Virtual reality, specifically virtual reality exposure therapy (VRE), provides an immersive environment that has been used effectively to treat patients with anxiety disorders. One of the central motivators for the development and dissemination of VRE is the need for clinical strategies to help emotionally avoidant patients engage in exposures that target the activation of strong emotion. The focus of this chapter is on how to optimize engagement in exposure therapy by using virtual reality (VR) to address and correct unhelpful avoidance, as well as other feasibility factors, which interfere with completing therapeutic exposures (e.g., cost and logistics). VRE can be both cost-effective and facilitative in its treatment of anxiety disorders and offers advantages in clinical assessment and treatment, as well as methodological control in research. This chapter will review the literature and summarize the evidence on the application and effectiveness of VRE. Strategies for VRE implementation and clinical considerations for providers utilizing this technology will be provided.