JMIR Publications

ABSTRACT

Background:

Increasing mental demands across multiple life domains underscore the importance of effective individual stress management to mitigate the adverse health consequences of chronic stress. Growing evidence suggests that virtual reality (VR) interventions constitute an effective approach to stress reduction both among individuals with mental health concerns and within the general population.

Objective:

This systematic review and meta-analysis aimed to examine and compare application areas of VR interventions for stress reduction in the general population and to identify potential predictors of effectiveness based on sample characteristics and intervention design.

Methods:

Five databases (MEDLINE, EMBASE, CENTRAL, PsycINFO, and Web of Science) were systematically searched for randomized controlled trials (RCTs) investigating the effectiveness of VR interventions for stress reduction in general population. Studies were included if they focused primarily on stress reduction, used a passive control group, and reported a validated measure of perceived stress. Trials targeting mental disorders or those conducted in the context of medical procedures were excluded. Two reviewers independently screened the literature, extracted data and assessed the risk of bias using the Cochrane Collaboration’s tool. Effects were synthesized using pooled standardized mean differences (SMD), and relevant predictors were evaluated through subgroup analyses and regressions.

Results:

A total of 41 relevant studies met inclusion criteria, with 28 investigating single-session and 13 examining multi-session interventions (ranging from 1–26 sessions over 2 days to 6 months). The meta-analysis included 29 studies with 3.035 participants (sample sizes 24–409; mean ages 19.2–70.6 years). Intervention types included VR-based nature exposure (18), biophilic architectural elements (4), guided meditation (5), and interactive tasks (4). VR interventions significantly reduced perceived stress (-0.55; 95% CI -0.70 to -0.40; P<.001; I²=73%), anxiety, and depression, and enhanced positive emotion (Ps<.001). Multi-session interventions showed greater stress reduction (SMD -0.86; P<.001) than single sessions (SMD -0.40; P<.001), with a significant difference between groups (F1,27=7.27, P=.012). Linear regression analyses identified image refresh rate (R²=.33; P=.005) and the level of user interactivity (R²=.19; P=.03) as significant predictors for VR-based stress reduction. Multivariate regression also linked older age to more pronounced effects (T -4.02; P=.003).

Conclusions:

VR interventions demonstrated significant effectiveness in reducing stress across diverse application areas and content categories. Repeated VR use was associated with enhanced effects, and immersion appears to be a crucial factor in promoting stress reduction. However, given the observed elevated risk of bias and some inconsistency in predictor findings, further research should prioritize identification and reporting of further relevant factors in methodologically more rigorous RCTs. Clinical Trial: PROSPERO CRD42024592600; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024592600