What Is VR Therapy?

Virtual reality (VR) therapy is a form of psychotherapy where the client uses a virtual reality headset to view specialized virtual environments during portions of their therapy. During the VR part of therapy, the therapist actively monitors and guides the client. The therapist also selects and controls what the client sees in virtual reality to provide therapeutic experiences. Using VR can make therapy faster and more effective.

The term 'VR therapy' can be misleading. VR is a tool that can used by a therapist to provide therapeutic experiences tailored to the needs of each client. Virtual reality experiences are not inherently therapeutic. An appropriate combination of therapeutic suggestions and VR content can be very compelling. 

VR can be used for therapy when the client and therapist are together in one location or for distance therapy (also known as teletherapy) where they are in different physical locations and communicate using a video link. A therapist may also recommend VR homework for a client (in some situations).

A virtual reality headset, or head-mounted display, fits over your head and covers your eyes. Displays and lenses in the headset give you a clear 3-D view of a virtual environment. As you move your head to look to one side, up, or down, what you see changes to reflect your new position and point of view. 

Virtual reality feels real and is immersive because you are surrounded by the visual images and cannot see anything else. Sound effects and other sensory inputs may be used to increase the authenticity of the virtual experience.

Depending on the type of VR headset, you may be able to move to a different location within the virtual world by using a handheld controller to teleport or by physically moving your body or walking (within limits). You may also be able to interact with virtual objects.

During VR therapy, the client wears a VR headset and views specialized virtual content. The therapist does not use VR or wear a headset. Typically, the therapist uses a computer where they can monitor and control what a client is seeing and doing in VR. The therapist can also change certain aspects of the virtual environment to create suitable experiences for each client.

Figure: VR Therapy Client and Therapist Display 

VR Therapy Client in headset and Therapist Display

VR therapy for anxiety issues uses a proven technique called cognitive behavioral therapy (CBT), sometimes combined with other types of therapy. Cognitive behavioral therapy involves understanding, challenging, and changing unhelpful thoughts as well as learning new ways of thinking and acting. Adding VR can help CBT progress quickly and may result in dramatic improvements. 

Therapy for anxiety issues typically includes:

  • Learning about the anxiety cycle in general and your personal anxiety cycle including your specific anxiety triggers, anxiety or panic sensations, fear and danger thoughts, and fear-based actions.

  • Reducing your triggers.

  • Changing your response to sensations and learning anxiety reduction or coping skills.

  • Changing your thinking by identifying and challenging fear thoughts (fears vs. facts), making contingency plans for dealing with realistic fears, and accepting things that cannot be changed.

  • Learning that physical sensations associated with anxiety are safe and harmless, even though they may feel uncomfortable. This may include physical exercises that cause similar physical sensations.

  • Facing feared or anxiety-producing activities and situations in a controlled manner to learn that these activities and situation are safe through repeated exposure.

To learn more about the anxiety cycle and how to break it, see Overcoming Anxiety and Panic interactive guide

A therapist may use virtual reality in several ways as part of anxiety treatment. Therapy sessions typically include a mix of talking and using VR. A client may not get to use VR during every session.

As part of anxiety treatment, a therapist may use VR for different purposes including:

  • Helping to identify or confirm a client's specific anxiety triggers and fears.

  • Training a client in specific anxiety reduction techniques or coping skills. For example, belly breathing, mindfulness, or progressive muscle relaxation.

  • Exposing a client to a feared activity or situation in a controlled manner while helping them practice and apply new ways of thinking and acting.

  • Creating positive, rewarding, or relaxing experiences.

 The 'exposure' part of anxiety therapy is where virtual reality provides the greatest benefit because VR exposure offers multiple advantages over the alternatives. Without VR a client must either imagine their feared experiences (imaginal exposure) or face these activities and situations in real life (in vivo exposure).

Virtual experiences are safe, repeatable, and fast, but they feel very real and can evoke a strong visceral response. Many different virtual environments are available. A therapist can select a virtual environment to match the specific activities or situations that each client finds anxiety producing. 

In virtual environments designed for therapy, the therapist can control aspects of the environment and tailor virtual experiences to the needs of each client. For example, in a virtual environment for treating public speaking anxiety, the therapist can adjust the number of audience members and how they react to a client's speech including their movements, verbal responses, and applause.

As part of treating a client for fear of flying a therapist might use VR to:

  • See if the client fears being in an enclosed space, by having the client enter a virtual environment of a small room and monitoring the client's reactions.

  • Have the client learn and practice belly breathing by following VR instructions.

  • Expose the client to different aspects of flying while they practice their new ways of thinking and acting with active monitoring and support from the therapist. For example, riding to the airport in a taxi, waiting for their flight in the gate area, boarding the airplane, take off, flying under different conditions (day/night, clear/stormy, smooth/turbulent), and landing.

  • Reward the client for working during the session by letting them experience a relaxing virtual environment.

Note: Exposure (in VR or any other form) is only therapeutic when a client has prepared for this step by learning new ways of thinking and acting while facing their feared activities and situations. The intensity of the experience must also be appropriate for the client's current progress in therapy. Exposure without adequate preparation, or experiences that are too intense, are not beneficial and can increase fears or damage the client-therapist relationship.