Evidence-Based Virtual Reality for Mental Health and Rehabilitation
This page provides an overview of Virtual Reality, VR Therapy, VR Therapy Research, and recent developments in VR-based healthcare and rehabilitation.
What is Virtual Reality?
Virtual Reality (VR) is a computer-simulated world that, through the use of VR technology, allows artificial situations to be perceived and experienced as realistic. VR users can look around, move, and interact with the virtual environment.
VR addresses visual, acoustic, vestibular, and—depending on the application—other sensory channels, allowing intuitive interaction through user interfaces ranging from input devices and gesture recognition to neural interfaces.
VR technology can include a head-mounted display (HMD) with stereoscopic visualization or a multi-channel projection system (CAVE), supported by localized audio and, if needed, additional components such as motion platforms or systems for simulating heat, cold, or wind stimuli. Further essential VR modules include tracking systems, 3D computing hardware, and software for simulation, visualization, and control.
The configuration of a VR system determines the degree of immersion, and thus one of the key factors for the sense of presence in virtual reality.
VR can reliably evoke realistic emotional responses such as fear, craving, or stress. This is achieved through purpose-built virtual environments, selected stimuli, and interactive elements of varying intensity—matching or even exceeding the corresponding real-life situations.
As a result, VR opens up diverse fields of application in psychotherapy, neurorehabilitation, diagnostics, training, and education.
Use of Virtual Reality in Therapy
Virtual reality enables innovative digital and medical-technical solutions to improve health outcomes. Below is a selection of already established and emerging therapeutic applications.
Exposure Therapy Using Virtual Reality (VRET) – Evidence
The German S3 Clinical Guideline “Treatment of Anxiety Disorders” ›› provides the following recommendation grades and levels of evidence:
Virtual Reality Exposure Therapy (VRET) should be offered to patients with spider, height, or flight phobias—when available—if in-vivo exposure is not feasible. This recommendation is based on evidence level Ib (Eccles & Mason, 2001), indicating support from at least one randomized controlled trial (RCT) or a meta-analysis of fewer than three RCTs.
For social phobia, Virtual Reality Exposure Therapy may be used in addition to standard psychotherapy, but not as a stand-alone treatment.
The guideline committee suggests that VRET can be integrated as a complementary measure to standard psychotherapy and notes that VR can reduce the number of patients who refuse exposure-based therapy.
The summary assessment concludes that there is no sufficient evidence suggesting that VRET is less effective than in-vivo exposure.
International Guidelines and Regulatory Framework
The United Kingdom’s National Institute for Health and Care Excellence (NICE) highlights the potential of VR-supported exposure therapy in its recent recommendations, particularly for anxiety disorders and agoraphobic symptoms in the context of psychotic conditions. As part of its Early Value Assessments, NICE recommended the automated VR therapy program gameChange for use within the NHS under defined conditions to treat severe agoraphobia in people with psychosis—subject to ongoing data collection and an accompanying health-economic evaluation (NICE, 2023).
In the United States, VR-based therapies for selected indications have been prioritized by the Food and Drug Administration (FDA) under the Breakthrough Device Program. This includes applications for the treatment of chronic lower back pain as well as VR-supported interventions addressing agoraphobic anxiety in the context of psychotic disorders. The FDA does not issue therapeutic recommendations; rather, it evaluates medical devices based on safety, technical quality, and clinical effectiveness within the specific intended use. The Breakthrough Device designation does not constitute market authorization but provides an accelerated pathway with prioritized guidance and review for devices with significant potential clinical benefit.
Exposure and Behavioral Exercises in Psychotherapy
Exposure and behavioral training in virtual reality environments allow therapists full and detailed control over therapeutic scenarios. Exposure steps can be individually graded and repeated as often as needed. Exercises can be performed in adaptable contexts, independent of weather or physical environment.
Advantages of VR for behavioral exercises include:
- Complete and detailed control of the scenario by the therapist
- Individually adjustable and repeatable exposure levels
- Exercises in variable, customizable contexts
- Independence from real-world conditions such as weather or location
- Safe handling of situations that could be dangerous in reality
How VR therapy is applied in the treatment of specific phobias — illustrated here using the examples of public-speaking anxiety, fear of heights and arachnophobia — is demonstrated in the following video ›› from the Bad Sassendorf Children’s Clinic in an impressively clear, practice-oriented presentation.
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VR Therapy Systems for Clinics and Practices
VR therapy is already established in many hospitals and outpatient facilities (see ››).
The highly integrated VT+ExpoCart2 and VT+ExpoCart3 systems from VTplus offer the following benefits:
- Optimized for inpatient and outpatient therapy environments
- Fully integrated VR software and hardware components
- Dedicated therapist interface for treatment control and documentation
- Scientifically validated usability and clinical suitability
- Listed in the BfArM Medical Device Information Database
VT+ VR Therapy Systems › provide individually controlled exposure and behavioral exercises for treating anxiety, addiction, and social competence training, as well as stress management through virtual reality.
The systems include interactive VR therapy modules addressing social anxieties (e.g. public speaking, job interviews, social interactions), specific phobias (heights, spiders, flying, claustrophobia), and addiction therapy, such as nicotine dependence, allowing users to practice rejecting an offered cigarette in virtual reality.
VR Therapy Research
Further promising VR applications are found in medical therapy, neurorehabilitation (e.g. post-stroke recovery), and chronic pain treatment.
VTplus develops scientifically grounded medical technology applications, demonstrated by the active participation of its staff in numerous academic publications. (see: Publications)
The following applications are developed and clinically evaluated in cooperation with leading scientific, clinical, and industrial partners.
Neurorehabilitation After Stroke
Every year, approximately 270,000 people in Germany suffer a stroke and must undergo a lengthy neurorehabilitation process to regain physical and cognitive function and reintegrate socially and professionally. Despite substantial investment in rehabilitation resources, the time available for individualized therapy by physiotherapists, occupational therapists, and speech therapists is limited.
Within the research consortium “Rehality” ›, VTplus collaborates with the Neurological University Clinic of Tübingen and the Stuttgart Media University to enhance neurorehabilitation after stroke using an EEG/EMG brain-state–driven virtual reality therapy paradigm.
Treatment of Chronic Pain
Chronic pain often causes long-term suffering and significant limitations in daily life. Purely pharmacological treatment is typically insufficient and associated with side effects.
In the “VirtualNoPain” research consortium ››, VTplus and partners from the health and medtech sectors are exploring the use of virtual reality combined with neurofeedback to provide side-effect-free treatment of chronic pain and improve patients’ quality of life.
VR-assisted neurofeedback enables individuals to learn to self-regulate specific brain activities, receiving real-time feedback on brain signals that are otherwise not consciously perceived or controlled.
VR in Empirical Research
VR is used as a method in both basic and applied empirical research, offering advantages such as:
- Highly standardized and repeatable virtual environments and simulations
- Controlled manipulation of stimuli and situations
- Greater ecological validity than paper-based, image, or video-stimulus studies
- Measurement of implicit behavioral data such as approach behavior, head and body movement, and gaze – offering objective metrics
- Modifiable and reusable simulation setups
VT+ VR-Research Systems ›
VT+ VR-Simulation Software ›
- experimentally controlled data collection in virtual reality
- support of head-mounted displays and multi-channel projection systems
Further Information
Press reports from users of VTplus VR Therapy and VR Research systems are available in the Press Review ›.
Additional resources can be found on CyberSession.Info ››, including:
- Brief overview of treatment facilities using VT+ VR Therapy Systems ››
- Publications on the scientific evidence ›› for Virtual Reality Exposure Therapy (VRET), including RCTs, meta-analyses, and reviews
- Publications from empirical research ›› in the fields of anxiety, therapy, safety, neurophysiology, and experimental psychology using VT+ VR research systems and CyberSession simulation software
References
- Bandelow, B.; Aden, I.; Alpers, G. W.; Benecke, A.; Benecke, C.; Beutel, M. E., Deckert, J.; Domschke, K.; Eckhardt-Henn, A.; Geiser, F.; Gerlach, A. L.; Harfst, T; Hau, S.; Hoffmann, S.; Hoyer, J.; Hunger-Schoppe, C.; Kellner, M.; Köllner, V.; Kopp, I.; B.; Langs, G.; Liebeck, H.; Matzat, J.; Ohly, M.; Rüddel, H. P.; Rudolf, S.; Scheufele, E.; Simon, R.; Staats, H.; Ströhle, A.; Waldherr, B.; Wedekind, D.; Werner, A. M., Wiltink, J.; Wolters, J. P., Beutel M. E. Deutsche S3-Leitlinie Behandlung von Angststörungen, Version 2 (2021). https://www.awmf.org/leitlinien/detail/ll/051-028.html
- Eccles M, Mason J. How to develop cost-conscious guidelines. Health Technology Assessment. 2001; 5(16): 1–69. doi:10.3310/hta5160
- NICE – National Institute for Health and Care Excellence (2023): Virtual reality technologies for treating agoraphobia or agoraphobic avoidance: early value assessment [HTE15]. Published: 15 November 2023. https://www.nice.org.uk/guidance/hte15
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