Is Virtual Reality the Future of CBT Exposure Work?
What if you could simulate a traumatic environment, safely, precisely, and at the pace your client needs? For many CBT therapists, that's the promise of virtual reality (VR) exposure therapy.
CBT therapists often face a major hurdle: how do you safely expose clients to distressing scenarios when those situations are too dangerous, distant, or difficult to recreate?
Virtual reality exposure therapy (VRET) is rapidly emerging as a practical solution. It blends immersive technology with CBT techniques to offer flexible, controlled exposure.
But how realistic is this for everyday clinicians, and how effective is it in practice?
What exactly is VRET?
Virtual reality exposure therapy (VRET) is the use of immersive virtual simulations to support graded exposure, a foundational CBT technique. By placing clients in computer-generated environments that replicate their fears, therapists can tailor exposures in a structured, paced, and safe manner.
Traditional exposure therapy typically uses either imaginal or in vivo techniques, each with limitations. Imaginal exposure may feel too abstract for some clients, while in vivo exposure is often impractical, particularly when feared situations involve combat, hospitals, or specific phobias that are hard to recreate.
VRET bridges this gap by offering multi-sensory realism without the logistical or ethical concerns of real-world exposure.
This approach is especially relevant in treating PTSD and phobias, where real-life exposure can be emotionally overwhelming.
How VRET is Already Enhancing CBT and Therapeutic Practice
Recent studies suggest VRET can replicate, and in some cases enhance, the benefits of traditional CBT exposure by offering greater control, safety, and adaptability.
VRET is being integrated into treatment for phobias and PTSD1. It shows that VR-based exposure aligns well with CBT's core components, such as desensitisation, cognitive restructuring, and coping skill reinforcement.
Folke et al. (2023) demonstrated its real-world impact by showing reduced PTSD symptoms in Danish veterans after tailored VR sessions that recreated combat environments2. Likewise, van Loenen et al. (2022) found VRET comparable to traditional CBT across anxiety disorders, OCD, and trauma-related conditions3.
Mayer et al. (2022) explored VRET in clients with claustrophobia and found that modifying scene intensity and personalising scenarios enhanced patient engagement4. Another example includes the use of VRET for social anxiety, where patients can rehearse public speaking or attend virtual social events1. This flexibility makes VR uniquely suited for disorders involving avoidance.
What Should Therapists Watch Out For?
Therapists remain central to the VRET process, the technology is a tool, not a replacement.
But several factors must be considered:
Not all clients tolerate VR equally: some may experience nausea or find the virtual world emotionally flat¹.
Others may over-rely on tech without engaging fully with the therapeutic process.
Therapists also face structural barriers, such as access to quality VR equipment, training, and ethical concerns around data privacy. And yet, as studies like those by Mayer et al. (2022)⁴ and Jin et al. (2023)⁵ show, client interest in VR tools is growing, especially among those who struggle with traditional exposure methods.
While the potential of VR is clear, integration into clinical settings can be complex:
Therapists may lack training in VR operation or be unsure how to integrate it with CBT protocols.
Clinics must consider practical concerns, such as cleaning equipment between sessions, ensuring sufficient internet connectivity for app-based platforms, or managing licensing for VR content libraries.
Where Is VRET Already Being Used in CBT?
So, how is this being applied in therapy rooms today?
In practice, virtual reality exposure therapy (VRET) has been applied to a wide range of anxiety-related triggers. Studies included in the 2024 review highlighted its successful use in simulating the following scenarios:
Arachnophobia: Clients confronted increasingly realistic spider simulations, enabling gradual exposure without needing real-life contact¹.
Combat-related PTSD: Veterans engaged in virtual recreations of military environments, such as patrols and explosions, within a safe therapeutic setting².
Medical trauma: ICU environments were simulated to help individuals process anxiety related to hospitalisation and intensive care³.
However, successful implementation depends on thoughtful planning. Therapists must:
Select or tailor VR scenarios that reflect individualised triggers
Monitor closely for emotional distress or cyber-sickness
Include structured debriefing and coping strategy reinforcement after sessions
When delivered with clinical care, VRET offers immersive, flexible exposure without sacrificing safety or therapist oversight.
Expanding Access to Home-Based VRET
One major strength of VRET is its potential for accessibility. As portable headsets become more affordable and user-friendly, clients with mobility limitations, agoraphobia, or those living in remote areas may be able to access exposure therapy from home or in blended formats.
Studies have highlighted this flexibility as a key factor in user satisfaction5. Mobile VR platforms, such as those using smartphone headsets and app-based scenarios, may also allow therapists to scale exposure work without needing expensive installations.
What’s Next for VRET in Everyday Practice?
VRET isn’t a universal fix, but it offers significant promise6. With affordability improving and client openness growing, it may soon become a regular feature in CBT toolkits, particularly for clients with avoidance-based symptoms.
Future research should continue to explore optimal session design, long-term effects, and training requirements for therapists. Studies might also examine how VRET compares with in vivo exposure across different disorders, or whether hybrid models, such as VR combined with imaginal techniques, can improve outcomes. Longitudinal research is especially important for understanding how durable these gains are over time, particularly in cases involving complex trauma.
Refinements in VR design may further improve its effectiveness. For example, increasing the realism of scenarios, through richer sensory cues or interactive virtual characters, could boost emotional engagement.
Some clients may also benefit from the therapist being physically present during sessions, depending on the severity or interpersonal nature of their triggers. Tailoring scenarios to accommodate comorbid issues, like social anxiety or agoraphobia, may also support more nuanced exposure.
However, the takeaway is clear:
“The use of VR in the treatment of mental disorders […] opens up new opportunities for safe and effective exposure to stressful stimuli1.”
Author: Jessica Gomez Llanos
What do you think?
Would you try virtual reality exposure therapy in your practice? Which clients would benefit most, and what might hold you back? Let us know in the comments below.