Virtual reality exposure therapy (VRET) is a type of exposure therapy that uses virtual reality technology to simulate real-life anxiety-provoking situations in individuals with anxiety disorders. VRET has been used to treat various anxiety disorders, including phobias, panic disorder, posttraumatic stress disorder (PTSD), and social anxiety disorder. 

The mechanism of VRET is based on the principles of classical conditioning and habituation, where repeated exposure to the feared stimuli in a safe and controlled environment reduces anxiety and fear responses. 

Table 1 summarizes some guidelines for VRET. 
Smart scheduling strategy  Weekly 60-90 min sessions. Increasing the frequency of sessions helps with avoidance and improves compliance.
Persistence is the key!  Encouraged continued exposure as long as needed to alleviate anxiety. The longer the exposure situation, the better the results.
It’s all in the details!  Patients should use as much detail as possible.
Move at your own pace  Allow patients to progress at their own pace. Don’t be afraid of pushing them outside of their comfort zone.
The power of positive 

reinforcement 

Show empathy 

 Show your patients you appreciate them. Praise them for the exposure completed. 

Acknowledge how difficult the VRET is for the patient. Guide your responses in accordance with the patient’s reaction to exposure to maximize the effect.
Stimulus  Potent stimulus with precise methodological control.

Table 1. Clinical and practical aspects of VRET

The use of VRET in treating anxiety disorders has several advantages, including minimizing avoidance behavior and facilitating exposure to feared stimuli. 

VRET has been found to be effective in reducing anxiety levels and facilitating emotional engagement in exposure therapy. One of the main advantages of VRET is that it allows therapists to control the intensity of exposure, allowing for a more efficient and effective treatment. It allows providers to collect objective data on patients’ responses to exposure therapy. This data can be used to monitor progress and adjust the treatment as needed. 

The VR environment can be customized to match the patient’s specific fears and triggers, allowing for tailored exposure therapy. For example, patients with social anxiety disorder can be exposed to social situations, such as giving a presentation in a virtual environment. This exposure can help patients desensitize to their fears and learn how to manage their anxiety. 

This treatment modality can be used in various settings, such as clinics and hospitals, making it more accessible to patients. VRET can also be used remotely, allowing patients to receive treatment from the comfort of their own homes. Moreover, the technology can also appeal to younger patients who may be more familiar with the technology. 

Limitations of VRET:

While VRET has been found to be effective in treating anxiety disorders, its use has some limitations. 

  • One limitation is that VRET requires specialized equipment and software, which can be expensive and not widely available. 
  • Another limitation is that VRET may not be suitable for all individuals with anxiety disorders, as some may not be comfortable with the technology or may not respond well to exposure therapy. 
  • Additionally, the effectiveness of VRET may depend on the quality of the virtual environment and the level of immersion, which can vary depending on the software used. Morina et al. also suggested that a sense of presence was positively correlated with anxiety during virtual social interactions. 
  • Finally, augmented reality exposure-based therapy (ARET) may be a promising alternative to VRET, as it limits itself to producing certain virtual elements and then merging them into the view of the physical world. 

VRET has been found to be effective in reducing anxiety levels, and it may be as effective as in vivo exposure therapy in producing long-term behavioral changes. While VRET has shown promising results, it is essential to acknowledge its limitations and continue to research its effectiveness. With continued development and refinement, virtual reality exposure therapy has the potential to revolutionize the treatment of anxiety disorders.

Written by – Dr Val Bellman, MD PsyD

University of Missouri Kansas City, Psychiatry Residency Training Program, 

Kansas City, MO

References: 

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