Background: Virtual Reality (VR) is an emerging non-pharmacological treatment for anxiety in palliative care patients. Anxiety, a common symptom in this population, has a significant effect on living standards. The aim of this systematic review is to evaluate the effectiveness of VR interventions in reducing anxiety and improving quality of life in palliative care. Methods: The systematic review protocol was registered in PROSPERO (CRD42024517914). The comprehensive search was performed in nine databases, including PubMed, PsycINFO, and EMBASE, and included studies published up to 15 November 2024. RCTs, pilot studies, and feasibility trials involving adult palliative care patients in which VR interventions were used, were compared with standard care. Two reviewers independently extracted and assessed the quality of the data using the RoB 2 tool. Results: A total of 13 studies were considered eligible, with 333 participants aged 15 to 85 years old. In these experiments, anxiety decreased steadily, and in some cases mood and quality of life were improved significantly. The VR interventions ranged from guided nature walks to memory-training sessions. Sessions lasted between 5 and 30 min and ranged in duration from single sessions to daily use. Personalized and participatory VR-based content was particularly effective in alleviating anxiety. The heterogeneity of the study designs and VR protocols hampered meta-analysis, despite promising findings. Conclusions: VR has considerable potential as an adjunctive anxiety therapy for palliative care. The personalization and immersion that VR provides are psychologically unique and have the potential to lower anxiety and improve well-being. But standardizing intervention protocols and more studies are required to define the best VR strategies and evaluate outcomes over the long term. The article highlights the promise of VR as part of palliative care as a viable bio-psycho-socio-spiritual approach.

Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.

Background: Virtual Reality (VR) is an emerging tool in the management of anxiety, one of the most disturbing symptoms of Alcohol Use Disorder (AUD), which often leads to relapse. Still, patients with Alcohol Use Disorder frequently have a history of Acute Symptomatic Seizures, and they are subsequently excluded from studies using VR because of the hypothesized fear of inducing photosensitive seizures. The first part of this narrative review explores the pathophysiological mechanisms of seizures associated with AUD, specifically acute symptomatic seizures. In contrast, the second part explores virtual reality’s safe use in seizure-prone individuals, highlighting that the current state-of-the-art is based on a biased per-ception and old epidemiological data from studies conducted on photosensitive seizures in the late 90s. VR exposure has yet to be reported as triggering seizures within known pharmacovigilance databases. Significance: The implications weigh heavily on VR research currently associated with this significant adverse event. Further studies are necessary to address the risk of seizures triggered by VR in patients predisposed to developing seizures, like alcohol use disorder patients with a history of acute symptomatic seizures. Such research is essential to ensure that the potential benefits of Virtual Reality as a tool for managing anxiety in individuals with alcohol use disorder and acute symptomatic seizures are not unduly restricted. Furthermore, AUD can also serve as an intervention model feasible to de-bias attitudes toward the current lack of evidence base concerning the significant adverse events of VR-induced seizures, therefore facilitating the clinical implementation of this unharnessed digital treatment interface.