Abstract
We report a meta-analysis of virtual reality (VR) interventions for anxiety and depression outcomes, as well as treatment attrition. We included randomized controlled trials comparing VR interventions, alone or in combination, to control conditions or other active psychological interventions. Effects sizes (Hedges’ g) for anxiety and depression outcomes, as post-test and follow-up, were pooled with a random-effects model. Drop-outs were compared using odds ratio (OR) with a Mantel-Haenszel model. We included 39 trials (52 comparisons). Trial risk of bias was unclear for most domains, and high for incomplete outcome data. VR-based therapies were more effective than control at post-test for anxiety, g = 0.79, 95% CI 0.57 to 1.02, and depression, g = 0.73, 95% CI 0.25 to 1.21, but not for treatment attrition, OR = 1.34, 95% CI 0.95 to 1.89. Heterogeneity was high and there was consistent evidence of small study effects. There were no significant differences between VR-based and other active interventions. VR interventions outperformed control conditions for anxiety and depression but did not improve treatment drop-out. High heterogeneity, potential publication bias, predominant use of waitlist controls, and high or uncertain risk of bias of most trials question the reliability of these effects.
Highlights
Virtual reality (VR) has garnered significant attention as a cost-effective tool for delivering psychological treatments[1]
In the reported meta-analysis, we showed moderate to large effects of virtual reality (VR) interventions compared to control conditions, for anxiety and depression outcomes
Virtual reality enhanced interventions had moderate to large effects compared to control conditions, though these effects were likely inflated by several factors in the design and implementation of the trials
Summary
Virtual reality (VR) has garnered significant attention as a cost-effective tool for delivering psychological treatments[1]. The effects of VR interventions on treatment attrition remained unclear, with some speculation of possible superiority[1,5,8], but no assessment in a meta-analysis. Assessment of quality[6,7] relied on mixed and potentially inadequate tools that included items not linked to any type of trial bias (e.g., treatment fidelity)[9], thereby potentially confounding the relationship between study quality and treatment effects. One meta-analysis[7] considered publication bias, with conflicting results between the assessment methods used (Egger’s test and fail-safe N). We report a meta-analysis for the effectiveness of VR-enhanced interventions in RCTs, for symptoms of anxiety and depression, as well as treatment attrition, along with assessment of risk of bias, heterogeneity, and potential moderators
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