Takeaway: VR exposure therapy for PTSD may be less effective, or had little to no difference in effect, when compared with non-VR exposure therapy. VR interventions may result in less craving for stimulant use disorder (compared with treatment as usual). The evidence is very uncertain for effects in other disorders. Future research should evaluate heterogeneity of treatment effects and participant engagement across important subgroups, and the impact of key VR characteristics.

Context: Evidence-based psychotherapies for mental health disorders are effective yet remain underutilized in VHA. In recent years, VR technology has become more affordable and more capable of producing realistic environments, and clinical applications are proliferating. We synthesized evidence on the benefits and harms of fully immersive VR interventions for treating mental health disorders and for suicide prevention.

Key Findings: Of 84 eligible studies, 45 (44 RCTs and one observational study) addressed prioritized mental health disorders: PTSD (k = 6), social anxiety disorder (k = 10), flying phobia (k = 7), alcohol use disorder (k = 2), stimulant use disorder (k = 2), depression (k = 6), and schizophrenia spectrum disorders (k = 12). Most studies were small (total N < 100) and half evaluated VR exposure therapies (k = 26). Compared with non-VR prolonged exposure therapy (PE), VR PE for PTSD may result in less improvement in symptoms immediately post-intervention, and little to no difference at 3 months (both low certainty of evidence [COE]). VR PE probably results in less treatment response immediately post-intervention (moderate COE). For stimulant use disorder, VR exposure therapy may result in less craving immediately post-intervention, as compared to treatment as usual (low COE). The evidence is very uncertain on the effects of VR interventions on symptom severity and/or treatment response for other prioritized disorders. The evidence on adverse effects is very uncertain across all prioritized disorders. Only 1 eligible study examined suicide prevention and reported limited findings on suicide ideation (assessed by unclear measures).