Abstract
OBJECTIVE: The paper aims to systematically review the literature on the efficacy of virtual reality (VR) based therapies to treat mental health disorders in Randomized Control Trials (RCTs). METHODS: As of January 2,025, three databases were searched using relevant key terms (PsycINFO, PubMed, and Medline) and Rayyan tool. Eligible studies were English-language RCTs of VR-based interventions with a clearly specified therapeutic framework (e.g., CBT) in adult psychiatric populations. We excluded pediatric or neurodevelopmental samples, animal studies, psychiatric symptoms secondary to medical conditions and those using non-immersive VR (e.g., AR) or inadequately described interventions. The three authors screened the abstracts and rotated the full review of selected papers. From the 1611 papers generated from the search results 41 were included in the systematic review, encompassing anxiety, mood, trauma-related, obsessive-compulsive, eating, substance use, and psychotic disorders. RESULTS: Narrative syntheses of RCTs studies showed that across diagnostic categories, VR-based therapies outperformed waitlist and other inactive controls. For specific phobias, panic disorder with agoraphobia, and social anxiety, VR exposure was generally as effective as in-vivo exposure. For post-traumatic stress disorder, VR served as an effective alternative to imaginal prolonged exposure but did not reliably exceed it. For obsessive-compulsive disorder, findings were mixed and largely non-inferior to other treatments; for eating disorders, small trials reported comparable efficacy with occasional advantages in body image or cue reactivity. Evidence for depression, substance use, and psychotic disorders remains preliminary. CONCLUSION: Overall, results support VR as an effective therapeutic modality, though heterogeneity across findings limits conclusions about its superiority over established evidence-based in-vivo treatments. The lack of consistency across VR software and hardware, number of sessions, session duration, combination of VR with other modalities and the content of VR used make it difficult to draw comparisons across studies and generalize the findings regarding the efficacy of VR.