Studies & Our Claims:

VR Exposure Therapy is Backed by Science.Here's Why:

At Rephobia, we've harnessed the power of technology to bring you a groundbreaking solution – the Rephobia Virtual Reality Exposure Therapy (VRET). Our journey began with a profound understanding that exposure therapy (ET) serves as the cornerstone for effectively addressing anxiety disorders, including specific phobias and Social Anxiety Disorder. This conviction is underpinned by a wealth of research, including the insightful works of Kaczkurkin & Foa (2015), Steinman et. al. (2016), and Wechsler et. al. (2019).
As recommended by Boeldt et. al. (2019), providing psychologists with access to ET through virtual reality (VR) has the potential to revolutionize therapy. It not only allows patients to maximize the benefits of psychotherapy but also optimizes time for patients, clinics, and therapists. Furthermore, it empowers psychologists to focus on individuals struggling with clinical anxiety, enhancing overall efficiency.
In the realm of traditional in vivo ET, despite its effectiveness, high dropout rates and poor patient acceptance are common due to the discomfort and inconvenience of confronting one's fears. This is corroborated by research conducted by Choy, Fyer & Lipsitz (2007), Garcia-Palacios et. al. (2007), and Clemmensen et. al. (2020). Notably, Garcia-Palacios et. al. (2007) revealed that 76% of individuals prefer VR over in vivo exposure, while the refusal rate for in vivo exposure is a staggering nine times higher than that of VR exposure.


With VR technology, users gain unprecedented control over the pace of their exposure, along with the freedom to choose when and where they undergo VRET. Rephobia's VRET solution offers accessibility, privacy, scalability, customizability, and remarkable effectiveness compared to traditional imaginal exposure. These findings are substantiated by the research of Bouchard et. al. (2017), Boeldt et. al. (2019), Maples-Keller et. al. (2017), Clemmensen et. al. (2020), and Garcia-Palacios et. al. (2007).
In terms of efficacy, VRET is on par with in vivo ET, as demonstrated by studies conducted by Fodor et. al. (2018), Wechsler et. al. (2019), and Morina et. al. (2015). Moreover, VRET surpasses in vivo ET by maintaining its effectiveness over a six-month period, as observed in the study by Bouchard et. al. (2017).
Rephobia utilizes high-definition 5.7k video technology to create the most immersive virtual environment possible. The emphasis on achieving a profound sense of presence significantly enhances the overall therapy experience, even in the absence of a therapist, as highlighted in the study by Donker et. al. (2020).
Our users are asked to complete two psychometric questions before and after engaging with the program. These questions assess the current state of their phobic symptoms on a Likert scale (Marks & Mathews, 1979) and the frequency of phobia-induced anxiety over the past two weeks (American Psychiatric Association, 2013). Users also provide self-reports on their emotional state at the end of each module for efficacy assessment, utilizing a Subjective Units of Distress Scale (SUDS) (Wolpe, 1969).
To measure immersiveness, we evaluate the sense of presence experienced by users post-immersion using the first question from the Gatineau Presence Questionnaire (Witmer & Singer, 1998). Users are invited to rate the realism of their VR experience on a sliding scale from 0 to 100 after their initial use of the VR headset.
Explore below for an annotated bibliography of research studies that affirm the viability of the Rephobia project and the effectiveness of VR exposure therapy.

Annotated Bibliography of Research Studies:



Boeldt, D., McMahon, E., McFaul, M., & Greenleaf, W. (2019). Using Virtual Reality Exposure Therapy to Enhance Treatment of Anxiety Disorders: Identifying Areas of Clinical Adoption and Potential Obstacles. Frontiers in Psychiatry, 10, 773. https://doi.org/10.3389/fpsyt.2019.00773




Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., Loranger, C., & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial. British Journal of Psychiatry, 210(4), 276–283. https://doi.org/10.1192/bjp.bp.116.184234




Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27(3), 266–286. https://doi.org/10.1016/j.cpr.2006.10.002



Clemmensen, L., Bouchard, S., Rasmussen, J., Holmberg, T. T., Nielsen, J. H., Jepsen, J. R. M., & Lichtenstein, M. B. (2020). Study protocol: Exposure in virtual reality for social anxiety disorder - a randomized controlled superiority trial comparing cognitive behavioral therapy with virtual reality based exposure to cognitive behavioral therapy with in vivo exposure. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-2453-4





Donker, T., van Klaveren, C., Cornelisz, I., Kok, R. N., & van Gelder, J.-L. (2020). Analysis of Usage Data from a Self-Guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Controlled Trial. Journal of Clinical Medicine, 9(6), 1614. https://doi.org/10.3390/jcm9061614




Fodor, L. A., Coteț, C. D., Cuijpers, P., Szamoskozi, Ștefan, David, D., & Cristea, I. A. (2018). The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-28113-6




Garcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S. (2007). Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias. CyberPsychology & Behavior, 10(5), 722–724. https://doi.org/10.1089/cpb.2007.9962





Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346.










Morina, N., Ijntema, H., Meyerbröker, K., & Emmelkamp, P. M. G. (2015). Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, 18–24. https://doi.org/10.1016/j.brat.2015.08.010








Steinman, S. A., Wootton, B. M., & Tolin, D. F. (2016). Exposure Therapy for Anxiety Disorders. In Encyclopedia of Mental Health (pp. 186–191). Elsevier. https://doi.org/10.1016/B978-0-12-397045-9.00266-4





Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019). Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?—A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01758


Incorporating VR in therapy can increase the ease, acceptability, and effectiveness of treatment for anxiety. 
VR exposure therapy (VRET) permits individualized, gradual, controlled, immersive exposure that is easy for therapists to implement and often more acceptable to patients than in vivo or imaginal exposure. 
VR is a scalable tool that can augment access to and effectiveness of exposure therapy thus improving treatment of anxiety disorders.


Conducting exposure in VR was more effective at post-treatment than in vivo. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure.
Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.


Comprehensive review of treatment studies in specific phobia. Acute and long-term efficacy studies of in vivo exposure, virtual reality, cognitive therapy and other treatments from 1960 to 2005.
Most phobias respond robustly to in vivo exposure, but it is associated with high dropout rates and low treatment acceptance.


Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out.

CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements.

Study examined user engagement with ZeroPhobia, a self-guided app-based virtual reality (VR) Cognitive Behavior Therapy for acrophobia symptoms using cardboard VR viewers.

Participants derive the most benefit when the practice time in the VR environment is 25.5 min irrespective of the amount of VR sessions.

The importance of feeling present in the VR environment is stressed out as a higher reported presence was associated with better outcomes.

Self-guided VR acrophobia treatment is effective and leads to consistent reductions in self-reported anxiety both between levels and after treatment. Most participants progressed effectively to the highest self-exposure level, despite the absence of a therapist.

Meta-analysis of virtual reality (VR) interventions for anxiety and depression outcomes, as well as treatment attrition.

There were no significant differences between VR-based and other active interventions. VR interventions outperformed control conditions for anxiety and depression but did not improve treatment drop-out.

The present survey explored the acceptability of virtual reality (VR) exposure and in vivo exposure in 150 participants suffering from specific phobias.

Seventy-six percent chose VR over in vivo exposure, and the refusal rate for in vivo exposure (27%) was higher than the refusal rate for VR exposure (3%).

Results suggest that VR exposure could help increase the number of people who seek exposure therapy for phobias.

A review of 5 studies found that patients report satisfaction with VR based therapy and may find it more acceptable than traditional approaches.

VR eliminates a barrier for patients who may experience difficulty with imagining or visualization.

VR affords complete control over ET aspects.

VRET protects confidentiality while conducting exposures which might not be found in in-vivo exposures.

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A meta-analysis of clinical trials applying VRET to specific phobias.Patients undergoing VRET:
- Did significantly better on behavioral assessments following treatment than before treatment.
- Performed better on behavioral assessments at post-treatment than patients on wait-list.
Behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo.
Behavioral measurement effect sizes were similar to those calculated from self-report measures.
The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias.


Exposure-based therapy is the gold-standard treatment for anxiety and related disorders.

Research suggests that exposure, alone or in combination with cognitive restructuring, can significantly reduce anxiety symptoms across diagnoses.

Further, treatment gains tend to be maintained over time.


No evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia.

The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR.

In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous.

Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.

Further References:

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We're a small startup, pioneering virtual reality exposure therapy. Based in Ireland.

Don't hesitate to get in touch!

Subscribe Now:

Keep up to date on our new launches:

Thank you!

We will contact you shortly

Can't send form.

Please try again later.

© Rephobia 2024

All Rights Reserved