Virtual reality allows patients to practise dealing with anxiety-provoking situations in a protected setting. Through exposure to anxiety-provoking situations in virtual reality, patients may experience within therapy that feared consequences do not occur and that they can cope with their anxiety.
Virtual Reality Exposure Therapy (VRET) enables exposure and behavioural exercises in controllable virtual situations. Therapists can present anxiety-provoking stimuli step by step, adjust the intensity and repeat exercises – directly in clinics, outpatient settings or psychotherapeutic practices.
VTplus develops CE-marked VR therapy systems listed in the BfArM medical device database for professional users in psychotherapy, psychiatry and psychosomatic medicine. The systems can also be used in therapy research. They support guideline-based exposure exercises with virtual reality, particularly where real-life exposure is difficult to organise, not available or only possible to a limited extent.
A compact general introduction to virtual reality, VR therapy, VR therapy research, tolerability and medical-device-related aspects is provided on the page VR Therapy Overview. Building on that overview, this page focuses specifically on the use of virtual reality in anxiety disorders and VR-supported exposure exercises.
Exposure Therapy with Virtual Reality
Avoidance plays a central role in many anxiety disorders. Affected individuals avoid situations, places, animals or social situations that trigger anxiety. In behavioural therapy, such situations are approached deliberately and under therapeutic guidance as part of exposure exercises.
Virtual reality extends these possibilities. Instead of having to create a real-life situation with considerable effort, a comparable situation can be presented in a virtual environment. Patients experience the situation through a VR headset, while therapists can observe, guide and adapt the course of the exercise.
Exposure and behavioural exercises with virtual reality give therapists detailed control over the situation. Exposure steps can be individually graded and repeated as needed. Exercises can be carried out in varied and adaptable contexts, independently of weather, location and external conditions.
VR does not replace psychotherapeutic treatment. It serves as a controllable tool within a professional therapeutic process.
VR Therapy for Anxiety Disorders
Anxiety disorders can relate to very different situations. These include specific phobias, social anxiety and situations in which physical anxiety symptoms, anticipatory anxiety and avoidance substantially restrict everyday life.
VR-supported exposure exercises are particularly useful for situations that are difficult to plan, hard to access or associated with considerable organisational effort in therapeutic practice. Typical fields of application include fear of heights, fear of flying, fear of spiders, claustrophobia, social anxiety, public speaking situations, job interviews and social interactions.
What remains essential is the professional integration into diagnosis, clinical indication, treatment planning and therapeutic guidance.
Benefits of Virtual Exposure Exercises
Virtual reality offers several practical benefits for exposure and behavioural exercises:
- detailed control of the situation by the therapist
- individually graded exposure steps
- exercises that can be repeated as needed
- exercises in varied and adaptable contexts
- implementation independent of weather and external environments
- reduced logistical effort compared with real-life exposure
- use in protected therapy rooms
- structured preparation and debriefing
- documentation of the therapy session
For therapists, this creates additional flexibility. Exercises can be prepared, adapted and repeated where necessary without having to organise a real-life environment for every exposure session.
Effectiveness and Safety of VRET
The effectiveness of anxiety exposure in virtual reality has been demonstrated in a wide range of studies. The safety of VRET has also been investigated, including in a study published in the Journal of Anxiety Disorders. The authors reported that symptom deterioration with VRET was not increased compared with a placebo control condition and that adverse effects were rare.
The German S3 guideline for the treatment of anxiety disorders recommends exposure exercises in virtual reality for specific phobias where in-vivo exposure is not available or not feasible. For social anxiety disorder / social phobia, Virtual Reality Exposure Therapy may be offered as an adjunct to standard psychotherapy.
From a clinical perspective, VRET should therefore not be understood as an isolated technical intervention, but as a supportive procedure within guideline-based psychotherapeutic treatment.
VTplus VR Therapy Systems for Clinics, Outpatient Services and Practices
VTplus provides VR therapy systems for inpatient and outpatient facilities. The systems combine coordinated hardware, specialised software and therapeutic content into an integrated system solution for professional users.
The user interface is designed around therapeutic workflows. Therapists can select, start and stop VR exercises and monitor the course of the session. The virtual situation can be followed on a control monitor. Depending on the system configuration, additional options for documentation, research or data acquisition are available.
VTplus systems have been developed for use in clinical and therapeutic settings. They are not designed as consumer products, but as professional medical technology solutions for qualified users.
Scientific and Clinical Context
Virtual reality has been investigated for many years in psychological research, psychotherapy research and clinical application. Virtual exposure in anxiety disorders is an established field of research and clinical use.
VTplus combines the development of VR therapy systems with long-standing research experience. The technological basis includes VR simulation software, interactive virtual environments, therapist-oriented control interfaces, documentation functions and interfaces for research and evaluation.
The use of virtual reality should always be considered within a professional, therapeutic and regulatory framework. For clinics, practices and research institutions, the relevant factor is therefore not only the VR headset, but the complete system consisting of software, hardware, operating concept, documentation, training, support and regulatory responsibility for the medical device.
Who Is This Page Relevant For?
This information is intended for:
- clinics and psychosomatic treatment facilities
- psychotherapeutic outpatient clinics
- psychotherapeutic practices
- psychiatric and psychosomatic departments
- university outpatient clinics
- research institutions
- institutions interested in digitally supported exposure therapy
Patients who have questions about whether VR-supported therapy may be suitable for them should contact their treating therapist, physician or an appropriate medical institution.
Information for Treatment Facilities
Clinically deployable, fully integrated VR exposure systems support exposure and behavioural therapy exercises in inpatient and outpatient therapeutic settings.
VTplus GmbH is the manufacturer of CE-marked VR therapy turnkey systems registered in the BfArM medical device database. These systems have been developed for integration into existing clinical treatment workflows.
Information on fields of application, system architecture and professional use is available on the product page VT+ VR Therapy Systems.
Literature and Scientific Evidence
The following publications provide an overview of the scientific evidence on the effectiveness, safety and clinical application of Virtual Reality Exposure Therapy:
- Freitas, J.R.S., Velosa, V.H.S., Abreu, L.T.N. et al. Virtual Reality Exposure Treatment in Phobias: a Systematic Review. Psychiatr Q 92, 1685–1710 (2021). doi: 10.1007/s11126-021-09935-6
- Fernández-Álvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P. L., Baños, R. M., Benbow, A. A., Bouchard, S., Bretón López, J. M., Cárdenas, G., Difede, J., Emmelkamp, P., García-Palacios, A., Guillén, V., Hoffman, H., Kampmann, I., Moldovan, R., Mühlberger, A., North, M., Pauli, P., Peñate Castro, W., Quero, S., Tortella-Feliu, M., Wyka, K., & Botella, C. (2018). Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis. Journal of Anxiety Disorders. doi: 10.1016/j.janxdis.2018.06.005
- Morina, N., Ijntema, H., Meyerbröker, K., & Emmelkamp, P. M. G. (2015). Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, 18–24. doi: 10.1016/j.brat.2015.08.010
- Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: A quantitative meta-analysis. Depression and Anxiety, 29(2), 85–93. doi: 10.1002/da.20910
- Parsons, T. D., & Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), 250–261. doi: 10.1016/j.jbtep.2007.07.007
- Powers, M. B., & Emmelkamp, P. M. G. (2008). Virtual reality exposure therapy for anxiety disorders: a meta-analysis. Journal of Anxiety Disorders, 22(3), 561–569. doi: 10.1016/j.janxdis.2007.04.006
- Wechsler, T., & Mühlberger, A. (2025). Virtuelle Realität in der Psychotherapie. Hogrefe Verlag, Reihe „Fortschritte der Psychotherapie“, Band 97.
Further scientific publications are available in Publications and in the overview literature section.
Further Information
A general introduction to virtual reality, VR therapy, VR therapy research, tolerability and medical-device-related aspects is available on the page VR Therapy Overview.
Information on relevant collaborative research projects in therapy and health services research can be found in the EVElyn and OPTAPEB project articles as well as in VR-XR specialist portal articles on anxiety disorders.
The technological foundation of VTplus VR-supported therapy and research systems is described on the page VTplus VR Platform.
Information on VTplus VR therapy systems is available on the product page VT+ VR Therapy Systems. A selection of clinical institutions with established VR therapy services can be found under References.
For questions about the professional use of VR therapy in clinics, practices or research, please contact VTplus via the Contact page.
