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There is not enough evidence to recommend virtual reality (VR) technologies for early routine use in the NHS. The following technologies should only be used in research for people aged 16 and over, once they have appropriate regulatory approval:
Amelia Virtual Care for agoraphobia and agoraphobic avoidance
gameChangeVR for agoraphobic avoidance in psychosis
XR Therapeutics for agoraphobia and agoraphobic avoidance.
Further research is recommended on:
clinical effectiveness including what the long-term benefits are, and how well and long they last
rates of relapse, including use and effectiveness of top-up sessions and repeat VR therapy
patient selection, including who may benefit most from using VR technologies
health-related quality of life
adverse effects
resource use during and after treatment, including maintenance and lifespan of the hardware, and healthcare professional grade and time needed to deliver treatment or support.
VR technologies show promise in improving access to care for people who would not otherwise access treatment. But the evidence on VR technologies is limited. There are 2 clinical trials comparing Amelia Virtual Care and gameChangeVR, both with standard care, with standard care alone. These suggest some benefit with virtual reality to treat agoraphobia and agoraphobic avoidance. But it is not clear whether these benefits are because of the VR technology or the standard care used. Additional analysis of the gameChangeVR trial suggests that it only has potential benefits for people with psychosis and more severe agoraphobia. But this needs confirming.
There is some evidence that people like VR technologies and may be less likely to stop treatment with them than medications or face-to-face therapy alone. But it is unclear whether this is because of better treatment adherence or more initial interest in using VR technologies.
The cost effectiveness of VR technologies is inconclusive because the clinical evidence is limited and uncertain compared with current pricing of the technologies. Cost modelling suggests that VR technologies are unlikely to be cost effective for treating agoraphobia and agoraphobic avoidance, but gameChangeVR may be cost effective in people with psychosis and more severe agoraphobia.
Overall, more evidence is needed on:
the benefits of VR technologies, including benefits in more severe agoraphobia and agoraphobic avoidance
whether people are more likely to continue treatment with virtual reality
how using VR technologies may affect clinical and system outcomes.
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