Virtual Reality Interventions for Stress Reduction in the General Population: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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. 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, CINAHL, CENTRAL, PsycInfo, and Web of Science) were systematically searched for randomized controlled trials investigating the effectiveness of VR interventions for stress reduction in the general population. Studies were included if they primarily focused on stress reduction, included a neutral control condition, and reported a validated measurement 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, and relevant predictors were evaluated through subgroup analyses and meta-regressions. Results: A total of 55 relevant studies met the inclusion criteria, with 37 investigating single-session and 18 multisession interventions (ranging from 1 to 42 sessions over 2 days to 6 months). The meta-analysis included 39 studies with 4024 participants (sample sizes 24-409; mean ages 19.2-70.6 years). Intervention types included VR-based nature exposure (21), biophilic architectural elements (6), guided meditation (9), interactive tasks (4), and other approaches (1). On average, VR interventions significantly reduced perceived stress level (-0.55, 95% CI -0.70 to -0.40; P<.001; I2=76%; 95% prediction interval [PI] -1.32 to 0.23), anxiety (-0.88, 95% CI -1.23 to -0.54; P<.001; I2=87%; 95% PI -2.07 to 0.31), and depression (-0.34, 95% CI -0.47 to -0.21; P<.001; I2=0%; 95% PI -0.47 to -0.21), and enhanced positive emotion (-0.64, 95% CI -0.84 to -0.46; P<.001; I2=62%; 95% PI -1.28 to -0.02). In addition, the decrease in systolic blood pressure was significant (-0.20, 95% CI -0.37 to -0.04; P=.02; 95% PI -0.37 to -0.04). Univariate linear regression analyses identified multiple sessions (R²=15%, P=.02) as a significant predictor of VR-based stress reduction. Further analyses of technical and content-related characteristics revealed that a higher image refresh rate (t15=-2.36, 2-tailed; P=.04) was associated with stronger intervention effects. Conclusions: This review highlights the considerable potential of VR interventions for reducing psychological stress in the general population and extends recent evidence by quantifying the effects of a broad range of VR-based stress reduction approaches and, for the first time, comparing diverse intervention characteristics. VR represents a promising alternative, particularly in contexts where access to real-life nature or conventional relaxation methods is limited or resource-intensive.