A recent publication addressing the side effects and contraindications of virtual reality exposure therapy (VRET) is the study by Lohse et al., 2025 "Examining the safety and side effects of exposure therapy in virtual reality for patients with obsessive-compulsive disorder," which evaluated the safety and side effect rate of exposure with response prevention in virtual reality (VRRP) in patients with obsessive-compulsive disorder.
Results of the study:
- 80 outpatient patients were examined (VERP vs. standard treatment).
- In 47% of the participants, at least one side effect occurred (about 55% in the VERP group for VR-specific side effects).
- The most common side effects were "cybersickness" symptoms such as dizziness, nausea, or headaches. However, these occurred only in a mild form and were reversible.
- There were no significant clinical deteriorations in the symptoms and no serious adverse events.
- The study concludes that VR-based exposure is safe and can be considered a well-tolerated therapy.
In a systematic review in Frontiers in Psychology, the side effects and contraindications of Virtual Reality Exposure Therapy (VRET) were examined. (Wechsler et al., 2019):
Results of the review:
- In over 30 randomized controlled trials, side effects and the safety of VRET were systematically documented.
- The most common side effects of VRET are cybersickness (nausea, dizziness, headaches), typically mild and temporary.
- In addition, short-term disorienting effects and, in rare cases, increases in anxiety may occur.
- Serious adverse events have not been reported in the study data.
- Contraindications: Patients with known migraine, epilepsy (due to the risk of light-induced seizures), severe psychotic disorders, pronounced vestibular disorders, or serious eye diseases are considered a risk group and should be evaluated individually by a physician.
Summary of additional current review articles:
Side effects from VRET:
- Common side effects of using VR exposures include short-term dizziness, nausea ("cybersickness"), and occasionally temporary headaches.(Lozar et al., 2024)
- Disorientation and occasional increases in anxiety are reported less frequently.
- These symptoms can often be minimized through habituation, breaks, and adjustments to technique.
Contraindications in VRET:
- Contraindications include primarily migraines, epilepsy triggered by light stimuli, pronounced balance disorders, severe neurological diseases, and in some cases, psychotic disorders, such as a risk of dissociation or exacerbation of psychotic symptoms. (J. Schneider, 2025)
- Precautions are also necessary for people with severe cardiovascular problems or serious eye issues.
- It is recommended that the use in children and adolescents be planned individually and with special clarification, as long-term experiences are lacking. (O. Kothgassner, 2022)
Fazit:
VR exposures are classified as well-tolerated. The most common side effects are mild and reversible, particularly cybersickness. Contraindications mainly include ophthalmological, neurological, and certain psychiatric disorders. Therapy should only be conducted after individual risk assessment and careful explanation..
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