One Tool, Many Fears: Treating Comorbid Phobias with Virtual Reality

Clients with specific phobias rarely present with just one fear. In fact, comorbidity among phobias and anxiety disorders is more common than not — and for clinicians, this often means navigating overlapping fear hierarchies, managing treatment length, and helping clients prioritise where to begin. Virtual Reality Exposure Therapy (VRET) offers a flexible, efficient, and evidence-based solution for treating multiple phobias in a targeted yet integrative way.

Meet Josh

Josh is 32, and he came to therapy for his fear of flying. But it quickly became clear that flying wasn’t the only issue. He also avoided elevators, couldn’t sit in the middle of a crowded movie theatre, and felt panicked at the thought of vomiting in public. These fears — claustrophobia, emetophobia, and social anxiety — were reinforcing one another and making it difficult for Josh to engage in everyday life, let alone get on a plane for work.

Rather than tackling each fear in isolation, Josh’s therapist used oVRcome’s VRET program to build a treatment plan that targeted the most disruptive fear first — flying — while keeping space open to explore the others. Sessions moved between a simulated airport, elevator environments, and public speaking scenarios. As Josh progressed, his confidence grew — and over time, his anxiety began to ease across the board.

The Challenge of Comorbid Phobias

Josh’s experience is far from rare. Many clients who seek help for one phobia will meet criteria for another. A person afraid of vomiting may also fear illness or contamination. Someone with aerophobia might also fear enclosed spaces, losing control, or being judged. These combinations aren’t just common — they’re clinically significant. Co-occurring fears can amplify each other, lead to more severe avoidance, and complicate treatment planning [1].

Traditional exposure therapy for multiple phobias can be time-consuming and logistically difficult. Coordinating real-world exposures for one fear — let alone several — might not be feasible within a short treatment window, especially when the feared situations involve flying, public speaking, or medical settings.

VRET Enables Efficient, Targeted Treatment

This is where VRET offers a clear advantage. With a digital platform like oVRcome, clinicians can access a wide range of phobia-specific environments in one place. That means multiple fears can be addressed without the logistical complexity of arranging in vivo exposure — and without leaving the therapy room.

For clients like Josh, who present with overlapping fears, VRET enables clinicians to tailor a protocol that mirrors their lived experience. A session might begin in an airport boarding lounge and end in a crowded lecture hall — with exposure intensity adjusted at every step. This flexibility is crucial when fear hierarchies are intertwined or difficult to untangle.

The virtual format also allows for rapid switching between scenarios, or focusing on one fear while keeping others in view — making the whole process feel more personalised and less overwhelming.

The Ripple Effect: Treating One Phobia Can Improve Another

One of the most promising findings in the treatment of comorbid phobias is this: targeting a single fear may lead to improvements in others. In a study of 100 children and adolescents receiving cognitive-behavioral treatment for a specific phobia, Ollendick and colleagues (2010) found that gains often extended beyond the primary target. Co-occurring fears and anxiety symptoms decreased — suggesting generalisation of treatment effects [2].

This has important implications. It means clinicians don’t necessarily need to resolve one fear entirely before addressing the next. Sometimes, just getting started — and helping a client master one fear — can spark broader change. For many clients, this builds motivation and a sense of self-efficacy that can fuel further progress.

A More Flexible Way to Deliver Exposure

Clients with multiple phobias often feel overwhelmed by the idea of “treating everything.” VRET offers a way to reduce that overwhelm by breaking exposures into manageable, step-by-step goals.

Clinicians can begin with the fear that’s most disruptive or distressing, then expand the scope as the client gains confidence. This could mean moving from enclosed spaces to fear of judgment in social settings — or layering two fears together when the client is ready. The therapist remains in control of pacing, intensity, and focus — helping the client feel safe and supported throughout.

Supporting Evidence-Based, Real-World Practice

oVRcome is built with real clinical use in mind. Therapists can monitor progress, adjust exposure intensity, and integrate cognitive strategies within the same platform. This makes it easier to stay grounded in CBT principles while working across multiple fear domains — even in short-term or resource-limited settings.

Importantly, VRET scenarios like those used in oVRcome are filmed in real-world environments, enhancing realism and emotional engagement. Compared to animated environments, this increased immersion can evoke more genuine anxiety responses — which makes the exposures more effective. 

A Smarter Way to Treat Complex Presentations

Comorbid phobias don’t have to mean complex or drawn-out treatment. With VRET, clinicians can work smarter — delivering targeted, effective exposure across multiple domains in a single treatment plan. Clients are more engaged, more willing to participate, and often see improvements that ripple into other areas of life.

Whether it’s flying, vomiting, social scrutiny, or enclosed spaces — helping clients face one fear may just help them face them all. 

References 

[1] Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678-686.

[2] Ollendick, T. H., Öst, L. G., Reuterskiöld, L., & Costa, N. (2010). Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders. Behaviour research and therapy, 48(9), 827-831.