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eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move.
In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health.
We compiled a table of 82 studies that made use of head-mounted devices in their interventions.
Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist.
Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.
Virtual reality (VR) is emerging as one of the key new technological tools in a digital revolution sweeping across the health care industry. Immersive VR allows users to interact with a computer-generated world, where the users natural sensory perceptions are replaced with a digital three-dimensional (3D) alternative [
Evidently, VR is a rapidly emerging field of research. Since 2016, new HMDs from Oculus, HTC, HP, Acer, Dell, and Sony and the arrival of a range of cheaper mobile phone alternatives have acted as a catalyst for a new wave of VR research. Despite recent investment in Oculus by Facebook, indicating VR is here to stay, its popularity among consumers is unlikely to affect the quantity of research around it. VR research has been continuously expanding in a time where it has not been at the forefront of digital consumerism. Oculus’ chief scientist Michael Abrash has suggested that in the next 5 years, we will see a new generation of VR products, which will operate with 4k screen resolution and with eye tracking that may allow for foveated rendering [
In this review, we aim to critically assess the current state of head-mounted VR research in relation to mental health. By doing so, we look to determine which conditions are more susceptible to VR interventions, which conditions need more attention, and in what form VR interventions are most effective. Our secondary aim is to understand more about VR used over the past 5 years and compare it to the new generation of VR in terms of accessibility and specifications. As there are indications that VR HMDs can be used at home as a self-help resource to provide a valuable tool for public health, in this review, we will assess head-mounted VR health research to date to determine whether this has been tested.
HMD specifications are categorized into FoV, image resolution, and refresh rate (Hz). FoV refers to the view or surroundings a human can see without any eye movement. The human eye has a rotating FoV of up to 270° [
We used a useful definition of mental health from a mental health foundation that defined it as:
A state of well-being in which the individual realises his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
The World Health Organization acknowledges that positive mental well-being is rooted within mental health; this state of well-being allows an individual to lead a fulfilling and productive life [
Health care and VR first met in the 1990s as a simulation tool for colonoscopy and upper gastrointestinal tract endoscopy simulation within medical education [
Narrative syntheses were conducted on VR studies that were pertinent to areas of mental health [
We set an inclusion timeframe from January 2012 to July 2017. A 5-year period was seen as sufficient enough to reflect the current state of the technology; this would allow us to assess studies that used both the new generation of HMDs and a range of older HMDs that have been in academia for the past decade. In line with this, studies were only included if they used an HMD. This meant excluding studies that used Cave Automatic Virtual Environment, the Computer-Assisted Rehabilitation Environment, and other projector systems without an HMD. As we focused on the systems used, if authors failed to disclose the type of VR used, or stated they used an HMD but provided no further information regarding its model or specifications, the study was excluded. Studies involving the use of two-dimensional (2D) virtual environments such as those seen in Second Life were excluded. Furthermore, augmented reality studies were not included as although augmented images are computer generated, the environment itself is not. Future VR may well feature an augmented experience within it [
Mental health conditions were categorized as behavioral conditions that showed the potential to be modified upon intervention. In accordance with the International Statistical Classification of Diseases and Related Health Problems [
The search strategy implemented in this review was conducted in 5 stages.
Key reviews in the area were identified; these contained broad mental health VR reviews to more condition-specific reviews.
The results and reference lists of these reviews were scanned to make an initial list of suitable studies.
Our own searchers were then carried out to identify any missed and more recent studies. The terms searched were: [“Virtual”] AND [“mental health” OR “well-being”]. This was followed with more condition-specific searches: [“Virtual”] AND [“Anxiety” OR “Social Anxiety” OR “Phobia” OR “Agoraphobia” OR “Arachnophobia” OR “Fear” OR “PTSD” OR “Depression” OR “Depress” OR “Stress” OR “Abuse” OR “Addiction” OR “pain” OR “Substance” OR “Eating” OR “Disorder” OR “Sleep” OR “Body Image” OR “Body” OR “sexual” OR “Dysfunction”]. Searches were conducted within “MEDLINE,” “Journal of Medical Internet Research,” “PsychINFO,” “Google Scholar,” and “Science Direct.”
Screening was carried out upon the completion of a comprehensive list of studies. At this stage, studies were excluded based on publication date, condition type, and lack of immersive VR.
The full texts of remaining articles were then assessed to find further reason for exclusion; at this stage, studies were typically excluded for not using an HMD or failing to disclose the type of VR used.
A full list of identified studies can be found in
The following findings have been compiled from 81 studies that used HMDs in interventions related to mental health; 18 HMDs appeared across six different areas of mental health. The eMagin z800 (n=34) was the most commonly used form of HMD appearing 34 times (
VR has been used as a form of exposure treatment (VRET). Its uses include the following conditions: social anxiety disorder [
VR has been used as a distraction tool for pain management. Different forms of VR distractions have been used for burn wound pain [
Stress was the primary target and depression the secondary in Shah et al’s VR mood induction procedure study [
We identified only one intervention that had depression as the primary target [
Head-mounted display (HMD) specifications.
Type | Resolution | Hz | Field of View | Number of Studies | ||
eMagin z800 | 800 × 600 | 60 Hz | 40° | 34 | ||
nVisor SX60 | 1280 × 1024 | 60 Hz | 60° | 8 | ||
nVisor SX111 | 1280 × 1024 | 60 Hz | 111° | 4 | ||
nVisor ST50 | 1280 × 1024 | 60 Hz | 50° | 1 | ||
Sony HMZ-T1 | 1280 × 720 | 60 Hz | 51.6° | 1 | ||
5DT HMD | 800 × 600 | N/Aa | 40° | 3 | ||
VisuaStim | 1280 × 1024 | 85 Hz | 40° | 1 | ||
Kaiser XL 50 | 1024 × 768 | 60 Hz | 50° | 1 | ||
VR1280 | 1280 × 1024 | 60 Hz | 60° | 1 | ||
Virtual Realities VR HMD pro 3D-42 | 800 × 600 | N/A | 42° | 1 | ||
Pro | 640 × 480 | 60 Hz | 71.5° | 2 | ||
Vuzix iWear VR920 | 640 × 480 | N/A | N/A | 5 | ||
Vuzix VR1200 | N/A | N/A | N/A | 2 | ||
VFX3D | 640 × 480 | N/A | 35° | 1 | ||
Sensis Zsight | 1280 × 1024 | 60 Hz | 60° | 2 | ||
V6 by Virtual Research Systems | 640 × 480 | 60 Hz | 60° | 1 | ||
V8 by Virtual Research Systems | 640 × 480 | 60 Hz | 60 | 1 | ||
Oculus Rift DK1 | 640 × 800 | 60 Hz | 110° | 1 | ||
Oculus Rift DK2 | 960 × 1080 | 75 Hz | 100° | 6 | ||
ITV goggles ITG Wideview Xl edition | N/A | N/A | N/A | 1 | ||
Samsung Gear VR | 2560 × 1440b | 60 Hz | 96° | 1 | ||
i-glasses 920HR | N/A | N/A | 35° | 1 | ||
Kaiser Optics SR80a | N/A | N/A | N/A | 1 | ||
HTC Vive | 2160 × 1200 (combined) | 90 Hz | 110° | N/A | ||
HTC Vive Pro | 2880 × 1600 (combined) | 90 Hz | 110° | N/A | ||
Oculus Go | 1280 × 1440 (per eye) | 72 Hz | N/A | N/A | ||
PlayStation VR | 1920 × 1080 | 90 Hz (120 Hz in cinema mode) | 100° (approximately) | N/A | ||
Samsung Odyssey | 1440 × 1600 per screen | 90-60 Hz | 110° | N/A |
aN/A: not applicable.
bSuper AMOLED (active-matrix organic light-emitting diode) and dependent on mobile phone used.
Studies on eating disorders included those on body image disturbance (BID) [
HMDs have been used to deliver exposure therapy to help treat tobacco addiction. Four studies investigated tobacco addiction [
This review confirms that HMDs have been used to treat mental health in different ways. VRET was one type of intervention that was consistently used across different conditions. VRET interventions with and without CBT content have been implemented for therapy of anxiety, PTSD, stress, eating disorders, and substance addiction. VR excels in its advantage of being able to draw on both audio and interactive visual stimuli, making the fearful stimuli appear as real as possible. In addition, CBT delivered in VR has shown consistent positive results; the accurate adaption of relevant stimuli allows CBT to pinpoint troublesome behaviors. The merging of VR and mobile phones is a timely collaboration, and stress management apps for mobile phones have been described as “incremental acquisitions” to cope with daily-life stresses [
Lindstrom [
The success of VR in the treatment of anorexia- and depression-focused embodiment studies [
The state of research suggests that VR cannot be a clinical tool itself and, instead, its success relies on the content it provides a platform for. Complex VR systems backed by PCs with high graphical and processing power to build detailed and adaptable environments allow the content of the intervention to be complemented further. The most common HMD was the eMagin z800, which in the UK is not an accessible product. In public health context, it is imperative that commonly sold HMDs are used with VR apps that can be used for self-help and to promote health. This review points to VR as a useful method of modifying the behavior in an effort to enhance mental health; the challenge now is to apply this to accessible products, which the public can use at home, work, and on the move.
The results of this review suggest the potential efficacy of VR to provide a platform for improved mental health. VR has demonstrated some compatibility with proven psychological interventions, but combined, they illustrate a potential for a real positive behavior change for a range of mental health conditions. The current state of research does not illustrate VR’s ability to improve mental health on its own; instead, it highlights the importance of the condition-oriented content within VR interventions.
However, the specifications of HMDs and the computers that power them are still important when trying to improve mental health using VR. Although increases in FoV have brought us closer to FoV of the human eye, an improved FPS may decrease the chances of motion sickness for some users. Currently, VR’s strengths are being used for exposure therapy, as successful interventions in the treatment of anxiety, phobias, and PTSD have been demonstrated. In addition, VR-induced distraction has proven to be a remarkable development in pain management. The lack of studies surrounding stress and depression, despite positive initial outcomes, highlights VR’s infancy in some areas of mental health. To help understand more about the relationship between VR systems and its efficacy as a mental health tool, we recommend a thorough reporting of HMD and computer specifications. Finally, there is a need to design interventions that make the most of VR’s increasing mobility, as self-help VR tools could prove to be a valuable asset for mental health services. Thus, researchers must make the most of a rapidly developing medium that is seeing advances in equipment; this will act as a catalyst to develop increasingly detailed and novel interventions that push the boundaries of virtual presence. By achieving this, VR has the potential to radically change the way we modify problematic behaviors that affect our mental health.
Literature table.
Head-mounted display (HMD) virtual reality (VR) use as reported in literature 2012-2017 (n=81).
cognitive behavioral therapy
field of view
frames per second
high definition
head-mounted display
posttraumatic stress disorder
Trier Social Stress Test
virtual reality
virtual reality exposure treatment
The authors acknowledge the contribution of NHS Highlands and the University of the Highlands and Islands whose funding supported this research.
None declared.
The study was conceptualized by all four authors. Furthermore, data was curated, formal analysis was performed, and methodology was devised by all four authors. Project administration & critical supervision was performed by MG, MKB, and HvW. The original draft was prepared by SJ, and revisions and editing were performed by all four authors.