Will VRET Become the First-Line Phobia Treatment in 10 Years?

The Framework for This Prediction

Predicting ten years out is an honest exercise only if it is framed in conditional terms. Predictions stated as certainties ("VRET will be first-line treatment by 2035") are noise. Predictions framed as probabilities across alternative scenarios, with critical variables identified, are a useful exercise for making decisions today.

This article does not claim that VRET will be the first-line treatment for specific phobias by 2035. It claims that this outcome is probable, based on current convergent signals, and it describes what would have to happen for that to be true, and what would have to happen for it not to be.

The intended audience is the psychologist who is considering training and equipping their practice with VRET today, and who wants to weigh that decision against a career-length horizon.

What 'First-Line' Means Today in Phobia Treatment

International clinical guidelines (NICE in the UK, the APA in the US, Spain's national health system practice guidelines for anxiety disorders) currently agree that first-line treatment for specific phobias is cognitive-behavioral therapy with in vivo or imaginal exposure, depending on the case. Medication (SSRIs, benzodiazepines) plays a secondary role, generally as an adjunct or when exposure is not feasible.

In vivo exposure has well-known advantages (robust efficacy, decades of accumulated evidence, low cost in its basic forms) and well-known operational limitations (dependence on a real-world stimulus, difficulty reproducing control conditions, risks in certain phobias such as blood/injury or heights, and treatment dropout in the face of intense initial activation).

VRET does not compete with in vivo exposure on mechanism — the therapeutic mechanism is the same: habituation, extinction of fear learning, cognitive restructuring. It competes on operational feasibility and clinical consistency.

For VRET to establish itself as first-line, it does not need to demonstrate superiority: clinical non-inferiority combined with pragmatic advantages (control, repeatability, safety, efficiency) would suffice. That bar is lower than it first appears.

Signal 1: Continuity of Public Research Investment

The US National Institutes of Health (NIH), through the National Institute of Mental Health (NIMH), has maintained competitive R01 and R34 funding for VR mental health projects over the past fifteen years. The absolute figures are modest compared with total mental health funding, but the flow is sustained and growing.

Horizon Europe, the EU's 2021-2027 research and innovation framework programme, has included specific calls in digital health and mental health that have funded VRET projects in the Netherlands, Germany, Spain, and Italy.

In Spain, the Instituto de Salud Carlos III, the Ministry of Science and Innovation (AEI-funded projects), and regional health R&D&I plans have financed occasional VRET projects at research groups in Valencia, Madrid, Barcelona, and elsewhere.

This funding is likely to continue through 2025-2035, especially if the next European framework programmes (the successor to Horizon Europe) keep mental health as a priority. Mental health is one of the declared priority areas in European health policy, and VR is one of the candidate technologies for scaling intervention.

Signal 2: Private Investment in the Sector

Series A and B funding rounds for VR mental health companies in 2023-2025 have held steady in volume, with several tens of millions of dollars raised annually in aggregate worldwide. Visible milestones include Mightier (cognitive-behavioral programs for children), BehaVR (behavioral intervention), Limbix (adolescent depression), Oxford VR (psychosis), and Sympatient/Invirto (Germany, specific phobias and social anxiety).

Large pharmaceutical companies have made moves of their own. Otsuka, as noted elsewhere on this blog, acquired a stake in Oxford VR. Other pharmaceutical companies are exploring acquisitions or partnerships in the space.

Private investment is an ambivalent signal: it indicates market expectation, but also carries hype risk followed by correction. The 2020-2022 digital health bubble produced significant corrections across the sector during 2023-2024. VRET has held up better than other segments (generic telehealth, evidence-free wellness apps), likely because of the robustness of its underlying clinical evidence.

Sector consolidation during 2026-2030 will likely reduce the number of players while professionalizing the survivors, which structurally favors their integration into health systems.

Signal 3: Institutional Adoption Already Underway

United Kingdom: the NHS has deployed more than 100 installations of the gameChange programme for psychosis following the evidence from the Freeman et al. (2022) trial. The institutional structure (NHS commissioning, NICE recommendations) is adapted to the product, and the use case has scaled in under four years since the trial was published.

Germany: the DiGA catalogue (Digital Health Applications), reimbursable by German statutory health insurers since 2020, includes Sympatient/Invirto for specific phobias, social anxiety, and panic disorder. It is the first case of systematic public reimbursement for clinical VR in Europe.

Netherlands: CleVR operates with partial insurer coverage and a presence in GGZ mental health centers under mixed funding.

United States: the VHA (Veterans Health Administration) maintains deployment of Bravemind and related tools for PTSD. US private insurers are beginning to code VR sessions specifically under some premium plans.

Spain and Italy: institutional adoption remains very limited, mostly pilot projects. But signals from the wider European environment (UK, Germany, Netherlands) exert indirect regulatory pressure on the systems lagging furthest behind.

Signal 4: Regulatory Maturation

The European Union has tightened its regulatory framework for medical products with the Medical Device Regulation (MDR 2017/745) and the In Vitro Diagnostic Regulation (IVDR 2017/746), being phased in progressively through 2021-2027. Medical software with clinical intent falls within this framework.

The EU AI Act (Regulation (EU) 2024/1689) classifies AI systems in healthcare as high-risk systems, with specific obligations. Its phased rollout through 2025-2027 directly affects VRET products with AI components.

In the US, the FDA regulates this kind of software under the SaMD (Software as a Medical Device) framework, with classifications I-IV and specific procedures (510(k) for Class II, PMA for higher classes).

Regulation is ambivalent: it raises barriers to entry (consolidating survivors with regulatory capacity), but it also legitimizes the field. A VRET product with, say, Class IIa medical CE marking is structurally more adoptable by public health systems than one without it.

Several VRET products with medical CE marking will likely appear on the European market within the next five to seven years, which will change the calculus of institutional adoption.

Signal 5: Cost-Effectiveness Pressure on Health Systems

European health systems are under growing budgetary pressure. Demand for mental health services has increased significantly since the pandemic, and available resources have not grown at the same pace.

Interventions that reduce treatment time, optimize human resources, or increase capacity to treat more patients with the same staffing are structurally attractive.

VRET has potential advantages on this axis: stimulus control (more efficient sessions), repeatability (patients can repeat exposure without a high marginal cost), distributed clinical supervision (one supervising psychologist can oversee several automated sessions), and reduced total treatment time in some protocols.

If cost-effectiveness studies confirm these advantages with methodological rigor — still a work in progress, not yet consolidated — institutional pressure to adopt VRET will increase significantly.

What Would Have to Happen for VRET to Be First-Line by 2035

Five convergent conditions would make this scenario probable.

An accumulation of multicenter non-inferiority trials in specific phobias demonstrating clinical equivalence with in vivo exposure and superiority on some pragmatic parameter (adherence, dropout, cost per session, accessibility).

Maturation of VRET products with Class IIa or higher medical CE marking, marketed by several established European providers.

Widespread institutional reimbursement: extension of the German DiGA model or the NHS UK gameChange model to other European health systems.

Inclusion in official clinical guidelines (an updated NICE, Spain's national health system guidelines, European Psychiatric Association guidelines) as a recommended option equivalent to in vivo exposure.

Formal university training: incorporation of VRET into master's programs in health psychology and clinical specialties, producing a professional cohort trained from the outset.

If all five are met between 2026 and 2033, consolidation as first-line treatment by 2035 is probable. If only three are met, it is plausible but not certain. If only one or two are met, it is unlikely.

What Would Have to Happen for VRET Not to Be First-Line by 2035

Three alternative scenarios are plausible.

Scenario A: a severe market correction, with consolidation reduced to a couple of niche players. Private investment declines, commercial products shrink, and the field survives in university research but does not scale. Clinical VR remains an interesting complementary modality without first-line status.

Scenario B: the emergence of a disruptive new modality (systematized non-invasive brain stimulation, pharmacologically assisted psychedelic interventions becoming mainstream, robust generative-AI therapeutics) that captures institutional attention and displaces VRET's momentum.

Scenario C: European regulation (the AI Act, a tightened MDR) so onerous that only two or three players with deep regulatory pockets survive, producing expensive products that are largely inaccessible to the average private clinic — which slows real adoption beyond the largest health systems.

None of the three is unlikely. Honest prediction is not certainty; it is weighted probability across scenarios.

What This Means for a Spanish Clinic's Decision Today

If the consolidation scenario is confirmed, clinics that train today and accumulate 8-10 years of VRET practice by 2033-2035 will be in a strong competitive position: documented clinical experience, their own case series, established training, and brand positioning in their local market.

If one of the alternative scenarios is confirmed instead, those clinics will have made an investment in training and equipment that has intrinsic clinical value — VR works, the evidence exists — even if it never consolidates as mass first-line treatment. The value is not lost; it simply does not multiply.

The rational question, in terms of decision theory under uncertainty, is this: the cost of training in VRET today — time, money, equipment — is low relative to the range of expected value over the next ten years. The asymmetry is favorable.

This is not a reason to rush in headlong. It is a reason for the psychologist who is on the fence to hesitate less. And for the one who has already decided to get in, it is a reason to do so with a career-length horizon, not just a trend to ride.

A Note on VRET and the Future

VRET (the product we distribute) is one player among several serious competitors in this sector. If the consolidation described in this article occurs, we do not assume we will necessarily be among the survivors. What we do assume is that the sector will consolidate in some form, and that clinics that have trained, equipped, and positioned themselves will have an advantage — whether with our product or another.

Our commitment for the years ahead is to build a product that deserves to keep being chosen by clinics that bet on VRET. If we do it well, we will survive consolidation. If not, others will. Either way, the sector and patients will come out ahead if consolidation happens with rigor.

VRET is a tool that supports psychological intervention, not a CE-marked medical device.

Further reading. To place this article within the rest of our editorial coverage, you can also read our complete clinical guide to virtual reality in psychological therapy, meta-analytic evidence supporting clinical equivalence with in vivo exposure, a current snapshot of VRET adoption in Spain, the regulatory framework applicable to clinical VR software, the investment and payback decision for a practice, and the state of insurer coverage for VR in Spain.

This article is for informational purposes for psychology professionals. It is not clinical advice for any individual case and does not replace the judgment of the licensed psychologist in charge. VRET is professional clinical-support software, not a CE-marked medical device.