Virtual Reality in Psychotherapy: A Commentary on Strategies, Interventions, and Perspectives From Five Clinical Reports

Virtual reality (VR) applications have shown significant potential in enhancing psychological interventions by evoking vivid emotional reactions and creating immersive environments. This commentary provides an overview of five clinical case reports illustrating the advantages and pitfalls of VR-enhanced psychotherapy in social anxiety disorder, PTSD due to military trauma, auditory hallucinations, depression, and chronic pain. The case reports are analyzed with a dimensional framework designed to evaluate VR applications to be used in psychotherapy. The framework is based on three key dimensions: Strategy (e.g., Exposure, Training, Exploration), Focus (Symptom, Attitudes, Identity and Flourishing), and Perspective (Self, Other, Witness, Multiperspective). For example, the use of VR-based body scan exercises in chronic pain management can enable the training of body-related attentional skills helping individuals to not only focus on pain sensations, while VR exposure therapy helps clients with social anxiety or PTSD to confront feared situations, reprocess traumatic experiences, and develop coping skills. VR Avatar Therapy, on the other hand, enables individuals with auditory hallucinations to actually have a dialogue with the voices they hear since these are embodied in avatars controlled by therapists, promoting symptom externalization and self-identity exploration. Finally, the Explore Your Meanings tool enables immersive multi-perspective exploration of self-identity in 3D immersive spaces where it is easy to visualize the differences between the perceived and ideal self. The cases demonstrate VR's unique ability to provide real-time, dynamic treatment personalization, aligning with the trend toward individualized care in psychotherapy.