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The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders
Open accessAbstract
LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate the literature regarding the effectiveness of incorporating virtual reality (VR) in the treatment of psychiatric disorders• Assess the use of exposure-based intervention for anxiety disorders ABSTRACT: Virtual reality (VR) allows users to experience a sense of presence in a computer-generated, three-dimensional environment. Sensory information is delivered through a head-mounted display and specialized interface devices. These devices track head movements so that the movements and images change in a natural way with head motion, allowing for a sense of immersion. VR, which allows for controlled delivery of sensory stimulation via the therapist, is a convenient and cost-effective treatment. This review focuses on the available literature regarding the effectiveness of incorporating VR within the treatment of various psychiatric disorders, with particular attention to exposure-based intervention for anxiety disorders. A systematic literature search was conducted in order to identify studies implementing VR-based treatment for anxiety or other psychiatric disorders. This article reviews the history of the development of VR-based technology and its use within psychiatric treatment, the empirical evidence for VR-based treatment, and the benefits for using VR for psychiatric research and treatment. It also presents recommendations for how to incorporate VR into psychiatric care and discusses future directions for VR-based treatment and clinical research.
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“Experiencing presence when immersed in VR has been reported to be an important factor for the implementation of effective interventions in VR (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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“VR exposure therapy allows the controlled delivery of sensory stimulation (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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“For instance, virtual reality (VR) technology, accessed through head-mounted displays, provides an immersive experience similar to real-life situations and has been used in controlled environments [7].”
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“However, when traditional graded exposure becomes complex to set up due to difficulties to control specific environment cues, VR offers opportunities for highly controllable settings empowering sensory exposure with the presence of the therapist, which would not be possible otherwise (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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“…treatment research has been conducted for anxiety disorders, and broadly, results suggest the VRE is related to large declines in anxiety symptoms, 12 demonstrates similar efficacy compared to traditional exposure interventions, has a powerful real-life impact, and demonstrates good stability of…”
ResultVirtual reality exposure therapy for anxiety disorders: A meta-analysis
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“14 There is evidence that treatment gains made in VRE generalize to real life, as meta-analytic results suggest that VRE patients, compared to wait-list patients, perform significantly better on behavioral assessments post-treatment, and found no significant differences between VRE and in-vivo…”
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Background
Cited by
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“One-way RM ANOVA showed a significant main effect in time only for HR (F (5,35)= 3.”
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Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology
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“15 16 As a therapy tool, VR is most widely used to perform Virtual Reality Exposure Therapy (VRET), 16 17 either as a stand-alone treatment, for example, 18 or integrated into a CBT treatment, for example.”
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“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.”
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“This period was selected as researchers started to explore the use of VR in non-entertainment settings (e.g. psychiatric treatment (Maples-Keller et al. 2017) in 1986.”
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“Virtual Reality for theManagement of Stress and Anxiety and Its Relevance During the COVID-19 Pandemic Several studies have shown that virtual reality represents an advanced and effective tool for the prevention and treatment of stress and anxiety (Parsons and Rizzo, 2008; Maples-Keller et al., 2017; Oing and Prescott…”
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Applications of Extended Reality in Orthopaedic Surgery
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“There seems to be a consensus in the literature, that VR can produce equivalent or better outcomes for exposure-based approaches for anxiety disorder treatment [21,22,66-67].”
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Yeo, E., Chau, B., Chi, B., Ruckle, D., & Ta, P. A. (2019) · PubMed Central · Cited by 15
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“There is already evidence showing that VRET is effective for treating anxiety disorders such as different types of phobia or PTSD (for a review, see [3]).”
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Lundstedt, R., Håkansson, C., Lõhmus, M., & Wallergård, M. (2021) · Technology and Disability · doi:10.3233/tad-210344 · Cited by 15
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“Second, since VRCBT protocols were implemented in relation to other anxiety disorders (Maples-Keller et al., 2017; Fodor et al., 2018), the IM-VRCBT applied in our study involved cognitive restructuring of irrational beliefs, problem-solving methods, besides the VR technology for exposure to anxiety-inducing and relax…”
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“So far, the treatment of somatic anxiety is mainly focused on symptom management and cognitive behavioral therapy, but it is difficult to manage [39,40].”
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Can Approaching Anxiety Like a Habit Lead to Novel Treatments?
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“Virtual reality delivery of cognitive and exposure treatments has a growing evidence base, yet is largely used in combination with in-person treatment (eg, CBT).(21,22)”
MethodVirtual Reality Exposure Therapy for Posttraumatic Stress Disorder
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“Primarily, the use of virtual reality to treat anxiety and other psychiatric disorders has relied on the accurate visual representation of the feared stimuli, with sound only playing an accompanying and lesser role [29,30].”
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“A sense of immersion is not only positively related to feelings of anxiety (which is a necessary component of exposure-based paradigms), but it may also enhance the effectiveness of the intervention in facilitating behavior change [52,53].”
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“Virtual reality has shown signi fi cant effectiveness by providing a realistic virtual experience and creating a safe and controllable environment for older adults to gradually adapt to and cope with the anxiety of medical procedures [60, 61].”
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Ding, M. E., Traiba, H., & Perez, H. R. (2024) · Journal of Medical Internet Research · doi:10.2196/59922 · Cited by 12
“VR interventions have demonstrated efficacy for more than a decade for mood and anxiety disorders [10,11], and emerging evidence suggests they can reduce pain symptoms in both acute and chronic pain [12-15].”
Nelson, J., Kaplan, J., Simerly, G., Nutter, N., Edson-Heussi, A., Woodham, B., & Broman‐Fulks, J. J. (2025) · Current Psychology · doi:10.1007/s12144-025-07320-1 · Cited by 17
“VR allows users to experience sensory information in a realistic computer-generated environment via a head-mounted display (Maples-Keller et al., 2017).”
Innovative Analysis of Higher Vocational Education Model Based on Virtual Reality Technology
Man, J., Guo, F., & Ma, C. (2020) · Journal of Physics Conference Series · doi:10.1088/1742-6596/1533/2/022097 · Cited by 12
Point cloud computing algorithm on object surface based on virtual reality technology
Zhang, W., Fu, X., & Li, W. (2021) · Computational Intelligence · doi:10.1111/coin.12449 · Cited by 12
“17 As far as the actual image is concerned, the brightness of its surface points is affected by many reasons, such as light source parameters, object surface material properties, object surface shape, and camera or observer position.”
BackgroundFacial Affect Recognition in Depression Using Human Avatars
Monferrer, M., García, A. S., Ricarte, J. J., Montes, M. J., Fernández-Sotos, P., & Fernández‐Caballero, A. (2023) · Applied Sciences · doi:10.3390/app13031609 · Cited by 13
The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers
Chaabane, S., Etienne, A., Schyns, M., & Wagener, A. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22690 · Cited by 11
Monitoring and Remote Patient Management with Immersive Technologies
Mulukuntla, S. (2025) · Springer eBooks · doi:10.1007/978-981-96-2952-7_9 · Cited by 11
Basketball Technology Simulation Application Based on Virtual Reality
Song, Y. (2021) · Mathematical Problems in Engineering · doi:10.1155/2021/6657670 · Cited by 11
RetractedKnobel, S. E. J., Kaufmann, B. C., Geiser, N., Gerber, S. M., Müri, R. M., Nef, T., Nyffeler, T., & Cazzoli, D. (2022) · JMIR Serious Games · doi:10.2196/34884 · Cited by 11
“Virtual reality (VR) devices are being increasingly used, and can be found in industries [1,2] and areas of entertainment, military [3,4], and medicine [5-11].”
BackgroundJiang, Z., Meltzer, A., & Zhang, X. (2023) · Disability & Society · doi:10.1080/09687599.2022.2150601 · Cited by 16
“…virtual reality therapy is effective for those experiencing mental health issues, such as anxiety (Anderson et al. 2013; bissonnette et al. 2016; Maples-Keller et al. 2017), eating disorders (Gutiérrez-Maldonado, Wiederhold, and Riva 2016; Riva et al. 2008), post-traumatic stress disorder and…”
BackgroundImproved Spatial Knowledge Acquisition through Sensory Augmentation
Schmidt, V., König, S. U., Dilawar, R., Pacheco, T. S., & Peter König, B. (2023) · Brain Sciences · doi:10.3390/brainsci13050720 · Cited by 11
Rejbrand, C., Fure, B., & Sonnby, K. (2023) · Upsala Journal of Medical Sciences · doi:10.48101/ujms.v128.9289 · Cited by 11
Ruíz-Ortega, D., Ricoy-Cano, A. J., García‐Domingo, M., & Robles, Y. D. L. F. (2023) · International Social Work · doi:10.1177/00208728231208002 · Cited by 11
“In addition, students are generally assumed to be proficient in the use of digital technologies, but this is not always the case (Maples-Keller et al., 2017).”
Visiting experience of digital museum interior design based on virtual reality and sensor networks
Feng, Q., Liu, P., Jiang, W., & Gao, Y. (2024) · Measurement Sensors · doi:10.1016/j.measen.2024.101232 · Cited by 11
Can virtual reality technology be considered as a part of the surgical care pathway?
Gendia, A., Rehman, M. U., Cota, A., Gilbert, J., & Clark, J. (2022) · Annals of The Royal College of Surgeons of England · doi:10.1308/rcsann.2022.0125 · Cited by 11
Gray, H. G., Tchao, D., Lewis-Fung, S. E., Pardini, S., Harris, L. R., & Appel, L. (2022) · JMIR Research Protocols · doi:10.2196/41523 · Cited by 11
“As VR-ET does not place individuals in the actual physical environment, participants have the opportunity to learn how to cope with the feared situation in a less threatening environment [22].”
Draschkow, D., Anderson, N., David, E. J., Gauge, N., Kingstone, A. F., Kumle, L., Laurent, X., Nobre, A. C., Shiels, S., & Võ, M. L. ‐. (2023) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322231196305 · Cited by 13
Metaverse and Psychiatry: A Review
Sönmez, D., & Hocaoğlu, Ç. (2023) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1283964 · Cited by 13
Liddicoat, S. (2019) · General Psychiatry · doi:10.1136/gpsych-2019-100061 · Cited by 11
The Application of Folk Art with Virtual Reality Technology in Visual Communication
Zhang, R., & Zhao, X. (2020) · Intelligent Automation & Soft Computing · doi:10.32604/iasc.2020.010113 · Cited by 11
A serious VR game for acrophobia therapy in an urban environment
Anton, C., Mitrut, O., Moldoveanu, A. D. B., Moldoveanu, F., & Kosinka, J. (2020) · IEEE International Conference on Artificial Intelligence and Virtual Reality (AIVR) · doi:10.1109/aivr50618.2020.00054 · Cited by 11
“The VRET applications are based on systematic desensitization, by combining gradual exposure and relaxation techniques [40].”
MethodCyber-Therapy: The Use of Artificial Intelligence in Psychological Practice
Lucifora, C., Angelini, L., Meteier, Q., Vicario, C. M., Khaled, O. A., Mugellini, E., & Grasso, G. M. (2021) · Advances in intelligent systems and computing · doi:10.1007/978-3-030-68017-6_19 · Cited by 11
Depression Prevention by Mutual Empathy Training: Using Virtual Reality as a Tool
Li, Y. J., & Luo, H. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw52623.2021.00017 · Cited by 11
“Advanced gaming tools, especially virtual reality (VR), have shown to be able to help improve or facilitate early intervention for mental disorders [24,28,29].”
BackgroundChen, H., Zou, Q., & Wang, Q. (2021) · Journal of Healthcare Engineering · doi:10.1155/2021/1746945 · Cited by 11
Технологии виртуальной и дополненной реальности в образовательном процессе
Полевода, И. И., Иваницкий, А. Г., Миканович, А. С., Пастухов, С. М., Грачулин, А. В., Рябцев, В. Н., Навроцкий, О. Д., Лихоманов, А. О., Винярский, Г. В., & Гусаров, И. С. (2022) · Journal of Civil Protection · doi:10.33408/2519-237x.2022.6-1.119 · Cited by 11
Assessing and Treating Offenders with Mental Illness
Nicholls, T. L., Butler, A., Kendrick‐Koch, L., Brink, J., Jones, R. M., & Simpson, A. I. F. (2018) · Springer eBooks · doi:10.1007/978-3-030-00452-1_2 · Cited by 11
Examining the potential of VR program Tilt Brush in reducing anxiety
Tan, J., Kannis‐Dymand, L., & Jones, C. M. (2022) · Virtual Reality · doi:10.1007/s10055-022-00711-w · Cited by 14
“2017) and psychological (Maples-Keller et al. 2017) interventions.”
BackgroundLopes, M. K. S., Jesus, B. J. D., Rosanne, O., Pardini, S., Appel, L., Smith, C. E., & Falk, T. H. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2024.1451704 · Cited by 13
Maggio, M. G., Bonanno, L., Rizzo, A., Barbera, M., Benenati, A., Impellizzeri, F., Corallo, F., Luca, R. D., Quartarone, A., & Calabrò, R. S. (2025) · Scientific Reports · doi:10.1038/s41598-025-08173-1 · Cited by 17
Majidi, E., & Manshaee, G. (2021) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.115684 · Cited by 10
Cuesta, M., Verty, L. V., Abdessalem, H. B., Byrns, A., Bruneau, M., Frasson, C., & Belleville, S. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.807991 · Cited by 10
“Immersive virtual reality (VR) has been increasingly used in clinical neuropsychology research and to treat neuropsychiatric symptoms (Maples-Keller et al., 2017; Ouellet et al., 2018; La Corte et al., 2019; Corriveau Lecavalier et al., 2020; Dermody et al., 2020).”
BackgroundSocial VR : A Promising Platform for Enhancing Mental Wellness among College Students
You, X., Bailey, J. O., Won, A. S., Ahn, S. J., & MacIntyre, B. (2023) · Proceedings of the Association for Information Science and Technology · doi:10.1002/pra2.805 · Cited by 10
“While previous studies have demonstrated the effectiveness of VR in treating psychological disorders (Freeman et al., 2017; Hoffman, 2004; Maples-Keller et al., 2017; Paul et al., 2022) and providing counseling services (Lin et al., 2021; Sarpourian et al., 2022; Wray & Emery, 2022), these studies…”
Key determinants of intention to use virtual reality in medical training
Urbistondo, P. A., Pérez-Aranda, J., & Molina, A. M. C. (2024) · Virtual Reality · doi:10.1007/s10055-024-00990-5 · Cited by 11
“…has reflected the medical community’s growing interest, expanding significantly in recent years and focusing largely on applications of this technology in health services for individuals with disabilities (De Ribaupierre et al. 2014; Levin et al. 2014; Maples-Keller et al. 2017; Sveistrup 2004).”
Metadata
- Authors
- Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O.
- Affiliations
- Emory University (US)
- Venue
- Harvard Review of Psychiatry
- Published
- 2017-05
- Volume
- 25
- Issue
- 3
- Pages
- 103-113
- ISSN
- 1067-3229 (ISSN-L)
- 1465-7309
- PMC
- PMC5421394
- OpenAlex
- W2611287876
- Cited by
- 862
- References
- 108
- Citations by year
- 2026: 111 · 2025: 147 · 2024: 115 · 2023: 93 · 2022: 113 · 2021: 117 · 2020: 85 · 2019: 51 · 2018: 24 · 2017: 5
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Harvard Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Genentech
- National Institute of Mental Health (R01MH094757, R01MH070880)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- virtual reality, anxiety disorders, mental illness, exposure therapy, virtual reality exposure therapy, immersive virtual reality, head-mounted displays, treatment effectiveness, psychiatric treatment
- MeSH terms
- Anxiety Disorders, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Virtual Reality Exposure Therapy
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