Immersive VR simulates real-life environments with visible, sensory, and auditory enter despatched to the consumer in actual time by way of a head-mounted show (HMD) – in any other case often called VR goggles, which many people may have seen earlier than. On this approach, immersive VR can simply recreate environments which may be tough to entry in actual life, which makes it an excellent instrument within the therapy of varied psychological well being issues (Freeman et al., 2017). For instance, in VR publicity therapy (VRET) for anxiousness issues, shoppers can change into immersed of their feared atmosphere no matter how tough it could 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 research, 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 typically deal with particular issues, or embody research with non-immersive VR (e.g., desktop-based therapies). Meta-analyses are generally carried out (e.g., Eshuis et al., 2021), however not at all times, which signifies that results aren’t at all times clearly quantified.
Of their complete evaluation and meta-analysis, Zeka and colleagues (2025) appeared solely at immersive VR and whether or not it really works as a therapy for numerous psychological well being issues.
Immersive digital actuality is ready to simulate real-life environments, making it a probably useful gizmo within the therapy of varied psychological well being issues, like anxiousness.
Strategies
The authors searched 4 databases and recognized 55 randomised managed trials (RCTs) evaluating immersive VR to both i) different lively 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, because of using 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 instrument (Schünemann et al., 2013).
Outcomes
Of the 55 included research (n = 3,031 members), 45 in contrast immersive VR to an lively therapy, whereas 27 in contrast immersive VR to a passive therapy (with 17 evaluating each lively 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:
- Dependancy issues (2 research)
- VR outperformed lively therapy in measures of state anxiousness (Hedge’s g = 0.89, 95% CI [0.24 to 1.55]),
- however not of alcohol craving.
- Schizophrenia spectrum issues (6 research)
- VR outperformed lively therapy 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 adverse signs (e.g., apathy), depressive signs, beliefs about voices, high quality of life, or functioning.
- Panic and agoraphobias (7 research)
- VR publicity therapy (VRET) was a lot 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 lively therapies in measures of symptom and functioning, both at post-treatment or at follow-up.
- Social anxiousness dysfunction (7 research)
- Equally, VR was higher than passive controls at decreasing social anxiousness signs (g = 0.83, 95% CI [0.49 to 1.17]), although not melancholy signs.
- In comparison with lively 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 drastically lowered 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 lively therapies, eradicating research with a excessive danger of bias modified findings in favour of VR (g = 0.30).
- Generalised anxiousness dysfunction (2 research)
- VR interventions carried out equally to passive controls.
- Publish-traumatic stress dysfunction (6 research)
- VRET lowered melancholy (however not PTSD) signs greater than passive controls (g = 0.67, 95% CI [0.22 to 1.13]).
- Initially, VRET was equally efficient as lively therapies at decreasing PTSD or depressive signs, however eradicating research with a excessive danger of bias modified leads to favour of different lively therapies (g = -0.20).
- Consuming issues (3 research)
- VR was not higher than different lively therapies at decreasing state anxiousness and enhancing physique satisfaction.
Roughly half of the reviewed research had been discovered to have a excessive danger of bias, primarily because of missing data on how members 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, through which digital actuality was proven to cut back phobia-related signs and attitudes and beliefs in relation to passive controls, with giant results.
Conclusions
Typically talking, the findings from this meta-analysis counsel that immersive VR is more practical than passive controls and, usually, at the least as efficient as different lively therapies for a wide range of psychological well being issues. That is significantly the case for anxiousness issues, for which the bigger variety of research has been carried out (n = 37). Nevertheless, you will need to remember that the literature is characterised by a small variety of research and a excessive danger of bias, which limits our confidence in these conclusions.
Typically talking, immersive digital actuality seems to be more practical than passive controls, and at the least as efficient as different lively therapies – however the proof base is small, with excessive danger of bias.
Strengths and limitations
This evaluation by Zeka and colleagues (2025) has a number of strengths. First, it was preregistered and adopted a clear protocol in step with the PRISMA pointers, thus adhering to prime quality requirements. Second, it centered explicitly on immersive VR, in contrast to some earlier evaluations that included non-immersive methods. Non-immersive methods make use of superior know-how however might lack the ingredient of “presence” within the digital atmosphere, which is taken into account necessary for therapy results, and which is simpler to attain with immersive applied sciences (Bell et al., 2024). By specializing in a particular kind of technology-assisted remedy, the evaluation 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 primary 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. Other than 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 data on randomisation and blinding of assessors lacking. Randomising members to situations and blinding the individuals who administer the questionnaires to situations ensures that outcomes are reliable – one thing which, for the time being, now we have inadequate data to assert.
Taking all the pieces collectively, we are able to say that the paper of Zeka and colleagues (2025) offers overview of the present state of the science as regards immersive VR therapy 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 may be drawn.
The literature on this evaluation is characterised by a small variety of research per dysfunction, usually small research samples, and lack of understanding on randomisation and blinding, which limits our confidence within the findings.
Implications for observe
Regardless of the constraints talked about above, the evaluation of Zeka and colleagues (2025) has a number of potential implications.
First, a fundamental 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 may be purchased for a few hundred kilos. As VR know-how turns into more and more reasonably priced, it’s probably that immersive VR therapies will change into extra broadly out there as properly. However will these be as efficient as they are going to declare to be? A great understanding of how immersive VR therapy works, and for whom, will give us the required data to provide evidence-based immersive VR therapies. This fashion, we are able to keep away from the priority that’s typically raised within the subject of psychological well being apps, that’s, that lots of them aren’t, or not sufficient, evidence-based (e.g., Van Daele et al., 2020).
What about implications for scientific observe, although? Zeka and colleagues counsel that immersive VR interventions might cautiously be thought-about efficient, however that:
extra data on efficacy, tolerability, and obstacles is required previous to initiating broader implementation (p. 226)
In different phrases, the information is encouraging, however it appears reasonably untimely to be suggesting the broader use of immersive VR in psychological well being.
Particular person variations should be taken into consideration when planning using immersive VR. For instance, it has been advised that not everybody has the capability to really feel current within the VR atmosphere (Maples-Keller et al., 2017). It’s probably that individuals who lack this “presence” won’t profit from the therapy, at the least to not the identical diploma as somebody feeling current. It might even be the case that individuals who don’t really feel current within the VR atmosphere won’t adhere to the therapy, for instance as a result of it doesn’t appear related to them – and naturally, a therapy that’s not adhered to is a therapy that can not be useful.
One other concern to not neglect is tolerability. Unintended effects of VR aren’t negligible, and embody a wide range of bodily signs similar to movement illness and dry eyes (Park et al., 2019), that are collectively referred to as “cybersickness” (Lundin et al., 2023). Concerningly, a disconnection from the self and the atmosphere are additionally reported by customers; nevertheless, unintended effects aren’t at all times thought-about in VR analysis (Lundin et al., 2023).
Earlier than with the ability to confidently advocate using immersive VR with sufferers, we want a greater understanding of each its effectiveness for treating psychological well being issues, in addition to the affect of its unintended effects.
Assertion of pursuits
This elf has no battle of pursuits to report.
Hyperlinks
Main paper
Zeka, F., Clemmensen, L., Valmaggia, L., Veling, W., Hjorthøj, C., & Glenthøj, L. B. (2025). The Effectiveness of Immersive Digital Actuality‐Primarily based Therapy for Psychological Issues: 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 using digital actuality to deal with psychological well being situations. Nature Critiques 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 evaluation 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 therapy 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). Antagonistic results of digital and augmented actuality interventions in psychiatry: Systematic evaluation. JMIR Psychological Well being, 10(10), e43240.
Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). The usage of digital actuality know-how within the therapy 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 therapy of psychiatric issues: Current 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., Evaluate, 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 observe of telepsychotherapy and e-mental well being in Europe and past. Journal of Psychotherapy Integration, 30(2), 160–173.
