The report is a product of the VA/HSR Evidence Synthesis Program.

Virtual Reality for Treating Mental Health Disorders and Prevention of Suicide: A Systematic Review

Takeaway: Virtual reality (VR) prolonged exposure (PE) therapy for PTSD may be less effective, or have little to no difference in effect, when compared with non-VR PE therapy. For stimulant use disorder, VR exposure therapy interventions may result in less craving compared to treatment as usual. The evidence is very uncertain regarding the effects of VR therapies for this review's other prioritized disorders, including social anxiety disorders, flying phobia, alcohol use disorder, depression, and schizophrenia spectrum disorders. The evidence is also very uncertain regarding adverse effects of VR interventions across prioritized disorders. There is a lack of evidence on VR interventions for suicide prevention. Future research should address these gaps, clarify the impact of key VR characteristics, and evaluate how population characteristics might affect effectiveness and engagement.

More than a quarter of Veterans in VA care have a diagnosed mental health disorder. Interest is rising in treatments incorporating virtual reality (VR) technology, which situates participants in a lifelike computer-generated virtual environment. In recent years, VR technology has become more affordable and more effective, and its clinical use in VHA has expanded.

In response to a request from VA’s Office of Mental Health, Office of Innovation and Learning, and Digital Health Office, HSR’s Evidence Synthesis Program (ESP) Center in Minneapolis synthesized evidence on the benefits and harms of fully immersive VR interventions for treating mental health disorders and for suicide prevention.

The ESP team searched for relevant studies in MEDLINE, Embase, CENTRAL, and PsycINFO from inception to December 2024, and identified additional eligible studies by hand-searching reference lists, consulting with content experts, and searching clinical trial registries. With input from a technical expert panel and the topic nominators, ESP investigators prioritized the following disorders for detailed abstraction of study characteristics and findings: PTSD, social anxiety, flying phobia, alcohol use disorder, stimulant use disorder, depression, and schizophrenia spectrum disorders.

Summary of Findings

• Of 84 eligible studies, 45 addressed the prioritized mental health disorders: PTSD (k = 6), social anxiety disorders (k = 10), flying phobia (k = 7), alcohol use disorder (k = 2), stimulant use disorder (k = 2), depression (k = 6), and schizophrenia spectrum disorders (k = 12). Most studies were small, and more than half evaluated VR exposure therapies.
• Characteristics of VR and comparators for evaluated VR interventions varied across studies.
• VR prolonged exposure (PE) therapy for PTSD may be less effective, or have little to no difference in effect, when compared with non-VR PE therapy.
• For stimulant use disorder, VR exposure therapy interventions may result in less craving immediately post-intervention, as compared to treatment as usual.
• The evidence is very uncertain regarding the effects of VR therapies for symptom severity and/or treatment response for other prioritized disorders.
• The evidence on adverse effects of VR therapies is very uncertain across prioritized disorders.
• Only one study evaluated a VR intervention for suicide prevention. It reported limited findings on suicide ideation (assessed by unclear measures).

Implications

The rationale for implementing VR exposure therapy interventions for PTSD, social anxiety, flying phobia, alcohol use disorder, and stimulant use disorder in widespread clinical contexts remains unclear, pending identification of subpopulations or contexts in which VR may increase effectiveness of therapy and/or patient engagement in therapy.

VR interventions for depression may improve access to self-management treatments (such as relaxation and exercise) for older adults, but prior to widespread implementation, it may be best to evaluate how these interventions compare with other low-touch interventions that address mental health for older adults.

Before clinical implementation of VR therapies for schizophrenia spectrum disorders, the benefits and harms of VR interventions require more definitive study.

Limitations

The review was limited to VR interventions that were fully immersive (i.e., virtual environments that visually separate participants from the physical environment) and to English-language studies.

Future Research

Future research is needed to compare VR treatments to other forms of therapy, particularly non-VR therapies with similar content (such as non-VR exposure therapies). Mechanistic research is needed to clarify key underlying contributions of VR characteristics, along with research that demonstrates whether VR relaxation and exercise interventions that have been evaluated for depression in older adults may work well for young and middle-aged adults. Future research should investigate comparative effectiveness against evidence-supported treatments. Additionally, research is needed to evaluate adverse events for VR interventions and comparator groups. Finally, future work is needed to understand whether VR interventions can reduce suicide risk, and to evaluate how population characteristics might affect effectiveness and engagement.

Citation:

Goldsmith ES, Zerzan N, Greer N, et al. Virtual Reality for Treating Mental Health Disorders and Prevention of Suicide: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2025.

To view the full report, go to vaww.hsrd.research.va.gov/publications/esp/vr-mental-health.cfm (This report is available via intranet only.)

How can VA leadership work with the ESP? Nominations for systematic review topics may be submitted to the program at any time. When you submit a topic nomination form, ESP Coordinating Center staff will work with you to determine the appropriate research approach and ESP product to address your questions of interest. Topics are selected and assigned to an ESP Center based on program capacity and alignment with VA national goals.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers; and to disseminate these reports throughout VA.

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