Responsible Trauma Research: Designing Effective and Sustainable Virtual Reality Exposure Studies

Virtual reality exposure therapy (VRET) enables controlled exposure to trauma-related stimuli to facilitate memory access and emotional processing. However, the field remains underexplored for complex post-traumatic stress disorder (C-PTSD). Unlike single-trauma PTSD, C-PTSD requires highly individualized triggers that are difficult to identify and implement safely. We conducted a feasibility study with 11 patients, two trauma therapists, and a VR developer to explore integrating VRET into C-PTSD treatment while safeguarding all stakeholders. Initial findings indicate that simple objects can be just as effective as complex scenes, therapeutic success does not correlate with VR presence levels, and the design process itself became integral to therapy rather than preparatory. However, involving developers in therapy sessions led to considerable emotional stress and role confusion, which required a cautious approach. Based on these insights, we provide methodological recommendations for safe and patient-centered VRET studies that balance therapeutic effectiveness with stakeholder safety across the research process.