Virtual-reality exposure therapy

Domain IX · Biomedical, neuro & digital · Rothbaum · 2001

What it is

Virtual-reality exposure therapy is exposure therapy in which the feared situation or trauma-related context is presented through a head-mounted display with head tracking and spatial audio, while the therapist watches the same scene on a monitor and controls what appears. It is a delivery medium…

Format

• PTSD (Virtual Vietnam): session 1 information gathering, emotional-processing rationale, brief breathing relaxation, and familiarisation with the equipment in a neutral environment.
• BRAVEMIND/Virtual Iraq: an introductory immersion of about 25 minutes exploring the environment with no narrative and no trigger stimuli, then full VRE with narration in the following sessions.

Who practises it, and how they are trained or regulated

• PTSD (BRAVEMIND MST pilot): session 1 history, treatment planning, rationale and breathing retraining; session 2 common reactions to trauma, in-vivo rationale and in-vivo hierarchy construction.
• Fear of flying: four sessions of information gathering, treatment planning, brief breathing retraining and cognitive restructuring.
• Regulatory and equipment status, as of October 2026 per the FDA's Augmented Reality and Virtual Reality in Medical Devices page (content current as of 4 September 2026): FDA's AR/VR device list names no device explicitly indicated for anxiety, phobia or PTSD; the mental-health-adjacent entries are pain and pain-related systems (e.g. AppliedVR's EaseVRx/RelieVRx, CognifiSense VRNT, Smileyscope). FDA states the list…

Evidence status, as the guide reports it

• Virtual-reality exposure therapy is exposure therapy in which the feared situation or trauma-related context is presented through a head-mounted display with head tracking and spatial audio, while the therapist watches the same scene on a monitor and controls what appears. It is a delivery medium…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• increased substance use, hopelessness, or self-harm after sessions.
• vendor terms that allow data reuse; recordings stored on shared devices.
• gaps between steps that are too large; hierarchies containing only VR items.
• clients asking you whether to change medicines; route those to the prescriber.
• the client hearing "get used to danger" rather than "learn the memory is not the present".

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.