Abstract
Virtual reality (VR) has emerged as a promising tool in the field of mental health. Central to this technology are immersive environments, which enable exposure to highly controlled virtual experiences that feel real. In this Review, we elaborate on the active elements of immersive experiences and how VR-based treatments work. We provide an overview of developments in the use of VR to treat mental health conditions (anxiety, psychotic symptoms, post-traumatic stress, eating disorders, depression and stress management) with a focus on the core mechanisms that drive effective interventions. Artificial intelligence, biofeedback and gamification are emerging areas of development, and we discuss how they might enhance the accessibility, engagement and effectiveness of psychological treatments. Conducting rigorous studies with user-centred designs in diverse populations is a key research priority. As the use of VR in mental health continues to evolve, addressing ethical and implementation considerations is critical for ensuring ongoing treatment improvements.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$59.00 per year
only $4.92 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Bell, I. et al. Digital technology for addressing cognitive impairment in recent-onset psychosis: a perspective. Schizophr. Res. Cogn. 28, 100247 (2022).
Valmaggia, L. The use of virtual reality in psychosis research and treatment. World Psychiatry 16, 246–247 (2017).
Slater, M. & Sanchez-Vives, M. V. Enhancing our lives with immersive virtual reality. Front. Robot. AI 3, https://doi.org/10.3389/frobt.2016.00074 (2016).
Freeman, D. et al. Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol. Med. 47, 2393–2400 (2017).
World Health Organization. The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health (WHO, 2019).
Bell, I. H., Nicholas, J., Alvarez-Jimenez, M., Thompson, A. & Valmaggia, L. Virtual reality as a clinical tool in mental health research and practice. Dialogues Clin. Neurosci. 22, 169–177 (2020).
Torous, J. et al. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 20, 318–335 (2021).
Rizzo, A., Koenig, S. & Lange, B. In: APA Handbook of Neuropsychology, Volume 2: Neuroscience and Neuromethods, Vol. 2 APA Handbooks in Psychology Ch. 023, 473-491 (American Psychological Association, 2023).
Wiebe, A. et al. Virtual reality in the diagnostic and therapy for mental disorders: a systematic review. Clin. Psychol. Rev. 98, 102213 (2022).
Rus-Calafell, M., Garety, P., Sason, E., Craig, T. J. K. & Valmaggia, L. R. Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychol. Med. 48, 362–391 (2018).
Philippe, T. J. et al. Digital health interventions for delivery of mental health care: systematic and comprehensive meta-review. JMIR Mental Health 9, e35159 (2022).
Jameel, L., Valmaggia, L., Barnes, G. & Cella, M. mHealth technology to assess, monitor and treat daily functioning difficulties in people with severe mental illness: a systematic review. J. Psychiatr. Res. 145, 35–49 (2021).
Cipresso, P., Giglioli, I. A. C., Raya, M. A. & Riva, G. The past, present, and future of virtual and augmented reality research: a network and cluster analysis of the literature. Front. Psychol. 9, 2086 (2018).
Cieślik, B. et al. Virtual reality in psychiatric disorders: a systematic review of reviews. Complement. Ther. Med. 52, 102480 (2020).
Dellazizzo, L., Potvin, S., Luigi, M. & Dumais, A. Evidence on virtual reality-based therapies for psychiatric disorders: meta-review of meta-analyses. J. Med. Internet Res. 22, e20889 (2020).
Halldorsson, B. et al. Annual research review: immersive virtual reality and digital applied gaming interventions for the treatment of mental health problems in children and young people: the need for rigorous treatment development and clinical evaluation. J. Child Psychol. Psychiatry 62, 584–605 (2021).
Riches, S. et al. Virtual reality relaxation for people with mental health conditions: a systematic review. Soc. Psychiatry Psychiatr. Epidemiol. 58, 989–1007 (2023).
Parsons, T. D., Duffield, T. & Asbee, J. A comparison of virtual reality classroom continuous performance tests to traditional continuous performance tests in delineating ADHD: a meta-analysis. Neuropsychol. Rev. 29, 338–356 (2019).
Lier, E. J., de Vries, M., Steggink, E. M., Ten Broek, R. P. & van Goor, H. Effect modifiers of virtual reality in pain management: a systematic review and meta-regression analysis. Pain 164, 1658–1665 (2023).
Tian, Q., Xu, M., Yu, L., Yang, S. & Zhang, W. The efficacy of virtual reality-based interventions in breast cancer-related symptom management: a systematic review and meta-analysis. Cancer Nurs. 46, E276–E287 (2023).
Frias, A. et al. Technology-based psychosocial interventions for people with borderline personality disorder: a scoping review of the literature. Psychopathology 53, 254–263 (2020).
Eckert, M., Volmerg, J. S. & Friedrich, C. M. Augmented reality in medicine: systematic and bibliographic review. JMIR mHealth uHealth 7, e10967 (2019).
Slater, M. & Wilbur, S. A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments. Presence Teleoperators Virtual Environ. 6, 603–616 (1997).
Slater, M. et al. A separate reality: an update on place illusion and plausibility in virtual reality. Front. Virtual Real. 3, https://doi.org/10.3389/frvir.2022.914392 (2022).
Wilson, M. Six views of embodied cognition. Psychon. Bull. Rev. 9, 625–636 (2002).
Holleman, G. A., Hooge, I. T. C., Kemner, C. & Hessels, R. S. The ‘real-world approach’ and its problems: a critique of the term ecological validity. Front. Psychol. 11, 721 (2020).
Loomis, J. M., Blascovich, J. J. & Beall, A. C. Immersive virtual environment technology as a basic research tool in psychology. Behav. Res. Methods Instrum. Comput. 31, 557–564 (1999).
Parsons, T. D., Gaggioli, A. & Riva, G. Virtual reality for research in social neuroscience. Brain Sci. 7, 42 (2017).
Baños, R. M. et al. Presence and emotions in virtual environments: the influence of stereoscopy. CyberPsychol. Behav. 11, 1–8 (2008).
Bandhu, D. et al. Theories of motivation: a comprehensive analysis of human behavior drivers. Acta Psychol. 244, 104177 (2024).
Cella, M. et al. Psychosocial and behavioural interventions for the negative symptoms of schizophrenia: a systematic review of efficacy meta-analyses. Br. J. Psychiatry 223, 321–331 (2023).
Edwards, C. J., Garety, P. & Hardy, A. The relationship between depressive symptoms and negative symptoms in people with non-affective psychosis: a meta-analysis. Psychol. Med. 49, 2486–2498 (2019).
Damaševičius, R., Maskeliūnas, R. & Blažauskas, T. Serious games and gamification in healthcare: a meta-review. Information 14, 105 (2023).
Cella, M. et al. Virtual reality therapy for the negative symptoms of schizophrenia (V-NeST): a pilot randomised feasibility trial. Schizophr. Res. 248, 50–57 (2022).
Szczepańska-Gieracha, J., Cieślik, B., Serweta, A. & Klajs, K. Virtual therapeutic garden: a promising method supporting the treatment of depressive symptoms in late-life: a randomized pilot study. J. Clin. Med. 10, 1942 (2021).
Ventura, J. et al. Virtual reality assessment of functional capacity in the early course of schizophrenia: associations with cognitive performance and daily functioning. Early Interv. Psychiatry 14, 106–114 (2020).
Paul, M., Bullock, K. & Bailenson, J. Virtual reality behavioral activation for adults with major depressive disorder: feasibility randomized controlled trial. JMIR Mental Health 9, e35526 (2022).
Schroder, B. & Muhlberger, A. Assessing the attentional bias of smokers in a virtual reality anti-saccade task using eye tracking. Biol. Psychol. 172, 108381 (2022).
Simon, J., Etienne, A. M., Bouchard, S. & Quertemont, E. Alcohol craving in heavy and occasional alcohol drinkers after cue exposure in a virtual environment: the role of the sense of presence. Front. Hum. Neurosci. 14, 124 (2020).
Caballeria, E. et al. Rehabilitation gaming system for alcohol-related cognitive impairment: a pilot usability study. Alcohol Alcohol. 57, 595–601 (2022).
Nowak, K. L. & Biocca, F. The effect of the agency and anthropomorphism on users’ sense of telepresence, copresence, and social presence in virtual environments. Presence Teleoperators Virtual Environ. 12, 481–494 (2003).
Bergstrom, I., Azevedo, S., Papiotis, P., Saldanha, N. & Slater, M. The plausibility of a string quartet performance in virtual reality. IEEE Trans. Vis. Comput. Graph. 23, 1352–1359 (2017).
Cummings, J. J. & Bailenson, J. N. How immersive is enough? A meta-analysis of the effect of immersive technology on user presence. Media Psychol. 19, 272–309 (2016).
Grassini, S. & Laumann, K. Questionnaire measures and physiological correlates of presence: a systematic review. Front. Psychol. 11, 349 (2020).
Price, M. & Anderson, P. The role of presence in virtual reality exposure therapy. J. Anxiety Disord. 21, 742–751 (2007).
Botella, C. et al. Virtual reality and psychotherapy. Stud. Health Technol. Inf. 99, 37–54 (2004).
Riva, G. & Mantovani, F. In Virtual Reality in Psychological, Medical and Pedagogical Applications (ed. Eichenberg, C.) Ch. 1, 3–34 (IntechOpen, 2012).
Matamala-Gomez, M. et al. Virtual body ownership illusions for mental health: a narrative review. J. Clin. Med. 10, 139 (2021).
Riva, G. et al. Affective interactions using virtual reality: the link between presence and emotions. Cyberpsychol. Behav. 10, 45–56 (2007).
Ling, Y., Nefs, H. T., Morina, N., Heynderickx, I. & Brinkman, W. P. A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders. PLoS ONE 9, e96144 (2014).
Schroder, D. et al. Impact of virtual reality applications in the treatment of anxiety disorders: a systematic review and meta-analysis of randomized-controlled trials. J. Behav. Ther. Exp. Psychiatry 81, 101893 (2023).
Whiteford, H. A. et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 1575–1586 (2013).
Morina, N., Ijntema, H., Meyerbröker, K. & Emmelkamp, P. M. G. Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behav. Res. Ther. 74, 18–24 (2015).
Valmaggia, L. R., Latif, L., Kempton, M. J. & Rus-Calafell, M. Virtual reality in the psychological treatment for mental health problems: a systematic review of recent evidence. Psychiatry Res. 236, 189–195 (2016).
Freitas, J. R. S. et al. Virtual reality exposure treatment in phobias: a systematic review. Psychiatr. Q. 92, 1685–1710 (2021).
Bouchard, S., Côté, S., St-Jacques, J., Robillard, G. & Renaud, P. Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games. Technol. Health Care 14, 19–27 (2006).
Laforest, M., Bouchard, S., Bosse, J. & Mesly, O. Effectiveness of in virtuo exposure and response prevention treatment using cognitive-behavioral therapy for obsessive-compulsive disorder: a study based on a single-case study protocol. Front. Psychiatry 7, 99 (2016).
Dua, D., Jagota, G. & Grover, S. Management of obsessive-compulsive disorder with virtual reality-based exposure. Ind. Psychiatry J. 30, 179–181 (2021).
Kothgassner, O. D. & Felnhofer, A. Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents: a systematic review. Neuropsychiatrie 35, 68–75 (2021).
van Bennekom, M. J., de Koning, P. P. & Denys, D. Virtual reality objectifies the diagnosis of psychiatric disorders: a literature review. Front. Psychiatry 8, 163 (2017).
Geraets, C. N. W., van der Stouwe, E. C. D., Pot-Kolder, R. & Veling, W. Advances in immersive virtual reality interventions for mental disorders — a new reality? Curr. Opin. Psychol. 41, 40–45 (2021).
Pot-Kolder, R. M. C. A. et al. Cost-effectiveness of virtual reality cognitive behavioral therapy for psychosis: health-economic evaluation within a randomized controlled trial. J. Med. Internet Res. 22, e17098 (2020).
Valmaggia, L. R. et al. Virtual reality and paranoid ideations in people with an ‘at-risk mental state’ for psychosis. Br. J. Psychiatry 191, s63–s68 (2007).
Turner, D. T., Burger, S., Smit, F., Valmaggia, L. R. & van der Gaag, M. What constitutes sufficient evidence for case formulation-driven CBT for psychosis? Cumulative meta-analysis of the effect on hallucinations and delusions. Schizophr. Bull. 46, 1072–1085 (2020).
Freeman, D. et al. Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction. Br. J. Psychiatry 209, 62–67 (2016).
Pot-Kolder, R. et al. Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial. Lancet Psychiatry 5, 217–226 (2018).
Rus-Calafell, M. & Schneider, S. Are we there yet?! — A literature review of recent digital technology advances for the treatment of early psychosis. mHealth 6, 3 (2020).
Stinson, K., Valmaggia, L. R., Antley, A., Slater, M. & Freeman, D. Cognitive triggers of auditory hallucinations: an experimental investigation. J. Behav. Ther. Exp. Psychiatry 41, 179–184 (2010).
Ward, T. et al. AVATAR therapy for distressing voices: a comprehensive account of therapeutic targets. Schizophr. Bull. 46, 1038–1044 (2020).
Leff, J., Williams, G., Huckvale, M. A., Arbuthnot, M. & Leff, A. P. Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study. Br. J. Psychiatry 202, 428–433 (2013).
Craig, T. K. et al. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. Lancet Psychiatry 5, 31–40 (2018).
Rus-Calafell, M. et al. The role of sense of voice presence and anxiety reduction in AVATAR therapy. J. Clin. Med. 9, 2748 (2020).
Garety, P. A. et al. Optimising AVATAR therapy for distressing voices: study protocol for the AVATAR2 multi-centre randomised controlled trial. Trials 22, 366 (2021).
Dellazizzo, L., Potvin, S., Phraxayavong, K. & Dumais, A. One-year randomized trial comparing virtual reality-assisted therapy to cognitive–behavioral therapy for patients with treatment-resistant schizophrenia. NPJ Schizophr. 7, 9 (2021).
Du Sert, O. P. et al. Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: a pilot clinical trial. Schizophr. Res. 197, 176–181 (2018).
Smith, L. et al. The CHALLENGE-trial: the effects of a virtual reality-assisted exposure therapy for persistent auditory hallucinations versus supportive counselling in people with psychosis: study protocol for a randomised clinical trial. Trials 23, 773 (2022).
Foa, E. B. Prolonged exposure therapy: past, present, and future. Depress. Anxiety 28, 1043–1047 (2011).
Rizzo, A. S. & Shilling, R. Clinical virtual reality tools to advance the prevention, assessment, and treatment of PTSD. Eur. J. Psychotraumatol. 8, 1414560 (2017).
Beidel, D. C. et al. Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: a randomized controlled trial. J. Anxiety Disord. 61, 64–74 (2019).
Beidel, D. C., Frueh, B. C., Neer, S. M. & Lejuez, C. W. The efficacy of trauma management therapy: a controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. J. Anxiety Disord. 50, 23–32 (2017).
Botella, C., Serrano, B., Baños, R. M. & Garcia-Palacios, A. Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability. Neuropsychiatric Dis. Treat. 11, 2533–2545 (2015).
Difede, J. et al. A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers. J. Nerv. Mental Dis. 195, 861–865 (2007).
Difede, J. et al. D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial. Neuropsychopharmacology 39, 1052–1058 (2014).
Peskin, M. et al. The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. J. Anxiety Disord. 61, 82–88 (2019).
Difede, J. et al. Enhancing exposure therapy for posttraumatic stress disorder (PTSD): a randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer. Transl. Psychiatry 12, 299 (2022).
Loucks, L. et al. You can do that?!: feasibility of virtual reality exposure therapy in the treatment of PTSD due to military sexual trauma. J. Anxiety Disord. 61, 55–63 (2019).
Maples-Keller, J. L., Yasinski, C., Manjin, N. & Rothbaum, B. O. Virtual reality-enhanced extinction of phobias and post-traumatic stress. Neurotherapeutics 14, 554–563 (2017).
Reger, G. M. et al. Does virtual reality increase emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy. J. Anxiety Disord. 61, 75–81 (2019).
Rizzo, A. S. et al. Development and early evaluation of the virtual Iraq/Afghanistan exposure therapy system for combat-related PTSD. Ann. N. Y. Acad. Sci. 1208, 114–125 (2010).
Rizzo, A. et al. Virtual reality as a tool for delivering PTSD exposure therapy and stress resilience training. Military Behav. Health 1, 52–58 (2013).
Norr, A. M. et al. Virtual reality exposure versus prolonged exposure for PTSD: which treatment for whom? Depress. Anxiety 35, 523–529 (2018).
Rothbaum, B. O. et al. Virtual reality exposure therapy for PTSD Vietnam veterans: a case study. J. Trauma. Stress 12, 263–271 (1999).
Rothbaum, B. O., Hodges, L. F., Ready, D., Graap, K. & Alarcon, R. D. Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J. Clin. Psychiatry 62, 617–622 (2001).
Rothbaum, B. et al. Early intervention following trauma may mitigate genetic risk for PTSD in civilians. J. Clin. Psychiatry 75, 1380–1387 (2014).
Burback, L., Bremault-Phillips, S., Nijdam, M. J., McFarlane, A. & Vermetten, E. Treatment of posttraumatic stress disorder: a state-of-the-art review. Curr. Neuropharmacol. 22, 557–635 (2024).
Reger, G. M. et al. Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). J. Consult. Clin. Psychol. 84, 946–959 (2016).
Monteleone, A. M. et al. Treatment of eating disorders: a systematic meta-review of meta-analyses and network meta-analyses. Neurosci. Biobehav. Rev. 142, 104857 (2022).
Butler, R. M. & Heimberg, R. G. Exposure therapy for eating disorders: a systematic review. Clin. Psychol. Rev. 78, 101851 (2020).
Riva, G., Malighetti, C. & Serino, S. Virtual reality in the treatment of eating disorders. Clin. Psychol. Psychother. 28, 477–488 (2021).
Low, T. L., Ho, R., Ho, C. & Tam, W. The efficacy of virtual reality in the treatment of binge-purging eating disorders: a meta-analysis. Eur. Eat. Disord. Rev. 29, 52–59 (2021).
Mountford, V. A., Tchanturia, K. & Valmaggia, L. What are you thinking when you look at me?” A pilot study of the use of virtual reality in body image. Cyberpsychol. Behav. Soc. Netw. 19, 93–99 (2016).
Bektas, S. et al. Exploring correlations of food-specific disgust with eating disorder psychopathology and food interaction: a preliminary study using virtual reality. Nutrients 15, 4443 (2023).
Cardi, V. et al. The use of a nonimmersive virtual reality programme in anorexia nervosa: a single case-report. Eur. Eat. Disord. Rev. 20, 240–245 (2012).
Cardi, V. et al. Transition care in anorexia nervosa through guidance online from peer and carer expertise (TRIANGLE): study protocol for a randomised controlled trial. Eur. Eat. Disord. Rev. 25, 512–523 (2017).
Natali, L. et al. Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: a feasibility study. Int. J. Eat. Disord. 57, 703–715 (2024).
Pyasik, M., Ciorli, T. & Pia, L. Full body illusion and cognition: a systematic review of the literature. Neurosci. Biobehav. Rev. 143, 104926 (2022).
Keizer, A., van Elburg, A., Helms, R. & Dijkerman, H. C. A virtual reality full body illusion improves body image disturbance in anorexia nervosa. PLoS ONE 11, e0163921 (2016).
American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders: DSM-5 (American Psychiatric Association, 2013).
Fodor, L. A. et al. The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: a meta-analysis. Sci. Rep. 8, 10323 (2018).
Falconer, C. J. et al. Embodying self-compassion within virtual reality and its effects on patients with depression. BJPsych Open 2, 74–80 (2016).
Ito, A. et al. Feasibility study of virtual reality-based cognitive behavioral therapy for patients with depression: protocol for an open trial and therapeutic intervention. JMIR Res. Protoc. 12, e49698 (2023).
Liu, H., Cheng, Z., Wang, S. & Jia, Y. Effects of virtual reality-based intervention on depression in stroke patients: a meta-analysis. Sci. Rep. 13, 4381 (2023).
Ekers, D. et al. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS ONE 9, e100100 (2014).
Riches, S., Azevedo, L., Bird, L., Pisani, S. & Valmaggia, L. Virtual reality relaxation for the general population: a systematic review. Soc. Psychiatry Psychiatr. Epidemiol. 56, 1707–1727 (2021).
Nijland, J., Veling, W., Lestestuiver, B. P. & Van Driel, C. M. G. Virtual reality relaxation for reducing perceived stress of intensive care nurses during the COVID-19 pandemic. Front. Psychol. 12, 706527 (2021).
Williams, G. & Riches, S. Virtual reality relaxation for staff wellbeing on a psychiatric rehabilitation ward: a feasibility and acceptability study. J. Psychiatr. Intensive Care 19, 51–58 (2023).
Li, H. et al. Access to nature via virtual reality: a mini-review. Front. Psychol. 12, 725288 (2021).
Riches, S. et al. Integrating a virtual reality relaxation clinic within acute psychiatric services: a pilot study. Psychiatry Res. 329, 115477 (2023).
Mistry, D. et al. Meditating in virtual reality: proof-of-concept intervention for posttraumatic stress. Psychol. Trauma 12, 847 (2020).
Wang, T. C., Tsai, C. L., Tang, T. W., Wang, W. L. & Lee, K. T. The effect of cycling through a projection-based virtual environment system on generalized anxiety disorder. J. Clin. Med. 8, 973 (2019).
Manzoni, G. M. et al. New technologies and relaxation: an explorative study on obese patients with emotional eating. J. Cyberther. Rehabil. 1, 182–192 (2008).
Mark, I., Bell, D., Kirsh, L. & O’Brien, A. The use of virtual reality in a psychiatric intensive care unit: a pilot study. J. Psychiatr. Intensive Care 17, 123–128 (2021).
Tan, H. L. E., Chng, C. M. L., Lau, Y. & Klainin‐Yobas, P. Investigating the effects of a virtual reality‐based stress management programme on inpatients with mental disorders: a pilot randomised controlled trial. Int. J. Psychol. 56, 444–453 (2021).
Veling, W., Lestestuiver, B., Jongma, M., Hoenders, H. J. R. & van Driel, C. Virtual reality relaxation for patients with a psychiatric disorder: crossover randomized controlled trial. J. Med. Internet Res. 23, e17233 (2021).
Bossenbroek, R. et al. Efficacy of a virtual reality biofeedback game (DEEP) to reduce anxiety and disruptive classroom behavior: single-case study. JMIR Mental Health 7, e16066 (2020).
Lim, J. Z., Mountstephens, J. & Teo, J. Emotion recognition using eye-tracking: taxonomy, review and current challenges. Sensors 20, 2384 (2020).
Shu, L. et al. Wearable emotion recognition using heart rate data from a smart bracelet. Sensors 20, 718 (2020).
van der Gaag, M., Valmaggia, L. R. & Smit, F. The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophr. Res. 156, 30–37 (2014).
Fei, Z. et al. Deep convolution network based emotion analysis towards mental health care. Neurocomputing 388, 212–227 (2020).
Higgins, O., Short, B. L., Chalup, S. K. & Wilson, R. L. Artificial intelligence (AI) and machine learning (ML) based decision support systems in mental health: an integrative review. Int. J. Mental Health Nurs. 32, 966–978 (2023).
Donker, T. et al. Effectiveness of self-guided app-based virtual reality cognitive behavior therapy for acrophobia: a randomized clinical trial. JAMA Psychiatry 76, 682–690 (2019).
Freeman, D. et al. Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. Lancet Psychiatry 5, 625–632 (2018).
Lindner, P. et al. Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: a randomized controlled trial. J. Anxiety Disord. 61, 45–54 (2019).
Lindner, P. et al. Gamified, automated virtual reality exposure therapy for fear of spiders: a single-subject trial under simulated real-world conditions. Front. Psychiatry 11, 116 (2020).
Freeman, D. et al. Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses. Lancet Psychiatry 9, 375–388 (2022).
Freeman, D. et al. Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses. Lancet Psychiatry 10, 836–847 (2023).
Altunkaya, J. et al. Estimating the economic value of automated virtual reality cognitive therapy for treating agoraphobic avoidance in patients with psychosis: findings from the gamechange randomized controlled clinical trial. J. Med. Internet Res. 24, e39248 (2022).
Brown, B. B. Stress and the Art of Biofeedback (Harper & Row, 1977).
Lehrer, P. et al. Heart rate variability biofeedback improves emotional and physical health and performance: a systematic review and meta analysis. Appl. Psychophysiol. Biofeedback 45, 109–129 (2020).
Weerdmeester, J., van Rooij, M. M., Engels, R. C. & Granic, I. An integrative model for the effectiveness of biofeedback interventions for anxiety regulation: viewpoint. J. Med. Internet Res. 22, e14958 (2020).
Kothgassner, O. D. et al. Virtual reality biofeedback interventions for treating anxiety: a systematic review, meta-analysis and future perspective. Wien. Klin. Wochenschr. 134, 49–59 (2022).
Weerdmeester, J., van Rooij, M. M., Maciejewski, D. F., Engels, R. C. & Granic, I. A randomized controlled trial assessing the efficacy of a virtual reality biofeedback video game: anxiety outcomes and appraisal processes. Technol. Mind Behav. 2, https://doi.org/10.1037/tmb0000028 (2021).
Fleming, T. M. et al. Serious games and gamification for mental health: current status and promising directions. Front. Psychiatry 7, 215 (2017).
Fleming, T., Poppelaars, M. & Thabrew, H. The role of gamification in digital mental health. World Psychiatry 22, 46 (2023).
Fleming, T., Lucassen, M., Stasiak, K., Sutcliffe, K. & Merry, S. Technology matters: SPARX–computerised cognitive behavioural therapy for adolescent depression in a game format. Child Adolesc. Mental Health 26, 92–94 (2021).
Merry, S. N. et al. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 344, e2598 (2012).
Thunström, A. O., Sarajlic Vukovic, I., Ali, L., Larson, T. & Steingrimsson, S. Prevalence of virtual reality (VR) games found through mental health categories on STEAM: a first look at VR on commercial platforms as tools for therapy. Nordic J. Psychiatry 76, 474–485 (2022).
Larsen, M. E. et al. Using science to sell apps: evaluation of mental health app store quality claims. NPJ Digit. Med. 2, 18 (2019).
Gooding, P. Mapping the rise of digital mental health technologies: emerging issues for law and society. Int. J. Law Psychiatry 67, 101498 (2019).
Torous, J. & Roberts, L. W. The ethical use of mobile health technology in clinical psychiatry. J. Nerv. Mental Dis. 205, 4–8 (2017).
Wies, B., Landers, C. & Ienca, M. Digital mental health for young people: a scoping review of ethical promises and challenges. Front. Digital Health 3, 697072 (2021).
Wykes, T., Lipshitz, J. & Schueller, S. M. Towards the design of ethical standards related to digital mental health and all its applications. Curr. Treat. Options Psychiatry 6, 232–242 (2019).
Lundin, R. M., Yeap, Y. & Menkes, D. B. Adverse effects of virtual and augmented reality interventions in psychiatry: systematic review. JMIR Mental Health 10, e43240 (2023).
Ramaseri Chandra, A. N., El Jamiy, F. & Reza, H. A systematic survey on cybersickness in virtual environments. Computers 11, 51 (2022).
van Heugten-van der Kloet, D., Cosgrave, J., van Rheede, J. & Hicks, S. Out-of-body experience in virtual reality induces acute dissociation. Psychol. Consciousness Theory Res. Pract. 5, 346–357 (2018).
Peckmann, C. et al. Virtual reality induces symptoms of depersonalization and derealization: a longitudinal randomised control trial. Comput. Hum. Behav. 131, 107233 (2022).
Lavoie, R., Main, K., King, C. & King, D. Virtual experience, real consequences: the potential negative emotional consequences of virtual reality gameplay. Virtual Real. 25, 69–81 (2020).
Mohr, D. C., Lyon, A. R., Lattie, E. G., Reddy, M. & Schueller, S. M. Accelerating digital mental health research from early design and creation to successful implementation and sustainment. J. Med. Internet Res. 19, e153 (2017).
Mohr, D. C., Riper, H. & Schueller, S. M. A solution-focused research approach to achieve an implementable revolution in digital mental health. JAMA Psychiatry 75, 113–114 (2018).
Greenhalgh, T. et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J. Med. Internet Res. 19, e8775 (2017).
Graham, A. K. et al. Implementation strategies for digital mental health interventions in health care settings. Am. Psychol. 75, 1080–1092 (2020).
Lindner, P. et al. Attitudes toward and familiarity with virtual reality therapy among practicing cognitive behavior therapists: a cross-sectional survey study in the era of consumer VR platforms. Front. Psychol. 10, 176 (2019).
Chung, O. S. et al. Are Australian mental health services ready for therapeutic virtual reality? an investigation of knowledge, attitudes, implementation barriers and enablers. Front. Psychiatry 13, 792663 (2022).
Chung, O. S. et al. Implementation of therapeutic virtual reality into psychiatric care: clinicians’ and service managers’ perspectives. Front. Psychiatry 12, 791123 (2021).
Brown, P. et al. Automated virtual reality cognitive therapy (gameChange) in inpatient psychiatric wards: qualitative study of staff and patient views using an implementation framework. JMIR Form. Res. 6, e34225 (2022).
Kip, H., Buitelaar-Huijsse, G. K. G., Kouijzer, M. T. E. & Kelders, S. M. From theory to implementation in practice: a qualitative case study of the implementation of virtual reality in mental healthcare. Glob. Implement. Res. Appl. 4, 66–88 (2023).
Kieling, C. et al. Worldwide prevalence and disability from mental disorders across childhood and adolescence: evidence from the global burden of disease study. JAMA Psychiatry 81, 347–356 (2024).
Islam, M. I. et al. The gap between perceived mental health needs and actual service utilization in Australian adolescents. Sci. Rep. 12, 5430 (2022).
Sawyer, M. G., Reece, C. E., Sawyer, A. C., Hiscock, H. & Lawrence, D. Adequacy of treatment for child and adolescent mental disorders in Australia: a national study. Aust. N. Z. J. Psychiatry 53, 326–335 (2019).
Timlin, U., Hakko, H., Heino, R. & Kyngäs, H. A systematic narrative review of the literature: adherence to pharmacological and nonpharmacological treatments among adolescents with mental disorders. J. Clin. Nurs. 23, 3321–3334 (2014).
Kelson, J. N., Ridout, B., Steinbeck, K. & Campbell, A. J. The use of virtual reality for managing psychological distress in adolescents: systematic review. Cyberpsychol. Behav. Soc. Netw. 24, 633–641 (2021).
Parsons, T. D. et al. Virtual reality in pediatric psychology. Pediatrics 140, S86–S91 (2017).
Bailey, J. O. & Bailenson, J. N. Considering virtual reality in children’s lives. J. Child. Media 11, 107–113 (2017).
Turnbull, P. R. K. & Phillips, J. R. Ocular effects of virtual reality headset wear in young adults. Sci. Rep. 7, 16172 (2017).
Banks, M. S., Hoffman, D. M., Kim, J. & Wetzstein, G. 3D displays. Annu. Rev. Vis. Sci. 2, 397–435 (2016).
Xiao, S. et al. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology 129, 77–85 (2022).
Rothbaum, B. O. et al. Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am. J. Psychiatry 152, 626–628 (1995).
Sutherland, I. E. A head-mounted three dimensional display. Assoc. Comput. Machinery 68, 757–764 (1968).
Cruz-Neira, C., Sandin, D. J., DeFanti, T. A., Kenyon, R. V. & Hart, J. C. The CAVE: audio visual experience automatic virtual environment. Commun. ACM 35, 64–72 (1992).
Vlake, J. H. et al. Reporting the early stage clinical evaluation of virtual-reality-based intervention trials: RATE-VR. Nat. Med. 29, 12–13 (2023).
Papa, A. & Follette, W. C. In: The Encyclopedia of Clinical Psychology 1-6 (Wiley, 2015).
Acknowledgements
The authors thank S. Louis for her contributions in reviewing and advising on the research agenda from a lived experience perspective.
Author information
Authors and Affiliations
Contributions
I.H.B., R.P.-K. and L.V. conceived the article and drafted, edited and revised the manuscript. I.H.B., R.P.-K., L.V., A.R., M.R.-C., V.C., M.C., T.W., S.R. and M.R. wrote sections of the article, and M.A.J. and A.T. contributed feedback. All authors reviewed and approved the final manuscript. All authors contributed substantially to discussion of the content and reviewed and/or edited the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Peer review
Peer review information
Nature Reviews Psychology thanks Niclas Braun, Azucena Garcia Palacios, and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Bell, I.H., Pot-Kolder, R., Rizzo, A. et al. Advances in the use of virtual reality to treat mental health conditions. Nat Rev Psychol 3, 552–567 (2024). https://doi.org/10.1038/s44159-024-00334-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s44159-024-00334-9