Virtual Reality Therapy (VRT): Definition, Usage and Drawbacks

Virtual Reality Therapy (VRT) involves the use of immersive virtual environments to help patients confront and manage various psychological and physical conditions. The Virtual Reality in Therapy Market Size was valued at USD 1.1 billion in 2023 and is expected to grow significantly. Projections show the market will expand from USD 1.5 billion in 2024 to USD 10.13 billion by 2032, with a compound annual growth rate (CAGR) of 31.20% during the forecast period (2024–2032), according to Market Research Future (2024).

VRT is applied in the treatment of anxiety disorders, substance use disorders, phobias, PTSD, and pain management, offering a controlled and safe environment for exposure therapy, stress reduction, and physical rehabilitation. Its versatility allows for personalized and progressive treatment, making it effective in many therapeutic settings. VRT has demonstrated a success rate of 66–90% for individuals with PTSD when combined with cognitive behavioral therapy (CBT), as explored in “Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis” by Goudman et al. 2022.

VRT also has drawbacks, including the potential for motion sickness, high costs, and limited accessibility, which affect its overall effectiveness for some users. About 22–80% of participants experienced cybersickness during or after VR use, as noted by Kim et al. 2021 in “Clinical Predictors of Cybersickness in Virtual Reality (VR) Among Highly Stressed People.” This discomfort reduces compliance with therapeutic VR applications, making it a challenge for treatment.

What Is Virtual Reality Therapy (VRT)?

Virtual Reality Therapy (VRT) is an immersive therapeutic technique that uses virtual environments to simulate real-life scenarios for psychological or physical treatment. VRT is employed for conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), phobias, substance use disorders, and chronic pain. VRT operates on principles of exposure, cognitive restructuring, and experiential learning, allowing patients to confront and manage fears or trauma in a controlled virtual setting. 

Sessions involve patients wearing VR headsets while interacting with virtual environments that mimic stressful or therapeutic situations, under professional guidance. Virtual Reality Therapy combines head-mounted displays, motion sensors, and therapeutic software to deliver immersive treatment experiences. 

Clark Atlanta University’s Human-Computer Interaction Laboratory established Virtual Reality Therapy (VRT) in 1992 as a therapeutic intervention using computer-generated environments. Max North pioneered Virtual Reality Therapy (VRT) research, starting in 1992 at Clark Atlanta University. North’s groundbreaking work included key publications and the development of therapeutic applications using computer-generated environments, with a focus on treating anxiety disorders and PTSD.

Researchers Pot-Kolder et al. 2020 examined the economic viability of VR-based CBT for treating paranoia in psychosis in the study “Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial.”The trial, conducted with 116 participants, demonstrated that VR-CBT led to a considerable uptick in social participation, with 90.74-99.74% of patients experiencing benefits over standard treatment. The cost per quality-adjusted life year (QALY) gained was estimated at €48,868 (approx. $53,000), indicating VR-CBT as a cost-effective option, though further long-term analysis is suggested.

A survey conducted in 2012 involving 262 therapists who had not previously utilized virtual reality (VR) revealed concerns regarding training, equipment, costs, and a lack of understanding of the benefits and applications of VR, as explored by Schwartzman et al. in “Perceptions of Virtual Reality Among Therapists Who Do Not Apply This Technology in Clinical Practice.” However, by 2019, a survey of 185 behavioral therapists indicated reduced concerns related to technical and cost issues, as VR equipment had become widely commercialized since 2016 as discussed by Lindner et al. 2019 in Attitudes Toward and Familiarity with Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-sectional Survey Study in the Era of Consumer VR Platforms.”

How Does Virtual Reality Therapy Work?

Virtual reality therapy (VRT) in addiction treatment works by using immersive virtual environments to simulate real-life triggers and scenarios associated with substance use. Therapists use VR technology, consisting of headsets and motion sensors, to create realistic, interactive experiences that allow patients to confront cravings and practice coping strategies in a safe setting. 

These virtual environments range from social situations where drugs are present to stress-inducing scenarios, helping individuals build resilience against relapse. Therapists guide them in controlling urges and making healthier decisions, enhancing the effectiveness of addiction recovery by repeatedly exposing patients to these simulations.

A meta-analysis of 39 trials evaluating virtual reality (VR) interventions for anxiety and depression found VR to be moderately effective in reducing symptoms compared to control conditions, with effect sizes of g = 0.79 for anxiety and g = 0.73 for depression at post-test, as stated in “The Effectiveness of Virtual Reality-Based Interventions for Symptoms of Anxiety and Depression: A Meta-Analysis” by Fodor et al. 2018. However, VR did not considerably reduce treatment drop-out rates, and issues such as high heterogeneity, potential publication bias, and the frequent use of waitlist controls impact the reliability of these findings.

How Is Virtual Reality Therapy Used for Addiction Treatment?

Virtual reality therapy is used for addiction treatment by addressing triggers and augmenting coping strategies. Virtual reality therapy (VRT) is increasingly utilized in addiction treatment to create immersive environments that simulate real-world scenarios, allowing individuals to confront triggers and practice coping strategies in a controlled setting. This innovative approach enhances traditional therapeutic methods by providing realistic experiences that promote engagement and learning. The common uses of virtual reality therapy for addiction treatment are explained below:

• Virtual Reality Exposure Therapy (VRET): VRET exposes patients to virtual environments that mimic situations associated with their addiction. This gradual exposure aids individuals in managing their cravings and anxiety in a safe space, reinforcing coping strategies as they navigate potential triggers.

Alcohol cravings in individuals with alcohol dependence were studied, including 10 patients who completed detox and 10 VR therapy sessions over five weeks, with brain scans showing that VR therapy slowed heightened brain metabolism linked to cravings, as outlined by Son et al. 2015 in “Virtual Reality Therapy for the Treatment of Alcohol Dependence: A Preliminary Investigation with Positron Emission Tomography/Computed Tomography.”

• Skills Training: VRT is used to teach essential skills for managing addiction, such as decision-making and assertiveness. Through role-playing scenarios, individuals practice responding to high-risk situations, amplifying their ability to cope with real-life challenges.

Virtual reality (VR) environments show potential in addiction therapy by triggering alcohol cravings and allowing patients to practice coping strategies in a safe space, as revealed in a study led by Associate Professor Bordnick P. 2008 in “Virtual World Therapeutic for Addicts: Study Shows Impact of Environment on Addiction Cravings.” The research involved 40 alcohol-dependent individuals who encountered realistic social scenarios, demonstrating that these immersive settings elicit cravings and help develop coping skills.

• Relapse Prevention: Virtual reality sessions focus on relapse prevention techniques by recreating environments where users are tempted to use substances. This approach allows individuals to rehearse their responses to cravings and stressors, strengthening their resilience against relapse.

In “Cigarette Craving in Virtual Reality Cue Exposure in Abstainers and Relapsed Smokers,” Schröder et al. 2024 found that lower craving levels during virtual reality cue exposure therapy (VR-CET) correlated with higher abstinence rates at six months. Of the 122 randomized participants, 102 received VR-CET, averaging 45.67 years old and attending an average of three out of four sessions. Before cessation, they smoked 17.93 cigarettes daily. After six months, 23.5% remained abstinent while 76.5% relapsed, indicating that effective craving management lowered relapse rates.

• Social Support: VRT facilitates social interaction by enabling patients to engage with peers in virtual settings. This promotes the development of a supportive community, supporting individuals to build connections that pivot them in their recovery journey.

A survey of 4,217 consumers conducted by Greenlight Insights revealed that 77% of virtual reality (VR) users desire increased social engagement within the VR environment, as noted by Koetsier J. 2018 in “VR Needs More Social: 77% of Virtual Reality Users Want More Social Engagement.” Despite many users not regularly utilizing their headsets, most plan to increase their VR usage in the future. The survey highlights that interest in social interactions in VR is particularly strong among Generation Z and Millennials, with activities such as playing games, watching videos, and engaging in video communications ranking highest in popularity.

What Are the Benefits of Virtual Reality Therapy?

The benefits of virtual reality therapy are numerous, encompassing enhanced accessibility, convenience, a controlled environment for practice, personalized interventions, and continuous support. VR therapy grants a unique and effective approach to mental health treatment by leveraging advanced technology. 

Virtual reality (VR) effectively reduces symptoms in individuals with anxiety disorders, including PTSD, specific phobias, and performance-based anxiety, according to Donnelly et al. 2021 in “Virtual Reality for the Treatment of Anxiety Disorders: A Scoping Review.” Of 28 studies, 17 showed positive outcomes with VR. One study established no major difference between standard care and VR treatment, while another showcased that standard care was more effective due to unrealistic VR stimuli. The remaining 9 studies confirmed VR’s feasibility for coaxing therapeutic anxiety levels, with one noting that immersive CAVE VR (which uses a multi-projection environment) provokes even greater anxiety.

The main benefits of virtual reality therapy include:

• Accessibility: Virtual reality therapy is accessed from anywhere in the world, breaking down geographical barriers and allowing individuals in remote or underserved areas to receive treatment.
• Convenience: Therapy sessions are conducted from the comfort of one’s environment, providing flexibility in scheduling appointments and eliminating travel time.
• Controlled Environment: VR allows individuals to practice coping strategies in a safe, controlled setting without the risks associated with real-life situations, aiding them to build resilience.
• Personalized Interventions: Therapists tailor VR experiences to meet the specific needs of each individual, ensuring that the therapy is relevant and effective for their unique circumstances.
• Continuous Support: Virtual reality therapy provides ongoing support and monitoring of individuals’ progress, allowing for adjustments to be made to the treatment plan as needed and reinforcing the therapeutic process.

What Are the Challenges of Virtual Reality Therapy?

The challenges of virtual reality therapy are ethical considerations, technological limitations, the need for trained therapists, security and privacy concerns, and high costs of technology. These challenges preclude the productive implementation of virtual reality therapy, influencing accessibility and efficacy for individuals seeking treatment.

The main challenges of virtual reality therapy include:

• Ethical Considerations: Ethical issues arise regarding informed consent and the potential emotional distress that immersive experiences cause. To address this challenge, therapists certify clients understand the VR experience, cover risks and benefits, and grant thorough debriefing sessions for emotional support.

A correlation exists between virtual reality gameplay and amplified negative emotions among players, as found in a study by Lavoie et al. 2020 “Virtual Experience, Real Consequences: The Potential Negative Emotional Consequences of Virtual Reality Gameplay.” Among the 138 participants, 96 (69.57%) had tried virtual reality, and of these, 34 (35.42%) reported experiencing a strong negative effect that persisted after the VR experience, with many recounting that this effect lasted for a considerable time.

• Technological Limitations: Hardware or software malfunctions disrupt therapy sessions, limiting accessibility. Ensuring regular maintenance and having backup systems in place mitigate this challenge.

Broadband internet access poses a barrier to virtual reality therapy, as approximately 27% of Americans lack reliable or affordable access, as discussed by Ong et al. (2022) in “The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review.”

• Trained Therapists: A shortage of therapists trained specifically in VR therapy hinders result-worthy patient guidance. Increasing training programs and resources build a workforce skilled in virtual reality interventions.

In a survey study examining therapists’ views on telehealth-based virtual reality (VR) therapy, 176 U.S. mental health providers were assessed in June- July 2023, revealing that 51.14% had no prior VR experience and only 6.25% had used it clinically. Despite this lack of experience, therapists expressed interest in various applications of tele-VR, such as for social situations and exposure therapy, with key factors for implementation identified as HIPAA compliance, affordability, and accessibility, as revealed by Ong et al. 2024 in “Mental Health Providers Are Inexperienced but Interested in Telehealth-Based Virtual Reality Therapy: Survey Study.”

• Security and Privacy Concerns: The storage and transmission of sensitive patient data in virtual environments pose privacy risks. Implementing robust data protection protocols and encryption safeguards patient information.

A study found that users are identified with 83% accuracy across multiple sessions of the same activity and with 80% accuracy when performing a different task, according to Kumarapeli et al. 2024 in “Privacy Threats of Behaviour Identity Detection in VR.”

• High Costs of Technology: The expense associated with acquiring and maintaining VR equipment is prohibitive for some practitioners and patients. Exploring funding options and partnerships breaks financial barriers to accessing VR therapy. Conversely, this cost has over the years been declining.

The price of VR systems has decreased over time, with smartphone-based VR therapy systems now available for as little as $600, as outlined by Maples-Keller et al. (2018) in “The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders.”

You may also be interested in our other articles such as:

Hypnotherapy: Definition, Usage, Process, Safety, Regulation and Misconceptions

Electroconvulsive Therapy (ECT): Benefits, Usage, Procedure, Side Effects and Efficacy

Pranic Healing: Technique, How It Works, Application, and Consideration

How Effective is Virtual Reality Therapy?

Virtual reality therapy is 60-90% effective. VRT has shown a success rate of 66% to 90% for individuals with PTSD when integrated with cognitive behavioral therapy (CBT), as discussed in the study “Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis” by Goudman et al. 2022. Virtual reality is being used in blending psychological elements with addiction science. Researchers at Indiana University, led by Professor Brandon Oberlin, are using virtual reality (VR) to aid recovery in individuals with substance use disorders. Funded by over $4.9 million from the NIH, the team developed life-sized “future-self avatars” that allow users to interact with personalized future versions of themselves. This VR method aims to strengthen connections to one’s future self, potentially reducing relapse risks and enhancing recovery by encouraging choices that favor long-term benefits over immediate rewards, as proposed by Oberlin’s pilot study published in Discover Mental Health.

Can Virtual Reality Therapy Be Combined with Other Therapies?

Yes, virtual reality therapy can be combined with other therapies. It’s acknowledged that virtual reality therapy (VRT)  VRT expresses an effectivity rate of 66% to 90% for individuals with PTSD when amalgamated with cognitive behavioral therapy (CBT), as spotlighted in the study “Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis” by Goudman et al. 2022.

How Long Does a Virtual Reality Therapy Session Last?

A virtual reality therapy session lasts 30-60 minutes. Treatment programs require 8-12 sessions over 6-8 weeks. VRET sessions oscillate from 25 minutes to 3 hours or even several hours. The duration of a VRET session depends on the patient’s tolerance levels and the therapeutic needs of the session as elaborated by Deng et al. (2023) in “The Efficacy of Virtual Reality Exposure Therapy for the Treatment of Alcohol Use Disorder Among Adult Males: A Randomized Controlled Trial Comparing With Acceptance and Commitment Therapy and Treatment as Usual.” 

How Much Does Virtual Reality Therapy Cost?

Virtual reality therapy costs about $25.23 per session. The yearly costs for training and supervision of psychologists were €13,400 (approximately $14,430), and the per-patient costs for 16 VR-CBT treatment sessions amounted to €373.95 (approximately $403.65) according to a health-economic evaluation by Pot-Kolder et al. (2020) in “Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial.” While some insurance providers cover VRT, coverage varies, and it’s advisable to consult your insurer to determine specific benefits. For example, XRHealth offers a self-pay plan at $276 per month, which includes a 60-minute initial evaluation and monthly 30-minute online therapy sessions, with services covered by insurance for over 70 million people. 

Are There Any Side Effects of Virtual Reality Therapy?

Yes, there are side effects of virtual reality therapy. Most patients report minimal side effects and positive experiences with virtual reality (VR) therapy, though side effects are variegated. Difficulty concentrating affected 14.2% of patients, while 8.3% experienced headaches. Panic was reported by 7.4% of participants, and worsened symptoms were seen in 1 out of 52 patients. Additionally, 32 patients experienced tiredness, dizziness, or back pain, with isolated cases of simulator sickness and careless walking as spotlighted in a systematic review by Lundin et al. 2023 in “Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry.”

Is Virtual Reality Therapy Safe for Children?

Yes, virtual reality therapy is safe for children.  VR’s safety and effectiveness in reducing anxiety among pediatric patients, facilitated by Certified Child Life Specialists (CCLS), was examined in 8,098 cases, with 3,696 meeting the age criteria. The study found that VR-related adverse events were rare, with only 3.8% reporting increased anxiety and 0.5% experiencing dizziness or nausea. Patient cooperation improved from 96.7% pre-intervention to 99.5% post-intervention, with the majority of VR use occurring in perioperative settings according to a retrospective review by Caruso et al. 2024 in “Retrospective Review of the Safety and Efficacy of Virtual Reality in a Pediatric Hospital.”

What Mental Health Conditions Can Virtual Reality Therapy Treat?

Virtual reality therapy (VRT) treats conditions like PTSD, phobias, anxiety, and depression by immersing patients in controlled environments to manage fears and emotions. It’s also effective for dual diagnosis, addressing co-occurring mental health and substance use disorders simultaneously and instigating patients to derive healthier coping mechanisms. Virtual reality therapy is recommended by the American Psychiatric Association (2021) in “Expanding Mental Health Uses for Virtual Reality.” One example foregrounded is a mindfulness program developed through a collaboration between Johns Hopkins and BehaVR. The program consists of six 20-minute sessions, guiding users through a calming, immersive VR environment where they learn new resilience and coping skills to help manage stress.