The Virtual Reality-based Exposure Therapy (VRET) is gaining increasing importance in the treatment of anxiety disorders. More and more research findings, guideline recommendations, and clinical reports support its use. However, despite convincing effectiveness, the reimbursement landscape in Germany remains inconsistent.
Current Reimbursement Situation in Germany
Statutory Health Insurance (SHI)
The inclusion of the Invirto app in the directory for digital health applications (DiGA) by the BfArM marks a milestone: it is currently the only VR-based therapy that is fully covered by statutory health insurance. It is approved for patients between the ages of 18 and 65 with agoraphobia, panic disorder, or social phobia.
Some health insurance companies are already going beyond this. For example, since 2024, the Techniker Krankenkasse has been reimbursing VR-supported rehabilitation measures using the CUREO® system in neurological aftercare. Other providers such as BKK Pfalz, AOK Sachsen-Anhalt, or the Innovationskasse support VR-based offerings within the framework of selective contracts. However, broad access outside of regional or DiGA offerings remains limited: therapists or patients must bear the costs themselves for a non-listed VR therapy.
Private Health Insurance (PHI)
Privately insured individuals have better access options: Coverage by private insurers is usually possible with the appropriate indication – especially for specific phobias or panic disorders. Often, a medical certificate or a psychotherapeutic report is sufficient to justify the necessity. Some providers also allow flexible reimbursement based on analog codes or within the framework of individual agreements.
Scientific Evidence and Recommendations
The S3 guideline for the treatment of anxiety disorders provides clear recommendations:
- In the case of specific phobias, VR exposure should be used when classical in-vivo exposure is not possible.
- VR can be used as a supplement to standard psychotherapy for social phobia.
- VRET is currently not explicitly recommended for panic disorder and agoraphobia, as there is not yet sufficient evidence available.
This differentiated stance also reflects the current state of research. At the same time, it calls for further clinical investigations.
Current Study Situation
Numerous meta-analyses support the effectiveness of VRET:
- A systematic overview (Goncalves et al. 2025) over 21 studies and 153 articles show that VRET delivers promising results, particularly in cases of panic, agoraphobia, and PDA.
- In a further analysis (Tsamitros et al., 2023) comparable effects to classical in-vivo exposure were observed.
- Für soziale Phobie bleiben die Ergebnisse teils uneinheitlich – manche Studien zeigen gleichwertige Ergebnisse, andere eine geringere Effektstärke im Vergleich zur In-vivo-Methode.
Exciting: New Studies(z. B. DRKS00031326) are currently expanding the use to outpatient settings, while projects like DRKS00035351 evaluating the application in borderline personality disorder – an indication of the increasing expansion of the use of VR in psychotherapy
Special Debate: Opportunities and Challenges
Therapeutic Benefits
Professional societies and practitioners emphasize the benefits of VR therapy:
- Controllability and repeatability of exposure
- Fine-tuning of anxiety intensity in real-time
- Lower threshold for patients
- Promotion of motivation through easy access to exposure
- Planning and deployment even with mobility restrictions
Especially for patients with severe agoraphobia or a high tendency to withdraw, VR is often a gateway to successful therapy processes.
Barriers to Implementation
Despite many advantages, challenges still exist:
- Kosten für Hardware und Software
- Mangel an Schulungsangeboten für Fachkräfte
- Uncertainties in the billing
- Fehlende Standardisierung der VR-Szenarien
- Legal uncertainties regarding data protection and documentation
These points are partly responsible for why many practices are still hesitant to adopt VR therapy – even though patients are increasingly open to it.
Future Perspectives: Digitalization as a Driver
With the Digital Healthcare Act, a structural framework for digital innovations has been established. Further VR-based applications are in development, both for anxiety disorders and for depression, chronic pain, and psychosomatic complaints.
Experts advocate for integrated therapy forms in which VR is not used as a replacement but as a complementary module to standard psychotherapy. Particularly promising are combinations with biofeedback, mindfulness training, or EMDR – for example, for stabilization in trauma therapy..
Conclusion
The virtual reality exposure therapy is fundamentally effective, recognized, and technically advanced, but the path to standard care is not yet fully paved. While DiGA-certified offerings are reimbursable, access for those with statutory health insurance to VR applications remains limited..
With growing evidence, increasing patient interest, and targeted investments in infrastructure and training, it is expected that VR-supported psychotherapy will become an integral part of psychotherapeutic care in the coming years.
