Anybody who spends time with youngsters and adolescents nowadays is aware of that they like hanging out in digital areas equivalent to Roblox, and that immersive digital actuality (VR) video games have gotten more and more widespread. However what if VR areas could possibly be used for remedy?
Immersive VR simulates real-world environments with visible, auditory, and infrequently different sensory enter that the person receives by way of a VR headset, formally referred to as a “head-mounted show” (HMD), and different {hardware}. Outcomes about immersive VR within the remedy of adults are encouraging (Eshuis et al., 2021; Zeka et al., 2024) – and we now have blogged about that beforehand right here at The Psychological Elf. Given its normal playful character and potential for engagement, immersive VR could also be a strong device within the remedy of kids and adolescents as properly.
Earlier opinions present promising outcomes for younger shoppers (Ridout et al., 2021; Varma et al., 2022; Wiebe et al., 2022). Nonetheless, these opinions are sometimes narrative, targeted on use of VR throughout medical procedures, and have included each non-immersive VR (e.g., laptop video games) in addition to immersive VR that depends on costly specialised {hardware} that’s tough to include in normal scientific follow.
To beat these limitations, Massanneck and colleagues (2026) carried out a scientific overview and meta-analysis through which they solely checked out immersive VR remedies delivered by way of commercially out there VR headsets for kids and adolescents.
Strategies
With a search technique conforming to PRISMA pointers, the authors searched throughout 4 databases for randomised managed trials (RCTs) on the consequences of immersive VR-assisted psychotherapy versus lively (e.g., CBT) or passive (e.g., waitlist) management circumstances, for kids and adolescents underneath 18 years. They included research revealed from 2016 onwards (till Oct 2024): the yr that VR headsets overcame the technical limitations of earlier variations and have become extensively out there for shopper use.
The authors carried out a collection of random results meta-analyses on a complete of 67 impact sizes. Additionally they thought of moderators such because the usability and interactivity of the remedies, in addition to using avatars. Threat of bias was assessed with the Cochrane Threat-of-Bias 2 device (Sterne et al., 2019); three research (out of the 9 recognized) had been judged to have low threat of bias, with the remainder both having a excessive threat or not being assessed as a result of lack of knowledge.
Outcomes
Massanneck and colleagues recognized 9 eligible research that included a complete of 929 youngsters and adolescents aged 6-18 years (M = 13.3). The research targeted on a spread of various circumstances, particularly:
- Acrophobia (worry of heights) (n = 1)
- Distractibility (n = 2) and social abilities (n = 1) in consideration deficit hyperactivity dysfunction (ADHD)
- Aggressive behaviour (n = 1)
- Anorexia (n = 1)
- Public talking nervousness (n = 1)
- Prevention of sex- and substance-related threat behaviours (n = 2)
The VR remedies ranged from 1 to fifteen periods (with session size starting from three minutes to 2 hours) for as much as 12 weeks.
5 research used digital classroom environments (some mentioning particulars like flying paper airplanes as distractors), and 5 research had interactive components (equivalent to enjoying video games in a digital schoolyard) – 9 research in complete (some overlapping) included interactive components.
Total, the meta-analyses confirmed a small however important constructive impact of the VR remedy (g = -0.26, 95% CI [-0.40 to -0.13]; notice {that a} unfavourable Hedges’ g is in favour of the VR remedy). The impact was reasonable when VR was in comparison with a passive management, equivalent to a waitlist (g = -0.51, 95% CI [-0.76 to -0.27]), and small, however nonetheless important, when VR was in comparison with different, non-VR remedies, like roleplay interventions (g = -0.13, 95% CI [-0.23 to -0.03]). Sensitivity analyses didn’t considerably change these findings.
Exploratory analyses confirmed that remedies involving excessive interactivity (z = -0.25, p = .01), excessive usability (z = -0.33, p < .01), and people who made use of extremely practical avatars (z = -0.49, p = .03), had a extra constructive impact on psychological well being measures (as with Hedges’ g above, unfavourable values are in favour of the VR remedy).
Conclusions
This systematic overview and meta-analysis demonstrates that VR remedies have potential within the remedy of varied circumstances in youngsters and adolescents, as they had been proven to be more practical than non-treatment, and a minimum of as efficient as different remedies. Within the authors’ personal phrases,
Our work emphasizes readily accessible and reasonably priced VR {hardware} appropriate for particular person practitioners and small clinics.
Strengths and limitations
Whereas the findings from this meta-analysis are attention-grabbing, the conclusions drawn have to be interpreted in mild of some limitations.
To begin with, the meta-analysis solely includes 9 research, which isn’t a excessive sufficient quantity to permit us to attract particular conclusions. Moreover, though the whole pattern measurement included within the meta-analysis (n = 929) is comparatively massive, about 40% of it comes from one research (Guldager et al., 2022), which means that this research could have had a disproportionate affect on the pooled findings and will influence total validity.
Additionally, as a result of lack of follow-up knowledge in a lot of the authentic research, the meta-analysis focuses on the modifications from earlier than remedy to proper after it (pre- to post- measurements), which means that we have no idea but whether or not the constructive results of VR remedy persist after remedy ends, and for a way lengthy. This info, nonetheless, may also help scientific decision-making, as a statistically small remedy impact turns into extra virtually related when it might probably nonetheless be seen, say, half a yr after remedy in comparison with when it disappears quicker.
Maybe the largest limitation is heterogeneity, i.e. the pooling of a bunch of research that checked out a variety of various well being circumstances. Systematic opinions ought to all the time pool comparable research and the younger folks in these analysis research had been experiencing all the pieces from consuming problems to public talking nervousness, to worry of heights!
That stated, this paper additionally has a number of strengths. First, the search was carried out in step with the PRISMA pointers, thus adhering to prime quality requirements. In my opinion, one other essential power is the give attention to particular expertise: extremely immersive VR remedies delivered utilizing comparatively low-cost, commercially out there gear. This not solely makes the findings simpler to know, as they don’t seem to be being obscured by means of completely different applied sciences (e.g., desktop purposes), it additionally makes them immediately related for therapists who’re seemingly to decide on industrial VR set-ups equivalent to those used within the research that this meta-analysis relies on, slightly than costly high-tech VR programs.
Taken collectively, we are able to conclude that the paper by Massanneck and colleagues offers a very good overview of the state-of-the-art in immersive VR remedies for kids and adolescents, while highlighting areas the place extra analysis is required.
Implications for follow
So, ought to therapists begin handing out VR goggles to their younger shoppers?
These findings are promising however, as of but, restricted. Immersive VR remedies appear to be barely extra, or a minimum of as efficient as different lively remedies for the circumstances studied right here, which is encouraging. However given the excessive threat of bias within the research and the limitation of pooling many various research collectively in a single meta-analysis (heterogeneity), we can’t be assured in these findings. So, does this seemingly slight benefit justify a swap to VR remedies?
In my opinion, there are extra components that have to be taken under consideration. Immersive VR and its game-like character might be fairly thrilling for kids and adolescents, which may imply that VR remedies result in decrease dropout charges than conventional remedy codecs. This could make VR extra advantageous than different remedies, even when effectiveness is of comparable magnitude. Alternatively, we all know that VR may cause uncomfortable side effects, equivalent to movement illness and disorientation, that are collectively known as “cybersickness” (Lundin et al., 2023). Are these particularly annoying – or, given the developmental challenges, even detrimental – for (some) youngsters and adolescents? A current overview discovered restricted proof that VR is dangerous for kids underneath 14, although it was famous that knowledge on security and hostile uncomfortable side effects of VR for kids isn’t reported (Bexson et al., 2024).
This results in clear implications for researchers and funding companies: as a lot because it seems like a cliché, extra analysis is basically wanted. Unsurprisingly, analysis on immersive VR remedies for kids and adolescents lags behind that for adults; evaluate the present measurement of 9 research to that of meta-analyses on VR remedies for adults, which have included over 50 research (Zeka et al., 2024). As well as, hostile side-effects, drop-out charges, (longer) follow-up durations, and, as Massanneck and colleagues additionally level out, a wider vary of circumstances which are typically seen amongst younger shoppers, equivalent to obsessive compulsive dysfunction, have to be thought of too.
Given the rising affordability of VR {hardware} for gaming, we’re more likely to see an increase in VR remedies as properly. A powerful proof base is required to be sure that these remedies are literally useful.
Assertion of pursuits
Rena Gatzounis has no conflicts of curiosity to declare. The reference to Roblox is impressed by current discussions on this Elf’s family, and has no industrial motives.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Main paper
Steffen Massanneck, Lennart Seizer, Nadine Schmitt, Anja Pascher, Johanna Löchner (2026). Immersive digital actuality psychotherapy for kids and adolescents—A scientific overview and meta-analysis. Web Interventions, 43, 100920. https://doi.org/10.1016/j.invent.2026.100920
Different references
Bexson, C., Oldham, G., & Wray, J. (2024). Security of digital actuality use in youngsters: a scientific overview. European Journal of Pediatrics, 183(5), 2071-2090. https://doi.org/10.1007/s00431-024-05488-5
Eshuis, L. V., van Gelderen, M. J., van Zuiden, M., Nijdam, M. J., Vermetten, E., Olff, M., & Bakker, A. (2021). Efficacy of immersive PTSD remedies: A scientific overview of digital and augmented actuality publicity remedy and a meta-analysis of digital actuality publicity remedy. Journal of Psychiatric Analysis, 143, 516-527. https://doi.org/10.1016/j.jpsychires.2020.11.030
Gatzounis, R. (2025). Immersive digital actuality for the remedy of psychological well being problems: nervousness leads the best way. The Psychological Elf.
Guldager, J. D., Kjær, S. L., Grittner, U., & Inventory, C. (2022). Efficacy of the digital actuality intervention VR FestLab on alcohol refusal self-efficacy: A cluster-randomized managed trial. Worldwide Journal of Environmental Analysis and Public Well being, 19(6). https://doi.org/10.3390/ijerph19063293
Lundin, R. M., Yeap, Y., & Menkes, D. B. (2023). Antagonistic results of digital and augmented actuality interventions in psychiatry: Systematic overview. JMIR Psychological Well being, 10(10), e43240. https://doi.org/10.2196/43240
Ridout, B., Kelson, J., Campbell, A., & Steinbeck, Okay. (2021). Effectiveness of digital actuality interventions for adolescent sufferers in hospital settings: systematic overview. Journal of Medical Web analysis, 23(6), e24967. https://doi.org/10.2196/24967
Sterne, J. A. C., Savović, J., Web page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H. Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., … Higgins, J. P. T. (2019). RoB 2: A revised device for assessing threat of bias in randomised trials. The BMJ, 366. https://doi.org/10.1136/bmj.l4898
Varma, A., Naqvi, W. M., Mulla, S., Syed, S., Thakur, S., Arora, S. P., Varma, A. R., & Besekar, S. (2022). A Systematic Evaluate of Randomized Managed Trials on Digital Actuality Utility in Pediatric Sufferers. Cureus. https://doi.org/10.7759/cureus.30543
Wiebe, A., Kannen, Okay., Selaskowski, B., Mehren, A., Thöne, A. Okay., Pramme, L., … & Braun, N. (2022). Digital actuality within the diagnostic and remedy for psychological problems: A scientific overview. Scientific Psychology Evaluate, 98, 102213. https://doi.org/10.1016/j.cpr.2022.102213
Zeka, F., Clemmensen, L., Valmaggia, L., Veling, W., Hjorthøj, C., & Glenthøj, L. B. (2024). The effectiveness of immersive Digital Actuality-based remedy for psychological problems: A scientific overview with meta-analysis. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13777
