Systematic Review of Virtual Reality Exposure-Based Therapy for Anxiety-Related Disorders Since the Commercial Release of Head-Mounted Display Virtual Reality

Objective: The purpose of this systematic review was to comprehensively examine the empirical research on Virtual Reality Exposure-Based Therapy (VRET) for adult anxiety-related disorders, using commercially available head-mounted displays.Methods: A comprehensive database search resulted in 1097 identified publications. Publications were excluded if anxiety was not a measured outcome or if exposure was paired with other techniques, such as relaxation techniques or other therapies, in a way that prevented evaluation of exposure as a stand-alone component. Publications were also excluded if the virtual reality was delivered through means other than head-mounted displays. The final review for data synthesis included 30 studies.Results: Of the 30 reviewed studies, 11 were on phobias, 4 were on Obsessive-Compulsive Disorder, 13 were on public speaking anxiety and social anxiety, and 2 were on other forms of anxiety (i.e., social physique anxiety and MRI anxiety). VRET consistently reduced anxiety symptoms, with outcomes comparable to traditional exposure therapy. High levels of engagement and acceptability were observed. However, methodological inconsistencies and small sample sizes limit conclusions.Conclusions: Findings suggest that VRET using modern commercially available head-mounted displays is an effective and scalable intervention for anxiety-related disorders. The technology enhances accessibility, personalization, and engagement, making it a promising alternative to traditional methods. However, variability in study quality underscores the need for larger, more rigorous trials to assess long-term efficacy and optimize implementation.