Innovative virtual reality exposure therapy for anxiety and posttraumatic stress disorder: a meta-analysis of randomised controlled trials

Abstract

Background: Anxiety disorders impose a substantial burden on individuals and society, affecting mental health, quality of life, and health care systems. Virtual reality exposure therapy (VRET) has emerged as a promising treatment. However, existing meta-analyses often included participants without clinically diagnosed anxiety or related disorders. This study aimed to evaluate the efficacy of VRET in reducing anxiety, phobia, behavioural symptoms, and posttraumatic stress disorder (PTSD) among patients with anxiety-related disorders and PTSD.

Methods: A systematic search was conducted across seven databases - CINAHL, Embase, PubMed, PsycINFO, Web of Science, Cochrane Library, and Medline-OVID. Eligible studies included randomised controlled trials (RCTs) examining the effects of VRET on anxiety-related outcomes. Data were pooled using a random-effects model with Comprehensive Meta-Analysis (version 3.0; Biostat, Englewood, NJ, USA). Effect size were calculated using Hedges' g, and moderator analyses explored potential factors influencing the effect sizes.

Results: Twenty-six RCTs involving 1649 participants met the inclusion criteria. Overall, VRET demonstrated significant and clinically meaningful effects across multiple domains. It reduced phobia symptoms (Hedges' g = -0.98; 95% confidence interval (CI) = -1.37, -0.60, P < 0.001), increased approach behaviour (Hedges' g = 0.62; 95% CI = 0.11, 1.12, P = 0.02), alleviated anxiety symptoms (Hedges' g = -0.61; 95% CI = -0.90, -0.33, P < 0.001), and mitigated PTSD symptoms (Hedges' g = -0.51; 95% CI = -0.72, -0.30, P < 0.001). Moderator analyses indicated that shorter intervention durations (<60 minutes) were associated with larger treatment effects on anxiety and phobia. VR-based Cognitive Behavioral Therapy (VR-CBT) and VRET demonstrated large and significant effects for phobia.

Conclusions: VRET effectively reduces anxiety, phobia, and PTSD symptoms while enhancing approach behaviour in clinically diagnosed patients. Its immersive and adaptable features make it a valuable exposure-based treatment tool. Further RCTs using advanced VR technologies and standardised protocols are needed to strengthen the evidence and optimise clinical application.

Registration: Open Science Framework (https://doi.org/10.17605/OSF.IO/AD4M2).