Virtual reality exposure therapy for fear of heights: clinicians’ attitudes become more positive after trying VRET
Open accessAbstract
BACKGROUND: Virtual reality exposure therapy (VRET) has the potential to solve logistic challenges when treating specific phobias. However, VRET has yet to see a large-scale implementation in clinical settings despite positive findings in treatment trials. This may partly be due to attitudes and lack of experience among clinicians, but also because of expensive and stationary VR solutions. OBJECTIVE: This study tested whether modern, wireless, commercially available VR equipment with controller-free hand tracking could induce and reduce discomfort using scenarios designed for fear of heights. Also, the study tested if clinicians' attitudes toward using VR in therapy changed after trying it themselves. METHOD: Attitudes to using VR in therapy and discomfort ratings were assessed for 74 clinicians before and after completing two VR scenarios. In addition, 54 non-clinicians completed the same scenarios. Participants were not diagnosed with acrophobia. RESULTS: The VR scenarios induced discomfort comparable to participants' reported fear of heights in real life. Repeated training reduced discomfort. Positive attitudes toward use of VR in therapy was predicted by previous experience with VR, as well as positive attitudes toward novel technology and exposure therapy. Clinicians' attitudes became more favorable after trying VRET themselves. Clinicians reported a range of possible advantages and disadvantages of using VR in therapy. CONCLUSION: VRET for fear of heights was able to induce and reduce discomfort in clinicians and non-clinicians, and clinicians' attitudes toward using VRET become more positive after trying VRET for themselves. The latest generation of VR solutions has potential to improve clinical availability and treatment options. Future research should explore how VRET can be implemented in clinical settings.
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As VR is a relatively novel technology for most individuals, its use can significantly influence its adoption.
“As VR is a relatively novel technology for most individuals, its use can significantly influence its adoption [20].”
From Exploring Predictors of Counselors’ Acceptance of Virtual Reality Exposure Therapy With Resistance and Job Contexts as Moderators: Cross-Sectional Mixed Methods Study (2025) · cites this paper as [20]
The Results section reports that 74 clinicians rated VR therapy significantly more favorably after trying VRET, and the Discussion suggests that letting clinicians experience VR may help implementation. The paper does not establish that VR is novel for most individuals or show that trying it significantly changes adoption across individuals generally; it measures clinicians’ attitudes, not adoption. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPrior VR use, particularly VRET experience, positively influences therapists' perceptions.
“Importantly, simultaneous VR education for patients and providers has been shown to improve participation rates [19], and prior VR use [20], particularly VRET experience, positively influences therapists’ perceptions.”
The participants likely had varying levels of experience and familiarity with VR.
“The limitation of this study is that the participants likely had varying levels of experience and familiarity with VR.”
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“In line with prior findings, inter-acting with VR had a significant positive impact on the attitudes and opinions of clinicians (Rimer et al., 2021) and the general public (Gomez Bergin et al., 2024).”
Prajapati, S., Yadav, S., & Singh, A. P. (2025) · Current Signal Transduction Therapy · doi:10.2174/0115743624406811251020052041 · Cited by 1 · see citing works
Rasmussen, K., Arnfred, B. T., Jørgensen, G., Clemmensen, L., Turgut, L., Thomsen, C. P., Midtgaard, J., & Glenthøj, L. B. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-114385 · Cited by 1 · see citing works
“52 82 Variables such as prior experience with VR, openness to new technology and favourable views on exposure therapy are positively associated with acceptance of VR in therapy.”
Transition ability to safe states reduces fear responses to heightPreprint
Haruno, M., & Fujino, M. (2024) · doi:10.31234/osf.io/r7p6w · Cited by 1 · see citing works
Kim, M., Jeon, M., Lee, Y., Lee, S., Kim, H., & Jung, D. (2025) · Journal of Medical Internet Research · doi:10.2196/81803
“Importantly, simultaneous VR education for patients and providers has been shown to improve participation rates [19], and prior VR use [20], particularly VRET experience, positively influences therapists’ perceptions.”
Wonghempoom, A., Chuangchai, W., & Selanon, P. (2023) · Safety · doi:10.3390/safety9020019
Virtual Reality Application for Height Fear Treatment
Ivanov, I., Manolova, A. H., Petkova, R., Bozhilov, I., & Christoff, N. (2023) · International Scientific Conference on Information, Communication and Energy Systems and Technologies (ICEST) · doi:10.1109/icest58410.2023.10187316
“There is no evidence to suggest that factors such as the gender of the patients, their age, religion, language, or cultural values influence their attitudes [5].”
BackgroundOn Performing Vestibular Damage Assessment and Therapy Using Virtual Reality: Lessons Learned
Bansal, A., Mikal, G., Surya, S., Harris, L. R., & Jenkin, M. R. M. (2023) · IEEE Gaming, Entertainment, and Media Conference (GEM) · doi:10.1109/gem59776.2023.10389963
“Since this early work, there have been a number of efforts to incorporate VR to deal with phobias (e.g., arachnophobia [2], public speaking [3], flying [4], acrophibia [5]), see [6] for a recent review), rehabilitation treatment following injury (e.g., [7], [8]), and for physical training generally.”
BackgroundPatil, V. S., Patkar, R. J., Mokal, A. A., Singh, K. K., Choughule, A. S., & Bora, R. (2024) · Advances in medical technologies and clinical practice book series · doi:10.4018/979-8-3693-1090-8.ch009
Eye movements reflect stress in virtual reality: post-analysis
Rogoleva, Y., Стрельников, С. В., & Kovalev, A. I. (2024) · Procedia Computer Science · doi:10.1016/j.procs.2024.09.213
An Exploration of Virtual Environments as Therapeutic Tools
Abdulla, S., & Gatzoulis, C. (2024) · Beyond Technology Summit on Informatics International Conference (BTS-I2C) · doi:10.1109/bts-i2c63534.2024.10942190
“From a VRET experiment for the fear of heights (acrophobia), results validated the effect of VR induced discomfort of fear compared to real life and improved positive attitude towards VR for clinicians [44].”
The Integration of Metaverse in Psychiatry and Mental Health
Malviya, R., & Rajput, S. (2025) · Wiley eBooks · doi:10.1002/9781394315680.ch9
Transition ability to safe states reduces fear responses to height
Fujino, M., & Haruno, M. (2025) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2416920122
“By contrast, model - based ( 36 – 39 ), the present study showed significant reductions in both subjective and physiological fear responses.”
Exploring Virtual Reality-Induced Anxiety in Iatrophobia: A Pilot Study for Future Exposure Therapy
Fabian, R.-A., Miró-Amarante, L., & Gómez-Rodríguez, F. (2025) · IEEE Access · doi:10.1109/access.2025.3591396
“Furthermore, VR has been successfully integrated into medical education and training [7], as well as in mental health interventions such as PTSD and social anxiety [7], [8], [9], [10], [11], [12], [13], [14], [15].”
Mujeeb, A. A., & Raza, R. H. (2025) · Lecture notes in networks and systems · doi:10.1007/978-3-032-05802-7_23
An Exploratory Study on Gamification and Interactivity in VRET with 6DoF
Hanlon, S., Fitch, C., & Morris, P. (2025) · International Conference Virtual and Augmented Reality Simulations · doi:10.1109/icvars66454.2025.11198751
“In an academic research investigation into the viability of VRET, only one [14] used 6DoF; and even then, the setting was confined to a small room and limited interactivity or user interface design, Fig.”
InfluentialTowards co-located multi-user mixed reality exposure therapy for anxiety disorders
Schier, F., Badeja, D., Hoyer, J., & McGinity, M. (2026) · Virtual Reality · doi:10.1007/s10055-025-01279-x
“Concerns furthermore include the multitasking demands of monitoring both screen and patient, as well as the perception of VR being a barrier between therapist and patient (Rizzo and Koenig 2017 ; Rimer et al. 2021 ; Bin et al. 2025 ).”
InfluentialImmersive Therapy: A Novel Approach to Stress Reduction and Mental Health
Mukherjee, T., & Banerjee, S. (2026) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-83708-156-120261009
Varšová, K. K., & Juřík, V. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1811278
“Several studies indicate that the attitudes of psychotherapists themselves play a decisive role in the adoption of VR (Jeon et al., 2025; Rimer et al., 2021).”
Smith, K. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-33677-5.00019-2
Predictive brains in hyperreal worlds: how XR exploits the indifference to being
Wood, G. M. D. O., & Kober, S. E. (2026) · AI & Society · doi:10.1007/s00146-026-03197-1
“In XR environments, our brain—when responding effectively to XR manipulations—shows indifference to being, in that we can be brought to fear a nonexistent spider (Roes-mann et al. 2023) or heights (Rimer et al. 2021).”
Alves, I., Conceição, N., & Esteves, A. (2026) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2026.2728236
Friedrich, P., Polifke, L., Obremski, D., Latoschik, M. E., & Wienrich, C. (2026) · Companion Publication of the International Conference on Multimodal Interaction (ICMI Companion) · doi:10.1145/3776591.3832491
- Authors
- Rimer, E., Husby, L. V., & Solem, S.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Solem, Stian
- ORCID
- Solem, Stian
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2021-07-15
- Volume
- 12
- Pages
- 671871-671871
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC8319686
- OpenAlex
- W3185044794
- Cited by
- 54
- References
- 45
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 15 · 2023: 11 · 2022: 3 · 2021: 1
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- virtual reality exposure therapy, fear of heights, acrophobia, specific phobia, clinician attitudes, hand tracking, exposure therapy, treatment implementation
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