Using Virtual Reality for Exposure Therapy: Applying Technology in Mental Healthcare

Virtual Reality Exposure Therapy (VRET) is revolutionizing mental health care by merging technology and psychotherapy. It provides an immersive, tailored option for treating anxiety disorders like social anxiety. It also has potential to be used in the treatment of PTSD, and specific phobias, by offering safer, more controlled, and engaging environments for care than traditional methods. For those who may not already be familiar with what virtual reality is, the experience consists of using a headset or similar device to visually and auditorily immerse in a new three-dimensional, interactive setting through a customized simulation1. 

Understanding Virtual Reality Exposure Therapy

VRET employs virtual environments to recreate feared scenarios or triggers, enabling patients to confront their anxieties in a safe and controlled setting. This method builds on principles of cognitive-behavioral therapy (CBT), using gradually increased exposure to the feared stimuli to help patients desensitize and reframe their responses.2 The input and coaching given to patients using VRET by mental healthcare providers can support the often difficult process of exposure therapy. 

For instance, those with social anxiety might practice public speaking in front of virtual audiences or practice navigating virtually-created social environments, while individuals with PTSD can process traumatic memories through carefully constructed simulations.1.2 

Benefits of VRET

There are several advantages to applying VRET tools, especially as a complement to an ongoing treatment plan. While it may not be as practical due to the constraints of traditional exposure therapy and the resources to coordinate environments that are needed, virtual reality can allow patients to immerse themselves in a scenario repeatedly1. Each patient may progress through exposure therapy at different rates, and revisiting a particularly difficult situation at a future time could be useful if that patients feels they need more experience with handling it. VR also offers customizable environments tailored to individual needs, enhancing therapeutic effectiveness.1 For example, tailoring situations to specific phobias or specific settings (e.g. navigating someone’s local airport) can help treatment tools be more true to life and the day-to-day experiences someone might face. 

Given that there are often high barriers to mental healthcare access, ranging from stigmatization of help-seeking, distance to care, providers shortages, and high costs due to, insurance coverage of treatments, VRET’s potential to address certain access barriers is promising.3 VR is unique in its ability to advance ease of access in exposure therapy. It removes logistical barriers to exposure by simulating complex or inaccessible scenarios, such as flying or natural disasters.4 Moreover, as VR equipment becomes more affordable, its reach is expanding to rural and remote areas, where telehealth may be the primary route for mental healthcare delivery.

Further, because providers have greater capacity to support the exposure therapy treatment of more patients, this technology can be expected to improve the efficiency of clinical treatments and reduce wait times. 

As is the case for most structured therapeutic approaches that extend across multiple sessions, exposure therapy is more effective when patients remain engaged over the course of all sessions. Dropout rates can be a significant obstacle in eliciting intended outcomes from exposure therapy. Again underscoring the need for technological integrations, studies show patients often prefer VR over in-vivo (real-life) or imaginal exposure due to its engaging nature and perceived safety.1If patients find VR more comfortable and engaging, there are better odds that they have strong adherence to their treatment plan. Because VR is a more scalable tool, more fine-tuned, gradual adjustments can be made to exposure scenarios. For example, increasing the size of an audience in a public speaking simulation by a given amount can be achieved through VR. Especially for veterans and trauma survivors, VRET allows safe re-experiencing of traumatic events, fostering emotional processing and resilience. 

Finally, more modern, high-quality VR systems integrate real-time monitoring, such as heart rate and eye movement tracking, to provide therapists with valuable insights into patient progress and stress levels.5 Because these physiological measure of arousal can be challenging to measure in real-time, whether that be due to the white-coat effect of being measured by a provider or delays in measurement, having realtime data on how exposure to different stimuli in the simulation impacted the client’s stress responses. 

Limitations of VRET

As with any technological innovation in mental healthcare, VRET is not without its own shortcomings. To acquire and utilize the highest-quality VR systems that would provide information on biological variables like heart rate and eye movements, costs would remain high.6 Though many VR systems are increasingly becoming cheaper, and trends are optimistic with regards to cost-effectiveness, this may replicate another disparity in access where low-income or remote patient populations are less able to access high-quality VR exposure therapy tools that may be the most beneficial. 

Though the use of VR for recreation and entertainment is widely understood, therapists require specialized training to effectively implement VR interventions for the sake of psychotherapy in clinical settings.7 There may be attitudes around the expense and time commitment required to be trained on the appropriate use of VR that increases resistance to provider uptake of this technology. For many, the fear that increased technological influence over the clinical sphere implies a reduction in the role of the provider can be another barrier.8 

Since VR technology used for exposure therapy functions may collect sensitive patient data, there are privacy and ethical concerns with its use.9 Therefore, VR needs additional layers of strict data protection measures. While there have been initial studies around the use of VRET in anxiety disorders and PTSD, there is a need for additional literature to base this practice in scientific evidence. One meta-analysis revealed that VRET significantly reduces symptoms of

PTSD, outperforming traditional exposure methods in some cases.10 Research published by Cambridge University Press highlighted its potential in treating social anxiety disorders, demonstrating both patient satisfaction and symptom alleviation.11 VRET effectively addresses social anxiety, generalized anxiety, and panic disorders by simulating distressing but non-threatening situations. A controlled study comparing VR and in-vivo exposure therapy for specific phobias found VR equally effective but more acceptable to patients.12 

Still, more large-scale, long-term trials are needed to assess its effectiveness across demographics and mental health conditions. 

The Road Ahead

All in all, Virtual Reality Exposure Therapy has potential to innovate mental health treatment, combining technological tools with therapeutic strategies to provide scalable, accessible, and effective care. By addressing existing challenges through research, provider training, and technological development, VRET can significantly reduce the burden of mental health disorders for the populations that face the highest barriers.