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Virtual Reality Exposure Therapy: What to Know

Medically Reviewed by Jennifer Casarella, MD on June 23, 2022

When you think of virtual reality (VR), you might imagine someone with a headset playing a video game or watching a movie. But this technology can also help treat certain mental health issues when used under the guidance of a licensed mental health professional. It’s called virtual reality therapy or virtual reality exposure therapy (VRET). Here’s what you need to know.

What Does Virtual Reality Therapy Treat?

Virtual reality (VR) uses technology to swap real-life environments with made-up ones that look real. That’s called simulation. Exposure therapy helps you face your fears in a safe environment. It’s used to treat:

With VRET, experts combine VR technology with exposure therapy to mimic any triggers, stressors, or fears you may have, exposing you to them through a VR headset. This might include sights, sounds, smells, and vibrations that create realistic versions of the traumatic or stressful experience.

For example, if you’re scared of flying on a plane, VRET can simulate takeoff and landing without you having to step foot on a real plane. A licensed mental health professional works with you to control the length, pace, and intensity of the VRET sessions. Ultimately, the goal of VRET is to help ease your fears over time and improve your overall quality of life.

Who Might Virtual Reality Exposure Therapy Help?

Nearly 40 million American adults have some form of anxiety disorder. Without treatment, symptoms usually don’t go away and tend to get worse over time. Only about 37% get the help they need. That’s for several reasons, which include:

Fear. With traditional exposure therapy, you’re often asked to expose yourself to whatever it is you fear several times. This could make you uncomfortable or be too frightening. In some studies, the dropout rate was as high as 50%.

A hard time re-creating experiences. Two common types of exposure therapies used are in vivo and imaginal. With in vivo, if you’re scared of snakes, you might be asked to actually handle one. With imaginal, you might be asked to remember the time you were bitten by a snake, what happened afterward, how you felt, and so on.

But it’s sometimes difficult to re-create real-life scenarios at your therapist’s office, such as military-related combat or a car accident. And a therapist can’t really control your imagination, which could make therapy ineffective or unsafe in some cases. This is when VRET might be a good option.

Lack of trained therapists. As VRET gets more popular, there’s a lack of training for therapists who want to use it during sessions.

What Can You Expect During a VR Session?

During a VRET session, you might sit in a dark room and wear a headset that covers your eyes. You’ll be immersed in a virtual environment that triggers your trauma or fear. Your therapist will be able to see what you’re seeing. They can guide you through the session and control the intensity, length, and details.

The length of the session depends on what you’re able to tolerate. Your therapist might discuss this with you beforehand and help you prepare for it mentally and emotionally.

In a study that looked at the effects of VRET for agoraphobia (fear of crowded spaces or social gatherings), therapy was effective when it was done at least once a week for 15 minutes over a period of 8-12 weeks. In some cases, the sessions can last from 45 minutes to 3 hours.

Your therapist might also suggest medication and work with you to learn skills that can help during or after a VRET session.

What Are the Benefits of VRET Over Traditional Exposure Therapy?

Benefits can include:

Cost-effective. As VR equipment and software get more popular, VRET will become affordable. In some studies, researchers have used VR equipment for as little as $5-$300 using off-the-shelf apps and smartphones. A virtual environment is cheaper to create than rebuilding a real-life version.

Users have a sense of control. You can always stop or start based on your tolerance.

Treatment for those who lack access. In some cases, as quality and access for VRET grow, it may be possible to have your VRET session in the comfort of your home. This is helpful for those who lack child care, can’t get to an in-person session, or live in rural areas.

Long-term results. Benefits from VRET may last a long time. A study that looked at VRET effects after a year found that anxiety symptoms eased during sessions had remained low at follow-up appointments.

What Are the Challenges of VRET Therapy?

VRET is still a growing field, and there are some barriers or challenges, such as:

Slow adoption of VRET as an effective therapy. Mental health professionals often prefer face-to-face therapy. They also often rely on human judgment to measure mental well-being.

Access and choice of VR equipment. VR equipment, software, apps, and information on how to use them are not yet readily available for all therapists. But on the other hand, the growing number of products might make it difficult to choose or buy and will depend on their needs and skills.

Lack of VRET training. While VRET grows in popularity, there’s a lack of training available for therapists who want to use it during sessions. Therapists might need to update their skills and training each time a new version of the software is released.

More research is needed. Currently, VRET mostly covers anxiety disorders like phobias and PTSD. But with the growing demand and effectiveness of this therapy, there’s a need for more types of clinical VR content to address the growing number of issues that can benefit from exposure therapy.

Show Sources

SOURCES:

American Psychological Association: “What Is Exposure Therapy?”

Anxiety and Depression Association of America: “Facts and Statistics.”

Brainline.org: “Virtual Reality Exposure Therapy (VRET)”

Frontiers: “The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review,” “Using Virtual Reality Exposure Therapy to Enhance Treatment of Anxiety Disorders: Identifying Areas of Clinical Adoption and Potential Obstacles,” “Tips for Effective Implementation of Virtual Reality Exposure Therapy in Phobias – A Systematic Review,” “Virtual Reality Exposure Therapy for Anxiety Disorders: Small Samples and No Controls?”

National Institute of Mental Health: “Anxiety disorders.”

PLOS One: “Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review.”

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