Effects of virtual reality interventions on mental health outcomes among healthcare workers in hospital settings: a systematic review

Abstract

Background:

Healthcare workers (HCWs), such as nurses and medical doctors in hospital settings routinely experience significant psychological stress, anxiety, and burnout, a situation greatly intensified since the COVID-19 pandemic. Virtual reality (VR) has emerged as an innovative intervention for promoting mental health. Yet the effects of VR-based interventions on mental health among HCWs remain insufficiently synthesized.

Methods:

This systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive database searches were performed across PubMed, MEDLINE, Ovid, CINAHL, IEEE Xplore, and Google Scholar for studies published from 2020 to August 2025. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis approach was adopted due to heterogeneity in interventions and outcomes.

Results:

Ten studies were included, representing diverse international hospital contexts and a range of VR intervention formats, content, and durations. The significant effects could be clustered into the five categories: stress reduction and management, anxiety management, burnout prevention and reduction, enhancement of psychological wellbeing, as well as resilience promotion and skill-building. Eight studies demonstrated that VR interventions led to significant reductions in acute subjective stress and improvements in mood. Anxiety management was addressed in three studies, all of which reported significant decreases in anxiety post-VR exposure. One study targeting burnout prevention showed statistically significant declines in emotional exhaustion and depersonalization and increases in work engagement metrics. Qualitative findings further indicated enhanced wellbeing, improved relaxation, and skill-building in coping and resilience. VR interventions were generally well-accepted, feasible to implement, and associated with minimal adverse effects.

Discussion:

This review demonstrates that VR interventions represent a promising approach to supporting the mental health of hospital HCWs. VR enables rapid stress and anxiety alleviation, and when delivered as a sustained program, it may also mitigate burnout and foster resilience. Despite heterogeneity among protocols and outcomes, the favorable acceptability and acute effectiveness of VR underscore its potential for integration into routine staff wellbeing initiatives. Future research should prioritize rigorous, longitudinal, and comparative studies to clarify optimal implementation strategies and long-term impact.

Systematic Review Registration:

https://aspredicted.org/prs9-bynt.pdf, identifier 241831.

1 Introduction

Mental health among healthcare workers (HCWs) remains a subject of critical concern, especially in the demanding environment of hospital settings. For the purposes of this review, mental health is defined as the capacity to manage one’s thoughts, emotions, behaviors, and relationships in ways that enable effective functioning, adaptation to change, and a sense of wellbeing (World Health Organization WHO, 2022). In this context, HCWs refer specifically to nurses and medical doctors/physicians whose roles are integral to the delivery of inpatient medical care within hospital settings.

Stressors in hospital settings include high workload demands, long working hours, shift work, close and emotionally charged patient contact, frequent exposure to illness and death, and the necessity to perform under pressure in rapidly changing environments (Chatzigianni et al., 2018; Gelsema et al., 2006; Papathanassoglou et al., 2012; West et al., 2018). Several systemic factors contribute to these outcomes, such as limited autonomy, moral distress, hierarchical work structures, and physically demanding tasks (Eder et al., 2025; Salehi et al., 2020). Nurses, in particular, experience higher levels of occupational stress and have been identified as the hospital staff group most affected by mental health issues, including depression, anxiety, and burnout (Gmayinaam et al., 2024; Babapour et al., 2022).

The COVID-19 pandemic has further exacerbated these challenges. Frontline HCWs had to adapt quickly to new protocols, cope with increased workloads, and manage the fear of virus transmission and quarantine (Greenberg et al., 2021; Sheraton et al., 2020). Empirical data from international research have demonstrated elevated levels of psychological distress, anxiety, emotional exhaustion, and sleep disturbances among HCWs during the pandemic (Häussl et al., 2021; Lenger et al., 2023; Tmava-Berisha et al., 2022; Sun et al., 2021). Furthermore, growing staff shortages, redeployment away from areas of expertise, and lack of team support have deepened the psychological burden and contributed to increased turnover intentions (West et al., 2018; Aiken et al., 2012; Khajuria et al., 2021). This is the reason why women and frontline staff, particularly those working in direct contact with infected patients, have been disproportionately affected (Häussl et al., 2021; Lenger et al., 2023; Wells and Miklencicova, 2021).

The mental health crisis among HCWs is not only an individual concern but a systemic one. Poor wellbeing and psychological impairment among HCWs have been linked to adverse outcomes such as reduced quality of care, diminished patient safety, and lower organizational performance (Hall et al., 2016; Windover et al., 2018). Consequently, promoting mental health among HCWs has become an urgent priority for health systems worldwide.

Despite the urgency of addressing these mental health burdens, studies indicate that conventional stress-reduction strategies like psychoeducation, relaxation techniques, mindfulness-based interventions, cognitive-behavioral stress management, and organizational measures (e.g., supervision and peer support) (Catapano et al., 2023; Kowalski et al., 2025; Worsley et al., 2022), are often insufficient in mitigating the magnitude of distress experienced by HCWs, particularly in the fast-paced and unpredictable setting of acute care hospitals (De et al., 2021; Jiang et al., 2025). This underscores a growing need for innovative and accessible intervention modalities tailored to the unique stressors encountered by nurses and physicians. Among these, virtual reality (VR) has gained considerable attention as a promising tool for mental health interventions. VR is defined as an immersive, computer-generated simulation that allows users to experience and interact with three-dimensional environments in real time that may closely mimic or abstract from real-world settings typically via head-mounted displays (VR goggles) and motion tracking (Uruthiralingam et al., 2020). The immersive nature of VR with its capacity to deliver multisensory stimuli and induce a strong sense of presence offers unique psychological affordances for emotional regulation, stress reduction, relaxation, and mindfulness practice (Uruthiralingam et al., 2020). It enables users to experience scenarios in a controlled, yet highly realistic and engaging way, promoting a sense of presence and emotional involvement that exceeds conventional digital tools. In the context of mental health, VR can be used to train emotional regulation, self-awareness, mindfulness, and coping strategies in highly immersive environments (Muratore et al., 2019; Pallavicini et al., 2022).

VR-based interventions offer several key advantages over traditional or other digital methods. First, VR enables realistic simulations of stress-inducing or emotionally relevant scenarios that would be difficult or impossible to recreate in conventional training settings (Muratore et al., 2019; Pallavicini et al., 2022). Second, it supports individualized learning paths by adapting the content and pace to the needs of the user, thereby fostering engagement and self-efficacy. Third, VR reduces external distractions and promotes focused attention, making it especially suitable for interventions targeting self-reflection and mindfulness (Muratore et al., 2019; Chen et al., 2020). Fourth, VR is flexible with respect to time and location, making it a feasible and sustainable tool even within demanding clinical work schedules (Saab et al., 2021; Shorey and Ng, 2021).

Despite the growing application of VR in education and health, its implementation for training among HCWs remains underexplored. Few studies have systematically examined the effectiveness of VR interventions in this population, and the evidence base remains fragmented. Moreover, given the heterogeneity of intervention designs and mental health constructs, it is unclear which mental health outcomes can be effectively addressed by VR-based training and under what conditions these interventions are most beneficial (Ang et al., 2022; Kunzler et al., 2022).

Against this backdrop, a systematic review and synthesis of the current literature is urgently needed to understand the scope, content, and effectiveness of VR-based interventions targeting mental health outcomes among HCWs. Such a review would help identify best practices, reveal knowledge gaps, and inform the development of evidence-based digital mental health strategies in the healthcare sector.

Therefore, this systematic review aims to address the following research question: What are the effects of VR interventions on mental health outcomes among HCW in hospital settings?

2 Methods and material

2.1 Search strategy

This systematic review was conducted in accordance with the PRISMA 2020 guidelines (Page et al., 2020). A comprehensive literature search was performed across five electronic databases: PubMed including MEDLINE, Ovid, CINAHL, IEEE Xplore, and Google Scholar. The final search was completed in August 2025. The search strategy was tailored to each database and included combinations of the following keywords: Virtual Reality, nurses, healthcare workers, healthcare professionals, medical doctors, mental health, and mental health outcomes. Boolean operators and filters were applied as appropriate for each database. To ensure the relevance of the identified records, specific filters were applied (e.g., publication type, date range from 2020 to 2025). In Google Scholar, the first 100 results sorted by relevance were screened due to feasibility constraints. A detailed overview of the search queries including the applied filters, and the number of hits per database is provided in Table 1.

2.2 Selection criteria

Studies were selected based on predefined inclusion and exclusion criteria. Eligible studies met the following inclusion criteria: 1) conducted in hospital or clinical settings, 2) included HCWs (only nurses and medical doctors), 3) involved a digitally supported training/intervention using VR, 4) published in English or German, and 5) reported primary research (quantitative or qualitative) including conference papers.

Studies were excluded if they met one or more of the following criteria: 1) conducted in non-clinical settings (e.g., home, universities, simulation labs, private practices), 2) focused on student populations (e.g., nursing or medical students), 3) included participants such as psychologists, psychotherapists, occupational or physical therapists, office or administrative employees 4) involved other digitally supported training using augmented reality (AR), mixed reality (MR), extended reality (XR), web-based, or tablet-based formats, 5) were reviews, meta-analysis, book, book chapters, posters, presentations or lectures, or 6) were published in languages other than English or German. Additionally, only studies published within the last 5 years (2020–2025) were considered. The timeframe from 2020 to 2025 was chosen to ensure inclusion of the most recent evidence, as virtual reality technologies and intervention designs have undergone rapid development, making earlier studies less representative of current clinical practice (Iqbal et al., 2024; Emma, 2026).

2.3 Study screening and selection process

All records (n = 6,946) were imported into the reference management app named “Rayyan” (Ouzzani et al., 2016), and duplicates were removed prior to screening. The remaining records (n = 5,497) were screened independently by two first authors (AH and IZ) based on titles and abstracts. Full texts were retrieved and reviewed for the remaining 14 records. In total, ten studies were included in this review.

Reasons for exclusion at the full-text stage included wrong interventions (e.g., therapeutic rather than training focus), ineligible population (students), or lack of full-text availability (conference abstracts only). Any discrepancies during the selection process were resolved by involving a third reviewer (ND) through consensus. The study screening and selection process is illustrated in Figure 1.

FIGURE 1

Page et al., 2020).

2.4 Data extraction and synthesis

A standardized data extraction form was developed to collect key information from the included studies. The two first authors independently extracted the following data: 1) authors, year and country, 2) methodology, 3) sample size and sample description, 4) intervention, duration/frequency, 5) mental health outcomes measured and 6) intervention effects.

2.5 Quality assessment

The methodological quality of the included studies was assessed using the “Mixed Methods Appraisal Tool (MMAT), version 2018” (see Table 2) (Hong et al., 2018). The MMAT allows for the evaluation of methodological quality across five study categories: qualitative research, randomized controlled trials, non-randomized studies, quantitative descriptive studies, and mixed-methods studies.

The appraisal process begins with two screening questions, both of which must be answered with ‘Yes’ to confirm the study’s eligibility for MMAT evaluation. The appropriate category is then selected, and each of the five criteria within that category is rated using ‘Yes’, ‘No’, or ‘Can’t tell’. Following best practices, we provided a detailed presentation of the ratings for each criterion to report the quality of the included studies in a nuanced manner, rather than calculating an overall score (Hong et al., 2018).

The appraisal aimed not to exclude studies based on poor quality but to offer a descriptive overview of methodological strengths and weaknesses and to identify research gaps. The two first authors independently conducted the appraisals to ensure accuracy and reliability (Hong et al., 2018).

2.6 Data synthesis

Due to the heterogeneity in intervention types, outcome measures, and study designs, a narrative synthesis approach was chosen. The findings were organized thematically based on the type of mental health outcome assessed (e.g., stress reduction, anxiety symptoms, resilience enhancement). Results were summarized across studies and stratified by intervention characteristics (e.g., type of VR content, duration, or degree of immersion).

Where possible, effect directions (positive, neutral, or negative) were indicated, and the consistency of findings across studies was evaluated. Due to the limited number of studies and heterogeneity in reporting, a meta-analysis was not conducted.

3 Results

In total, ten studies (Adhyaru and Kemp, 2022; Beverly et al., 2022; Bodet-Contentin et al., 2023; Clough et al., 2024; Croghan et al., 2022; Ferrer et al., 2024; Knight et al., 2025; Kwon et al., 2025; Lopes et al., 2024; Nijland et al., 2021) were included in this systematic review (see Table 3).

The effects of VR training can be clustered into the following five categories: 1) stress reduction and management, 2) anxiety management, 3) burnout prevention and reduction, 4) enhancement of psychological well-being, and 5) resilience promotion and skill building.

3.1 Stress reduction

Eight studies (Adhyaru and Kemp, 2022; Beverly et al., 2022; Bodet-Contentin et al., 2023; Clough et al., 2024; Knight et al., 2025; Kwon et al., 2025; Lopes et al., 2024; Nijland et al., 2021) focused primarily on the use of VR interventions for the rapid reduction of perceived stress among HCWs in hospital settings. These interventions typically involved nature-based immersive experiences and were delivered as single or brief repeated sessions during work hours or breaks.

Adhyaru and Kemp (2022) conducted a single-group pre-post intervention with 39 National Health Service (NHS) clinicians (mean age 36.6 years, 83.8% female) in a London trauma service. The intervention comprised a 10-min immersive VR “Green Meadows” nature experience using Nature Treks VR via Oculus Go headset, administered during designated work breaks. Heart rate was measured at three time points and mood was assessed using Visual Analog Scales (VAS) for emotional states, supplemented by satisfaction and acceptability questionnaires. A significant reduction in heart rate was observed (main effect: V = 0.38, F (2, 33) = 10.02, p < 0.001). The intervention was widely deemed acceptable and feasible, regardless of prior VR experience.

Lopes et al. (2024) performed a mixed-methods, within-subjects crossover pilot study involving 22 nurses (mean age 40.5 years) from a Canadian hospital. Each participant experienced both audio-visual (AV) and audio-visual-olfactory (AVO) immersive nature scenes (lake, beach, or waterfall) in randomized order for 2.5 min each via an instrumented Oculus Quest 2 headset. Outcomes included self-reported relaxation levels (Likert scale), engagement measures, open feedback, and EEG-derived physiological indices. Both AV and multisensory AVO conditions yielded significant increases in relaxation compared to baseline (p < 0.05 for each), with notably greater effects in the AVO condition for scenarios with high sensory congruence, though between-group differences in relaxation were not statistically significant (p > 0.05). EEG showed distinct neural patterns with AVO exposure. Participants emphasized the importance of sensory matching for optimal stress reduction.

In a rural US hospital, Clough et al. (2024) piloted a stress-relief program involving 7 nurses (ages 27–63). Over 8 weeks, nurses participated in as-needed, brief (10-min) VR meditation sessions with options for guided audio-visual meditation or immersive relaxing nature scenes. Nurses recorded descriptive pre- and post-session feelings and completed qualitative surveys on feasibility. While the sample size was too small for robust statistical testing, qualitative results indicated a clear shift from negative (e.g., “burnt out,” “tense”) to positive (e.g., “relaxed,” “grateful”) post-session, with universal endorsement of VR as an effective tool for immediate stress relief.

Beverly et al. (2022) conducted a single-arm pre-post pilot study with 102 frontline HCWs (71.6% female, 82.4% direct care) from three COVID-19 units in the US. Participants engaged in a 3-min 360-degree “cine-VR” cinematic nature scene via Oculus Go or Pico G2 headset during work breaks. The primary measure was a single-item VAS for subjective stress administered immediately before and after the session. The VR exposure produced a significant and large reduction in self-reported stress, with a mean reduction of −2.2 points on a 10-point scale (Cohen’s d = 1.08, p < 0.001). Stress reductions were even greater among those with high initial stress (p < 0.001). No differences were found by job role or prior VR experience.

Kwon et al. (2025) evaluated a 2-week repetitive VR program based on forest healing for stress reduction in 46 HCWs in South Korea. The intervention comprised multiple short VR nature and mindfulness sessions per day using head mounted displays. Stress was measured with the Perceived Stress Scale (PSS), alongside concurrent measures for sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Among healthcare professionals, VR yielded statistically significant reductions in PSS-assessed stress (mean decrease: 2.02, SD = 4.02, t = −3.69, p = 0.001) after 2 weeks, but sleep improvements were modest and inconsistent; weekday PSQI scores, in fact, significantly worsened over time (mean increase: 0.76, SD = 2.46, t = −2.26, p = 0.028).

Bodet-Contentin et al. (2023) executed a prospective crossover trial with 88 ICU nurses in a French hospital. On two consecutive shifts, each HCW experienced both conditions: (a) a 30-min break including an 8-min immersive VR session (nature scenery via Oculus Go, with hypnotic audio and breathing prompts), and (b) a usual break. Subjective VAS ratings of stress, fatigue, and work disconnection were measured pre- and post-break and at shift end. For fatigue, pairwise t-tests showed that VR breaks led to a mean reduction of −0.17 ± 1.87 versus a mean increase of +0.33 ± 1.87 without VR (p = 0.02). The difference in fatigue post-break was also significant (M = 3.91 ± 2.56 with VR vs. 4.71 ± 2.52 without VR; p < 0.01). A greater sense of work disconnection post-break was observed with VR (M = 5.98 ± 3.04 vs. 4.20 ± 2.64, p < 0.001). Stress scores decreased numerically but were not statistically significantly different (p > 0.05), and the benefits did not persist at shift end.

Nijland et al. (2021) studied 86 Dutch ICU nurses using an on-demand VR relaxation app (VRelax) on Oculus Go headsets during 10-min work breaks. The primary outcome was VAS rating of perceived stress pre- and post-use. VRelax use resulted in a mean acute reduction in subjective stress by 39.9% (mean decrease: 22.6 points on a 0-100 VAS, p < 0.001). Most users rated the intervention as helpful and easy to use; time constraints limited broader uptake.

Knight et al. (2025) implemented a prospective, single-arm pre-post study involving 85 nurses at a large academic medical center in the United States. Participants, most of whom had at least 5 years of nursing experience, took part in a 30–45-min VR session that simulated authentic workplace stress scenarios. This immersive experience was followed by practical mindfulness education, focused on awareness, breathing, and compassion techniques, and culminated with a nature-themed relaxation exercise. Self-reported outcomes were measured before and after the intervention, capturing levels of confidence and knowledge in stress management, and acute perceived stress using a visual analog scale. Acute stress levels saw a marked decline, with average visual analog scale scores improving from 4.5 before to 1.7 after the intervention (p < 0.001), and nearly 95% of participants reported a subjective reduction in stress.

3.2 Anxiety management

Three (Adhyaru and Kemp, 2022; Croghan et al., 2022; Kwon et al., 2025) of the ten included studies focused on anxiety management.

Croghan et al. (2022) ran a single-blind, randomized crossover pilot study with 24 frontline healthcare workers (mean age 46.3 years, 58% male; mainly physicians) in a large US facility. Each participated in four 30-min sessions over two to 3 weeks, alternately viewing two immersive nature VR scenarios (“walk in the woods,” “forest of focus”) and matched 4K computer-display scenes. The State-Trait Anxiety Inventory (STAI Y1) was the primary outcome. All four conditions (VR and non-VR) led to significant reductions in anxiety (post-pre change for VR walk: M = −6.4, SD = 5.98, t = −5.2, p < 0.001; for VR forest: M = −5.8, SD = 9.29, t = −3.1, p = 0.005; for screen walk: M = −4.1, SD = 6.22, t = −3.2, p = 0.004; for screen forest: M = –5.0, SD = 6.89, t = −3.5, p = 0.002), with the largest mean reduction after VR. An analysis of variance (ANOVA) showed that differences between modes were not statistically significant (p = 0.58), but all were clinically meaningful. Adverse effects were negligible, and acceptability was high (96% would recommend VR).

Kwon et al. (2025) also included anxiety measured using the Hospital Anxiety and Depression Scale (HADS) as their primary psychological endpoint. Among HCWs, anxiety scores declined significantly after repeated VR sessions (mean decrease: 1.24, SD = 2.23, t = −3.76, p < 0.001), corroborating the potential for VR not only in general stress reduction but also in anxiety management among healthcare professionals.

Adhyaru and Kemp (2022) reported a significant decrease in anxiety (t (38) = 4.55, p < 0.001).

3.3 Burnout prevention and reduction

One study focused on burnout prevention and reduction. Ferrer et al. (2024) conducted a nonrandomized, pre-post intervention study with 83 HCWs working in three Spanish health centers. Over the course of 8 weeks, participants engaged in weekly VR sessions lasting between 10 and 13 min, each designed to deliver structured training in mindfulness, emotional regulation, and self-compassion using custom immersive content delivered via Meta Quest 2 headsets. The impact of the intervention was rigorously evaluated using the Maslach Burnout Inventory (MBI) and the Utrecht Work Engagement Scale (UWES). The results showed statistically significant improvements across all dimensions of burnout: emotional exhaustion scores declined substantially (t (82) = 5.58, p < 0.001, Cohen’s d = 0.61), depersonalization was reduced (t (82) = 4.67, p < 0.001, d = 0.51), and there was a notable increase in personal accomplishment (t (82) = −3.62, p < 0.001, d = 0.4). These benefits were mirrored by significant enhancements in work engagement, with post-intervention gains in vigor (t (82) = −3.77, p < 0.001, d = 0.41), dedication (Z = −3.63, p < 0.001, r = 0.41), and absorption (Z = −3.52, p < 0.001, r = 0.4). Adherence to the program was high, with 92% completion, and only minimal, non-serious discomfort was reported by participants.

3.4 Enhancement of psychological wellbeing

In addition to stress and anxiety reduction, Adhyaru and Kemp (2022) specifically reported significantly increased happiness (t (38) = −3.85, p < 0.001) and relaxation (t (38) = −6.67, p < 0.001), with significant decreases in sadness (t (38) = 3.14, p = 0.003), and anger (t (38) = 3.95, p < 0.001). Qualitative data highlighted increased calm and work-related satisfaction, with several participants expressing a desire for routine implementation.

Beverly et al. (2022) found that participants frequently described post-session feelings of calmness, relaxation, and positive affect in open-ended survey responses, indicating immediate enhancement of emotional wellbeing.

3.5 Resilience promotion and skill building

Two (Ferrer et al., 2024; Knight et al., 2025) of the ten included studies addressed resilience promotion and the development of psychological skills.

Ferrer et al. (2024) repeated VR educational program also focused on enhancing emotional regulation, positive coping skills, and resilience as reflected in significant increases in UWES engagement domains (vigor, dedication, absorption, all p < 0.001) and reduction of negative work states (see burnout results above).

Knight et al. (2025) found out that after the intervention, there was a significant increase in self-reported confidence for managing workplace stress, with post-activity ratings showing a 10% rise in nurses deeming themselves extremely or very confident (p = 0.002). There was also a statistically robust increase in knowledge regarding stress management, with “very/extremely knowledgeable” ratings climbing by 37.6% (p < 0.001).

4 Discussion

This systematic review critically synthesized evidence from ten primary studies investigating the effects of VR interventions on mental health outcomes among HCWs, focusing exclusively on nurses and medical doctors in hospital environments.

4.1 Interpretation of findings and relationships to current research

The review revealed consistently positive effects of VR interventions on several domains of mental health among HCWs, with the majority of studies demonstrating significant immediate or short-term reductions in self-reported stress following engagement with immersive VR experiences. Stress reduction, as assessed by subjective visual analog scales or validated instruments, was the most reported outcome and showed effect sizes ranging from moderate to large (Adhyaru and Kemp, 2022; Beverly et al., 2022; Knight et al., 2025; Nijland et al., 2021). For example, Beverly et al. (2022) found a large significant decrease in subjective stress of more than two points on a 10-point scale, while Nijland et al. (2021) reported a nearly 40% reduction in perceived stress after only 10 min of VR engagement. This is in line with the broader literature on immersive technologies, which has documented rapid physiological and subjective stress relief with brief exposures to naturalistic virtual environments (Riches et al., 2021; Meshkat et al., 2024).

The review also highlights the efficacy of VR interventions for anxiety management, as seen in studies utilizing standardized instruments such as the State-Trait Anxiety Inventory (Croghan et al., 2022) and the Hospital Anxiety and Depression Scale (Kwon et al., 2025). In these studies, significant within-subject reductions in anxiety scores were observed post-VR, with effects comparable or superior to those from passive video controls. Adhyaru and Kemp (2022) similarly observed significant decreases in anxiety immediately following VR immersion. These results accord with a growing body of meta-analytical evidence showing that VR-based relaxation and mindfulness can yield greater reductions in anxiety than traditional approaches, likely through the unique capacity of VR to facilitate presence, attentional distraction, and emotional engagement (Carl et al., 2019; Freeman et al., 2017).

Importantly, beyond acute symptom alleviation, at least one study (Ferrer et al., 2024) rigorously demonstrated that regular VR-based mindfulness and emotion regulation training led to significant improvements in key dimensions of burnout. Participants showed substantial reductions in emotional exhaustion and depersonalization, alongside increased personal accomplishment, over the course of an 8-week program effects that, crucially, were mirrored by enhancements across work engagement domains (vigor, dedication, absorption). Burnout among HCWs is predictive of absenteeism, errors, and turnover (West et al., 2018; Melnyk et al., 2022), making this a clinically meaningful outcome.

The review’s findings regarding wellbeing and resilience promotion further reinforce the broader potential of VR interventions. Multiple studies independently reported increases in positive mood states, such as happiness, calm, and relaxation (Adhyaru and Kemp, 2022; Beverly et al., 2022), and improvements in resilience-related skills, including confidence and coping knowledge (Ferrer et al., 2024; Knight et al., 2025). This holistic effect profile is consistent with emerging VR research that emphasizes the value of repeated, skills-based exposure (e.g., cognitive-behavioral frameworks, mindfulness, and self-compassion) within immersive environments to foster psychological flexibility and adaptive functioning (Chard et al., 2023; Lindner et al., 2019; Ma et al., 2023).

It is noteworthy that while nearly all studies reported positive psychological shifts following VR use, the magnitude, persistence, and context-specificity of these benefits varied. For instance, Bodet-Contentin et al. (2023) found significant decreases in immediate post-break fatigue and increased sense of work disconnection following VR nature immersion, but no differences in stress or fatigue at shift end, suggesting time-limited effects. In contrast, repeated or multi-week interventions (Ferrer et al., 2024; Kwon et al., 2025) produced more durable changes, supporting the hypothesis that sustained engagement is required for lasting impact on complex constructs such as burnout and resilience.

4.2 Strengths and mechanisms of VR interventions

The included studies demonstrate several core strengths underlying VR’s effectiveness for psychological support in HCWs. Foremost is the capacity for immersive VR to simulate rich multisensory environments, which can transport users away from the stress-laden context of the hospital into restorative, naturalistic scenes (Anderson et al., 2017; Riva et al., 2025).

Further, the flexibility and portability of standalone VR systems (e.g., Oculus Go, Meta Quest 2) supported high acceptability and feasibility across diverse settings and user experience levels. Notably, most participants across studies had little to no prior exposure to VR technology (Adhyaru and Kemp, 2022; Nijland et al., 2021), yet the interventions were widely regarded as easy to use and nonthreatening, with minimal adverse effects reported. Qualitative feedback frequently highlighted a positive shift from stress and arousal toward calm, clear-headedness, and optimism, and participants often expressed a desire for integration of VR into standard work routines (Bodet-Contentin et al., 2023; Clough et al., 2024).

The potential mechanisms of VR’s therapeutic benefits extend beyond distraction and sensory immersion. Many interventions paired passive natural scenes with structured mindfulness, breathwork, or self-compassion exercises (Ferrer et al., 2024; Knight et al., 2025), harnessing established cognitive-behavioral and attentional-regulation strategies within an environment optimized for engagement and learning. VR-mediated mindfulness, for example, may be more rapidly acquired and readily practiced than traditional approaches, given reduced environmental barriers and increased perceptual salience (Lindner et al., 2019; Navarro-Haro et al., 2017). Furthermore, the positive effect induced by VR may, in turn, enhance psychological flexibility, motivation for self-care, and engagement in other wellbeing behaviors (Fredrickson, 2001).

Multisensory integration, as explored by Lopes et al., (2024), appears to be a further important mechanism: olfactory congruence (e.g., the smell of a virtual forest) amplified relaxation more than visual-auditory immersion alone, as indexed by both self-report and EEG. These findings are consistent with experimental research indicating that congruent multisensory stimulation can potentiate emotional engagement, memory, and physiological modulation (Anderson et al., 2017; Calderone et al., 2025; Quak et al., 2015).

4.3 Comparisons and contrasts across the included studies

Several methodological and contextual distinctions emerged among the studies reviewed. The majority used brief, one-off or as-needed VR relaxation sessions, typically leveraging nature-based, scenic, or guided meditation content (Adhyaru and Kemp, 2022; Beverly et al., 2022; Bodet-Contentin et al., 2023; Clough et al., 2024; Nijland et al., 2021). These interventions, varying from three to 10 minutes in length, were administered during scheduled breaks, downtime, or following particularly stressful events. While universally effective for rapid stress relief, their effects were most often acute; persistent mood or recovery benefits beyond the immediate post-session window were rarely demonstrated (Bodet-Contentin et al., 2023). This may be due, in part, to the profound and unrelenting nature of workplace demands in healthcare (Greenberg et al., 2021).

The reviewed studies were generally pragmatic and highly heterogeneous in terms of setting, sample size, and outcome reporting, with most using single-group pre-post designs. Adherence and feasibility were consistently high, but some studies highlighted barriers to access or sustained uptake, particularly time constraints for staff and technological challenges (older VR headsets, need for technical support). These nuances stress the importance of organizational, logistical, and individual readiness when implementing VR-based supports in high-demand work settings.

4.4 Clinical relevance and implications for practice

The clinical implications of these findings are substantial, as VR offers a scalable, engaging, and low-barrier solution for supporting mental health in hospital-based HCWs. The capacity to deliver brief, immersive, evidence-based interventions during or adjacent to work hours aligns well with the operational realities of healthcare environments, in which time and privacy are at a premium and workers may be reluctant to seek help through conventional psychological or occupational health services (Greenberg et al., 2021).

Importantly, the marked acceptability of VR among users regardless of prior technological exposure, the high rates of completion even among overstretched staff, and the absence of serious adverse events underscore the practicability of deploying VR wellness platforms hospital wide. Most participants advocated for the regular integration of VR into their work routine, often describing the experience as empowering, restorative, and relevant to both acute and ongoing resilience needs (Adhyaru and Kemp, 2022; Knight et al., 2025; Nijland et al., 2021).

However, integration at scale will require consideration of the optimal intervention dose, scheduling arrangements, and staff education, as well as continuous technical support. Concerns about time constraints, potential technological glitches, hygiene, and privacy, as identified in multiple studies, will need to be addressed with thoughtful workflow integration and equipment management (Clough et al., 2024; Knight et al., 2025). Moreover, while short-form VR appears most effective for acute stress and mood regulation, lasting effects on burnout, engagement, and resilience likely require repeated, programmatic delivery, perhaps tied to organizational wellbeing initiatives and paired with complementary psychosocial programs (Ferrer et al., 2024).

On a policy level, these findings advocate for investments in digital interventions as part of holistic staff wellness strategies, especially given the significant direct and indirect costs of burnout, turnover, absenteeism, and compromised patient care quality (West et al., 2018; Melnyk et al., 2022).

5 Strengths and limitations

While the consistency and strength of findings are encouraging, this review is limited by the small number of rigorous controlled trials, considerable methodological heterogeneity, and variable reporting of adverse events, sustained outcomes, or effect moderators. Sample sizes in several studies were modest to small (Clough et al., 2024; Lopes et al., 2024), and most were conducted in single sites or convenience samples, limiting generalizability. The absence of standardized definitions and outcome measures for constructs such as wellbeing and resilience further complicates meta-analytical synthesis.

Future research should prioritize large-scale, randomized, and longitudinal designs, comparing VR against active and passive controls, and should systemically evaluate potential moderators such as occupation, baseline mental health status, exposure frequency, and content type. In addition, exploration of physiological biomarkers, cost-effectiveness analyses, and integration with other digital and in-person initiatives will be crucial to realizing the full potential of VR-based mental health support for the healthcare workforce. Further, research should assess the impact of intervention fidelity, implementation strategies, and health system-level adoption practices, as well as conduct subgroup analyses by demographic or occupational variables. All these aspects are a central component of the XR2ESILIENCE project (Grant Agreement No. 101137237), funded by the European Union’s Horizon Europe (Cluster 1: Health) research and innovation program.

A notable strength of this systematic review lies in its adherence to the PRISMA 2020 guidelines, ensuring a transparent, rigorous, and reproducible synthesis of the evidence (Page et al., 2020). The comprehensive search strategy spanned six major electronic databases including PubMed, MEDLINE, Ovid, CINAHL, IEEE Xplore, and Google Scholar, thereby minimizing publication and retrieval bias and enhancing the representativeness of the included literature.

By explicitly defining stringent inclusion and exclusion criteria, the review ensured a focused and clinically relevant evidence base, targeting only primary research involving hospital-based nurses and medical doctors and excluding HCWs personnel as well as studies in non-clinical settings or involving student populations.

The use of the MMAT provided a systematic and nuanced approach to quality assessment, capturing methodological strengths and weaknesses without unjustly excluding studies based solely on risk of bias (Hong et al., 2018).

Further, data extraction and quality appraisal were independently conducted by multiple reviewers, with discrepancies resolved by consensus, which bolsters the reliability and objectivity of the review process (Mathes et al., 2017). The narrative synthesis allowed for an integrative and thematically rich interpretation of heterogeneous data, facilitating the identification of patterns and gaps across a spectrum of VR interventions and mental health outcomes. By stratifying results according to outcomes such as stress, anxiety, burnout, wellbeing, and resilience, the review generated actionable insights for future research and clinical practice. Importantly, the review’s special emphasis on recent studies (2020—2025) captures the rapid evolution of digital health interventions and directly addresses the urgent psychological needs of healthcare workers in the post-pandemic era. Ultimately, these methodological considerations enhance the validity, scope, and clinical applicability of the review’s findings, providing a solid foundation for evidence-informed recommendations and future investigation.

6 Conclusion

In summary, this systematic review demonstrates that VR interventions, particularly those employing immersive naturalistic environments, mindfulness, and skill-building, are not only feasible and acceptable to HCWs, but also clinically effective for acute stress and anxiety reduction, wellbeing enhancement, and potentially for burnout mitigation and resilience promotion when delivered programmatically. The technology represents a flexible, scalable, and innovative mental health solution for a workforce facing escalating psychological demands. With thoughtful implementation and further research, VR could play a pivotal role in shaping future staff wellness initiatives, supporting both the sustainability of the workforce and the quality of patient care.

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