The DOI matches its Crossref record; 187 of the 189 references it cites were found in a registry or an index.
Is clinical virtual reality ready for primetime?
Abstract
OBJECTIVE: Since the mid-1990s, a significant scientific literature has evolved regarding the outcomes from the use of what we now refer to as clinical virtual reality (VR). This use of VR simulation technology has produced encouraging results when applied to address cognitive, psychological, motor, and functional impairments across a wide range of clinical health conditions. This article addresses the question, "Is clinical VR ready for primetime?" METHOD: After a brief description of the various forms of VR technology, we discuss the trajectory of clinical VR over the last 20 years and summarize the basic assets that VR offers for creating clinical applications. The discussion then addresses the question of readiness in terms of the theoretical basis for clinical VR assets, the research to date, the pragmatic factors regarding availability, usability, and costs of clinical VR content/systems, and the ethical issues for the safe use of VR with clinical populations. RESULTS: Our review of the theoretical underpinnings and research findings to date leads to the prediction that clinical VR will have a significant impact on future research and practice. Pragmatic issues that can influence adoption across many areas of psychology also appear favorable, but professional guidelines will be needed to promote its safe and ethical use. CONCLUSIONS: Although there is still much research needed to advance the science in this area, we strongly believe that clinical VR applications will become indispensable tools in the toolbox of psychological researchers and practitioners and will only grow in relevance and popularity in the future. (PsycINFO Database Record
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“Exposure therapy within VR has shown promising results in treating various mental health conditions.”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [26]
In the citing paper
“It has been particularly effective in treating phobias and post-traumatic stress disorder (26).”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [26]
In the citing paper
“VR creates immersive and interactive environments that allow individuals to confront anxiety-inducing situations in a safe and controlled manner (26).”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [26]
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Knobel, S. E. J., Kaufmann, B. C., Gerber, S. M., Urwyler, P., Cazzoli, D., Müri, R. M., Nef, T., & Nyffeler, T. (2021) · JMIR Serious Games · doi:10.2196/29182 · Cited by 37
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“It furthermore also has important advantages over in-vivo exposure, such as context controllability or convenience (Parsons & Rizzo, 2008; Rizzo & Koenig, 2017).”
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“…reality ’ (VR), which has developed extensively over the last 2 decades in the fi eld of healthcare, refers to a computer-screen-based simulation that offers a multisensory and immersive interactive experience in a safe environment (Mantovani et al., 2003; Rizzo et al., 2017; Riva and Serino, 2020).”
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“Advances in virtual reality technologies can now support the creation of low-cost, yet sophisticated, immersive simulations, capable of running on consumer-level computing devices [31].”
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van Gelder, J.-L. (2023) · Crime and Justice · doi:10.1086/726691 · Cited by 31
“In other words, the viewing experience in VR corresponds with what a user would see (and possibly hear and feel) if the scene were real (Rizzo and Koenig 2017).”
BackgroundMultimodal immersive trail making-virtual reality paradigm to study cognitive-motor interactions
Plotnik, M., Ben‐Gal, O., Doniger, G. M., Gottlieb, A., Bahat, Y., Cohen, M., Kimel-Naor, S., Zeilig, G., & Beeri, M. S. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00849-9 · Cited by 30
“In addition to its continued popularity for entertainment, VR is now being applied in a variety of ‘serious’ contexts, ranging from surgical simulation to the study of human performance and psychological function (29, 30).”
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Virtual Reality and Correctional Rehabilitation: A Game Changer
Ticknor, B. (2019) · Criminal Justice and Behavior · doi:10.1177/0093854819842588 · Cited by 20
“Using a virtual simulation during treatment does appear to increase the patients’ motivation, ability to generalize what they have learned to the real world, and treatment outcomes (Rizzo & koenig, 2017).”
BackgroundKakoschke, N., Page, R., de Courten, B. V., Verdejo‐García, A., & McCormack, J. (2021) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2021.102626 · Cited by 30
Psychiatric interventions in virtual reality: why we need an ethical framework
MARLOTH, M., CHANDLER, J., & VOGELEY, K. (2020) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180120000328 · Cited by 26
Schütz, A., Kurz, K., & Busch, G. (2022) · PLoS ONE · doi:10.1371/journal.pone.0261248 · Cited by 27
“It can be defined as a highly developed type of human-computer interaction that allows users to interact with the computer in a more natural way compared to standard computer devices [20].”
BackgroundThe Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review
Ong, T., Wilczewski, H., Soni, H., Nisbet, Q., Paige, S. R., Barrera, J. F., Welch, B. M., & Bunnell, B. E. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.848066 · Cited by 28
“Despite its benefits, mental health providers have not yet embraced VRET for widespread use (Rizzo and Koenig, 2017).”
BackgroundReporting the early stage clinical evaluation of virtual-reality-based intervention trials: RATE-VR
Vlake, J. H., van Bommel, J., Riva, G., Wiederhold, B. K., Cipresso, P., Rizzo, A., Botella, C., Hooft, L., Bienvenu, O. J., Geerts, B. F., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-02085-7 · Cited by 27
Yu, C., Wang, C., Xie, Q., & Wang, C. (2024) · JMIR Serious Games · doi:10.2196/56918 · Cited by 26
Wei, X., Huang, C. K., Ding, X., Zhou, Z., Zhang, Y., Feng, X., Zheng, S., Li, T., & Lü, J. (2025) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-025-01675-z · Cited by 26
“VR accelerates therapeutic gains through neuroplastic reorganization— functional MRI studies confirm strengthened connectivity between prefrontal cortices and supplementary motor areas post-VR training [87].”
Breitkreuz, K. R., Kardong‐Edgren, S., Gilbert, G. E., Anderson, P., DeBlieck, C. J., Maske, M., Hallock, C., Lanzara, S., Parrish, K., Rossler, K. L., et al. (2021) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2020.10.003 · Cited by 26
Vlake, J. H., Drop, D. L. Q., van Bommel, J., Riva, G., Wiederhold, B. K., Cipresso, P., Rizzo, A., ROTHBAUM, B. O., Botella, C., Hooft, L., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/56790 · Cited by 27
“This approach should encompass technological, methodological, and safety aspects to support a more objective understanding of the validity and generalizability of findings [10].”
Høeg, E. R., Bruun‐Pedersen, J. R., & Serafin, S. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw52623.2021.00052 · Cited by 26
Sick Moves! Motion Parameters as Indicators of Simulator Sickness
Feigl, T., Roth, D., Gradl, S., Wirth, M., Latoschik, M. E., Eskofier, B. M., Philippsen, M., & Mutschler, C. (2019) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2019.2932224 · Cited by 25
“Today’s VR systems support learning, narrative experiences, gaming, physical and psychological therapy, enabling users to move and navigate in the simulations using various interaction metaphors [61, 78], etc.”
BackgroundInterracial Contact in Virtual Reality: Best Practices
Taylor, V. J., Valladares, J. J., Siepser, C., & Yantis, C. (2020) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/2372732220943638 · Cited by 26
“…VR could treat bias and racism (e.g., recognizing one’s own and others’ racist behavior, disparate treatment recommendations) with a VR version of exposure therapy or anxiety treatments (see Rizzo & Koenig, 2017; for related work on racial embodiment to counteract racism see Cogburn et al., 2018).”
BackgroundBolinski, F., Etzelmüller, A., De Witte, N. A. J., van Beurden, C., Debard, G., Bonroy, B., Cuijpers, P., Riper, H., & Kleiboer, A. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103877 · Cited by 23
Tromp, J., Klotzsche, F., Krohn, S., Akbal, M., Pohl, L., Quinque, E. M., Belger, J., Villringer, A., & Gaebler, M. (2020) · Frontiers in Virtual Reality · doi:10.3389/frvir.2020.611091 · Cited by 23
“From a clinical perspective, patients can also independently practice skills in a controlled environment outside the clinic and ideally at home (Rizzo and Koenig, 2017).”
BackgroundInfluentialSalagean, A., Hadnett-Hunter, J., Finnegan, D. J., de Sousa, A. A., & Proulx, M. J. (2022) · ACM Transactions on Applied Perception · doi:10.1145/3487563 · Cited by 22
Hugh‐Jones, S., Ulor, M. N., Nugent, T., Walshe, S., & Kirk, M. (2023) · Mental Health & Prevention · doi:10.1016/j.mhp.2023.200265 · Cited by 28
Virtual reality-based gait rehabilitation intervention for stroke individuals: a scoping review
Kim, M., & Kaneko, F. (2023) · Journal of Exercise Rehabilitation · doi:10.12965/jer.2346114.057 · Cited by 23
“While maintaining stimulus control and consistency, the number of stimuli and the difficulty of tasks can be changed at VR to meet patients’ needs and abilities (Maier et al., 2019a; Rizzo and Koenig, 2017).”
BackgroundVirtual Reality and ADHD: Clinical Assessment and Treatment in the Metaverse
Schweitzer, J. B., & Rizzo, A. (2022) · The ADHD Report · doi:10.1521/adhd.2022.30.3.1 · Cited by 20
Martínez‐Pernía, D., Olavarría, L., Fernández‐Manjón, B., Cabello, V., Henríquez, F., Robert, P. H., Alvarado, L., Barría, S., Antivilo-Bruna, A., Velásquez, J. D., et al. (2023) · Applied Neuropsychology Adult · doi:10.1080/23279095.2023.2174438 · Cited by 28
“…has been well-received in the field of rehabilitation (Legouverneur et al., 2011; Manera et al., 2015, 2017; Mart (cid:1) ı nez-Pern (cid:1) ı a et al., 2017), as a virtual training simulator to improve real-life skills (Vallejo et al., 2017), and as a therapeutic tool to improve behavioral…”
InfluentialMental health professionals’ attitudes towards virtual reality therapies: a systematic review
Bin, S., Alrashdi, D. H., Whitehead, T., Riches, S., & Drini, E. (2025) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-025-00499-x · Cited by 21
“One of the primary clinical applications is VR exposure therapy (VRET), which has been particularly valuable for trauma and stressor-related disorders, and phobias (Rizzo & Koenig, 2017).”
Bouchard, S., & Rizzo, A. (2019) · Virtual reality technologies for health and clinical applications · doi:10.1007/978-1-4939-9482-3_1 · Cited by 22
El-Qirem, F. A., Malak, M. Z., Salameh, A. B., Ali, R., & Alsswey, A. (2022) · Current Psychology · doi:10.1007/s12144-022-02939-w · Cited by 23
Kuleli, D., Tyson, P. J., Davies, N., & Zeng, B. (2025) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2025.100524 · Cited by 28
Ong, T., Barrera, J. F., Sunkara, C., Soni, H., Ivanova, J., Cummins, M. R., Schuler, K. R., Wilczewski, H., Welch, B. M., & Bunnell, B. E. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2024.1332874 · Cited by 19
Combining frontal gamma asymmetry neurofeedback with virtual reality: A proof of concept case study
Tarrant, J., & Cope, H. (2018) · NeuroRegulation · doi:10.15540/nr.5.2.57 · Cited by 20
“While this technology has been primarily associated with the video game industry, it is increasingly being utilized as a clinical intervention for a variety of medical and mental health concerns (Rizzo & Koenig, 2017).”
MethodDie Entwicklung virtueller Realität als Expositionsverfahren
Diemer, J., & Zwanzger, P. (2019) · Der Nervenarzt · doi:10.1007/s00115-019-0678-6 · Cited by 20
The study of virtual reality influence on the process of professional training of miners
Obukhov, A. D., Krasnyanskiy, M. N., Dedov, D. L., & Nazarova, A. O. (2022) · Virtual Reality · doi:10.1007/s10055-022-00687-7 · Cited by 19
The ObReco-360°: a new ecological tool to memory assessment using 360° immersive technology
Pieri, L., Serino, S., Cipresso, P., Mancuso, V., Riva, G., & Pedroli, E. (2021) · Virtual Reality · doi:10.1007/s10055-021-00526-1 · Cited by 19
“…of the study was based on the ongoing scientific debate concerning the ecological validity of standard paper-and-pencil tests (Chaytor and Schmitter-Edgecombe 2003; Parsons 2015) and on the evidence suggesting the implementation of VR in the neuropsychological assessment (Rizzo and Koenig 2017).”
BackgroundMethodBreuer, C., Loh, K., Leist, L., Fremerey, S., Raake, A., Klatte, M., & Fels, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416569 · Cited by 23
Giatzoglou, E., Vorias, P., Kemm, R., Karayianni, I., Nega, C., & Kourtesis, P. (2024) · Applied Sciences · doi:10.3390/app142110010 · Cited by 28
“Additionally, VR-based tools offer a platform not only for diverse behavioral and cognitive tests but also for enhancing and measuring critical cognitive functions such as working memory, executive functioning, and behavior [11–13].”
BackgroundPreliminary Work on a Virtual Reality Interface for the Guidance of Underwater Robots
de la Cruz, M., Casañ, G. A., Sanz, P. J., & Marín, R. (2020) · Robotics · doi:10.3390/robotics9040081 · Cited by 18
“The clinical domain has seen a large variety of applications, like [27] and it is considered ready for general application [28].”
BackgroundHigher cognitive load interferes with head-hand coordination: virtual reality-based study
Lustig, A., Wilf, M., Dudkiewicz, I., & Plotnik, M. (2023) · Scientific Reports · doi:10.1038/s41598-023-43337-x · Cited by 17
“…CTT format in addition to the growing evidence that VR-based neuropsychological tests are more predictive of ’functional behavior’ 27–29 , led us to translate and adapt the CTT task to a VR-based platform (VR-CTT) 30–32 , consequently forming a validated and better-suited…”
BackgroundŽilinský, T., & Halamová, J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032592 · Cited by 18
“This follows the observation of Rizzo and Koenig [5] that the identification of active ingredients in the use of clinical VR is still very much needed.”
BackgroundAvatar and virtual agent-assisted telecare for patients in their homes: A scoping review
Winkler, A., Kutschar, P., Pitzer, S., van der Zee‐Neuen, A., Kerner, S., Osterbrink, J., & Krutter, S. (2023) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x231174484 · Cited by 17
“34 Though proven to be effective in many areas of mental and physical health, 35 potential side effects of virtual reality include visual asthenopia, motion sickness and dissociation.”
Metadata
- Authors
- Rizzo, A. “., & Koenig, S. T.
- Affiliations
- University of Southern California (US)
- Venue
- Neuropsychology
- Published
- 2017-11
- Volume
- 31
- Issue
- 8
- Pages
- 877-899
- ISSN
- 0894-4105 (ISSN-L)
- 1931-1559
- OpenAlex
- W2786973165
- Cited by
- 372
- References
- 189
- Citations by year
- 2026: 60 · 2025: 78 · 2024: 49 · 2023: 41 · 2022: 26 · 2021: 39 · 2020: 32 · 2019: 27 · 2018: 15 · 2017: 5
- FWCI
- 26.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Education › Simulation-Based Education in Healthcare
- Physical Sciences › Engineering › Control and Systems Engineering › Simulation and Modeling Applications
- Keywords
- virtual reality simulation, technology readiness, barriers to adoption, usability, cost, ethical considerations, safety, cognitive impairment, motor impairment, functional disability, psychological rehabilitation, professional guidelines
- MeSH terms
- Virtual Reality, Feedback, Humans, Knowledge of Results, Psychological, Phobic Disorders, User-Computer Interface, Virtual Reality Exposure Therapy
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