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. 2025 Aug;56(4):1117-1128.
doi: 10.1007/s10578-023-01628-4. Epub 2023 Nov 20.

Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety

Kesley A Ramsey  1   2 , Joey Ka-Yee Essoe  3   4   5 , Nathan Boyle  3   6   5 , Ainsley K Patrick  3   7   5 , Joseph F McGuire  3   5
Affiliations

Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety

Kesley A Ramsey et al. Child Psychiatry Hum Dev. 2025 Aug.

Abstract

Exposure-based cognitive behavior therapy (CBT) has demonstrated efficacy and is recommended as a front-line treatment for childhood anxiety. Unfortunately, challenges exist that impact the effective implementation of exposure-based CBT in clinical practice. One of the primary challenges is the accessibility and availability of exposure stimuli (e.g., spiders, storms, heights) in CBT sessions. Immersive virtual reality (VR) has shown promise as a scalable and sustainable solution to address this clinical need, but remains largely untested in youth with anxiety disorders. Here, we examine the use of VR exposures in the treatment of youth with an anxiety disorder (i.e., specific phobias). We aimed to investigate: (1) the feasibility and clinical benefit of VR exposures; (2) whether VR exposures elicit changes in physiological arousal and/or subjective distress; and (3) whether habituation serves as a mechanism across physiological and subjective outcomes for VR exposures. Three youth and their parents completed a clinical evaluation, which was followed by a one session treatment (OST) with VR exposures. Afterward, youth and parents completed clinical assessments one-week and 1-month after treatment. Immersive VR exposures were found to be feasible and demonstrated clinical benefit for reducing anxiety severity. Additionally, VR exposures elicited changes in both physiological and subjective outcomes. Finally, physiological habituation to VR exposures was observed among participants who exhibited treatment response at follow-up. Collectively, these findings demonstrate preliminary evidence that VR exposures are feasible, tolerable, and show some therapeutic benefit for treating youth with anxiety.

Keywords: Adolescent; Anxiety; Child; Exposure therapy; Treatment; Virtual reality.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare that they have no conflicts of interest. Ethical Approval: This study was conducted in compliance with the ethical standards as outlined in the latest version of the Declaration of Helsinki. This study was approved by the Johns Hopkins School of Medicine Institutional Review Board on 6/29/2023 for continuing review. Consent to Participant: For all participants, written informed parental consent and child assent was obtained. Disclaimer: A member of the Editorial Board is an author of this article. Editorial Board members are not involved in decisions about papers which they have written themselves or have been written by family members or colleagues or which relate to products or services in which the editor has an interest. Any such submission is subject to all of the journal’s usual procedures, with peer review handled independently of the relevant editor and their research groups.

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Supplementary concepts