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 fashionable. However what if VR areas may very well be used for therapy?
Immersive VR simulates real-world environments with visible, auditory, and sometimes different sensory enter that the consumer 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 therapy of adults are encouraging (Eshuis et al., 2021; Zeka et al., 2024) – and we’ve got 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 robust instrument within the therapy of youngsters and adolescents as nicely.
Earlier evaluations present promising outcomes for younger purchasers (Ridout et al., 2021; Varma et al., 2022; Wiebe et al., 2022). Nevertheless, these evaluations are sometimes narrative, centered 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 troublesome to include in regular medical observe.
To beat these limitations, Massanneck and colleagues (2026) performed a scientific overview and meta-analysis during which they solely checked out immersive VR remedies delivered by way of commercially out there VR headsets for kids and adolescents.
Immersive VR video games have gotten successful with younger folks. May the identical be the case for immersive VR remedies?
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 situations, for kids and adolescents underneath 18 years. They included research revealed from 2016 onwards (till Oct 2024): the 12 months that VR headsets overcame the technical limitations of earlier variations and have become extensively out there for client use.
The authors performed a collection of random results meta-analyses on a complete of 67 impact sizes. In addition 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 instrument (Sterne et al., 2019); three research (out of the 9 recognized) had been judged to have low danger of bias, with the remaining both having a excessive danger or not being assessed because of lack of understanding.
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 centered on a variety of various situations, particularly:
- Acrophobia (worry of heights) (n = 1)
- Distractibility (n = 2) and social expertise (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 danger behaviours (n = 2)
The VR remedies ranged from 1 to fifteen classes (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 taking part in video games in a digital schoolyard) – 9 research in whole (some overlapping) included interactive components.
Total, the meta-analyses confirmed a small however important optimistic impact of the VR therapy (g = -0.26, 95% CI [-0.40 to -0.13]; notice {that a} unfavorable Hedges’ g is in favour of the VR therapy). 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 those who made use of extremely sensible avatars (z = -0.49, p = .03), had a extra optimistic impact on psychological well being measures (as with Hedges’ g above, unfavorable values are in favour of the VR therapy).
Total, VR therapy was more practical than passive management situations, and a minimum of as efficient as different lively remedies for kids and adolescents throughout a variety of issues.
Conclusions
This systematic overview and meta-analysis demonstrates that VR remedies have potential within the therapy of assorted situations 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 inexpensive VR {hardware} appropriate for particular person practitioners and small clinics.
Massanneck and colleagues focussed on “readily accessible and inexpensive 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 must 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 entire pattern dimension included within the meta-analysis (n = 929) is comparatively massive, about 40% of it comes from one research (Guldager et al., 2022), that means that this research could have had a disproportionate affect on the pooled findings and will affect general validity.
Additionally, as a result of lack of follow-up knowledge in a lot of the unique research, the meta-analysis focuses on the modifications from earlier than therapy to proper after it (pre- to post- measurements), that means that we have no idea but whether or not the optimistic results of VR therapy persist after therapy ends, and for a way lengthy. This data, nevertheless, might help medical decision-making, as a statistically small therapy impact turns into extra virtually related when it may well nonetheless be seen, say, half a 12 months after therapy in comparison with when it disappears quicker.
Maybe the most important limitation is heterogeneity, i.e. the pooling of a bunch of research that checked out a variety of various well being situations. Systematic evaluations ought to at all times pool comparable research and the younger folks in these analysis research had been experiencing all the pieces from consuming issues to public talking nervousness, to worry of heights!
That stated, this paper additionally has a number of strengths. First, the search was performed according to the PRISMA pointers, thus adhering to prime quality requirements. In my opinion, one other essential power is the deal with particular expertise: extremely immersive VR remedies delivered utilizing comparatively low-cost, commercially out there tools. This not solely makes the findings simpler to grasp, as they don’t seem to be being obscured by means of completely different applied sciences (e.g., desktop functions), it additionally makes them immediately related for therapists who’re seemingly to decide on business VR set-ups equivalent to those used within the research that this meta-analysis relies on, moderately than costly high-tech VR programs.
Taken collectively, we are able to conclude that the paper by Massanneck and colleagues offers a great overview of the state-of-the-art in immersive VR remedies for kids and adolescents, while highlighting areas the place extra analysis is required.
Extra research on VR remedies for kids and adolescents are wanted, significantly in areas the place findings are at present lacking, equivalent to obsessive compulsive dysfunction and studying issues.
Implications for observe
So, ought to therapists begin handing out VR goggles to their younger purchasers?
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 situations studied right here, which is encouraging. However given the excessive danger of bias within the research and the limitation of pooling many diverse research collectively in a single meta-analysis (heterogeneity), we can’t be assured in these findings. So, does this seemingly slight benefit justify a change to VR remedies?
In my opinion, there are extra elements that must be taken into 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 therapy codecs. This may make VR extra advantageous than different remedies, even when effectiveness is of comparable magnitude. Then again, we all know that VR could cause unintended 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 latest overview discovered restricted proof that VR is dangerous for kids underneath 14, although it was famous that knowledge on security and adversarial unintended 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 appears like a cliché, extra analysis is basically wanted. Unsurprisingly, analysis on immersive VR remedies for kids and adolescents lags behind that for adults; examine the present dimension 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, adversarial side-effects, drop-out charges, (longer) follow-up durations, and, as Massanneck and colleagues additionally level out, a wider vary of situations which are usually seen amongst younger purchasers, equivalent to obsessive compulsive dysfunction, must be thought of too.
Given the growing affordability of VR {hardware} for gaming, we’re prone to see an increase in VR remedies as nicely. A robust proof base is required to make it possible for these remedies are literally useful.
Extra data is required on the potential unintended effects of immersive VR, equivalent to cybersickness, and the way these could have an effect on therapy for kids and adolescents.
Assertion of pursuits
Rena Gatzounis has no conflicts of curiosity to declare. The reference to Roblox is impressed by latest discussions on this Elf’s family, and has no business motives.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major 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 therapy of psychological well being issues: 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). Hostile 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, Ok. (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 instrument for assessing danger 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 Assessment of Randomized Managed Trials on Digital Actuality Utility in Pediatric Sufferers. Cureus. https://doi.org/10.7759/cureus.30543
Wiebe, A., Kannen, Ok., Selaskowski, B., Mehren, A., Thöne, A. Ok., Pramme, L., … & Braun, N. (2022). Digital actuality within the diagnostic and remedy for psychological issues: A scientific overview. Scientific Psychology Assessment, 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 therapy for psychological issues: A scientific overview with meta-analysis. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13777
