Study type: retrospective observational database analysis
N: more than 3500 exposure sessions from the internal Psylaris database

Background and aim
Exposure therapy is a core intervention for anxiety disorders and related conditions, in which the build-up, dosing, and variation of exposure are clinically relevant. In Virtual Reality Exposure Therapy, stimuli are offered through simulated scenarios, often as video or interactive environments. Although treatment protocols often assume how clients conduct exposure, actual behavior during sessions is not automatically visible. This is particularly the case when clients make their own choices within a content library. The central question in this study was therefore descriptive: how do clients use exposure content in VR within a single session. The analysis focused on repetition of identical stimuli and variation between exposure categories. These behavioral measures are relevant because repetition of the same stimulus may align with a more repetitive approach, whereas variation between stimuli may align with generalization and addressing multiple triggers within a single session. The aim of this study was not to determine effectiveness on symptoms, but to empirically document how VR exposure is actually carried out in routine use.

Methods and data collection
A retrospective analysis was conducted on log data from the internal Psylaris database. The dataset consisted of more than 3500 exposure sessions. For each session, variables were extracted relating to video selection, the number of times the same exposure video was replayed within that session, and the categories to which the selected videos belong. The analysis was performed at the session level. Results were summarized in frequency distributions and proportions to show both the dominant usage pattern and the spread between sessions. Because the dataset reflects routine use, the analysis captures behavior in a realistic context, including heterogeneity between users, treatment contexts, and indications.

Outcome measures
The primary outcome measure for repetition was the proportion of sessions in which a specific exposure video was viewed only once versus being repeated one or more times. The primary outcome measure for variation was the proportion of sessions that contained videos within a single exposure category versus sessions that combined videos from multiple categories. No clinical outcomes such as symptom change, treatment duration, or adherence were included in this analysis.

Results
Repetition of identical videos within one session was limited. In 91.8 percent of sessions, a specific exposure video was viewed only once. Regarding category choice, 40.9 percent of sessions contained videos solely within one exposure category, whereas 59.1 percent of sessions included videos from multiple categories. This indicates that the dominant pattern in routine use consists of limited repetition and relatively frequent variation of content within the same session. At the same time, the proportion of sessions within one category shows that deepening within a defined domain also occurs frequently.

Interpretation and implications for practice
These findings support that clients use VR exposure in different ways. The pattern of variation may clinically fit exploring multiple anxiety cues, testing different situations, or increasing generalization. The pattern of staying within one category may fit a more focused, stepwise build-up in which the session remains within one theme. The low repetition rate suggests that repeating exactly the same stimulus does not occur automatically when clients choose freely. When repeated exposure to identical stimuli is therapeutically desired, for example within a habituation-oriented build-up, this may need to be guided more explicitly through treatment agreements, instructions, or monitoring. For product development, the message is that the platform should continue to facilitate both variation and deepening, for example through clear categorization, navigation, and support for clinicians when structuring sessions.

Limitations
The study is descriptive and observational. Therefore, it cannot be concluded which usage pattern is most effective for symptom reduction. In addition, contextual factors, treatment agreements, and clinician instructions may influence behavior without being visible in the log data. Follow-up research linking usage patterns to treatment outcomes is needed to further quantify clinical relevance.

Conclusion
Across more than 3500 exposure sessions within Psylaris Care, the same exposure video was not repeated in most sessions, and a majority of sessions combined multiple exposure categories. These data show that VR exposure in routine use is often shaped by variation, alongside a substantial group of sessions characterized by thematic deepening.

Figure 1. Number of repetitions of the same video within one session

Figure 2. Percentage of sessions with one category versus multiple categories