A Systematic Review of Virtual Reality-Based Exposure Therapy for Anxiety and Phobia Treatment: Current Evidence and Future Directions

Background: This systematic review and meta-analysis examined virtual reality‐based exposure therapy (VRET) for treating anxiety and phobic disorders. Methods: We found 30 controlled studies (N=3,000) across common databases and followed PRISMA guidelines. Results: Primary outcomes were validated anxiety scales. Overall, VRET significantly reduced anxiety symptoms compared to no‐treatment or standard care. Meta-analytic effect sizes were large. In a broader anxiety sample, VRET outperformed conventional interventions (SMD = –0.95). Importantly, pooled analyses found no significant difference between VRET and in vivo exposure for most phobia types. Quality of evidence was mixed: most trials were small, and some risk-of-bias concerns were noted. Theoretical models align with these findings, suggesting that immersive VR exposure can produce habituation and new learning to inhibit fear. Clinically, VRET appears to be a viable alternative or adjunct to traditional CBT for anxiety, especially specific phobias and social anxiety. Yet heterogeneity and gaps remain, and longer-term, high-quality trials are needed. Conclusion: This report provides detailed methods and a critical appraisal of current evidence, with recommendations for practice and future research.