3 - (SYM 10) Effectiveness of Virtual Reality Exposure Therapy for Anxiety Disorders: Findings for a Real-world Clinic

Clinicians frequently encounter patients who struggle to engage in exposure therapy for anxiety disorders due to fear, avoidance, or logistical constraints, creating a need for alternative delivery methods that preserve effectiveness while improving accessibility. Virtual reality exposure therapy (VRET) offers one such option, providing immersive and controllable environments that allow therapists to conduct exposures that would otherwise be impractical or difficult to arrange. Although VRET has gained increasing empirical support, its effectiveness in everyday clinical settings remains underexamined. Most studies evaluating VRET have focused on controlled laboratory environments or subclinical samples, leaving open the question of how this modality performs when delivered to patients with complex anxiety presentations in outpatient care. To address this gap, we assessed the clinical outcomes of a 12-session VRET protocol implemented in a hospital-based cognitive-behavioural therapy program. Eleven adults with mixed anxiety disorders completed the DSM-5 Severity Measure for Specific Phobia (Craske et al., 2013) before and after treatment. Within-group analyses showed a large reduction in symptoms (Hedges’ g = −0.97, 95% CI [−1.65, −0.27]). Post-treatment scores were also compared descriptively to those of patients who received traditional in vivo exposure therapy within the same clinic (non-randomized comparison; n = 25), who showed a similarly large pre-post effect (Hedges’ g = −0.80, 95% CI [−1.23, −0.35]). Confidence intervals overlapped substantially, suggesting comparable magnitudes of symptom improvement across treatment modalities. Within-group analyses further indicated that the observed effect size is consistent with pre-post effects reported in prior meta-analyses of VRET and exposure-based treatments (e.g., Carl et al., 2019; Opriș et al., 2012; Powers & Emmelkamp, 2008). This study provides naturalistic evidence for the effectiveness of VRET when delivered in a hospital outpatient setting. Moreover, these findings suggest that VRET can achieve meaningful symptom improvement in routine clinical practice, supporting its potential as a practical and scalable exposure-based treatment. Future research should examine whether VRET’s logistical advantages (e.g., ease of implementation, reduced preparatory demands, and patient acceptability) translate into improved engagement and reduced attrition in real-world care.