Virtual Reality in the treatment of depression; what therapeutic strategies does VR target?

• Implementing VR interventions in depression treatment is increasingly popular, but not strongly supported by theory • It is crucial to identify the therapeutic strategies that should be targeted in VR interventions for depression and to understand how they should be implemented in VR • Current VR interventions for depression target the following therapeutic strategies: psychoeducation, behavioral activation, cognitive restructuring, enhancing positive affect, mental imagery, skills training, enhancing cognitive functioning • Future studies should focus on the evaluation of presumed mechanisms of change in VR interventions for depression Major Depressive Disorder (MDD) is one of the most prevalent mental health conditions and has a tremendous impact on those affected. Immersive Virtual Reality (VR) technology has high potential to improve psychotherapy for MDD, as VR can personalize the treatment process and directly influence affect. Research on VR interventions for MDD is emerging, but current applications for treatment are heterogeneous and lack strong theoretical support. This scoping review aims to identify the therapeutic strategies that should and can be targeted in VR interventions for depression. A systematic search of the literature was conducted in PubMed, PsycINFO, Ovid Medline, Embase, Web of Science, Google Scholar, Clinical Trials Register, and the ‘Dutch Trial Register’ from inception through November 2023 to identify the most relevant research. Findings from 43 studies included in this review resulted in the following potential therapeutic strategies: 1) psychoeducation (n=5), 2) behavioral activation (n=16), 3) cognitive restructuring (n=4), 4) enhancing positive affect (n=5), 5) mental imagery (n=4), 6) skills training (n=3), 7) enhancing cognitive functioning (n=3), and 8) other (n=3). We did not conduct a systematic assessment of the methodological quality of the studies nor perform a statistical analysis of the results. VR shows potential to facilitate the treatment process for patients with depression in different ways, providing excellent prospects for personalizing and potentially improving the treatment of MDD. Future studies should focus on evaluating presumed mechanisms of change to fully understand the added value of VR in the treatment of depression.