Virtual reality exposure therapy
The same technique with a different channel for the stimulus. What changes is that the stimulus is controlled, repeats identically and leaves a record. What does not change is that the indication and the judgement are yours.
What it contributes, and what it does not
Against in vivo exposure
In vivo the stimulus is real, and that is an advantage virtual reality does not match. What VR solves is what you cannot stage in vivo: a take-off with turbulence, a full auditorium, a glass lift fifty floors up. Neither cost nor logistics let you repeat that twelve times, and exposure needs repetition.
Against imaginal exposure
Imaginal exposure depends on the patient's imagery capacity and you cannot verify it: if they say it no longer distresses them, you have to take their word. In VR you see the scene they see, you know which step they are on, and the record stays. The difference is not the strength of the stimulus — it is observability.
What does not change
Case formulation, indication, the decision to move up or down a step and clinical responsibility remain yours. VR changes the stimulus and its record, not the theoretical model or the judgement. A badly indicated scenario is still badly indicated.
None of the above is a claim of superior efficacy. The meta-analyses place virtual reality exposure as non-inferior to in vivo, not better. The four levels of evidence, separated.
Where it is used today
The direct fit is well-delimited specific phobias: heights, flying, enclosed spaces, driving, speaking in public. Those are the presentations where the stimulus can be staged faithfully and graded in small steps, and where the literature on the technique is strongest.
It is also used to acclimatise a patient to the headset before the first exposure, and to close a session without sending someone home at their peak of activation — which is a different clinical purpose and uses different scenarios.
The scenarios available — with their real status, without counting what is still in build.
The technique, in parts
Everything below is about exposure as a technique, not about our software. It is the part that does not change whether you deliver it in vivo, in imagination or in a headset.
What it is and how it works
Modalities
How it is done
Limits and evidence
What clinicians ask us
What exactly is VRET?
Virtual Reality Exposure Therapy: exposure therapy in which the feared stimulus is presented in a virtual environment instead of in vivo or in imagination. It is not a different technique from exposure — it is the same technique with a different channel for presenting the stimulus. That is why the theoretical model and the contraindications are exposure's, not a separate set of its own.
Does it work for any presentation?
No, and that is worth saying. Where it fits directly is well-delimited specific phobias, which is where the literature on the technique is strongest. With comorbid panic disorder, dissociation or psychotic presentation the indication changes and contraindications need reviewing case by case. The scenario does not decide the indication — you do, after formulation. Our catalogue runs 5 phobia scenarios today.
Does the evidence support doing it in virtual reality?
Four levels have to stay separate. One: exposure therapy has decades of support. Two: exposure delivered in virtual reality has meta-analyses and trials in specific phobias. Three: a given application may or may not have its own study. Four: this software has no published clinical trial of its own. Presenting level two as if it were level four is the most common error in the sector and we do not make it.
How many sessions does a virtual reality hierarchy take?
It depends on the presentation and the patient, and each scenario page states the typical range for its protocol. What virtual reality changes is less the number of sessions than the ability to repeat the same step several times within a single session, which is hard to arrange in vivo.
What about cybersickness?
It is the adverse effect specific to this modality and it is real. It shows up more in long sessions and in scenarios with locomotion, less in stationary ones. The sensible approach is screening before you start, short sessions at first, and keeping the stop within reach. It is not a reason to rule the modality out — it is a reason to dose it.
See it in a real session before deciding
Thirty minutes with a licensed clinical psychologist. Tell us what presentations you see and we will check whether the catalogue covers them — and say so plainly if it does not.
Book a 30-min demo