Immersive VR simulates real-life environments with visible, sensory, and auditory enter despatched to the person in actual time through a head-mounted show (HMD) – in any other case generally known as VR goggles, which many people can have seen earlier than. On this method, immersive VR can simply recreate environments that could be troublesome to entry in actual life, which makes it an ideal software within the remedy of assorted psychological well being issues (Freeman et al., 2017). For instance, in VR publicity remedy (VRET) for nervousness issues, purchasers can turn into immersed of their feared atmosphere no matter how troublesome it might be to come across in actual life (e.g., fight, flying) (Eshuis et al., 2021; Maples-Keller et al., 2017).
Within the UK, the superb gameChange (VR for psychosis) work led by Daniel Freeman has seen spectacular leads to an RCT and qualitative examine, and is now being rolled out within the NHS and studied at a bigger scale.
Earlier narrative (e.g., Freeman et al., 2017; Maples-Keller et al., 2017; Park et al., 2019) and systematic evaluations (e.g., Eshuis et al., 2021) present encouraging findings on the effectiveness of VR therapies. Nevertheless, they usually concentrate on particular issues, or embody research with non-immersive VR (e.g., desktop-based therapies). Meta-analyses are typically carried out (e.g., Eshuis et al., 2021), however not at all times, which implies that results are usually not at all times clearly quantified.
Of their complete overview and meta-analysis, Zeka and colleagues (2025) seemed solely at immersive VR and whether or not it really works as a remedy for numerous psychological well being issues.
Immersive digital actuality is ready to simulate real-life environments, making it a doubtlessly useful gizmo within the remedy of assorted psychological well being issues, like nervousness.
Strategies
The authors searched 4 databases and recognized 55 randomised managed trials (RCTs) evaluating immersive VR to both i) different energetic therapies (e.g., CBT) or ii) passive controls (e.g., waitlist) for numerous psychological well being issues. Measures of signs, cognition, functioning, and high quality of life had been the outcomes of curiosity.
Meta-analyses based mostly on a random impact mannequin had been carried out individually for every dysfunction and every management situation. The research that would not be included, resulting from the usage of incompatible measures, had been mentioned individually within the paper.
Threat of bias was assessed with the Cochrane Threat-of-Bias Device 2 (Higgins et al., 2019), and certainty of proof with the GRADE software (Schünemann et al., 2013).
Outcomes
Of the 55 included research (n = 3,031 individuals), 45 in contrast immersive VR to an energetic remedy, whereas 27 in contrast immersive VR to a passive remedy (with 17 evaluating each energetic and passive therapies – therefore the odd numbers!). Fifty-one research measured signs, 5 research measured cognition, and 10 research measured functioning or high quality of life.
Per dysfunction, the meta-analysis discovered that:
- Habit issues (2 research)
- VR outperformed energetic remedy in measures of state nervousness (Hedge’s g = 0.89, 95% CI [0.24 to 1.55]),
- however not of alcohol craving.
- Schizophrenia spectrum issues (6 research)
- VR outperformed energetic remedy relating to optimistic signs like hallucinations at post-treatment (g = 0.37, 95% CI [0.04 to 0.70]) however not at follow-up.
- There was no distinction between therapies in destructive signs (e.g., apathy), depressive signs, beliefs about voices, high quality of life, or functioning.
- Panic and agoraphobias (7 research)
- VR publicity remedy (VRET) was significantly better than passive controls at decreasing agoraphobia signs at post-intervention (g = 0.90, 95% CI [0.45 to 1.35]).
- Nevertheless, it didn’t differ from energetic therapies in measures of symptom and functioning, both at post-treatment or at follow-up.
- Social nervousness dysfunction (7 research)
- Equally, VR was higher than passive controls at decreasing social nervousness signs (g = 0.83, 95% CI [0.49 to 1.17]), although not despair signs.
- In comparison with energetic therapies, VR didn’t differ within the preliminary evaluation and appeared much less efficient (g = -0.24) when research with a excessive danger of bias had been eliminated.
- Particular phobias (15 research)
- Compared to passive controls, VR tremendously diminished phobia signs (g = 1.07, 95% CI [0.22 to 1.92]) and phobia-related attitudes and beliefs (g = 0.92, 95% CI [0.46 to 1.38]).
- Though the preliminary evaluation confirmed no distinction between VR and energetic therapies, eradicating research with a excessive danger of bias modified findings in favour of VR (g = 0.30).
- Generalised nervousness dysfunction (2 research)
- VR interventions carried out equally to passive controls.
- Put up-traumatic stress dysfunction (6 research)
- VRET diminished despair (however not PTSD) signs greater than passive controls (g = 0.67, 95% CI [0.22 to 1.13]).
- Initially, VRET was equally efficient as energetic therapies at decreasing PTSD or depressive signs, however eradicating research with a excessive danger of bias modified leads to favour of different energetic therapies (g = -0.20).
- Consuming issues (3 research)
- VR was not higher than different energetic therapies at decreasing state nervousness and enhancing physique satisfaction.
Roughly half of the reviewed research had been discovered to have a excessive danger of bias, primarily resulting from missing info on how individuals had been randomised, and on blinding of assessors. For an additional 25% of research, there have been some issues of bias, whereas the remaining 25% was judged as having a low danger of bias. The certainty of proof was usually judged as low to very low.
The biggest physique of proof (15 research) was discovered for particular phobias, during which digital actuality was proven to cut back phobia-related signs and attitudes and beliefs in relation to passive controls, with massive results.
Conclusions
Usually talking, the findings from this meta-analysis recommend that immersive VR is more practical than passive controls and, usually, not less than as efficient as different energetic therapies for quite a lot of psychological well being issues. That is notably the case for nervousness issues, for which the bigger variety of research has been carried out (n = 37). Nevertheless, it is very important understand that the literature is characterised by a small variety of research and a excessive danger of bias, which limits our confidence in these conclusions.
Usually talking, immersive digital actuality seems to be more practical than passive controls, and not less than as efficient as different energetic therapies – however the proof base is small, with excessive danger of bias.
Strengths and limitations
This overview by Zeka and colleagues (2025) has a number of strengths. First, it was preregistered and adopted a clear protocol in keeping with the PRISMA pointers, thus adhering to top quality requirements. Second, it centered explicitly on immersive VR, not like some earlier evaluations that included non-immersive methods. Non-immersive methods make use of superior expertise however could lack the aspect of “presence” within the digital atmosphere, which is taken into account essential for remedy results, and which is less complicated to attain with immersive applied sciences (Bell et al., 2024). By specializing in a particular sort of technology-assisted remedy, the overview helps us perceive its distinctive results and challenges with out obscuring them with these of various technology-assisted therapies.
Nevertheless, there are additionally some limitations that should be saved in thoughts.
The principle limitation regards the standard of the included research. Most had small pattern sizes, which restrict their statistical energy to disclose true results. Equally, the pool of research for every particular person psychological well being dysfunction was comparatively small. Aside from the meta-analysis on particular phobias, which contained 15 research, virtually all different meta-analyses included seven research or fewer, once more limiting the statistical energy of every particular person meta-analysis.
Additionally, many research had a excessive danger of bias, with info on randomisation and blinding of assessors lacking. Randomising individuals to situations and blinding the individuals who administer the questionnaires to situations ensures that outcomes are reliable – one thing which, in the mean time, we have now inadequate info to assert.
Taking the whole lot collectively, we are able to say that the paper of Zeka and colleagues (2025) provides a superb overview of the present state of the science as regards immersive VR remedy for psychological well being issues, while on the similar time highlighting the areas the place extra high-quality analysis is required earlier than protected conclusions might be drawn.
The literature on this overview is characterised by a small variety of research per dysfunction, usually small examine samples, and lack of understanding on randomisation and blinding, which limits our confidence within the findings.
Implications for follow
Regardless of the restrictions talked about above, the overview of Zeka and colleagues (2025) has a number of potential implications.
First, a primary implication for researchers and funding companies is that extra (and extra rigorous) analysis is required within the space of immersive VR therapies for psychological well being issues. On the time of scripting this weblog, VR goggles for gaming might be purchased for a few hundred kilos. As VR expertise turns into more and more reasonably priced, it’s possible that immersive VR therapies will turn into extra broadly accessible as nicely. However will these be as efficient as they may declare to be? understanding of how immersive VR remedy works, and for whom, will give us the required info to provide evidence-based immersive VR therapies. This manner, we are able to keep away from the priority that’s usually raised within the discipline of psychological well being apps, that’s, that lots of them are usually not, or not sufficient, evidence-based (e.g., Van Daele et al., 2020).
What about implications for scientific follow, although? Zeka and colleagues recommend that immersive VR interventions could cautiously be thought of efficient, however that:
extra info on efficacy, tolerability, and obstacles is required previous to initiating broader implementation (p. 226)
In different phrases, the info is encouraging, nevertheless it appears fairly untimely to be suggesting the broader use of immersive VR in psychological well being.
Particular person variations should be taken under consideration when planning the usage of immersive VR. For instance, it has been steered that not everybody has the capability to really feel current within the VR atmosphere (Maples-Keller et al., 2017). It’s possible that individuals who lack this “presence” is not going to profit from the remedy, not less than to not the identical diploma as somebody feeling current. It could even be the case that individuals who don’t really feel current within the VR atmosphere is not going to adhere to the remedy, for instance as a result of it doesn’t appear related to them – and naturally, a remedy that isn’t adhered to is a remedy that can’t be helpful.
One other challenge to not neglect is tolerability. Negative effects of VR are usually not negligible, and embody quite a lot of bodily signs reminiscent of movement illness and dry eyes (Park et al., 2019), that are collectively known as “cybersickness” (Lundin et al., 2023). Concerningly, a disconnection from the self and the atmosphere are additionally reported by customers; nevertheless, unintended effects are usually not at all times thought of in VR analysis (Lundin et al., 2023).
Earlier than having the ability to confidently advocate the usage of immersive VR with sufferers, we’d like a greater understanding of each its effectiveness for treating psychological well being issues, in addition to the impression of its unintended effects.
Assertion of pursuits
This elf has no battle of pursuits to report.
Hyperlinks
Major paper
Zeka, F., Clemmensen, L., Valmaggia, L., Veling, W., Hjorthøj, C., & Glenthøj, L. B. (2025). The Effectiveness of Immersive Digital Actuality‐Primarily based Remedy for Psychological Problems: A Systematic Evaluate With Meta‐Evaluation. Acta Psychiatrica Scandinavica, 151(3), 210-230.
Different references
Bell, I. H., Pot-Kolder, R., Rizzo, A., Rus-Calafell, M., Cardi, V., Cella, M., Ward, T., Riches, S., Reinoso, M., Thompson, A., Alvarez-Jimenez, M., & Valmaggia, L. (2024). Advances in the usage of digital actuality to deal with psychological well being situations. Nature Evaluations Psychology, 3(8), 552–567.
Eshuis, L. V., Van Gelderen, M. J., Van Zuiden, M., Nijdam, M. J., Vermetten, E., Olff, M., & Bakker, A. (2021). Efficacy of immersive PTSD therapies: A scientific overview of digital and augmented actuality publicity remedy and a meta-analysis of digital actuality publicity remedy. Journal of Psychiatric Analysis, 143, 516-527.
Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Digital actuality within the evaluation, understanding, and remedy of psychological well being issues. Psychological Medication, 47(14), 2393–2400.
Higgins, J. P., Savović, J., Web page, M. J., & Sterne, J. A. C. (2019). RoB 2 Steering: Parallel Trial. Cochrane Collaboration, 28, 1–24.
Lundin, R. M., Yeap, Y., & Menkes, D. B. (2023). Hostile results of digital and augmented actuality interventions in psychiatry: Systematic overview. JMIR Psychological Well being, 10(10), e43240.
Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). Using digital actuality expertise within the remedy of tension and different psychiatric issues. Harvard Evaluate of Psychiatry, 25(3), 103–113.
Park, M. J., Kim, D. J., Lee, U., Na, E. J., & Jeon, H. J. (2019). A literature overview of digital actuality (VR) in remedy of psychiatric issues: Latest advances and limitations. Frontiers in Psychiatry, 10, 1–9.
Schünemann, H., Brożek, J., Guyatt, G., & Oxman, A. E. (2013). GRADE Handbook for Grading High quality of Proof and Power of Suggestions. Grade Working Group.
Van Daele, T., Karekla, M., Kassianos, A. P., Examine, A., Haddouk, L., Salgado, J., Ebert, D. D., Trebbi, G., Bernaerts, S., Van Assche, E., & De Witte, N. A. J. (2020). Suggestions for coverage and follow of telepsychotherapy and e-mental well being in Europe and past. Journal of Psychotherapy Integration, 30(2), 160–173.
