VR exposure at home

At a glance

Compared with waiting

Better than waiting in small trials. In a New Zealand trial of 126 adults, scores on a social anxiety questionnaire fell by about 36 points with the app and about 2 points while waiting.

Compared with other treatments

Only one trial, of 32 people in Germany, had a fair comparison. Self-rated anxiety fell about the same in both groups, but fewer people in the app-and-VR group still had the diagnosis afterwards.

Does it last

Gains held for 6 to 12 months in the trials that checked. No study has followed people for longer than a year.

What it takes

A headset (some programs use your phone in a cheap holder), about 6 weeks of short sessions, and often a subscription. You do it alone, so you need to keep yourself going.

What it is

Home VR for social anxiety means using a headset and an app on your own. The app shows you social scenes: a meeting, a job interview, a café, a talk to a group. You start with an easy scene and move up, a little harder each time. Many programs also teach skills from cognitive behavioural therapy (CBT), such as noticing anxious thoughts.

This is exposure: facing a feared situation on purpose, in small steps, so the fear can fade. The difference from VR exposure therapy is that no therapist is in the room. You set the pace.

Some programs use a full VR headset. Others use your phone in a simple holder, often with 360° video: filmed scenes you can look around in, rather than computer-made people who react to you.

Why people choose it

• No booking, no waiting room. For many people with social anxiety, phoning a clinic is itself the hard part. A home program skips that step.
• It can feel like a smaller first step. You can practise a feared moment with nobody watching.
• You can repeat it. You can do the first minute of an interview ten times in one evening.
• It is often cheaper than therapy, though no study has compared the costs for social anxiety.

What the evidence shows

• It helps more than waiting, in small trials. In a New Zealand trial of 126 adults, people used the oVRcome phone app with a headset for 6 weeks. Their scores on a social anxiety questionnaire fell by about 36 points, against about 2 points in the waiting group. The company that makes the app is listed as a collaborator on the trial’s registration. About 2 in 3 people were still in the study at week 6.
• A US trial found the same direction. In a trial of 44 people, self-guided VR exposure eased social anxiety and fear of job interviews more than waiting. Gains held at 6 months, and motion sickness got less over the sessions.
• One session can help fear of public speaking. In a Swedish trial, people did one session of VR speech practice with a therapist, or later a self-led version at home. Both groups improved a lot, and gains held at 12 months. The home version was not tested against a separate comparison group.
• The only fair comparison was mixed. In a German trial of 32 people, an app plus VR was compared with a control group that had the same number of appointments. Self-rated anxiety fell about the same in both groups. But at follow-up, fewer people in the app-and-VR group still met the criteria for social anxiety disorder.
• A review of 21 studies found self-guided VR promising, with few dropouts. It also found no study longer than 12 months, and no comparison with internet CBT or a self-help book.

What the trials have not answered

• Is it better than other self-help? Internet CBT has much more evidence. No trial has put the two side by side.
• Is it as good as real-life practice? In the one trial of VR exposure alone, with a therapist but without the rest of therapy, real-life practice did better.
• Does an industry trial tell us much? A US company trial of a home VR program, BVR-100, measured whether people found the program believable, not whether their anxiety went down. 56 people took part.
• Does it work for teenagers? A study of 27 teenagers aged 13 to 16 who were afraid of public speaking improved after one session with a low-cost headset. It had no comparison group.

How to try it

1. Pick a program that has been tested. Ask: was there a trial? Against what? Who ran it? The VR guide has a checklist and a dated list of products.
2. Start low. Choose a scene that makes you a bit nervous, not terrified. Stay until the fear drops a little.
3. Drop your safety behaviours in the scene. Look at the virtual people. Don’t rehearse every word. What keeps social anxiety going explains why this matters.
4. Take it outside. After a session, do a small real version within a few days: ask a shop worker a question, say one thing in a meeting. VR is practice for real life, not a replacement.
5. Even a simple setup can help. In a trial of 360° video for public speaking, practising in an empty virtual room helped almost as much as practising in front of a virtual crowd. And a home study with phone-based 360° video also found less speaking fear, though without a comparison group.

Side effects and risks

• Motion sickness. Some people feel dizzy or sick in a headset. Short sessions, sitting down, and a fan in the room help. It often gets better with practice.
• Using VR to avoid real life. If VR practice becomes the only practice, it can turn into another way to stay safe. Set a date for a real-life step.
• Getting stuck alone. If you try a program for several weeks and nothing changes, that is not a failure. It is a sign to get help. Finding a therapist can help.