The impact of virtual reality cognitive behavioral therapy on mental disorders among children and youth: A systematic review and meta-analysis

BackgroundCognitive behavioral therapy (CBT) is an effective treatment for mental disorders, however, it can be associated with limited patient engagement, low adherence, and stigma among younger populations. Virtual reality (VR) environments can facilitate innovative approaches to enhance CBT implementation in a controlled and immersive way. ObjectivesThis study evaluates the impact of VR-CBT interventions on mental disorders in children and youth through a systematic review and meta-analysis. MethodsA search was conducted in PsycINFO, PubMed, EMBASE, Scopus, and Web of Science. Studies compared VR-CBT interventions to traditional therapy or control conditions. Extracted data included post-intervention means, standard deviations, and 95% confidence intervals. Pooled effect sizes were calculated using Hedges g and analyzed with a random-effects model. Risk of bias was evaluated using the Cochrane risk-of-bias (RoB) 2 tool and the JBI Critical Appraisal Tool. ResultsIn total, 20 studies were included in the systematic review, with 85% (n = 17) utilizing virtual reality exposure therapy (VRET), and 15% (n = 3) implementing broader VR-CBT frameworks. VR technologies included wearable head-mounted displays (70%, n = 14), with 30% (n = 6) relying on non-wearable systems, and 15% (n = 3) incorporating gamification elements. Seven studies were included in a meta-analysis, which showed that VR-CBT was associated with a small to moderate reduction in mental disorder symptoms in full-scale studies (pooled Hedges g = -0.46 (95% CI: [-0.84], [-0.09]). ConclusionsVR-CBT interventions demonstrate potential for addressing mental disorders in children and youth, particularly when traditional therapy alone is insufficient and/or inaccessible.