Current State of Evidence for VRET in Psychotherapy

The current state of research on Virtual Reality Exposure Therapy (VRET) for various mental disorders shows both established effectiveness in certain areas and significant research gaps in others. Based on the latest meta-analyses, systematic reviews, and clinical studies, the evidence can be summarized as follows:

Specific Phobias

VRET shows very strong evidence for specific phobias (heights, spider phobia, fear of flying)1, 2, 3. A meta-analysis published in 2025 with 3,182 participants confirms the significant superiority of VR therapy over conventional interventions for anxiety disorders. (SMD = -0.95, 95%CI [-1.22,-0.69]) 4, 5. 

Specific findings:

• Efficacy: VRET shows significant effects compared to waitlist controls and is equivalent to traditional in-vivo exposure.
• Acceptance: Significantly higher acceptance with lower dropout rates (3% vs. 27% in real exposure)
• Self-guided interventions: Smartphone-based VR apps 6 weeks
• Dosage: Effective already after a longer session (45-180 min) or 8-12 sessions of 15+ min each 6, 7

Social Anxiety Disorder and Glossophobia

Die Evidenz für VRET bei sozialer Angststörung ist gut etabliert, jedoch mit Einschränkungen 1, 8, 9:

• Effectiveness: Significant reduction of social anxiety, comparable to traditional CBT exposure 1, 8
• Self-guided VR programs: Show effectiveness in social anxiety and public speaking with low drop-out rates 10
• Limitations: In generalized social anxiety disorder, pure VRET was less effective than in-vivo exposure 9
• Meta-analytic findings: Large effects vs. passive controls (g = 0.82), but non-significant effects vs. active controls​ 9

Post-Traumatic Stress Disorder (PTSD)

VRET for PTSD shows moderate effects with significant limitations 11, 12, 13:

• Primary efficacy: Moderate effects for PTSD symptoms (g ≈ 0.62) and depressive comorbid symptoms (g ≈ 0.50) vs. waitlist 12, 13
• Comparison with active controls: No significant differences to other active therapies (g = 0.25​)  12, 13
• Long-term effects: Sustained improvements after 3-6 months 13, 14 Population limitation: Predominantly male veterans studied, limited evidence for other types of trauma  12, 13

Depression

The evidence for VR-based interventions for depression is promising but still limited15, 16, 17:

• Effectiveness: VR interventions (often combined with CBT) show significant symptom reduction (g = 0.73, 95% CI 0.25-1.21) vs. controls
• Bewertung: Noch keine starke Evidenz für VR als unabhängige Erstlinientherapie, eher als ergänzende Option
• Heterogeneity: High variability between studies regarding intervention type and duration

Attention Deficit/Hyperactivity Disorder (ADHD)

VR interventions for ADHD show initial promising results19, 20, 21:

• Effectiveness: Meta-analysis shows large effects for omission errors (SMD = -1.38) and correct hits (SMD = -1.50)
• Attention: Significant improvements in sustained attention and vigilance measures
• Limitation: No improvements in impulsivity responses, limited number of studies 
• Current Research: A 2025 meta-analysis confirms a moderate reduction in attention deficits (SMD = -0.33)

Obsessive-Compulsive Disorder (OCD)

In obsessive-compulsive disorders, the evidence is very limited22, 23, 24, 25:

• Contamination OCD: Initial controlled studies show the effectiveness of Virtual Reality Exposure and Response Prevention (VRERP)
• Mixed Reality: A 2024 RCT with mixed reality ERP showed no significant differences compared to self-help ERP
• Gold standard: Classic ERP remains first-line treatment 26, 27, 28
• Research needs: Lack of solid VRET studies on OCD effectiveness 

Substance use disorders

VR-based cue exposure shows growing evidence29, 30, 31, 32, 33:

• Craving Induction: VR can successfully trigger cravings for various substances
• Alcohol dependence: VR cue exposure is feasible and well tolerated in patients in long-term rehabilitation 34
• Mixed therapy results: Studies on cue-exposure therapy with VR show heterogeneous outcomes
• Potential: Promising for relapse prevention, but more RCTs are needed 35

Eating disorders

VR interventions for eating disorders primarily focus on body image disturbances36, 37, 38, 39:

• Body image interventions: VR-CBT shows significant improvements in body image disorders and eating symptoms
• Cue-Exposure: VR environments with high-calorie foods trigger greater body dissatisfaction in ED patients
• First positive findings: One-year follow-up shows sustained improvements

Psychotic Disorders - gameChange Project

The gameChange VR project shows impressive results for agoraphobic avoidance in psychosis 40, 41, 42, 43:

• Efficacy: 6-week VR therapy led to moderate to large sustainable reductions in avoidance (49%), distress (19%), and paranoid symptoms (41%​)
• Automated Therapy: Self-Guided VR Therapy with a Virtual Coach in Everyday Social Situations
• IImplementation: Already recommended by the NHS for severe agoraphobic avoidance in psychosis patients

Implementation barriers and clinical practice

Despite positive evidence, significant implementation barriers exist45, 46, 47:

Main barriers:

• Knowledge and Training Gaps: Lack of VR Knowledge Among Therapists
• Financial Barriers: High Costs, Lack of Reimbursement
• Technological barriers: Technical issues, cybersickness, equipment shortage
• Therapeutic concerns: Worries about a "real" therapeutic relationship

Recommendations for Implementation:

• Training: Comprehensive training programs and hands-on training 
• Technology Development: More User-Friendly, Cost-Effective Systems
• Context-specific assessments: Site-specific barrier evaluations before implementation

Methodological Quality and Future Perspectives

Eine 2025er Meta-Analyse zu VR-Interventionen bei mentalen Störungen zeigt

• Study limitations: >50% of studies with high risk of bias
• Quality of evidence: Mostly low to very low certainty according to GRADE assessment
• Research needs: More high-quality RCTs with longer follow-ups required

The VR-CORE Framework49 recommends structured development phases:

• VR1: Content Development with Patient/Therapist Input
• VR2: Early tests on feasibility and acceptance
• VR3: Randomized controlled efficacy studies

Summary of Evidence Strength

Disorder picture	Evidence strength	Recommendation
Specific Phobias	Very strong	Clinical application recommended
Social Anxiety	Stark	Effective alternative to in-vivo exposure
PTBS	Moderate​	Equivalent to other active therapies
Panic/Agoraphobia	Moderate​	Comparable to standard CBT
Depression	Limited	Promising as a supplementary option
ADHD	Promising​	More research needed
Obsessive-Compulsive Disorder	Very limited	Classic ERP remains the gold standard
Substance disorders	Growing	Potential for Cue-Exposure Therapy
Eating disorders	Promising​	Focus on body image disorders
Psychose	Promising​	GameChange shows strong results

 

VRET has established itself as an evidence-based treatment for specific phobias and social anxiety disorders, while research on other disorders is still in the developmental stage. The biggest challenges lie in practical implementation and the need for higher quality research with longer follow-up periods..