Cited by 372Virtual Reality Applications and ImpactsSimulation-Based Education in HealthcareSimulation and Modeling Applications

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Is clinical virtual reality ready for primetime?

Rizzo, Albert “Skip”, Koenig, Sebastian Thomas·2017·Neuropsychology

DOI 10.1037/neu0000405

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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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“Here, its applications are already varied, encompassing areas such as mental health, social interaction, and training, with expectations for an even broader usage in the future (Martingano and Persky 2021; Rizzo and Koenig 2017; Vasser and Aru 2020).”
A Systematic Review of Virtual Reality Applications for Adaptive Behavior Training in Individuals with Intellectual Disabilities
Zhou, P., & Zhan, Z. (2025) · Education Sciences · doi:10.3390/educsci15081014 · Cited by 6
Art Project Virtual Reality for Global Citizenship Education
Prieto, M. S., González, G. D. P., & de Pablo, N. (2024) · Technology Knowledge and Learning · doi:10.1007/s10758-023-09716-z · Cited by 6
Calling HCI professionals into health research
Gotsis, M., & Jordan‐Marsh, M. (2018) · Panhellenic Conference on Informatics · doi:10.1145/3291533.3291562 · Cited by 6
“The next frontier of interactive entertainment in healthresearch is virtual reality (VR)—a medium that has finally matured for scaling in health[62].”
Background
DC: Clinical Application of Immersive VR in Spatial Cognition: The Assessment of Spatial Memory and Unilateral Spatial Neglect in Neurological Patients
Belger, J. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw52623.2021.00244 · Cited by 6
VIRTUAL REALITY IN CLINICAL SIMULATION: A MODALITY FOR UNDERGRADUATE NURSING EDUCATION
Ramakrishnan, A., Lleva, A., & Okupniak, C. (2020) · INTED proceedings · doi:10.21125/inted.2020.1958 · Cited by 6
Posibilidades psicoterapéuticas de la realidad virtual desde el punto de vista de sus primeros usuarios en España
Sánchez-Cabrero, R., Peris, M., & Mejía, A. C. L. (2020) · 3C TIC Cuadernos de desarrollo aplicados a las TIC · doi:10.17993/3ctic.2020.91.41-73 · Cited by 6
Virtual reality for MRI preparation: Participant perceptions from a feasibility study
Hudson, D. M., & Heales, C. J. (2025) · Journal of medical imaging and radiation sciences · doi:10.1016/j.jmir.2025.101890 · Cited by 5
Detection of mild cognitive impairment using a virtual reality-based stroop task: a cross-sectional study of embodied behavioral markers
Park, J.-H. (2025) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-025-01714-9 · Cited by 4
“Despite increasing evidence for the diagnostic value of VR-based tools, their clinical adoption remains limited due to high equipment costs, lack of platform standardization, and usability issues such as cybersickness or user unfamiliarity [45, 46].”
Colour Perception in Immersive Virtual Reality: Emotional and Physiological Responses to Fifteen Munsell Hues
Febbraio, F., Collina, S., Lepida, C., & Kourtesis, P. (2025) · Virtual Worlds · doi:10.3390/virtualworlds4040045 · Cited by 5
“Gradual transitions to warmer hues could then be used to support the graded introduction of therapeutic stressors, enabling clinicians to calibrate challenge and safety dynamically [13].”
Threat Perception Captured by Emotion, Motor and Empathetic System Responses: A Systematic Review
Jacobs, E., Deligianni, F., & Pollick, F. E. (2023) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2023.3323043 · Cited by 7
“First, due to greater SCR being identiﬁed from the viewing of emotional images, it can be used to identify the period of peak emotional arousal, identifying emotion induction and its impact on defensive behaviours [117].”
Background
Creation of a Novel Virtual Reality Simulation to Increase Nursing Skills in Management of Workplace Violence
Tobias, J., DiDonato, S., Whitfield-Harris, L., Okupniak, C., Santulli, G. M., Das, N., & Marino, M. A. (2025) · JONA The Journal of Nursing Administration · doi:10.1097/nna.0000000000001548 · Cited by 5
The Landscape of Virtual Reality Use in Mobility Rehabilitation from 2010–2023: A Scoping Review
Felsberg, D. T., Pousti, R., Howard, C. K., Ross, S. E., Raisbeck, L. D., McGuirt, J. T., & Rhea, C. K. (2025) · Technologies · doi:10.3390/technologies13050167 · Cited by 5
The Extent of the Proteus Effect as a Behavioral Measure for Assessing User Experience in Virtual Reality
Kocur, M., Henze, N., & Schwind, V. (2021) · University of Regensburg Publication Server (University of Regensburg) · doi:10.5283/epub.45543 · Cited by 5
User-Agent Bond in Generalizable Environments: Long-Term Risk-Reduction via Nudged Virtual Choices
Wang, L., Christensen, J. L., Smith, B. J., Gillig, T. K., Jeong, D. C., Liu, M., Appleby, P. R., Read, S. J., & Miller, L. C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.695389 · Cited by 7
“…visual, acoustic, etc.) through which users re-imagine and experience trauma triggering events with a trained therapist (see Rizzo et al., 2014; Rizzo and Koenig, 2017) or just work through challenging situations with intelligent agent mentors/guides (e.g., Marsella et al., 2000; Christensen…”
Background
Virtual Reality Exposure Therapy
Bender, S. M., & Broderick, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-82547-8_4 · Cited by 7
A Visualisation Analysis Using the VOSviewer of Literature on Virtual Reality Technology Application in Healthcare
Liu, X., Chau, K. Y., Chan, H. S., & Wan, Y. (2021) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-7998-8790-4.ch001 · Cited by 5
The Effects of Virtual Reality Training on Cognition in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials
Kantola, M., Ilves, O., Honkanen, S., Hakonen, H., Yli-Ikkelä, R., Köyhäjoki, A., Anttila, M.-R., Rintala, A., Korpi, H., Sjögren, T., et al. (2024) · Journal of Aging and Physical Activity · doi:10.1123/japa.2023-0217 · Cited by 5
Systematic Representative Design and Clinical Virtual Reality
Mozgai, S., Hartholt, A., & Rizzo, A. (2019) · Psychological Inquiry · doi:10.1080/1047840x.2019.1693873 · Cited by 5
“…to the predecessor field of aviation simulation technology (Jentsch & Curtis, 2017) and an earlier detailing of these assets relevant to neuropsychology appeared in Rizzo, Schultheis, Kerns, and Mateer (2004) and more recently (for both research and clinical practice) in Rizzo and Koenig (2017).”
Background
Introduction to Virtual Reality
Preim, B., Raidou, R. G., Smit, N. N., & Lawonn, K. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-822962-0.00022-5 · Cited by 6
Settling the Score: Virtual Reality as a Tool to Enhance Trauma-Focused Therapy for PTSD
Rizzo, A., Hartholt, A., & Mozgai, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-56537-3_14 · Cited by 5
Design and Development of a Virtual Reality System for the Management of Adult Neurogenic Communication Disorders
Vaezipour, A., Aldridge, D., Wall, K. J., Koenig, S. T., & Theodoros, D. (2019) · IEEE International Symposium on Mixed and Augmented Reality Adjunct (ISMAR-Adjunct) · doi:10.1109/ismar-adjunct.2019.00043 · Cited by 5
“VR is a computer-generated simulation of a three-dimensional environment that can be interacted with using laptops/desktop computers (non-immersive) or head-mounted displays, sensors and hand controllers (immersive) [7].”
Background
Celebrating the 125th anniversary of the American Psychological Association: A quarter century of neuropsychology.
Brown, G. G., Anderson, V. A., Bigler, E. D., Chan, A. S.-Y., Fama, R., Grabowski, T. J., & Zakzanis, K. K. (2017) · Neuropsychology · doi:10.1037/neu0000450 · Cited by 5
Next Generation Virtual Reality Exposure Therapy Systems - A Study exploring Design Implications
Koller, M., Schäfer, P., Sich, M., Diemer, J., Müller, M., & Meixner, G. (2018) · IEEE International Conference on Intelligent Systems · doi:10.1109/is.2018.8710504 · Cited by 5
“Rizzo and Koenig conclude that this advance in technology and the public awareness of VR will foster its application in clinical use-cases and will have major impact in therapy and research [24].”
Background
Virtual Reality as a Research Method in Criminology
Cornet, L. J. M., & van Gelder, J. (2021) · The Encyclopedia of Research Methods in Criminology and Criminal Justice · doi:10.1002/9781119111931.ch174 · Cited by 5
Virtual Reality in Training of Sustained Attention, Processing Speed, and Working Memory After Traumatic Brain Injury: A Randomized Controlled Trial
Johansen, T. E. B., Matre, M., Løvstad, M., Olsen, A., Lund, A. D., Martinsen, A. C. T., Becker, F., Brunborg, C., Rizzo, A., Spikman, J. M., et al. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.07.005 · Cited by 7
The influence of complex classroom noise on auditory selective attention
Breuer, C., Schmitt, R. H., Leist, L., Fremerey, S., Raake, A., Klatte, M., & Fels, J. (2025) · Scientific Reports · doi:10.1038/s41598-025-18232-2 · Cited by 4
Do not immerse and drive? prolonged effects of cybersickness on physiological stress markers and cognitive performance
Zielasko, D., Rehling, B., von Dawans, B., & Domes, G. (2026) · Virtual Reality · doi:10.1007/s10055-026-01335-0 · Cited by 5
“However, despite its advantages, prolonged exposure to XR can introduce physiological and cognitive challenges, including motion sickness, fatigue, and stress responses, which may impact performance and well-being (Parsons et al, 2017; Rizzo et al, 2017).”
Creating safe environments for children: prevention of trauma in the Extended Verse
Jane Patel, N. (2025) · Empathic Computing · doi:10.70401/ec.2025.0003 · Cited by 4
Artificial Intelligence for Predictive Health Analytics: Challenges, Methods, and Immersive System Integration
Daineko, Y. A., & Seitnur, A. (2025) · Procedia Computer Science · doi:10.1016/j.procs.2025.07.232 · Cited by 6
Continuous Interaction for a Virtual Reality Exposure Therapy System
Koller, M., Rauh, S. F., Lundstom, A., Bogdan, C., & Meixner, G. (2020) · IEEE International Conference on Healthcare Informatics (ICHI) · doi:10.1109/ichi48887.2020.9374379 · Cited by 4
“Among these emerging fields of application is clinical VR [2].”
Background
Developing the Rationale for Including Virtual Reality in Cognitive Rehabilitation and Exercise Training Approaches for Managing Cognitive Dysfunction in MS
Wender, C. L. A., DeLuca, J., & Sandroff, B. M. (2022) · NeuroSci · doi:10.3390/neurosci3020015 · Cited by 4
Clinical applications of extended reality
Khan, S. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-98381-5.00013-1 · Cited by 4
Acrophobia and consumer-based automated virtual reality cognitive behavior therapy
Donker, T., & Heinrichs, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85726-0.00035-1 · Cited by 4
SURVIVRS: Surround Video-Based Virtual Reality for Surgery Guidance
Taweel, A., Jorge, J. A., Maciel, A., Vissoci, J. R. N., & Kopper, R. (2023) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw58643.2023.00047 · Cited by 4
Keep It Clean: The Current State of Hygiene and Disinfection Research and Practices for Immersive Virtual Reality Experiences
Høeg, E. R., Serafin, S., & Lange, B. S. (2025) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2025.3549130 · Cited by 8
“Although clinical VR has the potential to offer innovative and cost-efficient methods of treat-ment, diagnosis, and altering the delivery of care [5,30,33,44], ensuring patient safety remains of utmost importance.”
Beyond user experience and technology acceptance: Criteria to select a technology for a road safety behavioural change intervention
Vankov, D. (2021) · Transactions on Transport Sciences · doi:10.5507/tots.2021.017 · Cited by 4
Exploring the Impact of Immersion on Situational Awareness and Trust in Remotely Monitored Maritime Autonomous Surface Ships
McGregor, A., Allison, R. S., & Heffner, K. (2023) · MTS/IEEE OCEANS Conference (OCEANS) · doi:10.1109/oceanslimerick52467.2023.10244249 · Cited by 4
“NVR involves interacting with a virtual environment using limited sensory cues [11], [12], for example when”
Background

Authors: Rizzo, A. “., & Koenig, S. T.
Affiliations: University of Southern California (US)
ORCID: Rizzo, Albert “Skip”
Koenig, Sebastian Thomas
Venue: Neuropsychology
Publisher: American Psychological Association (APA)
Published: 2017-11
Volume: 31
Issue: 8
Pages: 877-899
ISSN: 0894-4105 (ISSN-L)
1931-1559
DOI: 10.1037/neu0000405
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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