The Power of Presence: Why Real-Life Feel Matters in VRET

In the world of exposure therapy, the task is simple in theory: let clients face their fears, allow new learning, and help them realise that the previously dreaded situation is manageable. With virtual reality exposure therapy (VRET), we are offered a powerful way to simulate feared situations in a safe, controlled space. But simply putting on a headset isn’t enough. What makes VRET effective is presence — the sense of “being there” in the virtual environment.

What is Presence?

Presence is the experience of being in one place or environment, even when physically you are somewhere else. In VR, it’s the psychological state where the virtual environment is treated by the brain as if it is real. According to research, presence is a key mechanism through which VR can evoke emotional responses like fear or anxiety, making exposure effective [1, 2, 3].

A meta-analysis found that in VRET for anxiety disorders, the correlation between self-reported sense of presence and anxiety during the session was moderate (r = .28 overall) — meaning the stronger the presence, the more the fear was activated. However, this correlation varied by disorder (for example, fear of animals r ≈ .50) which highlights the importance of designing environments that generate high presence [1].

Another study found that immersive VR (vs desktop or lesser immersion) significantly increased sense of presence (d = 0.90) and positive affect, suggesting that hardware and environment quality matter [4].

Why Presence Matters in VRET

• Emotional activation: For exposure to work, fear responses must be triggered. If a client feels no fear because the scene feels fake, then the learning is minimal. Research indicates that presence amplifies affective response in VR, meaning that a more “real-feel” environment is more likely to elicit the physiological and psychological arousal necessary for exposure learning [5].

• Transfer to real life: If the VR environment feels real enough, it bridges the gap between session and world, helping clients apply what they learn in VR to their everyday lives. When presence is low, the experience can feel like a game rather than a rehearsal for life.

• Engagement & retention: When a client “forgets” they’re in VR and reacts as they would in real life, the process becomes more immersive and meaningful—this increases engagement and thus supports better adherence to exposure tasks.

  
  

How oVRcome Delivers Real-Life Feel

At oVRcome, we embed presence into our VR modules through several design features:

• Real-life filmed scenes (not simple game graphics) so the environment, sounds, and interactions mirror what clients face outside.

• Multiple levels of difficulty to allow graded exposure and sustained presence as the client progresses.

• Integrated measurement of client responses (SUDs, session duration, tolerance) so you can see how presence and engagement correlate with progress.

• Blended approach: VR paired with facilitator or clinician debriefing helps translate the presence experience into therapeutic gains.

Practical Tips for Clinicians

• Set an intention before each VR session. Instead of jumping straight into exposure, ask your client: “What do you want to practise noticing today?” This anchors the experience and deepens immersion.

• Use grounding and embodiment cues. Encourage clients to notice physical sensations — the floor beneath them, their breathing, their heart rate. This sensory focus helps bridge their real body with the virtual scene, increasing presence.

• Introduce post-VR reflection. After each session, invite clients to describe what “felt real.” Discussing those moments reinforces learning and helps you fine-tune scene selection.

• Experiment with environmental realism. Adjust lighting, sound, and visual perspective within the headset (if supported) — small sensory tweaks can make a big difference to presence.

• Pair exposure with relaxation modules. If clients disengage due to overwhelm, integrating brief VR-guided breathing or PMR sessions between exposures helps sustain immersion over time.

Conclusion

Presence is not a luxury in VR therapy—it’s central. Without it, VRET risks becoming a simulation that fails to evoke the fear, the learning, and the change that clients need. With presence, the virtual becomes real enough to shift clients’ biological and psychological responses, enabling them to practise, adapt, and succeed.

By leveraging high-presence environments, tools like oVRcome give clinicians a way to deliver exposure that feels real, measurable and meaningful — and ultimately helps clients face their fears not just in the headset, but in living life.

References

[1] Ling Y, Nefs HT, Morina N, Heynderickx I, Brinkman WP. A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders. PLoS One. 2014;9(5):e96144. PubMed

[2] Garrett B, Taverna J, Gromala D. The Role of Presence in Virtual Reality Exposure Therapy. Cyberpsychol Behav. 2008;11(1):1–12.

[3] Slater M, Wilbur S. A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments. Presence (Camb). 1997;6(6):603–616.

[4] Ougland R, Torsheim T, Sørebø Ø, Grøtteland E, Jacobsen K. The effect of immersion on sense of presence and affect when experiencing an educational scenario in virtual reality: A randomized controlled study. Educ Inf Technol. 2023;28:6537–6557. PubMed

[5] Västfjäll D, Kleiner M, Gärling T, Meyer G. Effects of system‐ and media‐driven immersive capabilities on presence and affective experience. Virtual Reality. 2023;27:371–384. SpringerLink