Cybersickness in VR Therapy:
Quality as a Key Factor for High Acceptance and Satisfaction
Introduction
Cybersickness remains one of the greatest challenges in the therapeutic use of Virtual Reality (VR). Symptoms include nausea, dizziness, disorientation, and oculomotor discomfort, occurring in 40–60% of new users (Kourtesis et al., 2023).
Numerous studies have identified the causes: in addition to the classical sensory conflict—i.e., a discrepancy between visual and vestibular signals—low refresh rates (< 60 Hz), high latency (> 20 ms), and strong optical flow without corresponding self-motion play a decisive role (Palmisano et al., 2020). Particularly problematic are pre-rendered 360° videos with moving cameras. In a randomized study, around 40% of participants reported significant nausea symptoms after just a few minutes if the recordings were not stabilized (Litleskare & Calogiuri, 2019).
Even with stabilized videos, interactivity remains limited, as only head rotations are considered (3-DoF), while free positional changes or interventions in the scene are not possible. Cybersickness refers to discomfort, dizziness, and nausea associated with VR exposure, affecting 40–60% of people (Kourtesis et al., 2023). The result: overload, therapy dropouts, disappointed patients.
CGI vs. Moving 360° Videos
In general, computer-generated interactive VR scenarios (CGI) show significantly better tolerability than pre-rendered moving 360° videos.
CGI environments are computed in real time and allow full mapping of six degrees of freedom (6-DoF). This enables consistent integration of head and body movements, reducing the occurrence of cybersickness.
In addition, CGI scenarios enable the use of so-called comfort mechanics, which are scientifically proven to be effective: teleportation reduces nausea compared to continuous joystick control by up to 50% (Hořejší et al., 2025), snap-turns minimize symptoms compared to smooth rotations, and dynamic FOV vignettes (“tunneling”) reduce optical flow by up to 40% (Wu et al., 2022). Another advantage of interactive CGI environments is the possibility of gradual exposure: scenes can be controlled, paused, or adjusted in intensity by the therapist. Video providers also advertise “gradual increase” and “modular structure”; however, this merely means sequencing different films—each with its own loading time and immersion interruption.
The VR Coach smart system by VR Coach GmbH
The VR Coach smart system consistently leverages the advantages of CGI. The software enables real-time control, adjustment, or termination of exposures. In addition, external biofeedback systems can be integrated to monitor physiological stress markers (e.g., heart rate, skin conductance) as early warning signals for overload. By using high-quality HMDs with at least 90 Hz refresh rate, a technical basis is created that corresponds to the state of research and minimizes latency issues.
This clearly distinguishes the smart system from simple consumer solutions or low-cost offerings, which often rely on unstabilized 360° videos with low frame rates and thus risk high dropout rates due to cybersickness.
Overall, it should be emphasized that the smart system not only has higher tolerability but is also therapeutically superior to simple videos, as it enables active behavior, control of actions, and gradual adjustment.
The VR Coach smart system thus represents an evidence-based and practice-oriented solution that systematically addresses the scientifically identified risk factors for cybersickness while meeting clinical requirements for controllability, safety, and effectiveness.
Sources
Hořejší, P., et al. (2025). Virtual reality locomotion methods differentially affect navigation performance, perceived usability, and cybersickness. Scientific Reports. https://doi.org/10.1038/s41598-025-12143-y
Kourtesis, P., Papadopoulou, A., & Roussos, P. (2023). Examination of cybersickness in virtual reality: The role of individual differences, effects on cognitive functions & motor skills, and intensity differences during and after immersion. arXiv. http://arxiv.org/abs/2310.17344
Litleskare, S., & Calogiuri, G. (2019). Camera stabilization in 360° videos reduces cybersickness: A randomized controlled trial of a simulated nature walk. Frontiers in Psychology, 10, 2436. https://doi.org/10.3389/fpsyg.2019.02436
Palmisano, S., Allison, R. S., Kim, J., & Kuchenbecker, K. J. (2020). Cybersickness in head-mounted displays is caused by differences in virtual and physical head pose (DVP). Frontiers in Virtual Reality. https://doi.org/10.3389/frvir.2020.587698
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