Every market analysis points the same way: within healthcare virtual reality, mental health is the fastest-growing segment: ahead of surgery, training and rehabilitation. The interest is real, and in some areas so is the evidence.
The side effect is less pleasant: “virtual reality in mental health” today covers two different products, which demand different things of the buyer. A service that acquires one thinking it is acquiring the other finds out late: usually with equipment already in a cupboard.
This article is a map for telling them apart, and it says plainly which one RVer is.
The first: virtual reality exposure therapy
It is psychotherapy. It recreates the feared situation under control (the height, the aeroplane, the spider, the audience) so the person can face it in steps, with intensity rising at their own pace, until the fear response subsides.
Two features define it, and both are demanding:
- It is delivered by a mental health professional, within a therapeutic plan. The technology is the scene; the treatment is the clinician's work.
- It provokes anxiety on purpose. That is the mechanism, not a side effect to be avoided.
The evidence for specific phobias is among the strongest in all healthcare VR research, and we gathered it in virtual reality for treating phobias. Across anxiety disorders in general the picture is more mixed: see virtual reality and anxiety disorders.
What an institution needs to use this: psychologists or psychiatrists trained in the technique, consultation time, a clinical framework and, depending on the manufacturer's claim, a device in a higher risk class than ours. Without those people the equipment does nothing: this is not software you install and let run.
The second: comfort and wellbeing environments
This is not psychotherapy and should not be presented as such. It is an experience of comfort, distraction and meaningful activity, run by the institution's own professionals, which complements existing care.
The mechanism is the opposite of the first: instead of moving the person towards what frightens them, it moves attention away from what is bothering them: the wait, the procedure, the long afternoon, the room that never changes. The success criterion differs too: not the extinction of a fear response over weeks, but how this session went, today.
This is where RVer sits. The base product is a Class I medical device, and the boundary that implies is set out in Class I medical device: we make no treatment claims, we do not replace clinical follow-up, and we do not provide exposure therapy.
Why the distinction is not cosmetic
Three practical consequences of swapping one for the other:
Who runs it. In the first case, a mental health professional trained in the technique. In the second, the institution's own team with usage training (nursing, occupational therapy, activity coordinators) as described in who can run a session. Buying the first without having the first's people is buying a cupboard of idle equipment.
What gets promised. A service presenting comfort environments as anxiety treatment creates an expectation the product cannot meet, and it is the institution, not the supplier, standing in front of the patient when that shows.
What gets measured. Psychotherapy metrics (symptom reduction across a plan) applied to wellbeing sessions produce a report saying the project failed, when the project never promised that. Choosing the wrong metric is the quietest way to kill a pilot that was going well.
Six questions to put to any supplier
They work over the phone, before going further:
- What is the product's stated intended purpose, and what is the device's risk class?
- Does the product treat any condition, or complement care? Ask for the exact sentence, in writing.
- Who has to be in the room for a session: a psychotherapist, or a team member with usage training?
- Does the experience provoke anxiety on purpose at any point?
- What evidence exists for the stated purpose specifically, and not for “VR in healthcare” in general?
- What training is included, and for which professional profile?
The answers to 3 and 4 separate the two products in under a minute, and there is no bad answer: there is the answer that matches what the service needs and the one that does not. The full procurement criteria are in how to choose therapeutic virtual reality.
What this does not mean
It does not mean the second product is the poor relation of the first. It means they answer different questions.
Most of the services that contact us do not have a waiting list of specific phobias to treat: they have anxious patients waiting for a scan, residents with empty afternoons, bedbound people with nothing to do between visits. For those situations a VR psychotherapy plan would be the wrong tool: expensive, oversized and dependent on people the service does not have. And if what the service actually needs is the first product, the most useful thing we can do is say so in the first meeting, which is what we do.
The place of non-pharmacological approaches in the system, and their limits, is set out in mental health in Portugal.
The RVer platform's base product is a Class I medical device registered in EUDAMED and with INFARMED (Portugal). Sessions are run by the institution's own professionals, complement existing care and do not replace assessment, psychotherapy or clinical follow-up.
Frequently asked questions
Does RVer provide virtual reality exposure therapy?
No. Exposure therapy is psychotherapy delivered by a mental health professional within a therapeutic plan, and it provokes anxiety deliberately and under control. RVer provides comfort, distraction and meaningful activity environments, run by the institution's own professionals, which complement existing care and do not constitute treatment.
What is the practical difference between the two kinds of product?
Who runs it, and what the mechanism is. Exposure therapy requires a mental health professional trained in the technique in the room, and the experience deliberately moves the person towards what frightens them. A comfort environment is run by a team member with usage training, and moves attention away from what is bothering them. The metrics differ too: symptom reduction across a plan in one case, how today's session went in the other.
What should I ask a supplier before buying?
Six things: the stated intended purpose and the device's risk class; whether the product treats a condition or complements care, with the exact sentence in writing; who has to be in the room during a session; whether the experience provokes anxiety on purpose; what evidence exists for the stated purpose specifically; and what training is included, for which professional profile.
Does a VR comfort environment treat anxiety?
No, and presenting it that way creates an expectation the product cannot meet, with the institution, not the supplier, standing in front of the patient when that shows. What these environments do is offer comfort and distraction at a specific moment, under a professional's supervision.
Why is mental health the fastest-growing segment of healthcare VR?
A combination of unmet need and mature evidence in some specific areas, above all the treatment of phobias. The growth in interest brings the side effect of grouping products with very different purposes and requirements under one label.