Virtual reality-based psychological counseling and psychotherapy for mental health conditions: a systematic review of randomized controlled trials on applications and therapeutic effectiveness

Abstract

Virtual reality (VR) has moved from laboratory prototypes into clinical counseling, yet its therapeutic value relative to conventional approaches remains debated. This systematic review mapped the counseling and psychotherapeutic applications of VR evaluated in randomized controlled trials and appraised their effectiveness against conventional or control conditions. Following PRISMA 2020 and a PICOS-structured strategy, Scopus was searched with Boolean combinations of VR and counseling or psychotherapy terms, yielding 981 records. Eligible studies were English-language, open-access, final-stage journal articles published between 2016 and 2025 that randomized people with mental health conditions to a VR-based psychological intervention; protocols, reviews, non-randomized designs, and non-psychotherapeutic uses of VR were excluded. After removing 14 duplicates and 542 records outside the search limiters, 425 records were screened and 17 trials were included. Applications clustered into depression, anxiety and fear, substance use, trauma, and transdiagnostic stress. VR consistently outperformed usual care or no-VR conditions, whereas comparisons with active conventional therapies mostly indicated equivalence or non-inferiority. VR therefore appears to extend rather than replace established counseling models. Future research should prioritize adequately powered comparative trials, longer follow-up, and implementation studies in counseling settings.