What is supported, and what is not
The question every clinician asks before paying. Answering it honestly means separating four things the industry blurs on purpose — and one of them is our own product.
Four separate planes, cited as if they were one
The move is always the same: cite a meta-analysis on virtual reality exposure, put the product logo underneath, and let the reader close the loop. Formally nothing was claimed; in practice, evidence belonging to a technique has been transferred to a piece of software.
Here are the four planes, most supported to least. The forbidden leap is citing the second to justify the fourth.
- 1
Exposure therapy as a technique
It is the treatment of choice for specific phobias and sits at the centre of clinical guidelines for anxiety disorders. Decades of literature and professional consensus.
None of this says anything about virtual reality. It is the common ground every platform starts from, competitors included.
NICE, 2011 (CG113) · APA, 2022
- 2
Exposure delivered in virtual reality
The available meta-analyses place it as effective against control and non-inferior to in vivo exposure across several anxiety presentations, with gains maintained at 12 months in the studies that measured it.
«Non-inferior» is not «better». Virtual reality contributes stimulus control, fine grading and repeatability — things in vivo exposure cannot give — not demonstrated superior efficacy.
Powers y Emmelkamp, 2008 · Opriş et al., 2012 · Carl et al., 2019 · Parsons y Rizzo, 2008
- 3
A specific application to a specific presentation
There are presentation-specific trials: acrophobia, social anxiety, spider phobia. The evidence is uneven and does not cover everything that can be simulated.
An acrophobia trial in virtual reality does not validate a driving-phobia scenario. Each presentation stands on its own literature or it does not stand at all.
Rothbaum et al., 1995 · Anderson et al., 2013 · García-Palacios et al., 2002
- 4
The VRET software
Nothing. VRET has no clinical trials of its own, no CE marking as a medical device, and no ISO certification. We are a tool a licensed psychologist uses to deliver a technique that is supported.
Any vendor using the level 1-3 literature to claim THEIR product is clinically validated is making a leap the data does not permit. Us included, which is why it is written here.
An operational advantage, not a clinical one
If virtual reality is not more effective than in vivo exposure, the reasonable question is why use it. The answer is not in efficacy; it is in what becomes possible:
- Exposing a patient, in the consulting room, to stimuli that do not fit in a consulting room: a take-off, a glass lift, an auditorium with an audience.
- Grading for real. Height, turbulence or audience size move in small reproducible steps, not in the jumps reality imposes.
- Repeating the exact same step next week — the precondition for knowing whether anything changed.
- Stopping in one second. The exit is taking the headset off, and that changes what a patient is willing to attempt.
- Not depending on the calendar or the weather to schedule an exposure session.
None of those five is a clinical claim. They are properties of the medium, and they stand on their own.
Twelve sources, with their links
These are the references used across the whole site, reviewed by our licensed clinical advisor. When an article cites something, it comes from here. If a source you consider relevant is missing, write to us and we will review it.
- Meta-analysisPowers y Emmelkamp, 2008
Virtual reality exposure therapy for anxiety disorders: A meta-analysis
Journal of Anxiety Disorders
Meta-analysis (k=13): virtual reality exposure is comparable to in vivo exposure across anxiety disorders, with a large effect size against control.
doi.org/10.1016/j.janxdis.2007.04.006 - Meta-analysisOpriş et al., 2012
Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis
Depression and Anxiety
Effective against waitlist and comparable to in vivo exposure, with gains maintained at 12 months.
doi.org/10.1002/da.21889 - Meta-analysisCarl et al., 2019
Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials
Journal of Anxiety Disorders
30 randomised controlled trials, roughly 1,057 participants: superior to control and non-inferior to in vivo exposure in specific phobias, social anxiety, PTSD and panic disorder.
doi.org/10.1016/j.janxdis.2018.08.003 - Meta-analysisParsons y Rizzo, 2008
Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias
Journal of Behavior Therapy and Experimental Psychiatry
Meta-analysis (k=21) confirming a large effect size (g=0.95) in specific phobias.
doi.org/10.1016/j.jbtep.2007.07.007 - Randomised controlled trialRothbaum et al., 1995
Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia
American Journal of Psychiatry
The first published controlled trial of virtual reality exposure, in acrophobia. The empirical starting point of the field.
doi.org/10.1176/ajp.152.4.626 - Randomised controlled trialAnderson et al., 2013
Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial
Journal of Consulting and Clinical Psychology
Randomised controlled trial against cognitive behavioural therapy in social anxiety: comparable results post-treatment and at 12 months.
doi.org/10.1037/a0033559 - Randomised controlled trialGarcía-Palacios et al., 2002
Virtual reality in the treatment of spider phobia: A controlled study
Behaviour Research and Therapy
Controlled study in spider phobia establishing clinical feasibility.
doi.org/10.1016/S0005-7967(01)00068-7 - ReviewMaples-Keller et al., 2017
The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders
Harvard Review of Psychiatry
Broad narrative review of virtual reality use across psychiatry and clinical psychology.
doi.org/10.1097/HRP.0000000000000138 - Clinical guidelineNICE, 2011 (CG113)
Generalised anxiety disorder and panic disorder in adults: management
National Institute for Health and Care Excellence, guía CG113
Reference clinical guideline. Frames virtual reality exposure as an adjunct to cognitive behavioural treatment, not a substitute.
https://www.nice.org.uk/guidance/cg113 - Clinical guidelineISTSS, 2018
ISTSS PTSD Prevention and Treatment Guidelines: Methodology and Recommendations
International Society for Traumatic Stress Studies
Recommendations for PTSD. Cited as a frame of reference, not as an indication for our catalogue: VRET has no PTSD scenario.
- Diagnostic manualAPA, 2022
DSM-5-TR — Trastornos de ansiedad: Fobia específica
DSM-5-TR
Canonical diagnostic criteria for specific phobia. Used to define, never to diagnose.
- Diagnostic manualAPA, 2022
DSM-5-TR — Trastorno de estrés postraumático
DSM-5-TR
Canonical PTSD criteria, with the same pedagogical and non-diagnostic use.
The reference corpus also includes several foundational works on exposure therapy — Wolpe, Foa & Kozak, Öst, Craske, Abramowitz — that are awaiting sign-off from our clinical lead and are therefore not cited on this page yet. They will be added when they are, not before.
What clinicians ask us
Is VRET clinically validated?
No, and any platform telling you otherwise is selling you something. What the literature supports is exposure as a technique and exposure delivered in virtual reality as a modality. VRET is software a licensed psychologist uses to deliver that technique: it has no clinical trials of its own, no CE marking as a medical device and no ISO certification. Conflating those two things is the mistake this page exists not to make.
Does virtual reality work better than in vivo exposure?
There is no data supporting that. The meta-analyses place it as non-inferior, which is a different and more modest result. What virtual reality contributes is not superior efficacy: it is stimulus control, fine grading, exact repeatability and the ability to expose a patient in the consulting room to things you cannot bring into the consulting room. Those are real operational advantages, and they do not need to dress up as clinical ones.
Does an acrophobia trial justify any scenario?
No. A controlled trial of acrophobia in virtual reality does not validate a driving-phobia or public-speaking scenario: presentation-level evidence is uneven and does not cover everything that is technically simulable. Each application stands on its own literature, and where there is none, the judgement is yours as a clinician.
Is VRET a medical device?
No. It carries no CE marking and is not marketed as a medical device. It is a tool supporting the practice of a licensed psychologist, who indicates, directs and interprets the intervention. Any diagnostic or therapeutic decision is theirs, with the instruments they already use for that.
What about cybersickness? Is there evidence of adverse effects?
Yes, and it is worth stating plainly: discomfort from visual-vestibular mismatch affects an appreciable minority of adults and is the best-documented adverse effect of virtual reality exposure. It is managed with prior screening, stationary scenarios, short sessions at first and immediate exit. The scenarios that provoke it least are the ones that do not move the patient, which is why they are where to start with anyone reporting motion sensitivity.
From the evidence to the consulting room
- The scenarios available — with their real status, without counting the ones still in build.
- Pricing — per practice, not per headset, and published.
- The clinical blog — protocols, hierarchies and the SUDS scale applied.
Thirty minutes, with your judgement in the room
If you have read this far, you already know we are not going to promise you clinical outcomes. The demo is to see the tool and decide whether it fits how you work.
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