What is Virtual Reality Exposure Therapy (VRET), and How Can It Help Your Clients?

Virtual Reality Exposure Therapy (VRET) is an innovative and increasingly evidence-based treatment approach that brings a new dimension to exposure therapy — quite literally. By using immersive virtual environments to recreate anxiety-inducing scenarios, VRET allows clinicians to deliver exposure in a controlled, repeatable, and often more engaging way than traditional in vivo or imaginal methods.

For clinicians working with clients who experience phobias or anxiety-related conditions, VRET can serve as a practical, accessible, and flexible tool to enhance therapeutic outcomes.

How Does VRET Work?

VRET builds on the well-established principles of exposure therapy, a core technique in cognitive-behavioural therapy (CBT), and the gold standard approach for anxiety disorders [1]. The idea is simple but powerful: repeated exposure to a feared stimulus, without the feared consequence occurring, can lead to desensitisation and reduced anxiety over time.

Traditionally, this is done by asking clients to imagine the feared situation (imaginal exposure) or to confront it in real life (in vivo exposure). However, both approaches come with limitations — clients may struggle to vividly imagine the scenario, or real-life exposure may be logistically challenging, expensive, or ethically difficult to replicate in-session.

This is where VRET offers an advantage. Using virtual reality headsets, clients can be immersed in realistic environments that simulate feared stimuli. Whether it's boarding a plane, standing at the edge of a balcony, or giving a speech to an audience, clients can engage in exposure tasks that feel real — but happen safely within the therapy room.

What Conditions Is It Useful For?

VRET has been most widely studied in the treatment of specific phobias, such as:

• Fear of flying (aerophobia)

• Fear of heights (acrophobia)

• Fear of public speaking (glossophobia)

• Fear of needles, spiders, dogs, and enclosed spaces

  
  

It has also shown promise for social anxiety disorder, PTSD, and panic disorder, particularly when exposure is a key component of treatment [2, 3].

Importantly, virtual environments can be graded in intensity, allowing for the kind of stepwise exposure hierarchy that clinicians are already familiar with. For example, a client afraid of flying can begin by simply entering an airport lounge virtually, then progress to boarding, takeoff, and turbulence simulations.

Why Might Clinicians Consider Using VRET?

There are several reasons VRET is gaining traction in clinical settings:

• Greater control and safety: VRET allows therapists to control the intensity and pacing of exposure with precision. If a client becomes overwhelmed, the session can pause instantly.

• Improved engagement: Many clients find VRET more engaging and less intimidating than real-life exposure, especially in early sessions.

• Accessibility: For clients in rural or remote areas — or those with limited mobility — VRET can offer experiences that would otherwise be out of reach.

• Consistency: Unlike in vivo exposure, where external factors may vary (e.g., weather on a bridge exposure), virtual environments are consistent and repeatable.

• Efficiency: Sessions can include multiple exposures in one sitting, making it easier to progress through an exposure hierarchy.

  
  

What Does the Research Say?

A growing body of research supports the use of VRET across a range of anxiety disorders. Meta-analyses have shown that VRET is as effective as traditional exposure therapy for anxiety-related disorders, and in some cases, even more acceptable to clients due to its flexibility and safety [4].

In a comparative study of patients with long-term agoraphobia, researchers examined three treatment groups: VRET combined with CBT, CBT alone, and medication only [5]. All patients were taking antidepressants, but both psychological interventions — VRET and CBT — led to significant reductions in symptoms at post-treatment and again at six-month follow-up. Notably, participants in the VRET group showed clinical improvement across most measures at follow-up, while the CBT-alone group had the highest dropout rates. These findings suggest that VRET may not only be clinically effective, but also enhance treatment adherence — a meaningful advantage for clients who find in vivo exposure too distressing or logistically difficult.

The appeal of VRET isn’t just in outcomes, but in accessibility. Exposure scenarios that might be difficult, unsafe, or impossible to arrange in real life — like boarding a plane or giving a speech to a crowd — can be simulated safely and repeatedly in session. For clients with avoidance tendencies, this often translates to greater willingness to engage, which can help maintain momentum in therapy.

What About Practical Concerns?

One of the most common questions from clinicians is: What do I need to get started?

The good news is that the technology is becoming increasingly affordable and user-friendly. oVRcome is designed with clinicians in mind — offering pre-programmed exposure hierarchies, phobia-specific environments, as well as skill building meditations to balance out exposure sessions. All that's required is a compatible smartphone and VR headset, and the app takes care of the rest.

Clinicians can use VRET as a standalone intervention or integrate it into existing CBT frameworks. It can be used in-session with therapist guidance, or in some cases, as part of a homework program for clients to use between sessions.

A Tool, Not a Replacement

It’s worth remembering that while VRET is a powerful tool, it’s not a stand-in for the therapeutic relationship. The expertise of the clinician remains central — guiding the client through exposures, helping them process emotions and cognitive patterns, and tailoring the experience to their unique needs. VRET simply expands what's possible in session. By integrating it thoughtfully, clinicians can offer clients a safe, structured, and often more engaging pathway to facing their fears — with the support, insight, and care that only a skilled professional can provide.

References

[1] Chowdhury, N., & Khandoker, A. H. (2023). The gold-standard treatment for social anxiety disorder: A roadmap for the future. Frontiers in psychology, 13, 1070975.

[2] Gonçalves, R., Pedrozo, A. L., Coutinho, E. S. F., Figueira, I., & Ventura, P. (2012). Efficacy of virtual reality exposure therapy in the treatment of PTSD: a systematic review. PloS one, 7(12), e48469.

[3] Botella, C., García‐Palacios, A., Villa, H., Baños, R. M., Quero, S., Alcañiz, M., & Riva, G. (2007). Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 14(3), 164-175.

[4] Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., ... & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of anxiety disorders, 61, 27-36.

[5] Castro, W. P., Sánchez, M. J. R., González, C. T. P., Bethencourt, J. M., de la Fuente Portero, J. A., & Marco, R. G. (2014). Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia. International Journal of Clinical and Health Psychology, 14(1), 9-17.