Zeka Fatime, Clemmensen Lars, Valmaggia Lucia, Veling Wim, Hjorthøj Carsten, Glenthøj Louise Birkedal
VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Mental Health Services, CPH, Denmark.
Department of Psychology, University of Copenhagen, Denmark.
Acta Psychiatr Scand. 2025 Mar;151(3):210-230. doi: 10.1111/acps.13777. Epub 2024 Dec 22.
The increasing number of studies of immersive virtual reality (VR) interventions for mental disorders call for an examination of the current level of evidence on their effectiveness. The findings may guide scalability and contribute to the advancement and optimization of immersive VR-based interventions for mental disorders.
A systematic literature search across four databases screened 2443 studies. Outcomes were disorder-specific symptoms, cognition, function, and quality of life. The study is registered on PROSPERO (CRD42023465845) and follows the reporting standards outlined in the PRISMA guidelines.
Fifty-five studies involving a total of 3031 participants covering 10 mental disorders were included in the analysis. VR interventions demonstrated statistically significant effects of post-treatment compared to active control conditions for alcohol use disorder (reduced state anxiety, g = 0.89, 95% CI[0.24, 1.55]) and schizophrenia spectrum disorders (reduced psychotic symptoms, g = 0.37, 95% CI[0.04, 0.70]). Compared to passive control conditions, statistically significant effects of VR interventions were observed for panic and agoraphobia (g = 1.28, 95% CI [0.47, 2.10]), social anxiety disorder (g = 0.83, 95% CI [0.49, 1.17]), specific phobias (g = 1.07, 95% CI[0.22, 1.92]), depression symptoms in PTSD (g = 0.67, 95% CI [0.22;1.13]). In contrast, no significant differences were found between VR interventions and active control conditions for functioning and quality of life in schizophrenia spectrum disorder and panic or agoraphobia. No meta-analyses were conducted on cognition due to insufficient data. Over 50% of the included studies were assessed as having a high risk of bias. According to the GRADE assessment, evidence for VR-based interventions across various mental disorders was generally of low to very low certainty, with a few exceptions rated as moderate certainty.
VR interventions may potentially have benefits, particularly when compared to passive control conditions, however, the evidence remains uncertain necessitating more large-scale, methodologically robust studies. Current findings can thus only be considered indicative. Recommendations on future directions of the VR field are discussed.
针对精神障碍的沉浸式虚拟现实（VR）干预研究数量不断增加，这就需要对其有效性的现有证据水平进行审视。研究结果可为扩大规模提供指导，并有助于推进和优化基于沉浸式VR的精神障碍干预措施。
在四个数据库中进行系统的文献检索，共筛选出2443项研究。结局指标为特定疾病的症状、认知、功能和生活质量。该研究已在国际前瞻性注册系统（PROSPERO，注册号：CRD42023465845）上注册，并遵循PRISMA指南中概述的报告标准。
分析纳入了55项研究，共3031名参与者，涉及10种精神障碍。与积极对照条件相比，VR干预在酒精使用障碍（状态焦虑减轻，g = 0.89，95%可信区间[0.24, 1.55]）和精神分裂症谱系障碍（精神病性症状减轻，g = 0.37，95%可信区间[0.04, 0.70]）的治疗后显示出统计学显著效果。与消极对照条件相比，VR干预在惊恐障碍和广场恐惧症（g = 1.28，95%可信区间[0.47, 2.10]）、社交焦虑障碍（g = 0.83，95%可信区间[0.49, 1.17]）、特定恐惧症（g = 1.07，95%可信区间[0.22, 1.92]）、创伤后应激障碍的抑郁症状（g = 0.67，95%可信区间[0.22;1.13]）方面显示出统计学显著效果。相比之下，在精神分裂症谱系障碍的功能和生活质量以及惊恐障碍或广场恐惧症方面，VR干预与积极对照条件之间未发现显著差异。由于数据不足，未对认知进行荟萃分析。超过50%的纳入研究被评估为存在高偏倚风险。根据GRADE评估，针对各种精神障碍的基于VR的干预措施的证据总体确定性较低至极低，少数被评为中等确定性。
VR干预可能具有潜在益处，尤其是与消极对照条件相比，然而，证据仍然不确定，需要更多大规模、方法学严谨的研究。因此，目前的研究结果只能作为参考。文中还讨论了VR领域未来方向的建议。
