Efficacy of virtual reality-based exposure therapy for post-traumatic stress disorder in military veterans: a systematic review and meta-analysis.

This systematic review and meta-analysis evaluated the effectiveness of Virtual Reality Exposure Therapy (VRET) for treating Post-Traumatic Stress Disorder (PTSD) in military veterans. A comprehensive search of electronic databases identified 9 randomized controlled trials involving 444 veterans that met inclusion criteria. The primary outcomes were changes in PTSD symptom severity measured by the Clinician-Administered PTSD Scale (CAPS) and PTSD Checklist (PCL). The meta-analysis demonstrated significant reductions in PTSD symptom severity in pre-post comparisons following VRET. In contrast, comparisons between VRET and control conditions showed smaller and more variable effects, highlighting the importance of cautious interpretation when assessing comparative efficacy. The pooled mean difference in CAPS scores was 33.73 (95% CI: 7.80 to 59.65) for pre-post comparisons, indicating a marked reduction in symptom severity following treatment. For PCL scores, the pooled mean difference was 20.96 (95% CI: 13.05 to 28.86). When compared to controlled conditions, VRET was associated with modest effects, with a pooled mean difference of 4.86 (95% CI: -8.34 to 18.07) for CAPS scores and 1.93 (95% CI: - 0.02 to 3.89) for PCL scores. Overall, combining pre-post and controlled comparisons yielded statistically significant effects favoring VRET, with mean differences of 23.26 (95% CI: 8.00 to 38.52) for CAPS and 13.66 (95% CI: 5.00 to 22.31) for PCL scores. However, high heterogeneity was observed across studies, warranting cautious interpretation. Risk of bias assessment indicated low to moderate risk of bias across the included studies. Visual inspection of funnel plots suggested no strong asymmetry; however, interpretation is limited due to the small number of studies included. These findings suggest that VRET may be an effective intervention for reducing PTSD symptoms in military veterans, particularly in within-group analyses, although comparative effects relative to control conditions were more modest. The immersive features of VRET may offer an alternative means of delivering exposure-based interventions, although patient acceptability and clinical utility likely vary across individuals and settings. VRET shows promise as an alternative or adjunct to conventional treatments, potentially improving engagement and reducing dropout rates. However, small sample sizes in some studies and heterogeneity of results limit definitive conclusions. Further large-scale trials are needed to establish VRET's comparative efficacy and long-term benefits in military populations. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251207784, identifier CRD420251207784.