After a burst of popular interest, virtual reality (VR) faded somewhat from view, but research and development have continued. Applications have expanded as costs have come down and hardware has improved. Originally, VR was used to treat simple phobias, especially fear of heights and flying. Applications for claustrophobia, fear of driving, and fear of spiders ensued. Currently, there is ongoing work on posttraumatic stress disorder, eating disorders, sexual dysfunction, schizophrenic hallucinations, and addictions. Considerable success has been achieved in using VR for distraction from pain. Attention is now being given to panic disorder and agoraphobia. The latter syndromes require the use of simulated human beings (avatars). Existing avatars are standardized, schematic, and limited in their ability to interact, but exciting work is proceeding on the development of highly interactive avatars that can be personalized.The use of virtual reality (VR) technology in psychotherapy has taken some time to come of age. After capturing the public imagination some years ago, enthusiasm for VR flagged as a result of hardware limitations, the need for expensive equipment, and the lack of a commercial market. Recently, however, significant improvements have been made in computer speed and the quality of head-mounted displays. Further, costs have come down dramatically. The original studies were conducted with environments that were at best animated caricatures of real environments yet could cost over $250,000. Today, richer and much more complex environments perform effortlessly on typical desktop and high-end laptop computers.These technological developments have contributed to an increase in the amount of work being done with VR. Although it is difficult to estimate how many clinical VR installations are currently operating-there is no central registry-one company, Virtually Better, has systems in approximately 40 locations in 6 countries, including the United States, Canada, Australia, Israel, Argentina, and Ireland. These installations are in hospitals, universities, private practice settings, and small groups. Many of these sites conduct a mix of clinical training, research, and clinical work. Even more interesting is the fact that according to a recent poll published in an APA journal, the use of VR and other computerized Kalman Glantz, independent practice, Cambridge, Massachusetts; Albert (Skip) Rizzo,