VIRTUAL REALITY INTERVENTIONS FOR WAR-RELATED PSYCHIATRIC DISORDERS: A REVIEW OF EXPOSURE, NON-EXPOSURE, AND MULTIMODAL APPROACHES
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5416Keywords:
PTSD, Virtual Reality, 3MDR, Veterans and Military Personnel, Exposure TherapyAbstract
Introduction: Armed conflict results in severe psychiatric disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety, often associated with repeated trauma exposure. According to DSM-5 criteria, PTSD involves clusters of symptoms including intrusion, avoidance, and negative alterations in cognition and mood. As military populations frequently display resistance to standard evidence-based treatments like cognitive-behavioural therapy (CBT), alternative interventions are required.
Purpose: This review examines virtual reality (VR)-based therapies, categorising them into non-exposure (e.g., relaxation, biofeedback), exposure-based (VRET), and multimodal approaches, specifically Multi-modal Motion-assisted Memory Desensitisation and Reconsolidation (3MDR).
Methodology: A comprehensive search of PubMed was conducted to identify studies examining VR interventions for war-related psychiatric disorders, with a specific focus on more recent literature published up to 2025. Additional studies were identified through manual screening of relevant systematic reviews. The search incorporated keywords related to PTSD, military personnel, virtual reality and exposure therapy. We included randomized controlled trials, case reports, and meta-analyses, while articles not published in English were excluded.
Results: VR-based interventions demonstrate promising efficacy in reducing symptoms of war-related psychiatric disorders, particularly in treatment-resistant military populations, and when used as an adjunct to conventional therapies such as CBT. However, current evidence remains limited and heterogeneous, highlighting the need for more rigorous randomized controlled trials to establish long-term effectiveness, safety, and standardised clinical protocols.
Conclusions: VR offers immersive, controlled environments that may enhance emotional engagement and reduce dropout rates. While promising as an adjunctive or alternative tool for treatment-resistant cases, VR implementation requires careful clinical assessment and consideration of individual patient needs.
References
Williamson, V., Murphy, D., Stevelink, S. A. M., et al. (2021). The impact of moral injury on the wellbeing of UK military veterans. BMC Psychology, 9(1), Article 73. https://doi.org/10.1186/s40359-021-00578-7
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., pp. 271–272). American Psychiatric Association.
Bryant, R. A., Schnurr, P. P., Pedlar, D., & 5-Eyes Mental Health Research and Innovation Collaboration in Military and Veteran Mental Health. (2022). Addressing the mental health needs of civilian combatants in Ukraine. The Lancet Psychiatry, 9(5), 346–347. https://doi.org/10.1016/S2215-0366(22)00097-9
U.S. Department of Defense. (2024). Calendar year 2023 annual report on suicide in the military: Including the Department of Defense Suicide Event Report (DoDSER). DoD Office of the Under Secretary of Personnel and Readiness. https://www.dspo.mil/Portals/113/2024/documents/annual_report/ARSM_CY23_final_508c.pdf
Milligan, T., Smolenski, D., Lara-Ruiz, J., et al. (2025). Loss of PTSD diagnosis in response to evidence-based treatments: A systematic review and meta-analysis. JAMA Psychiatry, 82(7), 718–727. https://doi.org/10.1001/jamapsychiatry.2025.0695
Heo, S., & Park, J. H. (2022). Effects of virtual reality-based graded exposure therapy on PTSD symptoms: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(23), Article 15911. https://doi.org/10.3390/ijerph192315911
Seiz, A., Kweon, B. S., Ellis, C. D., et al. (2023). Exploring the psychophysiological effects of viewing urban nature through virtual reality using electroencephalography and perceived restorativeness scale measures. Sustainability, 15(17), Article 13090. https://doi.org/10.3390/su151713090
Anderson, A. P., Mayer, M. D., Fellows, A. M., et al. (2017). Relaxation with immersive natural scenes presented using virtual reality. Aerospace Medicine and Human Performance, 88(6), 520–526. https://doi.org/10.3357/AMHP.4747.2017
Blum, J., Rockstroh, C., & Göritz, A. S. (2019). Heart rate variability biofeedback based on slow-paced breathing with immersive virtual reality nature scenery. Frontiers in Psychology, 10, Article 2172. https://doi.org/10.3389/fpsyg.2019.02172
Grassini, S., Segurini, G. V., & Koivisto, M. (2022). Watching nature videos promotes physiological restoration: Evidence from the modulation of alpha waves in electroencephalography. Frontiers in Psychology, 13, Article 871143. https://doi.org/10.3389/fpsyg.2022.871143
Kukharuk, O., Tkalich, K., Kamash, N., et al. (2025). Effectiveness of immersive VR therapy in reducing stress-associated symptoms in Ukraine. European Journal of Psychotraumatology, 16(1), Article 2488097. https://doi.org/10.1080/20008066.2025.2488097
Jensen, B. S., Andersen, N., Petersen, J., et al. (2021). Enhanced mental health with virtual reality mental hygiene by a veteran suffering from PTSD. Case Reports in Psychiatry, 2021, Article 5576233. https://doi.org/10.1155/2021/5576233
Riva, G., Bernardelli, L., Castelnuovo, G., et al. (2021). A virtual reality-based self-help intervention for dealing with the psychological distress associated with the COVID-19 lockdown: An effectiveness study with a two-week follow-up. International Journal of Environmental Research and Public Health, 18(15), Article 8188. https://doi.org/10.3390/ijerph18158188
Weibel, R. P., Kerr, J. I., Naegelin, M., et al. (2023). Virtual reality-supported biofeedback for stress management: Beneficial effects on heart rate variability and user experience. Computers in Human Behavior, 143, Article 107584. https://doi.org/10.1016/j.chb.2023.107584
Kenemore, J., Benham, G., Charak, R., et al. (2024). Heart rate variability biofeedback as a treatment for military PTSD: A meta-analysis. Military Medicine, 189(9–10), e1903–e1909. https://doi.org/10.1093/milmed/usae003
Eshuis, L. V., van Gelderen, M. J., van Zuiden, M., et al. (2021). Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy. Journal of Psychiatric Research, 143, 516–527. https://doi.org/10.1016/j.jpsychires.2020.11.030
Vianez, A., Marques, A., & Simões de Almeida, R. (2022). Virtual reality exposure therapy for armed forces veterans with post-traumatic stress disorder: A systematic review and focus group. International Journal of Environmental Research and Public Health, 19(1), Article 464. https://doi.org/10.3390/ijerph19010464
Kida, S. (2019). Reconsolidation/destabilization, extinction and forgetting of fear memory as therapeutic targets for PTSD. Psychopharmacology, 236(1), 49–57. https://doi.org/10.1007/s00213-018-5086-2
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.
Kindt, M. (2018). The surprising subtleties of changing fear memory: A challenge for translational science. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1742), Article 20170033. https://doi.org/10.1098/rstb.2017.0033
Reger, G. M., Smolenski, D., Norr, A., et al. (2019). Does virtual reality increase emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy. Journal of Anxiety Disorders, 61, 75–81. https://doi.org/10.1016/j.janxdis.2018.06.001
Knaust, T., Felnhofer, A., Kothgassner, O. D., et al. (2020). Virtual trauma interventions for the treatment of post-traumatic stress disorders: A scoping review. Frontiers in Psychology, 11, Article 562506. https://doi.org/10.3389/fpsyg.2020.562506
Difede, J., Rothbaum, B. O., Rizzo, A. A., et al. (2022). Enhancing exposure therapy for posttraumatic stress disorder (PTSD): A randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer. Translational Psychiatry, 12(1), Article 299. https://doi.org/10.1038/s41398-022-02066-x
van Loenen, I., Scholten, W., Muntingh, A., et al. (2022). The effectiveness of virtual reality exposure-based cognitive behavioral therapy for severe anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder: Meta-analysis. Journal of Medical Internet Research, 24(2), Article e26736. https://doi.org/10.2196/26736
van ’t Wout-Frank, M., Arulpragasam, A. R., Faucher, C., et al. (2024). Virtual reality and transcranial direct current stimulation for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 81(5), 437–446. https://doi.org/10.1001/jamapsychiatry.2023.5661
Jones, C., Smith-MacDonald, L., Brown, M. R. G., et al. (2022). The redesign and validation of multimodal motion-assisted memory desensitization and reconsolidation hardware and software: Mixed methods, modified Delphi-based validation study. JMIR Human Factors, 9(3), Article e33682. https://doi.org/10.2196/33682
van Gelderen, M. J., Nijdam, M. J., Dubbink, G. E., et al. (2020). Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: A mixed methods study. European Journal of Psychotraumatology, 11(1), Article 1829400. https://doi.org/10.1080/20008198.2020.1829400
Hamilton, T., Burback, L., Smith-MacDonald, L., et al. (2021). Moving toward and through trauma: Participant experiences of multi-modal motion-assisted memory desensitization and reconsolidation (3MDR). Frontiers in Psychiatry, 12, Article 779829. https://doi.org/10.3389/fpsyt.2021.779829
Nijdam, M. J., & Vermetten, E. (2018). Moving forward in treatment of posttraumatic stress disorder: Innovations to exposure-based therapy. European Journal of Psychotraumatology, 9(1), Article 1458568. https://doi.org/10.1080/20008198.2018.1458568
Gausemel, Å., & Filkuková, P. (2024). Virtual realities, real recoveries: Exploring the efficacy of 3MDR therapy for treatment-resistant PTSD. Frontiers in Psychology, 15, Article 1291961. https://doi.org/10.3389/fpsyg.2024.1291961
Tang, E., Jones, C., Smith-MacDonald, L., et al. (2021). Decreased emotional dysregulation following multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR): Identifying possible driving factors in remediation of treatment-resistant PTSD. International Journal of Environmental Research and Public Health, 18(22), Article 12243. https://doi.org/10.3390/ijerph182212243
Bisson, J. I., van Deursen, R., Hannigan, B., et al. (2020). Randomized controlled trial of multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment-resistant post-traumatic stress disorder. Acta Psychiatrica Scandinavica, 142(2), 141–151. https://doi.org/10.1111/acps.13200
Jones, C., Smith-MacDonald, L., Brown, M. R. G., et al. (2022). Quantitative changes in mental health measures with 3MDR treatment for Canadian military members and veterans. Brain and Behavior, 12(8), Article e2694. https://doi.org/10.1002/brb3.2694
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Paulina Jasak, Michał Majewski, Marta Żółtowska, Aleksandra Wesołowska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
