While virtual reality exposure therapy (VRET) shows promise as a treatment for anxiety and pain (Powers & Emmelkamp, 2008), many users complain that computer-generated virtual reality (VR) stimuli appear unrealistic, eccentric, and too much like a video game (Kwon, Powell, & Chalmers, 2013). Historically, programmers using video game assets and computer-generated imagery (CGI) created VR content. While CGI can be used to make intricate virtual environments, unless there is a team of expert digital artists, the virtual stimulus may look unrealistic and exhibit a number of graphical glitches that could prove distracting in therapy. Furthermore, CGI often suffers from the uncanny valley effect, where CGI representations of people are perceived as unsettling as the representations become more lifelike. Thus, the only method to overcome the uncanny valley effect is to present the VR as less realistic (CGI) or photorealistic. In addition, current CGI VR packages are expensive and difficult to implement in widespread medical settings. Recently, however, an exciting alternative to traditional computer-generated VR has emerged: 360-Degree 3-D HD Video VR (Live Action). The benefit of Live Action VR as opposed to CGI VR is that it is photorealistic and doesn’t cause the uncanny valley effect of CGI. In addition, the projected cost of the end product is approximately $500 and delivered using a portable VR headset. In this RCT, participants in a Level I Trauma Center reporting pain (N = 78) were randomized to waitlist, 10-minutes of CGI VR, or 10-minutes of Live Action VR. Consistent with prediction, both VR conditions showed greater reduction in anxiety relative to waitlist (p < .05). However, there was no difference between the conditions. The two VR conditions also showed significantly greater reductions in pain (p < .001) and pain interference (p < .001) relative to the waitlist with no differences between conditions. As expected, participants rated Live Action VR significantly more realistic than CGI VR (p < .001) and reported a greater sense of being in the virtual world (p < .05). Finally, 92% of participants in the waitlist preferred to view the Live Action VR.