Facing fears in virtual worlds: A systematic review and meta-analysis on immersive VR therapy for children and adolescents with social anxiety and related disorders

Anxiety disorders are common mental health issues in children and adolescents. Virtual reality (VR) offers promising opportunities for exposure-based interventions in immersive and controlled environments. This systematic review aimed to evaluate the effectiveness of VR-based exposure therapies for anxiety disorders and related symptoms in children and adolescents aged 4 to 18 years. A secondary objective was to assess user experience and adherence, where reported. A systematic search of six databases (Web of Science, ScienceDirect, PubPsych, EBSCOhost, PubMed, Cochrane Library) was conducted from January 1, 2015, to April 11, 2025 (last date of search), in title and abstract fields. Studies were included if they involved immersive VR-based exposure interventions targeting anxiety disorders (including social anxiety, generalized anxiety disorder, separation anxiety, or related symptoms) in participants aged 4 to 18 years. A narrative synthesis was conducted, and a random-effects meta-analysis was performed on subjective units of distress (SUDs) from eligible studies. Five out of 466 screened studies met the inclusion criteria. VR-based exposure therapy was associated with significant reductions in anxiety-related symptoms, particularly in social and public speaking anxiety. The meta-analysis of SUD ratings showed a large pre-post effect (Hedges' g = - 1.51, (95%CI [- 2.20, - 0.82], p < .001), though heterogeneity was high (I² = 81.0%), and number of included studies small (k = 3). VR-based interventions appear to be effective in reducing anxiety symptoms in youth. However, the small number of studies, limited sample sizes, and methodological heterogeneity highlight the need for further research using standardized outcome measures.