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Research Spotlight: Patient Perceptions of In Vivo Versus Virtual Reality Exposures

Virtual reality exposure therapy offers a new dimension for the treatment of specific and social phobias, complementing traditional courses of therapy like CBT and in vivo exposure. For clinicians, the big question about integrating treatment into their practice revolves around two things: efficacy and client perceptions.

Several research papers have backed the efficacy of virtual reality exposure therapy (VRET) [1]. But what do clients think of this new technological treatment? A new paper from researchers at Brown University explored this question, comparing attitudes to VRET with those towards in vivo exposure across five criteria. Let’s take a look.

Why Patient Perceptions are Vital to Treatment Outcomes

Patient perceptions are important for several reasons, spanning both the vital client-clinician relationship and user engagement with treatment programs.

Firstly, positive attitudes towards VR can significantly enhance engagement and adherence to virtual reality exposure therapy. When patients perceive VR as an innovative, safe, and effective treatment, they are more likely to commit to the therapy, attend sessions regularly, and complete the full course of treatment. While meta-analysis has identified that the attrition rate of in-vivo and VRET therapies are roughly similar [2], studies have identified that attrition rates of VRET can be lowered thanks to the opportunities for additional ‘homework’ sessions.

Additionally, when clients sense that their clinician is working to integrate innovative technologies into their practice, it can strengthen the relationship between patient and practitioner. While clinicians can be skeptical of new technology, it’s received enthusiastically when it’s presented effectively to patients and clients [3]. 

Demonstrating an embrace of cutting-edge technology in general, and VRET in particular, can be hugely beneficial for your practice, your client’s engagement with treatment, and ultimately, treatment outcomes.

Exploring Patient Perceptions of Virtual Reality Exposure Therapy

Virtual reality exposure therapy is a relatively new treatment option and can complement and precede traditional in vivo exposure. Understanding the interplay of client perception of these therapies is vital to providing effective treatment.

A study exploring this, titled Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study [4] was published in late 2023 by researchers at Brown University in the United States.


Participants in the study suffered from a broad range of phobias and disorders, including social phobias and specific phobias, as well as PTSD. They were presented with educational videos about both VRET and in vivo exposure therapy, before being presented with a web-based survey assessing five criteria across the two treatment forms. These were:

  1. interest in VRET and in vivo exposure

  2. willingness to use VRET and in vivo exposure,

  3. comfort with VRET and in vivo exposure,

  4. enthusiasm toward VRET and in vivo exposure, and

  5. perceived effectiveness of exposure therapy when delivered in vivo and through VR.

Quantitative and qualitative data was gathered through this survey with a rated scale and free-text response options to each question.


Of 184 completed surveys, 151 (82%) reported willingness to receive in vivo exposures while 166 (90.2%) were willing to receive VRET. The researchers stated: 

“Participants reported higher interest in, comfort with, enthusiasm toward, and perceived effectiveness of VRET compared to in vivo.”

The study found that patients and clients have a more positive perception of VRET when compared to in vivo exposure. They identified in vivo exposure with risks of  “feelings of embarrassment or shame” and exacerbation of their current condition, while concerns around VRET focussed on cost and efficacy.

Why do Clients Love VRET?

VRET is a popular treatment approach for a range of reasons. It’s easily accessed, offers encouraging progress from the outset, and gives clients a sense of control: a feeling that’s often lost when facing specific phobias and anxiety disorders.

  • Privacy, Safety and Comfort: In the qualitative responses, the surveyed participants commonly identified privacy as a benefit of VRET. Clients can undergo exposure therapy in a safe, familiar setting without the risks or logistical challenges associated with real-world exposure.

  • Gradual Exposure: VRET can provide gradual exposure to fear-inducing stimuli, which can be precisely tailored to the patient's pace, enhancing the therapeutic process.

  • Accessibility: For patients with mobility issues or those living in remote areas, VRET offers greater accessibility. It removes any need for travel and physical presence required by in-vivo exposure.

  • Reduced Stigma: Some patients may feel less self-conscious using VRET compared to real-life exposure, especially for socially stigmatized fears or phobias. In the study, participants related in vivo exposure to feelings of “embarrassment or shame”.

Wrapping Up

Studies exploring patient perceptions of treatment are important for two reasons. Firstly, they allow you to tailor your treatment options to your clients' needs, enabling you to grow your practice. Secondly, understanding clients’ reservations about treatment plans, and the benefits they perceive, is the first step in empowering them to engage enthusiastically with the treatment on offer. 

Your clients — current and future — could benefit from oVRcome’s innovative treatment. So are you ready to see how VRET could transform your practice? Sign up to our Clinician Portal today and add your first client for free.


1. Parsons TD, Rizzo AA. Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. J Behav Ther Exp Psychiatry. (2008) 39:250–61. 10.1016/j.jbtep.2007.07.007

2. Benbow, A. A., & Anderson, P. L. (2019). A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. Journal of Anxiety Disorders, 61, 18-26.

3. Madanian, S., Nakarada-Kordic, I., Reay, S., & Chetty, T. (2023). Patients' perspectives on digital health tools. PEC Innovation, 2, 100171.

4. Levy AN, Nittas V, Wray TB. Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study. JMIR Form Res. 2023 Oct 16;7:e47443. doi: 10.2196/47443. PMID: 37843884; PMCID: PMC10616729.

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