Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
University of Montreal, Montreal, QC, Canada.
J Med Internet Res. 2020 Aug 19;22(8):e20889. doi: 10.2196/20889.
Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)-based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders.
This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies.
A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence.
The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia.
VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.
在全球所有疾病中，精神疾病是主要负担之一。由于许多人对传统的基于证据的治疗方法有抵触，因此需要实施新的心理健康治疗方法。为了提高精神病学中基于证据的心理治疗的效果和益处，人们努力开发虚拟现实（VR）为基础的干预措施。这些干预措施与传统心理治疗相比具有广泛的优势。目前，基于 VR 的干预措施主要是为与焦虑相关的障碍而开发的；但是，它们也用于发育障碍、严重精神障碍和神经认知障碍。
本元分析旨在通过评估元分析研究提供的证据质量，总结目前关于 VR 为基础的干预措施对各种精神疾病疗效的证据状况。
使用以下电子数据库进行系统搜索：PubMed、PsycINFO、Web of Science 和 Google Scholar（截至 2020 年 2 月的任何时间）。只要定量检查了 VR 为基础的干预措施对精神障碍症状的疗效，就包括元分析。为避免元分析之间的重叠，对于本元分析中包含的每个亚分析，仅根据最佳证据质量选择来自一个元分析的一个分析。
检索到 11 项符合条件的元分析。证据质量从极低到中等质量不等。证据质量较低的原因有很多，例如随机对照试验数量有限、缺乏随访分析或对照组，以及存在异质性和发表偏倚。尽管如此，证据表明，与非活动对照相比，针对与焦虑相关障碍的 VR 为基础的干预措施具有中等至较大的总体效果，但与标准基于证据的方法相比，没有显著差异。初步数据表明，这些效果似乎随时间持续，并且受试者的表现可能优于活动对照。神经认知障碍似乎也可以通过 VR 为基础的方法得到改善，各种临床结果（如认知、情绪）都发现了小的效果。最后，没有足够的数据将 VR 为基础的干预措施归类为神经发育障碍中的社交技能训练和精神分裂症患者依从性的基于证据的实践。
VR 通过针对特定复杂问题和个性化干预措施提供了无限的机会。但是，与传统的基于证据的治疗方法相比，基于 VR 的干预措施并未显示出优越性。未来的 VR 为基础的干预措施应专注于开发针对复杂和治疗抵抗症状的创新方法，这些症状用传统治疗方法难以解决。未来的研究还应旨在更好地了解可能影响 VR 结果的潜在因素，以改善治疗效果。
