Evidence on Virtual Reality-Based Therapies for Psychiatric Disorders: Meta-Review of Meta-Analyses
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Abstract
BACKGROUND: Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)-based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. OBJECTIVE: This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. METHODS: A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. RESULTS: The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. CONCLUSIONS: VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.
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VRET delivers an advantage to practitioners compared to traditional exposure, as it is sometimes almost impossible to fine-tune exposure levels in real-world scenarios.
“VRET undoubtedly delivers an advantage to practitioners compared to traditional exposure, as it is sometimes almost impossible to fine-tune exposure levels in real-world scenarios [30].”
From SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia (2024) · cites this paper as [30]
The Discussion (page not provided) says VR lets therapists better control exposure content, rhythm, and repetition than classical or in vivo exposure. The Introduction also describes a high level of control over exposure parameters. Neither passage says fine-tuning exposure in real-world scenarios is sometimes almost impossible. (LLM, conf=0.83)
Experimental — accuracy not yet measuredNumerous studies have integrated VR with various psychotherapies, and their effectiveness and safety have been preliminarily validated.
“Numerous studies have integrated VR with various psychotherapies, and their effectiveness and safety have been preliminarily validated (16–18).”
From A virtual reality-based self-guided training on identification of negative automatic thoughts in healthy adults: a mixed-methods feasibility study (2024) · cites this paper as [16]
The Introduction describes VR approaches based on cognitive-behavioral principles, and the Discussion and Conclusions report preliminary evidence of effectiveness, particularly for anxiety-related disorders. The paper does not establish that their safety has been validated; the Introduction instead notes that VR may cause cybersickness in some patients. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe VRET system proposed by Oana Bălan et al. 2020 comprises nine interconnected modules and includes real-time biophysical signal viewing, a reward system, and an emotion dimension.
“The VRET system proposed by Oana Bălan et al. 2020 stands out for its unique features. It comprises nine interconnected modules, each offering patient profile setup, therapy scenes, audio-visual options, and physiological monitoring. What sets this system apart is the real-time biophysical signal viewing for therapists, enabling dynamic adjustment of the exposure scenario. The system also includes”
From SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia (2024) · cites this paper as [30]
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The Overview Effect and Well-Being
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Virtual Reality in the Treatment of Panic Disorder in the Last Decade: A Systematic Review
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- Authors
- Dellazizzo, L., Potvin, S., Luigi, M., & Dumais, A.
- Affiliations
- Institut universitaire en santé mentale de Montréal (CA)
- Institut national de psychiatrie légale Philippe-Pinel (CA)
- Corresponding author
- Dumais, Alexandre
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-08-19
- Volume
- 22
- Issue
- 8
- Pages
- e20889
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7468638
- OpenAlex
- W3056989392
- Cited by
- 135
- References
- 105
- Citations by year
- 2026: 21 · 2025: 33 · 2024: 25 · 2023: 25 · 2022: 17 · 2021: 14
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Eli Lilly and Company
- Eli Lilly Canada
- 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 therapy, mental illness, anxiety disorders, neurocognitive disorders, neurodevelopmental disorders, schizophrenia, social skills training, treatment-resistant symptoms, quality of evidence, meta-analyses of meta-analyses, personalized interventions, medication adherence, publication bias, treatment effect heterogeneity
- MeSH terms
- Mental Disorders, Humans, Psychotherapy, Virtual Reality Exposure Therapy
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