The use of neuropsychological and psychophysiological measures in studies of patients immersed in high-fidelity virtual environments offers the potential to develop current psychophysiological computing approaches into affective computing scenarios that can be used for assessment, diagnosis and treatment planning. Such scenarios offer the potential for simulated environments to proffer cogent and calculated response approaches to real-time changes in user emotion, neurocognition, and motivation. The value in using virtual environments to produce simulations targeting these areas has been acknowledged by an encouraging body of research. Herein the authors describe (1) literature on virtual environments for neurocognitive and psychophysiological profiles of users' individual strengths and weaknesses; and (2) real-time adaptation of virtual environments that could be used for virtual reality exposure therapy and cognitive rehabilitation. Specifically, the authors discuss their approach to an adaptive environment that uses the principles of flow, presence, neuropsychology, psychophysiology to develop a novel application for rehabilitative applications.