Virtual reality against phobias: Fighting fear with VR

Virtual reality against phobias: Fighting fear with VR

The app oVRcome addresses phobias like fear of heights or spiders by using virtual reality headsets. An earlier clinical study demonstrated the effectiveness of VR in the treatment of anxiety disorders.

Just put on a virtual reality headset and in the next moment be confronted with your own fear of flying. Or watch a large, hairy spider make its way through the bathroom. Stand on a cliff, feeling the vertigo that comes with looking at the abyss. Virtual Reality Exposure Therapy (VRET) uses such confrontational scenarios to treat various phobias with the help of VR.

New Zealand researchers and developers unveiled a comprehensive app. The app, designed for private use, can be used to overcome phobias. Currently, it works with common phobias like fear of flying, heights, needles, dogs, and spiders.

The app, oVRcome, is available in all major app stores. Developers previously tested the app in a clinical study conducted at New Zealand's University of Otago, Christchurch, which demonstrated the effectiveness of the oVRcome program's VR-based therapy.

Study promises great potential

The three-month VR study, conducted last year, treated 129 subjects for 5 different phobias. Each individual was exposed to at least 16 VR scenarios invoking the fear of flying, heights, needles, spiders, or dogs. The VR simulations were first designed to induce discomfort while subjects experienced the fear-inducing situation.

Subsequently, investigators questioned whether confrontation with the stimuli reduced the fear sensation over time. Immediately after the end of the study and again six weeks later, investigators asked the subjects to rate the current severity of their phobia on a scale between 0 and 40.

Even people who had entered a value between 26 and 40 at the beginning of the program responded with values no higher than 7 at the end of the study. The study thus concluded that the participants' anxiety symptoms decreased by up to 75% after six weeks.

Virtual reality therapy is not a new invention. The first approaches date back to as early as the 1990s. But, it has so far remained primarily an academic research discipline. In the case of oVRcome, the researchers at the University of Otago now see for the first time a viable and easily accessible option for self-guided treatments via smartphone app. Not least because of its low cost.

Adam Hutchinson, founder of oVRcome, hopes to help more people overcome their phobias this way. He likes to emphasize that the app is based on a meaningful clinical study.

"Recently there was a report that came out in the US, and it shows that 86% of mental health apps have no form of clinical evidence behind them, and we really didn't want to be in that," says the entrepreneur.

Virtual Reality apps as a solution to gaps in care?

oVRcome currently offers treatment for eleven different phobias at a price of around $60. That includes six weeks of premium access to all VR simulations in beta. It also includes a VR headset used with the app. The user inserts his own smartphone into the VR headset, on whose screen the selected simulation can be seen - similar to GearVR. The app is available worldwide, and has so far sold to 19 countries.

That the treatment method can be carried out at a low threshold in one's own home is important. Many of those suffering from anxiety disorders, particularly those with social phobias, often have inhibitions about actively trying to overcome their fear.

Another barrier is the sometimes limited accessibility of therapy services. Many associate traditional therapy with waiting lists or high costs. In addition, for many people, seeking therapy carries a stigma. It is estimated that up to 80 percent of those affected do not seek professional help.

Together with researchers at the University of Otago, Hutchinson now plans further clinical trials to determine whether VRET technology works for other mental health disorders, such as depression, substance abuse, eating disorders, panic disorders, and fear of failure.

Virtual encounter with real fears

Exposure therapy is part of behavioral therapy and involves confronting patients with their phobias without them being in a seriously dangerous or risky situation. The treatment method is a standard in psychotherapy. Several other clinical studies prove the effectiveness of the VRET approach.


Positive results were achieved, for example, in gameChange. The largest clinical trial of VR-assisted psychotherapy to date was conducted in the United Kingdom from July 2019 to May 2021.

The VR therapy program, developed at the University of Oxford, allowed patients to choose between six different VR scenarios that they avoid in their daily lives, such as going to a coffee shop or pub, shopping at a supermarket, or using public transportation. A virtual coach additionally accompanied each VR session. After the six-week VR therapy, the schizophrenic or psychotic symptoms of the 346 subjects had decreased significantly.

A larger metastudy was also able to support the effectiveness of the VRET treatment method: It examined the results of a total of 34 clinical studies published between 2017 and 2021. The authors of the meta-study concluded that the therapy approach is an effective treatment method for both anxiety disorders and depression and can meaningfully support conventional therapies.

"For the treatment to work, your brain has to know that it's in this environment, and over time you become desensitised," Hutchinson said. When looking at a simple photo or video, for example, the brain usually understands that this environment is not real. With the help of virtual reality, however, the brain can be tricked into believing it is actually in that environment. "Therefore the treatment is effective," Hutchinson says.

Promising application with obstacles

Although VR confrontation therapy has already shown positive results, widespread implementation in therapeutic practices or hospital settings is currently unrealistic. VR requires space to be properly applied. In addition, setting up the technology is time-consuming, requiring close scrutiny by adequately trained staff to ensure everything is working correctly.

The cost factor should also not be forgotten. Until now, this form of therapy has usually only been possible for a single phobia using high-end devices. It has therefore tended to be the domain of academic research. The potential as a broad-based technology that could be used in behavioral therapy could thus not be exploited. This is one reason why the technology is often met with skepticism.

However, a study by the Norwegian University of Technology and Natural Sciences (NTNU) showed that therapists who tested the VRET technology themselves were far more amenable to the technology as a result of self-experimentation. The study concluded that the skeptical attitude of therapists is a major obstacle to the spread of the VRET treatment method.

While the VRET methodology still faces several obstacles before it moves from the status of a pure research topic to applied virtual reality on a widespread basis, some psychotherapists have already been using the treatment method for some time.

One of them is German behavioral therapist Felix Eschenburg, who takes advantage of the low-threshold access to technology in his practice and uses it especially with patients who are afraid of heights, spiders or wasps. In the latter case, auditory stimuli are also used to give patients the impression that a wasp is flying around.

Virtual reality's relevance to society as a whole

For the technology to be successful on a massive scale, Eschenburg believes it needs to be extended to other realistic fear scenarios such as public speaking, highway driving, or fear of rodents. In this way, a positive effect could be achieved for specific anxiety disorders.

However, the psychologist does not see this as a substitute for conventional therapy settings. These require treatment methods tailored to the individual patient and an interaction. They also require an empathy-based relationship between patient and therapist.

The range of applications for VRET services is now likely to change thanks to apps such as oVRcome, which can be used to carry out therapy for specific phobias conveniently from home. The fact that one's own smartphone can be used as a screen makes the application much more affordable and accessible, even if this entails limitations in terms of the quality of the experience.

For the specific objective of overcoming anxiety, however, the treatment method via app represents a low-threshold offer, and possibly paves the way for higher-quality applications of VR technologies outside the gaming sector and academic research.

Sources: University Otago, GameChange Trial, The Guardian, Sage Journals