In recent years, Virtual Reality Exposure Therapy (VRET) has established itself as a serious alternative and complement to traditional exposure therapy. Particularly for specific phobias, there is a noticeable increase in high-quality studies in the current literature between 2022 and 2025 that demonstrate its effectiveness and practical applicability. This opens up a growing range of possibilities for therapists to make exposure with patients more flexible, safer, and simultaneously more intense.
The evidence base is most advanced in the treatment of acrophobia.. Freeman et al. were able to show in a large randomized study with 100 participants in 2018 that a fully automated VR intervention with a virtual coach led to exceptionally high effect sizes. The results were so clear that the VR therapy was superior to the traditional standard care, and this was achieved with comparatively inexpensive hardware. More recent work, such as that by Francová et al. (2025), confirm these findings. Standardized VR protocols with clearly defined task sets led to stable improvements that persisted even after two months of follow-up. Particularly interesting: the more the patients immersed themselves in the virtual environment, the better the treatment outcomes.
There is also a growing evidence base for animal phobias. A large-scale study by Schuler et al, 2025 the telemedical VRET treatment of dog, snake, and spider phobias has shown for the first time that sessions can be conducted entirely in the home environment using commercially available VR headsets. This development is particularly relevant for regions with limited access to care. Additionally, screening instruments such as the shortened SNAQ and SPQ scales have been validated, which allow for reliable diagnostics and correlate well with clinical ratings.
A particularly exciting field is emetophobia. Here, it succeeded Wallace et al, 2025 with an app-based VRET intervention a breakthrough: four out of six participants showed significant improvements, and two even fell below the diagnostic threshold. Although the sample size was small, this is the first controlled evidence for a previously underserved patient group.
Of high social relevance is also needle anxiety. The British healthcare system (NHS) has offered a free VR-Behandlungsprogramm implemented, which should facilitate access for patients in the context of vaccinations. Given that around ten percent of the population is affected, these programs represent a promising option. At the same time, automated VR therapies for adolescents have been developed in Oxford, which can be used in the school context.
There are also innovative approaches for claustrophobia. One of Gaina et al., 2024 developed, free VR app allows patients to independently carry out exposure exercises. Adaptive game elements increase motivation, while safety features ensure controlled use. Such solutions demonstrate how digital tools can also be applied in low-threshold settings.
Conclusion: In summary, it can be stated that VRET is not only "effective enough" to replace traditional in-vivo exposure for specific phobias. It is already comparable in many areas and superior in some aspects. Meta-analyses from the last two years confirm large effect sizes that are comparable to the results of traditional methods. Particularly relevant for practice is the possibility of utilizing automated and telemedicine offerings, which reduces the dependence on the immediate presence of therapists and significantly increases the reach of care.
Practical relevance: VRET is ready for clinical routine and everyday practice use. The evidence is robust for acrophobia, aviophobia, and animal phobias, significantly increasing for claustrophobia and trypanophobia, and promising for rare phobias such as emetophobia. Open questions mainly concern sustainability over longer periods, the treatment of comorbidities, and health economic aspects.
Outlook: The next few years will be crucial for developing standardized protocols and consistently translating the benefits of automation, telemedicine, and AI-based personalization into practice. VRET has the potential to fundamentally transform the treatment of specific phobias and is on the verge of moving from an experimental approach to becoming a staple of modern psychotherapy.
