# Immersive virtual reality psychotherapy for children and adolescents—A systematic review and meta-analysis

## TL;DR

This paper reviews and analyzes immersive virtual reality psychotherapy for children and adolescents, finding it effective in improving mental health outcomes.

## Contribution

The study provides a meta-analysis focused specifically on high-immersive VR applications in child and adolescent psychotherapy.

## Key findings

- VR applications are comparably effective as active treatments like standard CBT.
- VR intervention was more beneficial in 52 of 67 cases (fewer symptoms/better skills).
- Realistic avatars and high interactivity are linked to better treatment outcomes.

## Abstract

Although virtual reality has been used in psychotherapy since the 1990s, research and clinical practice have focused strongly on its application in exposure therapy. Over the last decade, the emergence of a new generation of virtual reality devices has led to a surge in virtual reality applications, which are also gaining traction in other areas of mental health care. The use of virtual reality in children and adolescent psychotherapy is especially interesting because it provides engaging and fun opportunities to strengthen therapeutic success. Despite these emerging needs, most systematic reviews focus not on high-immersive virtual reality applications but instead include low-immersive virtual reality applications, which may influence the results. This review fills the gap by providing a systematic review and meta-analysis of high-immersive virtual reality applications for child and adolescent psychotherapy. A total of nine eligible randomized controlled trials were included. The meta-analysis highlights that virtual reality applications can significantly enhance therapeutic success (Hedge’s g = −0.25, 95% CI [−0.37, −0.13]). During the extensive literature search, several research gaps were identified. Future research should concern itself with additional RCTs on mental health conditions that are currently lacking, such as Learning Disorders, Obsessive-Compulsive Disorder (OCD), Depression, and others. Initially, we also searched for augmented reality applications, but our literature search revealed no suitable studies.

•VR applications are comparably effective as active treatments, such as standard CBT.•VR intervention was more beneficial in 52 of 67 cases (fewer symptoms/better skills).•Realistic avatars were associated with more beneficial VR treatment effects.•High interactivity had a positive effect on the patients’ mental health measures.

VR applications are comparably effective as active treatments, such as standard CBT.

VR intervention was more beneficial in 52 of 67 cases (fewer symptoms/better skills).

Realistic avatars were associated with more beneficial VR treatment effects.

High interactivity had a positive effect on the patients’ mental health measures.