What Is Virtual Reality Exposure Therapy, and Is It Right for My Phobia?
Phobias have a way of shrinking your world. A fear of flying rules out holidays. A fear of needles makes routine medical care something to dread. A fear of public speaking can hold someone back at school or at work for years. Traditional exposure therapy, gradually and safely facing the feared situation, is one of the most effective treatments we have for phobias. The challenge has always been practical: you can’t always take a client onto a plane, into a crowded room, or up a tall building as part of a session.
That’s where Virtual Reality Exposure Therapy (VRET) comes in.
What VRET actually involves
Using a VR headset and a therapeutic application, I can bring the feared situation into the therapy room in a controlled, gradual way. In my practice this means oVRcome software with a Pico 3 headset, which lets clients move into a range of environments in seconds.
Instead of only picturing standing somewhere high, a client can step onto a virtual balcony and look down, at a height they choose, for as long as they choose, with the ability to pause or step back at any point. This isn’t about throwing someone into their worst fear. It’s the same gradual, paced approach as traditional exposure therapy, just with a tool that makes the early, hardest steps far more manageable.
What it can help with
VRET can help with a wide range of specific phobias, including fear of animals such as spiders, snakes and dogs, as well as heights, enclosed spaces and lifts, darkness, needles, flying, traffic, crowds, vomiting (emetophobia), and public speaking, along with broader anxieties around open or unfamiliar spaces.
Why it works
The nervous system responds to VR environments in much the way it responds to the real thing, which is exactly what makes exposure effective. Because the situation is simulated, though, it can be introduced far more gradually and safely than real-world exposure often allows, and a session can include several rounds of exposure that would be impractical to arrange in real life.
Bringing the feared situation into the consulting room also removes a lot of practical friction. There is no need to travel to a high tower to work on a fear of heights, no cost-intensive trip to work on a fear of flying, and no need to source living spiders or an audience. Safety and insurance arrangements are far simpler too.
What the research says
VR exposure therapy, sometimes called exposure in virtuo, rests on the same rationale as in vivo exposure: the phobic stimulus is presented to the client, only here it is presented in virtual reality. The system tracks head movement and position in real time so that the virtual world responds as the real one would (Diemer et al., 2015).
The German Practice Guideline for anxiety disorders recommends VR exposure, on expert consensus, for specific phobias where in vivo exposure is unavailable or impractical (Bandelow et al., 2014).
Source: Frontiers in Psychology, Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg.
What a session looks like
We start with a conversation, not a headset. Understanding your specific fear, how it affects your life, and what you want to work towards comes first. When you’re ready, VR sessions are paced entirely around what you can tolerate, building up gradually. Between sessions, we talk through what came up and how you’re managing outside the room.
Is it right for you?
VRET is one tool among several I use, and it isn’t the right fit for every phobia or every person. If you’ve been putting off dealing with a specific fear because the idea of traditional exposure feels too overwhelming, it’s worth a conversation to see whether this approach could help. Get in touch to arrange an initial session.
