Qualification and a fear hierarchy
We establish what we are working with, check contraindications, and build a ladder of situations together — from one that is already bearable today up to the target one.
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One-to-one sessions · Warsaw · in cooperation with fobos.tech
VR CHANGEWORKExposure therapy in virtual reality
Exposure is the best-documented way of working with anxiety and, at the same time, the one people most often refuse. VR CHANGEWORK brings it into the consulting room: under controlled conditions, at a pace you set, with the option of stopping at any second. We run it on the fobos.tech platform.
Led by Piotr Matejuk, Magdalena Gajdzińska and Weronika Wąsiakowska
Starting point
„You do not have to board a plane to start working with the fear of flying. You do, however, have to board one eventually — and we say that from the first meeting too.”
What it actually is
Exposure therapy means controlled, graded contact with what is being avoided, held long enough for the nervous system to stop treating the situation as a threat. It works better than anything else we have for anxiety, and it has one serious drawback: it sounds like something hard to agree to. In a study that gave people with phobias a choice, twenty-seven percent refused exposure in the real world; for the same work in virtual reality, three percent refused.
In the consulting room you put on a headset and find yourself inside a scene filmed in three hundred and sixty degrees with real people and real places: an airport terminal, a doctor's office, a conversation at work, a room full of listeners. The therapist stays beside you in the same room throughout, sees the scene you are watching and hears everything you say. Before and after each exposure you rate your own tension on a simple scale — and it is your ratings, not the therapist's impression and no automated system, that decide whether a scene repeats or we move up.
You can work on the same situation ten times within a single session, which in the real world would be unworkable or absurdly expensive. You can also stop at any moment by taking off the headset — and here that is not treated as a failure but as information about where today's limit lies.
Beyond classical anxiety work we use the same tool in two places connected with psychedelic experience. «Before» — as a space for settling, grounding and getting used to the idea of losing ordinary control over perception, which is what most often causes fear ahead of a session. «After» — as a closed environment free of outside stimuli, where you can return to the content of the experience and work it through in images, when words are not yet enough.
These two applications have no clinical trials behind them today and we say so plainly, including in the first conversation. Classical VR exposure has dozens — and everything we promise rests on that.
How it runs
From the first message to closing the process.
First contact with the equipment
Short, neutral scenes with no anxiety load: we check comfort, tolerance of the headset, and whether simulator sickness appears.
Graded exposure
You enter a scene from the appropriate rung of the ladder and stay in it until the tension genuinely drops. Ratings before and after each attempt, repeated as many times as needed.
Raising the bar
The next rung only once the previous one has stopped being difficult — not on a schedule and not because three weeks have passed.
Transfer to the real world
We agree on concrete tasks outside the consulting room and review how they went. Without this step, work in the headset stays in the headset.
Who it is for
Clear expectations before the first session.
People who bounced off classical exposure
If the very thought of entering that situation live is unacceptable today, VR can be a threshold that is possible to cross.
People whose anxiety genuinely narrows their life
Flights given up, medical appointments cancelled, a car sold, talks and conversations avoided — where the cost of avoidance is already countable.
People preparing for psychedelic work
For those who want to get used to an altered state of consciousness, or to return to the content of an experience by other means than words alone.
The library
What can actually be worked on here.
The scenarios are 360-degree recordings with real people and real places, watched through a headset — not animated worlds. Below is what the library actually contains. If your particular fear is not on this list we will say so plainly and suggest another route, rather than stretching a scene to fit a situation it was not made for.
01Social situations
A conversation, a group, being watched.
The core of the library — the widest set of scenes, from brief contact to a longer presence in a group.
02Public speaking
A presentation, a room, eyes on you.
Work with the fear of speaking to people, including in a professional context.
03Difficult conversations at work
Giving feedback, letting someone go.
Scenes covering both sides of the conversation — including for people who hold such conversations professionally.
04Fear of flying
The airport, the terminal, the cabin.
Exposure focused on anticipatory anxiety: the journey, check-in, waiting and watching planes, and only then the flight itself.
05Driving
Traffic, the route, situations on the road.
For people who have stopped driving, or who drive in constant tension.
06Medical appointments
The office, the examination, the procedure.
Fear of contact with medicine, which genuinely keeps people away from diagnosis and treatment.
07Settling module
Three calm spaces.
Used before exposure as preparation, after it as a close, and in the psychedelic strand as a tool in its own right.
08Psychedelic work
Preparation and integration.
Settling, grounding and getting used to an altered state before an experience, and returning to its content in a closed space afterwards.
Evidence
What the research shows, and what it does not.
Exposure therapy in virtual reality is one of the better-researched uses of this technology in psychotherapy and, at the same time, an area where it is easy to promise too much. Below are both sides of that balance, with sources.
What is established
- In specific phobias and agoraphobia, exposure in VR performs the same as exposure in the real world, and both clearly beat no treatment (Carl et al., 2019 — 30 studies, 1,057 people; Wechsler et al., 2019).
- In social anxiety the effect against no treatment is large and holds at one-year follow-up (Horigome et al., 2020 — 22 studies, 703 people).
- People agree to exposure in VR far more readily than to the same work in the real world: 27% refusals against 3% (Garcia-Palacios et al., 2007).
- Safety in clinical practice is well documented — a controlled study of 80 patients recorded no adverse events and no worsening of symptoms (Lohse et al., 2025).
What we do not promise
- In social anxiety, exposure in the real world performs better than VR and that advantage grows over longer follow-up (Wechsler et al., 2019). This is why we treat VR as a bridge to real exposure, not a replacement for it.
- Any advantage of VR over another active treatment disappears in every sound analysis (Fodor et al., 2018; Schröder et al., 2023). The real value is accessibility, repeatability and control over the dose — not higher efficacy.
- In PTSD the effect against active control groups is close to zero (Deng et al., 2019). We do not use this method for complex trauma.
- The use of VR in psychedelic preparation and integration has no clinical trials behind it today — there are only theoretical papers (Sekula et al., 2022) and data from adjacent fields. We do this deliberately and say so plainly, rather than pretending the literature backs it.
Status of the tool. The fobos.tech platform we use is a tool supporting the therapist's work; it is not a medical device and not a diagnostic instrument. It does not replace the therapist and does not make decisions for them — it proposes a next step based on your own tension ratings, and whether to take that step is decided together in the consulting room.
An important boundary
What this is not.
- VR does not replace exposure in the real world. In social anxiety, live work performs better than virtual work and that gap widens over time — which is why every process ends with stepping outside the consulting room.
- The fobos.tech platform is a tool supporting the therapist's work. It is not a medical device, not a diagnostic instrument and not a therapy in its own right.
- We do not use this method for complex trauma or PTSD — in that area the evidence for VR against other active methods is close to zero.
- Some people feel nausea, dizziness or disorientation in a headset (simulator sickness). We check for this at the first meeting, before any anxiety-provoking stimulus appears.
- We do not accept people in an acute psychotic episode, with unstable epilepsy, with serious vestibular disorders or in a state of strong dissociation. That is our own precautionary rule — the literature does not set out a closed list of contraindications here.
- This service is developmental and educational in nature. It is not a healthcare service under the Polish Act on Medical Activity of 15 April 2011 and does not replace psychiatric treatment, psychotherapy or pharmacotherapy. In a mental health crisis contact a doctor — Polish crisis line: 116 123.
Next step
Led by Piotr Matejuk, Magdalena Gajdzińska and Weronika Wąsiakowska
Before booking you can ask about the format, the scope and availability. We answer plainly — including when a different method would serve you better.