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A Telemedicine Approach to Therapist-Free VR Exposure Therapy for Acrophobia: A pilot study

Authors :

Arya Gholipoor Hanizi¹ Samaneh Minakhani² Poorya Gholipoor³

1- دانشگاه تبریز 2- دانشگاه علوم پزشکی تبریز 3- دانشگاه آزاد اسلامی واحد کرج

Keywords :

Acrophobia،Autonomous VR Therapy،Real-time Biosignal Adaptation،Telemedicine،Exposure Therapy

Abstract :

Acrophobia, an excessive fear of heights, impairs daily functioning and quality of life. While exposure therapy is effective, therapist dependence limits accessibility. This pilot study evaluates a fully automated, therapist-free virtual reality (VR) system that dynamically adjusts exposure intensity using real-time biosignals (heart rate/blood pressure) to treat acrophobia. Twenty participants with clinically confirmed acrophobia underwent a 27-session protocol featuring three phases: voluntary exploration, adaptive exposure (VR scenarios modulated by physiological feedback), and abrupt stress challenges. The system combined Unity-based VR environments (HTC Vive Pro Eye) with real-time biosignal monitoring (Polar H10, Finapres NOVA) to personalize therapy. Results demonstrated significant reductions in physiological arousal (mean heart rate 19%, systolic BP 18%) and anxiety (29.3% reduction in STAI-Y1 scores, p<0.001). Retention rates (90%) and safety outcomes surpassed traditional therapist-guided methods. This study provides first evidence that biosignal-driven, autonomous VR exposure therapy can achieve outcomes comparable to clinician-led approaches, offering a scalable telemedicine solution. Future work should validate efficacy in larger cohorts.