TABLE 1.
Studies included in the review.
| Study | Country | Objectives (I or P) | Participants | N (E, C) | Age (M, SD) | Type of intervention | Immersion/interaction a | Control | Intervention description | Outcomes | Findings |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Alcohol | |||||||||||
| Kim and Lee (2019) | Republic of Korea | I | Heavy social drinkers | 28 (14, 14) | 22.36 (2.31); 22.79 (2.89) | VAAAT |
Immersion: no Interaction: yes |
Sham training | VAAAT training in 3 sessions over 3 days within 2–3 weeks (at the interval of 4–5 days) |
1. Implicit approach tendencies towards alcohol 2. Explicit cravings for alcohol |
The intervention group showed a decrease in implicit approach tendencies towards alcohol, but not in explicit craving for alcohol. In contrast, the control group showed an increase in both. |
| Hernández‐Serrano et al. (2020) | Spain | I | Patients with alcohol use disorder | 42 (15, 27) | 54.60 (7.71) | TAU + VR‐CET |
Immersion: yes Interaction: yes |
TAU | Eight sessions (2 assessment sessions + 6 VR‐CET sessions using ALCO‐VR software). Each VR‐CET session lasted 50 min |
1. Alcohol consumption, drinking behaviours and alcohol‐related problems 2. Alcohol craving 3. Attentional bias for alcohol‐related content 4. State anxiety |
The intervention group showed greater changes in improvement in the levels of alcohol craving than the control group. Intragroup changes in alcohol craving from pre‐ to post‐treatment were significant in the intervention group but not within the control group. |
| Ma (2020) | USA | P | College students | 107 (55, 52) | 19.06 (n/a) | VR |
Immersion: yes Interaction: no |
360‐video on iPad | A 360‐video named ‘Decisions: a 360 virtual reality drunk driving experience’ (4 min and 41 s long), using a head‐mounted display |
1. Attitudes towards alternatives to drinking and driving 2. Behavioural intentions to engage in drinking and driving 3. Perceived similarity to the protagonist |
The immersive story led to lower intentions to drink and drive only among female participants when viewed through a VR headset (vs. iPads). |
| Figueras‐Puigderrajols et al. (2020) | Spain | I | Patients with alcohol use disorder | 38 (12, 16) | 53.82 (7.93) | VR‐CET |
Immersion: yes Interaction: no |
TAU | Eight sessions (2 assessment sessions + 6 VR‐CET sessions using ALCO‐VR software). Each VR‐CET session lasted for 1 h. |
1. Alcohol consumption, drinking behaviours and alcohol‐related problems 2. Alcohol craving 3. Attentional bias for alcohol‐related content 4. State anxiety |
Although group differences did not reach significance, the decrease in the measures was more evident in the experimental group. |
| Gamito et al. (2021) | Portugal | I | Individuals with alcohol use disorder undergoing residential treatment | 40 (22, 18) | 44.83 (12.04) | TAU + VR‐CBT |
Immersion: no Interaction: yes |
TAU |
VR intervention plus TAU during participants' second and third weeks of hospitalization. This intervention consisted of 10 sessions, lasting 30–40 min, twice a week over 5 weeks. |
1. Global cognition 2. Executive functions 3. Memory 4. Attention 5. Cognitive flexibility |
Results indicated better cognitive and executive functioning in the experimental group than in the control group. |
| Guldager et al. (2022) | Denmark | P | Students | 378 (183, 195) | 15.66 (0.76) | VR |
Immersion: yes Interaction: yes |
Active: control game ‘Oculus Quest—First Steps’ | One session included a gameplay introduction (45 min), gameplay (15 min), and structured reflection of the experiences. |
1. Drinking refusal self‐efficacy 2. Drug refusal skills 3. Knowledge/awareness of blood alcohol concentration 4. Communication skills 5. Social support willingness 6. Susceptibility to peer pressure 7. Outcome expectations |
There is no significant difference between the intervention and control groups. |
| Zhang et al. (2023) | China | I | Alcohol dependent according to the ICD‐10 criteria | 44 (23, 21) | 34.30 (5.23) | TAU + VR‐CET |
Immersion: yes Interaction: no |
TAU | VR‐CET video in 8 sessions, 3 sessions per week (1 day apart) for 8 min |
1. Subjective craving 2. Heart rate, skin conductance and respiratory signals |
The changes in subjective craving and heart rate in the intervention group were significantly lower than in the control group. In contrast, the changes in skin conductance and respiration between the intervention and control groups were not significantly different. |
| Thaysen‐Petersen et al. (2024) | Denmark | I | Treatment‐seeking AUD‐diagnosed individuals | 9 (5, 4) | 48.33 (13.72) | VR‐CBT |
Immersion: yes Interaction: no |
CBT | VR‐assisted CBT sessions once weekly for 3 weeks; each session lasted 45–60 min. Patients were exposed to a VR high‐risk restaurant scene, which was the basis for cognitive analysis during or after the VR exposure. |
1. Feasibility measured through: drop‐out rates, VR‐induced reactions (thoughts, emotions, psychological reactions incl. cravings) and simulator sickness 2. Preliminary efficacy: percentage change from inclusion to 1‐ and 4‐week FU in total alcohol consumption |
Patients receiving VR‐CBT had more reduction in alcohol consumption and craving than patients receiving conventional CBT at 1‐week and 1‐month follow‐up. |
| Nicotine | |||||||||||
| Girard et al. (2009) | Canada (Quebec) | I | People smoking at least 10 cigarettes per day during the last year | 91 (46, 45) | 44 (11) | Psychosocial support + VR (cigarette crush game) |
Immersion: yes Interaction: yes |
Psychosocial support + VR (balls crush game) | 4 VR sessions—one per week. Participants had to find and crush up to 60 virtual cigarettes. | 1. Nicotine dependence | In the experimental group, there was a statistically significant reduction in nicotine addiction, abstinence rate (confirmed with exhaled carbon monoxide), and drop‐out rate from the 12‐week psychosocial minimal‐support treatment programme. |
| Culbertson et al. (2012) | USA | I | Treatment‐seeking cigarette smokers | 11 (5, 6) | 42.2 (12.5) | VR‐CET + CBT |
Immersion: no Interaction: yes |
The placebo‐VR cues sessions | VR‐CET: bi‐weekly 30‐min individual VR sessions before or following group CBT, at least 8 sessions |
1. Self‐reports of smoking 2. Exhaled breath CO samples during each CET session 3. Craving ratings |
Smoking‐VR CET participants had a higher quit rate than placebo‐VR CET participants. Smoking‐VR CET‐treated participants also reported smoking significantly fewer cigarettes per day at the end of treatment than placebo‐VR CET‐treated participants. |
| Malbos et al. (2018) | France | I | People with a past diagnosis of chronic smoking—DSM‐5 criteria for nicotine dependence and smoking abstinence of 1 week | 61 (n/a) | 49 (13) | VR‐CET |
Immersion: yes Interaction: yes |
CBT | VR‐CET 8 weekly sessions of 45 min; exposure to smoking cues in different situations |
1. Tobacco dependence 2. Tobacco craving 3. Anxiety 4. Depression 5. Self‐esteem 6. Presence 7. Tobacco abstinence |
Results demonstrated that VR‐CET is at least as efficacious as traditional CBT in terms of maintenance of tobacco abstinence, craving reduction, and decrease in nicotine dependence. |
| Pericot‐Valverde et al. (2019) | Spain | I | People with a diagnosis of nicotine dependence | 102 (50, 52) | 39.21 (12.97); 39.68 (12.77) | VR‐CET + CBT |
Immersion: yes Interaction: yes |
CBT | 5 VR‐CET sessions in 6 weeks, VR provided before or after the CBT session, previously validated virtual environments used for eliciting craving. |
1. Smoking abstinence 2. Treatment retention 3. Relapse rate 4. Cue‐induced craving |
The intervention group showed a significant reduction in cue‐induced craving. There were no significant differences in either retention or abstinence rates between the control and intervention groups. |
| Goldenhersch et al. (2020) | Argentina | I | People smoking more than 5 cigarettes per day | 120 (60, 60) | 43.25 (10.06) | VR‐MET |
Immersion: yes Interaction: no |
The smoking cessation manual | Practice sessions in informal mindfulness using VR included 2 sessions of VR‐MET in a 21‐day programme, each lasting 10 min. |
1. Self‐reported abstinence (after a day, after 90 days) 2. Adherence to treatment 3. Cigarette consumption 4. Craving 5. Mindfulness 6. Readiness to quit 7. Nicotine dependence |
Participants in the intervention group reported greater abstinence than participants in the control group. Among participants still smoking postintervention, the intervention group was significantly more ready to quit compared with the control group. |
| Machulska et al. (2021) | Germany | I | People smoking at least 6 cigarettes per day during the last 6 months | 96 (47, 49) | 50.3 (11.6) | TAU + VR‐ABM |
Immersion: yes Interaction: yes |
TAU + VR (game) | 6 sessions within 2 weeks, approach bias modification VR training—all smoking‐related objects were labelled red and had to be thrown away, whereas non‐smoking‐related objects were grasped/approached. |
1. Attitude towards smoking 2. Stages of change 3. Thoughts about abstinence 4. Impulsiveness 5. Positive mental health 6. Alcohol Use Disorders Identification 7. Alcohol use 8. Health behaviour checklist |
VR‐ABM did not change approach biases, nor other cognitive biases, but it was superior in reducing daily smoking. |
| Malbos et al. (2023) | France | I | People with past diagnosis of chronic smoking—DSM‐5 criteria for nicotine dependence and smoking abstinence of 1 week | 100 (50, 50) | 47.65 (13.31) | VR‐CET |
Immersion: yes Interaction: yes |
CBT | 8 weekly sessions of 45 min; exposure to smoking cues in different situations |
1. Tobacco dependence 2. Tobacco craving 3. Anxiety 4. Depression 5. Self‐esteem 6. Quality of life 7. Presence 8. Tobacco abstinence 9. Physiological measures |
More participants in the intervention group did not experience smoking relapses. Intervention is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rates in the intervention group were noticeably lower than in the control group. |
| Bordnick et al. (2012) | USA | I | Nicotine‐dependent adults | 86 (44, 42) | 47.9 (10.4), 46.2 (8.4) | NRT + VRST |
Immersion: yes Interaction: yes |
NRT | VRST combined with NRT for 10 weeks (1 screening and 9 VRST sessions). |
1. Cigarette craving 2. Self‐reports of smoking 3. Smoking abstinence self‐efficacy |
Smoking rates and craving nicotine were significantly lower for the intervention group compared with the control group at the end of treatment. Self‐confidence and coping skills were also significantly higher for the intervention group, and a number of cigarettes smoked was significantly lower, compared with the control group at follow‐up. |
| Weser et al. (2021) | USA | P | Middle school students | 287 (155, 132) | 12.45 (0.57) | VR |
Immersion: yes Interaction: yes |
TAU | Invite Only VR gameplay to practice refusing peer pressure to vape e‐cigarettes. 2–4 sessions for approximately 40 min |
1. General e‐cigarette knowledge 2. Nicotine addiction knowledge 3. Perceived addictiveness of e‐cigarettes 4. Perceptions of e‐cigarette harm 5. Social perceptions about e‐cigarettes |
Invite Only VR players improved in e‐cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e‐cigarettes, perceptions of harm, and social perceptions about e‐cigarette use compared with the control group. |
| Illicit drugs | |||||||||||
| Ketamin | |||||||||||
| Man (2018) | Hong Kong | I | Ketamine users recruited from the treatment programmes | 90 (30, 30 (TAG), 30) | 22.80 (5.41); 24.77 (4.14); 24.60 (3.91) | VRVTS |
Immersion: no Interaction: yes |
Two control groups: 1. delayed VR; 2. TAG (training from a tutor according to a training manual, which was like those experienced by the intervention group). | 3 levels with 5 sessions each (15 sessions); 3D nonimmersive type of VR training (virtual reality‐based vocational training system or VRVTS) |
1. Cognitive assessment (general intellectual abilities, attention, memory, executive function) 2. Work assessment 3. Participants' knowledge and skills regarding the performance of sales‐related activities 4. Participants' self‐efficacy when performing sales‐related activities |
The intervention group exhibited significant improvements in attention and improvements in memory that were maintained after 3 months. Both the intervention and tutor‐administered (control) group exhibited significantly improved vocational skills after training, which were maintained during follow‐up, and improved self‐efficacy. |
| Methamphetamine | |||||||||||
| Wang et al. (2019) | China | I | Patients with METH dependence | 61 (31, 30) | 35.03 (7.53); 32.55 (6.64) | TAU + VR |
Immersion: yes Interaction: no |
TAU | Six VRCP sessions (two times/week) plus TAU (i.e., physical exercises and supportive psychotherapy as usual) during the study period. VR intervention included 8‐min VR video. |
1. Heart rate 2. Craving |
Patients with METH dependence who received VRCP showed a significantly larger decrease in the score of METH‐craving and METH‐liking from baseline to follow‐up assessments, compared with those who did not receive VRCP. Participants who received VRCP showed a significantly larger decrease in HRV indexes on the time domain and non‐linear domain from baseline to follow‐up assessments during exposure to VR cues, compared with those in a control group. |
| Opioids | |||||||||||
| Herbert et al. (2020) | USA | P | General population | 98 (58, 40) | Median: 40 (E) and 41 (C) | VR video |
Immersion: yes Interaction: no |
OOPP | One‐time, 9‐min OOPP VR video |
1. Opioid overdose knowledge 2. Opioid overdose attitudes |
Results demonstrate participants exposed to the immersive video OOPP had equivalent improvements in post‐test knowledge and more favourable attitudes about responding to an opioid overdose than those exposed to the standard OOPP. |
Abbreviations: AUD—alcohol use disorder; HRV—heart rate value; ICD‐10—International Classification of Diseases 10th Revision; METH—methamphetamine; N (E—experimental group, C—control group); NRT—nicotine replacement therapy; Objectives (I—intervention, P—prevention); OOPP—opioid overdose prevention programme; TAU—treatment as usual; VAAAT—Virtual Alcohol Approach‐Avoidance Training Task; VR‐ABM—Virtual Reality Approach Bias Modification; VR‐CBT—VR cognitive behavioural therapy; VR‐CET—V cue exposure therapy; VRCP—virtual reality counterconditioning procedure; VR‐MET—VR mindful exposure therapy; VRST—virtual reality skills training; VR—virtual reality; VRVTS—virtual reality–based vocational training system.
Immersion (i.e., the extent to which participants are immersed in the virtual environment) and interaction (i.e., the degree to which participants can actively engage or manipulate elements within the virtual environment) were assessed based on information provided in the included articles. We categorized the types of immersion according to the display mode: (1) immersive VR environments—virtual environments presented via a head‐mounted display; and (2) nonimmersive VR environments—content displayed on a computer/laptop screen. Interactivity was assessed based on whether participants could interact (e.g., manipulating objects or navigating the scene) with the virtual environment.