Systematic scoping review of virtual reality exposure-based therapy for anxiety-related disorders since the commercial release of head-mounted display virtual reality

Abstract This systematic scoping review mapped the empirical literature on Virtual Reality Exposure-Based Therapy (VRET) delivered via commercially available head-mounted displays for adult anxiety-related disorders, to characterize study targets, methods, and gaps. A comprehensive database search yielded 1097 records. Publications were excluded if anxiety was not a measured outcome; if exposure was paired with other techniques (e.g., relaxation or additional therapies) in a way that prevented evaluation of exposure as a stand-alone component; or if virtual reality was delivered via methods other than head-mounted displays. Thirty studies met inclusion criteria and were charted for synthesis. The 30 included studies examined phobias (n = 11), Obsessive-Compulsive Disorder (n = 4), public speaking anxiety and social anxiety (n = 13), and other anxiety presentations (n = 2; social physique anxiety; MRI anxiety). Most studies reported pre- to post-intervention reductions in anxiety symptoms, but study designs and outcome measures varied substantially. Acceptability and engagement were generally favorable when assessed, but measurement approaches were inconsistent and adverse effects were not uniformly reported. Methodological heterogeneity and limited replication constrained cross-study comparability. The current evidence base indicates growing application of HMD-based VRET across multiple anxiety-related targets and suggests potential clinical benefit in many studies; however, heterogeneity and small samples limit the strength of inferences regarding comparative outcomes. Future research would benefit from standardized reporting of intervention parameters and equipment, consistent measurement of acceptability, and adequately powered comparative designs with longer follow-up to clarify where HMD-based VRET is most feasible and beneficial.