Virtual Reality Exposure Therapy: Why Clients Prefer It — And Why Clinicians Should Pay Attention

Bella O'Meeghan
9 hours ago
3 min read

Exposure therapy has long been considered the gold standard for treating specific phobias and social anxiety. Traditionally, this has meant in vivo exposure therapy (IVET) — asking clients to confront feared situations in real life, such as stepping into an elevator, holding a spider, or giving a presentation. While effective, in vivo exposure is not without challenges: it can be logistically difficult, and anxiety-provoking enough that some clients refuse treatment altogether.

That’s where Virtual Reality Exposure Therapy (VRET) comes in. A 2025 systematic review and meta-analysis by Kuleli, Tyson, Davies, and Zeng has explored the important question of how VRET compares to traditional in vivo methods, with striking findings.

What the Review Found

The review analysed randomized controlled trials directly comparing VRET and IVET for adults with specific phobias and social anxiety disorder. The results were clear:

VRET and IVET are equally effective. Both produced moderate, significant reductions in anxiety symptoms. In other words, VR is no longer just an “interesting alternative,” it is clinically on par with the traditional gold standard.
Clients prefer VRET. Across studies, an impressive 76% of participants said they preferred VR exposure over in vivo exposure. Refusal rates were also far lower: only 3% declined VRET, compared with 27% refusing IVET (Garcia-Palacios et al., 2001).
Dropout rates are lower with VR. Because the environment feels safer and more controlled, clients are more likely to stick with the process and complete treatment.

Why Clients Prefer VR

From a client’s perspective, VR offers several advantages:

A safer starting point. Entering a virtual airplane cabin feels less daunting than boarding a real flight.
Control and flexibility. Exposures can be repeated, paused, or scaled in intensity in ways that are difficult to achieve in real life.
Privacy and dignity. Clients don’t have to face potentially embarrassing exposures (like public speaking in front of strangers) until they are ready.

This sense of safety and control doesn’t reduce effectiveness. In fact, it makes engagement more likely. For clients who would otherwise avoid therapy altogether, VR can be the gateway that makes treatment possible.

Why This Matters for Clinicians

For clinicians, these findings highlight several key implications:

VRET expands accessibility. Arranging in vivo exposures can be complicated. It often requires time and resources that people don’t necessarily have. With VR, you can bring these environments into your practice instantly.
Client engagement improves outcomes. The lower refusal and dropout rates mean more clients will actually stay in treatment long enough to benefit from it.
VRET integrates with existing models. The review notes that VR can be used alone or combined with CBT strategies like cognitive restructuring, relaxation, or skills training. This flexibility makes it easy to adapt VR to your therapeutic approach.
Evidence is now robust. While earlier reviews suggested VRET was promising, this 2025 meta-analysis confirms that VR is a clinically valid option for treating phobias and social anxiety, not just an experimental add-on.

The Bigger Picture

We’re living in a world where clients are increasingly comfortable with digital solutions. The fact that most prefer VR exposure over traditional methods is not just a curiosity, it’s a signal that the therapeutic landscape is shifting.

For clinicians, the takeaway is clear: VR is no longer a niche tool. It is an evidence-based, client-preferred, and practical way to deliver exposure therapy. Integrating VR into practice isn’t about replacing tried-and-true methods. It’s about meeting clients where they are, reducing barriers, and enhancing engagement with one of the most effective treatments we have for anxiety.

Reference

Kuleli, D., Tyson, P., Davies, N. H., & Zeng, B. (2025). Examining the comparative effectiveness of virtual reality and in-vivo exposure therapy on social anxiety and specific phobia: A systematic review & meta-analysis. Journal of Behavior Therapy and Cognitive Therapy, 100524. https://doi.org/10.1016/j.jbct.2025.100524