Virtual reality exposure and imaginal exposure in the treatment of fear of flying: a pilot study.
VR flight scenes cut panic more than imagination and keep fear low half a year later.
01Research in Context
What this study did
Rus-Calafell et al. (2013) randomly assigned adults with fear of flying to two groups. One group faced a virtual flight inside a head-mounted display. The other group pictured the flight in their mind while sitting quietly. Both groups had the same number of sessions and ended with a real plane ride.
The team tracked heart rate and self-rated fear during the final flight. They also checked in six months later to see who stayed calm.
What they found
Both groups felt less fear after treatment, but the VR flyers stayed calmer during the real flight. Their heart rates stayed lower and they reported less panic. Six months on, only the VR group kept improving.
How this fits with other research
Rothbaum et al. (1999) ran the first RCT of VR for height phobia and saw big drops in anxiety. Rus-Calafell et al. (2013) repeats that success for flying and adds a head-to-head twist: VR beats plain imagination.
Miller et al. (2020) took the same VR airport idea and gave it to autistic preschoolers. Instead of lowering fear, they taught travel skills. All five kids later walked through a real airport on their own. The tool flips from exposure to skills training.
Ferris et al. (2025) also used immersive VR for safety, teaching autistic kids to cross streets. Together these studies show VR works for both cutting anxiety and building new skills.
Why it matters
If you serve anxious teens or adults, swap imaginal scripts for a cheap 360° flight video and a phone headset. One ten-minute VR run can drop panic faster than weeks of talk-through practice. Track heart rate or simple fear ratings during the real trip to show the gain. The same gear later lets you teach airport routines to kids with autism, so one device covers both exposure and life-skills lessons.
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02At a glance
03Original abstract
Fear of flying (FF) is an impairing psychological disorder that is extremely common in developed countries. The most effective treatment for this particular type of phobia is exposure therapy. However, there are few studies comparing imaginal exposure (IE) and virtual reality (VR) exposure for the treatment of FF. The present study compared the effectiveness of these two approaches using two manualized interventions based on the exposure technique. Patients with FF (N = 15) were randomly assigned to either VR (n = 7) or IE therapy (n = 8), consisting of a total of eight sessions: two assessment sessions (pre-treatment and after the real flight) and six exposure therapy sessions, which were conducted twice a week. During each exposure session, subjective perceived anxiety was measured every 5 min. Participants were also asked to sit through a real flight immediately after the treatment. The results showed no differences between the two treatments in relation to reduced clinical symptomatology associated with the FF, although participants in the VR group experienced less anxiety during the real flight after treatment. Furthermore, at 6-month follow-up, danger expectations and flight anxiety continued to decrease in participants who had received the VR exposure therapy, and four of these seven participants took at least one more flight.
Behavior modification, 2013 · doi:10.1177/0145445513482969