’s over 20 million adults in the US struggling with SAD.

Clearly, we need accessible, effective and scaleable, treatment. Virtual reality exposure therapy presents a solution: let’s dive into the results of this study.

Background and Method

Dysfunctional self-referential processing is often a component of social anxiety disorder [2]. The individual perceives themselves as embarrassing, awkward, or more noticeable than they are, and SAD sufferers typically show hypersensitivity to self-related feedback. 

Despite a bulk of evidence indicating that VRET is as effective in treating social anxiety disorders and phobias as traditional treatment [3], little is known about the impact of VRET on neurological pathways. The authors set about to answer the question: how does virtual reality therapy change self-referential processing and neural mechanisms?

To do so, the researchers recruited 25 individuals with social anxiety disorder and 22 control individuals also participated. Participants with SAD received a six-session course of virtual reality exposure therapy, taking place after baseline testing. After the final session, participants completed follow-up MRI scans during which they were asked to judge whether a series of words with positive, negative, and neutral connotations were relevant to them.

Pre-study scans found that participants in the SAD group:

“had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing.”

How would a six-session course of VRET change the brains of these participants?

Results and Conclusions

Positively, we note that the authors found that overall symptoms of social anxiety disorder were reduced after just six sessions, demonstrating the immediate impact of VRET. Previous studies have found that clients can see positive results after just two sessions of VRET, with an optimal number of sessions at around nine to 10 [4].

In the post-treatment MRI scans, the researchers found increased activity in the SAD group when viewing positive words, in regions responsible for self-referential and autobiographical memory processes. A six-week course of VRET enabled better positive self-referential processing.

The authors concluded that these results reflect that virtual reality exposure therapy can lead to enhanced physiological and cognitive processing for those with social anxiety disorder. This allows self-referential information to be better interpreted, and accounts for the positive effect of VRET: patients and clients can accurately frame self-referential information, rather than experiencing it blown out of proportion in a way that causes shame, embarrassment and anxiety.

Virtual Reality Exposure Therapy in Practice

In practice, clinicians and therapists can leverage VRET in several ways. In-clinic VRET is safe and empowering for clients, and leads to better engagement and lower drop-out rates than traditional in-vivo exposure. Virtual reality is an excellent preparation for real-world exposure and allows clients to progress at a comfortable pace.

Additionally, VRET presents the possibility of prescribing therapy ‘homework’ to clients. Because VRET can be undertaken outside of face-to-face practice, it allows clients to progress faster and enables therapists to take on more clients, both remotely and in person.

This makes VRET a powerful tool for any practice: improved results and a lightened workload allow therapists and clinicians to allocate stretched resources effectively.

Wrapping Up

We know that VRET is an effective treatment option for social anxiety disorder, as well as a range of other phobias. This study provides insight into the neurological changes that take place as clients undergo treatment, and provides further evidence of significant long-lasting outcomes. 

With oVRcome, you can offer this powerful and proven new form of therapy remotely and in-clinic. Get started today and for a limited time only, you can add your first client completely free.


1. Lacey, C., Frampton, C., & Beaglehole, B. (2022). OVRcome – Self-guided virtual reality for specific phobias: A randomised controlled trial. Australian & New Zealand Journal of Psychiatry.

2. Yoon HJ, Seo EH, Kim JJ, Choo IH. Neural Correlates of Self-referential Processing and Their Clinical Implications in Social Anxiety Disorder. Clin Psychopharmacol Neurosci. 2019 Feb 28;17(1):12-24. doi: 10.9758/cpn.2019.17.1.12. PMID: 30690936; PMCID: PMC6361035.

3. Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., Loranger, C., & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial. British Journal of Psychiatry, 210(4), 276–283. 

4. Jeong, H. S., Lee, J. H., Kim, H. E., & Kim, J. (2021). Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder. Journal of Clinical Medicine, 10(5), 915.

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