The impact of virtual reality cognitive behavioral therapy on mental disorders among children and youth: a systematic review and meta-analysis
Open accessAbstract
Background: Cognitive behavioral therapy (CBT) is an effective treatment for mental disorders, however, it can be associated with limited patient engagement, low adherence, and stigma among younger populations. Virtual reality (VR) environments can facilitate innovative approaches to enhance CBT implementation in a controlled and immersive way. Objectives: This study evaluates the impact of VR-CBT interventions on mental disorders in children and youth through a systematic review and meta-analysis. Methods: A search was conducted in PsycINFO, PubMed, EMBASE, Scopus, and Web of Science. Studies compared VR-CBT interventions to traditional therapy or control conditions. Extracted data included post-intervention means, standard deviations, and 95% confidence intervals. Pooled effect sizes were calculated using Hedges’ g and analyzed with a random-effects model. Risk of bias was evaluated using the Cochrane risk-of-bias (RoB) 2 tool and the JBI Critical Appraisal Tool. Results: In total, 20 studies were included in the systematic review, with 85% (n = 17) utilizing virtual reality exposure therapy (VRET), and 15% (n = 3) implementing broader VR-CBT frameworks. VR technologies included wearable head-mounted displays (70%, n = 14), with 30% (n = 6) relying on non-wearable systems, and 15% (n = 3) incorporating gamification elements. Seven studies were included in a meta-analysis, which showed that VR-CBT was associated with a small to moderate reduction in mental disorder symptoms in full-scale studies (pooled Hedge’s g = -0.46 (95% CI: [-0.84], [-0.09]). Conclusions: VR-CBT interventions demonstrate potential for addressing mental disorders in children and youth, particularly when traditional therapy alone is insufficient and/or inaccessible.
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AR-integrated CBT exerts a more favorable impact on patient treatment engagement and adherence than conventional in vivo exposure approaches.
“Furthermore, studies suggested that AR-integrated CBT exerts a more favorable impact on patient treatment engagement and adherence than conventional in vivo exposure approaches [33].”
From Advancing Undergraduate Student Mental Healthcare of Social Anxiety Disorder: Evaluating the Acceptance of AR-Assisted Cognitive Behavioral Therapy Through TAM-Based Constructs. (2026) · cites this paper as [33]
The Introduction (page unavailable) reports lower treatment refusal for VR exposure therapy than for in vivo exposure, and section 3.5 (page unavailable) describes VR-CBT as enabling earlier engagement for people with high avoidance. The claim specifies AR-integrated CBT, but the paper's relevant comparison concerns VR, and these passages do not establish better adherence than in vivo exposure. (LLM, conf=0.88)
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Flagged first, then by citations
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Cited by
Sorted by citations
Zhou, Z., Zhou, Y., Ouyang, B., Man, S. S., & Chan, A. H. S. (2026) · Healthcare · doi:10.3390/healthcare14131978
Alevizopoulos, A. G., Anastasiou, G. G., Kritikos, I., Alevizopoulou, M., & Alevizopoulos, G. (2026) · Biosensors · doi:10.3390/bios16050265
- Authors
- Li, M., Patel, J., Ibrahim, S., & Katapally, T. R.
- Affiliations
- Western University (CA)
- Corresponding author
- Katapally, Tarun Reddy
- Venue
- medRxiv
- Publisher
- openRxiv
- Published
- 2025-08-24
- OpenAlex
- W4413480847
- Cited by
- 2
- References
- 114
- Citations by year
- 2026: 2
- Type
- posted content
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- medRxiv (acceptedVersion, cc-by)
- 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 exposure therapy, psychiatric symptoms, head-mounted displays, gamification, medication adherence, access to mental health care
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