Abstract
Background
Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.
Objective
To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.
Data source
Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.
Eligibility criteria
To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.
Study evaluation
For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.
Results
Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.
Conclusion
While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.
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The remaining six studies presented a variety of different VR-implementations. The first study (Camacho-Conde & Climent, 2020) examined a new virtual aquarium task and reported that adolescents with ADHD performed significantly worse than HC in various attention measures. The second study (Fang, Han, & Luo, 2019) examined the task performances of children with ADHD in three different VR tasks (Position Tracking Task, Stroop Task and Recognition Task) and found that, across tasks, they showed significantly worse performances than HC.
Regarding craving, a reoccurring result in smokers is that virtual 3D environments with nicotine cues elicited higher craving compared to exposure to both 2D nicotine-related pictures (Lee et al., 2003; Lee, Lim, Wiederhold, & Graham, 2005) and neutral VR environments without nicotine cues, such as an empty room with an art gallery (Bordnick et al., 2004; Bordnick, Traylor, Graap, Copp, & Brooks, 2005), a bus, a waiting room and a library (Liu, Andrade, Schulze, Doran, & Courtney, 2022), an aquarium (Bordnick, Graap, Copp, Brooks, & Ferrer, 2005), screens with nature scenes (Acker & MacKillop, 2013; Traylor, Bordnick and Carter, 2008, Traylor, Bordnick and Carter, 2009, Traylor, Parrish, Copp and Bordnick, 2011), a mountain landscape (Tamburin et al., 2021; Zandonai et al., 2021), an entire virtual office (Lee et al., 2005) or a neutral street and apartment route (Baumann & Sayette, 2006).
Stimulants: Two studies were found on cocaine (Saladin, Brady, Graap, & Rothbaum, 2006; Tau et al., 2014). The study by Saladin et al. (2006) compared a virtual cocaine environment against a neutral environment (a virtual 3D aquarium) and found increased craving and an elevated heart rate in cocaine dependents after being exposed to the cocaine environment. The study by Tau et al. (2014), in turn, compared adult abstinent cocaine dependents with a HC group while performing a virtual spatial learning task. They found, inter alia, deviations in the medial temporal lobe, which is associated with spatial learning.
