{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T21:20:08Z","timestamp":1794345608771,"version":"4.9.0"},"reference-count":76,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005690","name":"Universit\u00e4t des Saarlandes","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005690","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Child Adolesc Psychiatry"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Anxiety disorders are common mental health issues in children and adolescents. Virtual reality (VR) offers promising opportunities for exposure-based interventions in immersive and controlled environments. This systematic review aimed to evaluate the effectiveness of VR-based exposure therapies for anxiety disorders and related symptoms in children and adolescents aged 4 to 18 years. A secondary objective was to assess user experience and adherence, where reported. A systematic search of six databases (Web of Science, ScienceDirect, PubPsych, EBSCOhost, PubMed, Cochrane Library) was conducted from January 1, 2015, to April 11, 2025 (last date of search), in title and abstract fields. Studies were included if they involved immersive VR-based exposure interventions targeting anxiety disorders (including social anxiety, generalized anxiety disorder, separation anxiety, or related symptoms) in participants aged 4 to 18 years. A narrative synthesis was conducted, and a random-effects meta-analysis was performed on subjective units of distress (SUDs) from eligible studies. Five out of 466 screened studies met the inclusion criteria. VR-based exposure therapy was associated with significant reductions in anxiety-related symptoms, particularly in social and public speaking anxiety. The meta-analysis of SUD ratings showed a large pre-post effect (Hedges\u2019\n                    <jats:italic>g<\/jats:italic>\n                    \u2009=\u2009\u2212\u20091.51, (95%CI [\u2212\u20092.20, \u2212\u20090.82],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001), though heterogeneity was high (\n                    <jats:italic>I<\/jats:italic>\n                    \u00b2 = 81.0%), and number of included studies small (\n                    <jats:italic>k<\/jats:italic>\n                    \u2009=\u20093). VR-based interventions appear to be effective in reducing anxiety symptoms in youth. However, the small number of studies, limited sample sizes, and methodological heterogeneity highlight the need for further research using standardized outcome measures.\n                  <\/jats:p>","DOI":"10.1007\/s00787-025-02945-w","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T12:20:49Z","timestamp":1768998049000},"page":"1079-1092","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Facing fears in virtual worlds: A systematic review and meta-analysis on immersive VR therapy for children and adolescents with social anxiety and related disorders"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8514-8657","authenticated-orcid":false,"given":"J. F.","family":"Baschab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-1563","authenticated-orcid":false,"given":"E.","family":"Moehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1794-3817","authenticated-orcid":false,"given":"J.","family":"Hussong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"2945_CR1","unstructured":"IHME. GDB Results [Internet]. GBD Results. (2021) [cited 2025 May 19]. Available from: https:\/\/vizhub.healthdata.org\/gbd-results\/?params=gbd-api-2019-permalink\/380dfa3f26639cb711d908d9a119ded2"},{"key":"2945_CR2","unstructured":"WHO (2021) Comprehensive mental health actionplan 2013\u20132030.\u00a0"},{"issue":"4","key":"2945_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpsy.2023.06.003","volume":"37","author":"U Panchal","year":"2023","unstructured":"Panchal U, Vaquerizo-Serrano JD, Conde-Ghigliazza I, Aslan Gen\u00e7 H, Marchini S, Pociute K et al (2023) Anxiety symptoms and disorders during the COVID-19 pandemic in children and adolescents: systematic review and meta-analysis. Eur J Psychiatry 37(4):100218. https:\/\/doi.org\/10.1016\/j.ejpsy.2023.06.003","journal-title":"Eur J Psychiatry"},{"issue":"1","key":"2945_CR4","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1176\/appi.focus.20150029","volume":"14","author":"A Chiu","year":"2016","unstructured":"Chiu A, Falk A, Walkup JT (2016) Anxiety disorders among children and adolescents. Focus 14(1):26\u201333. https:\/\/doi.org\/10.1176\/appi.focus.20150029","journal-title":"Focus"},{"issue":"1","key":"2945_CR5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.nurpra.2020.08.021","volume":"17","author":"I Garcia","year":"2021","unstructured":"Garcia I, O\u2019Neil J (2021) Anxiety in adolescents. J Nurse Pract 17(1):49\u201353. https:\/\/doi.org\/10.1016\/j.nurpra.2020.08.021","journal-title":"J Nurse Pract"},{"issue":"10","key":"2945_CR6","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1111\/jpc.14167","volume":"54","author":"DM Riordan","year":"2018","unstructured":"Riordan DM, Singhal D (2018) Anxiety-related disorders: an overview. J Paediatr Child Health 54(10):1104\u20139. https:\/\/doi.org\/10.1111\/jpc.14167","journal-title":"J Paediatr Child Health"},{"key":"2945_CR7","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1038\/532020a","volume":"532","author":"E Anthes","year":"2016","unstructured":"Anthes E (2016) Mental health: there\u2019s an app for that. Nature 532:20\u20133. https:\/\/doi.org\/10.1038\/532020a","journal-title":"Nature"},{"issue":"1","key":"2945_CR8","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s15016-016-5393-y","volume":"27","author":"S Paganini","year":"2016","unstructured":"Paganini S, Lin J, Ebert D, Baumeister H (2016) Internet- und mobilebasierte Intervention bei psychischen St\u00f6rungen. Neurotransmitter 27(1):48\u201357. https:\/\/doi.org\/10.1007\/s15016-016-5393-y","journal-title":"Neurotransmitter"},{"key":"2945_CR9","unstructured":"WHO (2022) COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide [Internet]. Available from: https:\/\/www.who.int\/news\/item\/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide"},{"issue":"1","key":"2945_CR10","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1080\/j.1440-1614.2006.01741.x","volume":"40","author":"LJ Barney","year":"2006","unstructured":"Barney LJ, Griffiths KM, Jorm AF, Christensen H (2006) Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry 40(1):51\u201354. https:\/\/doi.org\/10.1080\/j.1440-1614.2006.01741.x","journal-title":"Aust N Z J Psychiatry"},{"issue":"1","key":"2945_CR11","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1055\/a-0592-0264","volume":"19","author":"H Baumeister","year":"2018","unstructured":"Baumeister H, Gr\u00e4ssle C, Ebert D, Kr\u00e4mer L (2018) Blended psychotherapy \u2013 verzahnte Psychotherapie: Das Beste aus zwei Welten? PiD - Psychotherapie im Dialog 19(1):33\u20138. https:\/\/doi.org\/10.1055\/a-0592-0264","journal-title":"PiD - Psychotherapie im Dialog"},{"issue":"1","key":"2945_CR12","first-page":"S35","volume":"187","author":"D Rickwood","year":"2007","unstructured":"Rickwood D, Deane F, Wilson C (2007) When and how do young people seek professional help for mental health problems? Med J Aust 187(1):S35-9","journal-title":"Med J Aust"},{"issue":"2","key":"2945_CR13","doi-asserted-by":"publisher","first-page":"184","DOI":"10.5694\/j.1326-5377.2007.tb01334.x","volume":"19","author":"JE Curtiss","year":"2021","unstructured":"Curtiss JE, Levine DS, Ander I, Baker AW (2021) Cognitive-behavioral treatments for anxiety and stress-related disorders. FOC 19(2):184\u20139. https:\/\/doi.org\/10.5694\/j.1326-5377.2007.tb01334.x","journal-title":"FOC"},{"issue":"1","key":"2945_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2020.101904","volume":"81","author":"E Howes Vallis","year":"2020","unstructured":"Howes Vallis E, Zwicker A, Uher R, Pavlova B (2020) Cognitive-behavioural interventions for prevention and treatment of anxiety in young children: a systematic review and meta-analysis. Clin Psychol Rev 81(1):101904. https:\/\/doi.org\/10.1016\/j.cpr.2020.101904","journal-title":"Clin Psychol Rev"},{"issue":"12","key":"2945_CR15","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1007\/s11920-022-01384-7","volume":"24","author":"S Pegg","year":"2022","unstructured":"Pegg S, Hill K, Argiros A, Olatunji BO, Kujawa A (2022) Cognitive behavioral therapy for anxiety disorders in youth: efficacy, moderators, and new advances in predicting outcomes. Curr Psychiatry Rep 24(12):853\u20139. https:\/\/doi.org\/10.1007\/s11920-022-01384-7","journal-title":"Curr Psychiatry Rep"},{"issue":"3","key":"2945_CR16","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1136\/ebmental-2019-300096","volume":"22","author":"C Schwartz","year":"2019","unstructured":"Schwartz C, Barican JL, Yung D, Zheng Y, Waddell C (2019) Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice. Evid Based Ment Health 22(3):103\u201310. https:\/\/doi.org\/10.1136\/ebmental-2019-300096","journal-title":"Evid Based Ment Health"},{"key":"2945_CR17","doi-asserted-by":"publisher","unstructured":"B\u00fcch H (2020) Exposition und Konfrontation. In: D\u00f6pfner M., Hautzinger M., Linden M., (eds) Verhaltenstherapiemanual: Kinder und Jugendliche . Berlin, Heidelberg: Springer Berlin Heidelberg, p 81\u20134. https:\/\/doi.org\/10.1007\/978-3-662-58980-9_16","DOI":"10.1007\/978-3-662-58980-9_16"},{"issue":"1","key":"2945_CR18","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.chc.2011.01.003","volume":"20","author":"LD Seligman","year":"2011","unstructured":"Seligman LD, Ollendick TH (2011) Cognitive-behavioral therapy for anxiety disorders in youth. Child Adolesc Psychiatr Clin N Am 20(1):217\u201338. https:\/\/doi.org\/10.1016\/j.chc.2011.01.003","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"2945_CR19","doi-asserted-by":"crossref","unstructured":"Frank H, Rifkin L, Sheehan K, Becker-Haimes E, Crane M, Phillips K et al (2023) Therapist perceptions of experiential training for exposure therapy. Behavioural and Cognitive Psychotherapy. 21;51:1\u201316. http:\/\/dx.doi.org\/10.2139\/ssrn.3971391","DOI":"10.1017\/S1352465822000728"},{"issue":"2","key":"2945_CR20","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.cbpra.2015.04.003","volume":"23","author":"JA Gola","year":"2016","unstructured":"Gola JA, Beidas RS, Antinoro-Burke D, Kratz HE, Fingerhut R (2016) Ethical considerations in exposure therapy with children. Cogn Behav Pract 23(2):184\u201393. https:\/\/doi.org\/10.1016\/j.cbpra.2015.04.003","journal-title":"Cogn Behav Pract"},{"key":"2945_CR21","doi-asserted-by":"crossref","unstructured":"Hembree EA, Cahill SP (2007) Chapter\u00a017 - Obstacles to successful implementation of exposure therapy. In: Richard DCS, Lauterbach D, editors. Handbook of Exposure Therapies [Internet]. Burlington: Academic Press; p. 389\u2013408. https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780125874212500181","DOI":"10.1016\/B978-012587421-2\/50018-1"},{"key":"2945_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/mti2010008","author":"C Cruz-Neira","year":"2018","unstructured":"Cruz-Neira C, Fern\u00e1ndez M, Portal\u00e9s C (2018) Virtual reality and games. Multimodal Technol Interact. https:\/\/doi.org\/10.3390\/mti2010008","journal-title":"Multimodal Technol Interact"},{"key":"2945_CR23","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.janxdis.2018.10.006","volume":"61","author":"JL Maples-Keller","year":"2019","unstructured":"Maples-Keller JL, Jovanovic T, Dunlop BW, Rauch S, Yasinski C, Michopoulos V et al (2019) When translational neuroscience fails in the clinic: dexamethasone prior to virtual reality exposure therapy increases drop-out rates. J Anxiety Disord 61:89\u201397. https:\/\/doi.org\/10.1016\/j.janxdis.2018.10.006","journal-title":"J Anxiety Disord"},{"issue":"5","key":"2945_CR24","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s00127-007-0173-4","volume":"42","author":"L Gregg","year":"2007","unstructured":"Gregg L, Tarrier N (2007) Virtual reality in mental health: a review of the literature. Soc Psychiatry Psychiatr Epidemiol. 42(5):343\u201354. https:\/\/doi.org\/10.1007\/s00127-007-0173-4","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2945_CR25","unstructured":"Herbelin B (2005) Virtual reality exposure therapy for social phobia. http:\/\/dx.doi.org\/10.5075\/epfl-thesis-3351"},{"key":"2945_CR26","doi-asserted-by":"publisher","DOI":"10.2196\/41589","volume":"9","author":"SS Lie","year":"2023","unstructured":"Lie SS, Helle N, Sletteland NV, Vikman MD, Bonsaksen T (2023) Implementation of virtual reality in health professions education: Scoping review. JMIR Med Educ 9:e41589. https:\/\/doi.org\/10.2196\/41589","journal-title":"JMIR Med Educ"},{"issue":"24","key":"2945_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182413209","volume":"18","author":"P Caponnetto","year":"2021","unstructured":"Caponnetto P, Triscari S, Maglia M, Quattropani MC (2021) The simulation game - virtual reality therapy for the treatment of social anxiety disorder: A systematic review. IJERPH 18(24):13209. https:\/\/doi.org\/10.3390\/ijerph182413209","journal-title":"IJERPH"},{"issue":"3","key":"2945_CR28","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s00115-023-01570-9","volume":"95","author":"J Diemer","year":"2024","unstructured":"Diemer J, Kothgassner OD, Herrmann MJ, Zwanzger P (2024) VR-supported therapy for anxiety and posttraumatic stress disorder: Current possibilities and limitations. Nervenarzt 95(3):223\u20139. https:\/\/doi.org\/10.1007\/s00115-023-01570-9","journal-title":"Nervenarzt"},{"key":"2945_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2015.12.016","author":"PMG Emmelkamp","year":"2016","unstructured":"Emmelkamp PMG, Brinkman WP, Kampmann IL, Morina N, Zijlstra BJH, Hartanto D (2016) Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. Behav Res Ther. https:\/\/doi.org\/10.1016\/j.brat.2015.12.016","journal-title":"Behav Res Ther"},{"issue":"SUPPL 2, 2, SI","key":"2945_CR30","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s00608-023-01112-1","volume":"58","author":"A Felnhofer","year":"2023","unstructured":"Felnhofer A (2023) Opportunities of virtual reality in the therapy of children and adolescents. Paediatr Paedol 58(SUPPL 2, 2, SI):130\u20133. https:\/\/doi.org\/10.1007\/s00608-023-01112-1","journal-title":"Paediatr Paedol"},{"issue":"4","key":"2945_CR31","doi-asserted-by":"publisher","DOI":"10.2196\/10965","volume":"6","author":"T Oing","year":"2018","unstructured":"Oing T, Prescott J (2018) Implementations of virtual reality for anxiety-related disorders: systematic review. JMIR Serious Games 6(4):e10965. https:\/\/doi.org\/10.2196\/10965","journal-title":"JMIR Serious Games"},{"key":"2945_CR32","doi-asserted-by":"publisher","DOI":"10.2196\/48916","author":"S Shahid","year":"2024","unstructured":"Shahid S, Kelson J, Saliba A (2024) Effectiveness and user experience of virtual reality for social anxiety disorder: Systematic review. JMIR Ment Health. https:\/\/doi.org\/10.2196\/48916","journal-title":"JMIR Ment Health"},{"key":"2945_CR33","doi-asserted-by":"crossref","unstructured":"David OA, Costescu C, Cardos R, Mogoa\u015fe C (2020) How Effective are Serious Games for Promoting Mental Health and Health Behavioral Change in Children and Adolescents? A Systematic Review and Meta-analysis. Child & Youth Care Forum. 49(6):817\u201338. https:\/\/link.springer.com\/article\/10.1007\/s10566-020-09566-1","DOI":"10.1007\/s10566-020-09566-1"},{"issue":"3","key":"2945_CR34","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1089\/g4h.2016.0068","volume":"6","author":"C Eichenberg","year":"2017","unstructured":"Eichenberg C, Schott M (2017) Serious games for psychotherapy: A systematic review. Games Health J 6(3):127\u201335. https:\/\/doi.org\/10.1089\/g4h.2016.0068","journal-title":"Games Health J"},{"issue":"2","key":"2945_CR35","doi-asserted-by":"publisher","first-page":"109","DOI":"10.17083\/ijsg.v8i2.416","volume":"8","author":"M H\u00f8iseth","year":"2021","unstructured":"H\u00f8iseth M, Alsos OA, Holme S, Ek S, Tendenes Gabrielsen C (2021) Serious game design to support children struggling with school refusal. IJSG 8(2):109\u201328. https:\/\/doi.org\/10.17083\/ijsg.v8i2.416","journal-title":"IJSG"},{"key":"2945_CR36","doi-asserted-by":"publisher","DOI":"10.2196\/30482","author":"K Martinez","year":"2021","unstructured":"Martinez K, Men\u00e9ndez-Men\u00e9ndez MI, Bustillo A (2021) Awareness, prevention, detection, and therapy applications for depression and anxiety in serious games for children and adolescents: systematic review. JMIR Serious Games. https:\/\/doi.org\/10.2196\/30482","journal-title":"JMIR Serious Games"},{"issue":"2","key":"2945_CR37","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1007\/s11121-017-0843-8","volume":"19","author":"EA Schoneveld","year":"2018","unstructured":"Schoneveld EA, Lichtwarck-Aschoff A, Granic I (2018) Preventing childhood anxiety disorders: is an applied game as effective as a cognitive behavioral therapy-based program? Prev Sci 19(2):220\u201332. https:\/\/doi.org\/10.1007\/s11121-017-0843-8","journal-title":"Prev Sci"},{"key":"2945_CR38","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2025.104731","author":"A Hildebrand","year":"2025","unstructured":"Hildebrand A, Planert J, Roesmann K, Machulska A, Neubert M, Klucken T (2025) Fear not: Combining digital and virtual reality interventions for the treatment of social anxiety disorder \u2013 a randomized controlled trial. Behav Res Ther. https:\/\/doi.org\/10.1016\/j.brat.2025.104731","journal-title":"Behav Res Ther"},{"key":"2945_CR39","doi-asserted-by":"publisher","unstructured":"Rejbrand C, Fure B, Sonnby K (2023) Stand-alone virtual reality exposure therapy as a treatment for social anxiety symptoms: A systematic review and meta-analysis 128. https:\/\/doi.org\/10.48101\/ujms.v128.9289, https:\/\/ujms.net\/index.php\/ujms\/article\/view\/9289","DOI":"10.48101\/ujms.v128.9289"},{"key":"2945_CR40","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01758","volume":"10","author":"TF Wechsler","year":"2019","unstructured":"Wechsler TF, K\u00fcmpers F, M\u00fchlberger A (2019) Inferiority or even superiority of virtual reality exposure therapy in phobias? - A systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Front Psychol 10:1758. https:\/\/doi.org\/10.3389\/fpsyg.2019.01758","journal-title":"Front Psychol"},{"key":"2945_CR41","doi-asserted-by":"crossref","unstructured":"Opri\u015f D, Pintea S, Garc\u00eda-Palacios A, Botella C, Szamosk\u00f6zi \u015e, David D (2012) Virtual reality exposure therapy in anxiety disorders: A quantitative meta-analysis. Depression and Anxiety 1;29(2):85\u201393.","DOI":"10.1002\/da.20910"},{"key":"2945_CR42","doi-asserted-by":"crossref","unstructured":"Kampmann IL, Emmelkamp PMG, Morina N (2016) Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders 1;42:71\u201384.","DOI":"10.1016\/j.janxdis.2016.06.007"},{"key":"2945_CR43","doi-asserted-by":"crossref","unstructured":"Chesham R. K., Malouff J. M., Schutte N. S. (2018). Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety. Behaviour Change 35(3):152\u201366.","DOI":"10.1017\/bec.2018.15"},{"issue":"5","key":"2945_CR44","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1111\/jcpp.13400","volume":"62","author":"B Halldorsson","year":"2021","unstructured":"Halldorsson B, Hill C, Waite P, Partridge K, Freeman D, Creswell C (2021) Annual research review: Immersive virtual reality and digital applied gaming interventions for the treatment of mental health problems in children and young people: The need for rigorous treatment development and clinical evaluation. J Child Psychol Psychiatry 62(5):584\u2013605. https:\/\/doi.org\/10.1111\/jcpp.13400","journal-title":"J Child Psychol Psychiatry"},{"issue":"2","key":"2945_CR45","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s40211-020-00349-7","volume":"35","author":"OD Kothgassner","year":"2021","unstructured":"Kothgassner OD, Felnhofer A (2021) Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents a systematic review. Neuropsychiatrie 35(2):68\u201375. https:\/\/doi.org\/10.1007\/s40211-020-00349-7","journal-title":"Neuropsychiatrie"},{"issue":"5","key":"2945_CR46","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1007\/s00431-024-05488-5","volume":"183","author":"C Bexson","year":"2024","unstructured":"Bexson C, Oldham G, Wray J (2024) Safety of virtual reality use in children: a systematic review. Eur J Pediatr 183(5):2071\u201390. https:\/\/doi.org\/10.1007\/s00431-024-05488-5","journal-title":"Eur J Pediatr"},{"issue":"6","key":"2945_CR47","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1080\/16506073.2023.2229017","volume":"52","author":"TB Wray","year":"2023","unstructured":"Wray TB, Kemp JJ, Larsen MA (2023) Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions. Cogn Behav Ther 52(6):603\u201324. https:\/\/doi.org\/10.1080\/16506073.2023.2229017","journal-title":"Cogn Behav Ther"},{"key":"2945_CR48","doi-asserted-by":"publisher","unstructured":"Lee P, Zehgeer A, Ginsburg GS, McCracken J, Keeton C, Kendall PC et al (2019) Child and adolescent adherence with cognitive behavioral therapy for anxiety: Predictors and associations with outcomes. Journal of Clinical Child & Adolescent Psychology. 48(sup1):S215\u201326. https:\/\/doi.org\/10.1080\/15374416.2017.1310046","DOI":"10.1080\/15374416.2017.1310046"},{"key":"2945_CR49","unstructured":"Hellweger S, Wang X (2014) What is user experience really: Towards a UX conceptual framework. http:\/\/dx.doi.org\/10.6084\/M9.FIGSHARE.1319576"},{"issue":"7","key":"2945_CR50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):1\u20136. https:\/\/doi.org\/10.1371\/journal.pmed.1000097","journal-title":"PLoS Med"},{"key":"2945_CR51","doi-asserted-by":"crossref","unstructured":"Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. n160. http:\/\/dx.doi.org\/10.1136\/bmj.n160","DOI":"10.1136\/bmj.n160"},{"key":"2945_CR52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/EFI-180221","volume":"34","author":"QN Hong","year":"2018","unstructured":"Hong QN, F\u00e0bregues S, Bartlett G, Boardman F, Cargo M, Dagenais P et al (2018) The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf 34:1\u20137. https:\/\/doi.org\/10.3233\/EFI-180221","journal-title":"Educ Inf"},{"key":"2945_CR53","unstructured":"Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al (2006) Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. http:\/\/dx.doi.org\/10.13140\/2.1.1018.4643"},{"key":"2945_CR54","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","volume":"22","author":"S Balduzzi","year":"2019","unstructured":"Balduzzi S, R\u00fccker G, Schwarzer G (2019) How to perform a meta-analysis with R: A practical tutorial. Evid Based Ment Health 22:153\u201360. https:\/\/doi.org\/10.1136\/ebmental-2019-300117","journal-title":"Evid Based Ment Health"},{"key":"2945_CR55","doi-asserted-by":"publisher","unstructured":"Biggs B, Whiteside S, Knutson M, Seifert S, Hofschulte D, Geske J, et al (2025) A comparison of virtual reality and verbal imaginal exposure for childhood anxiety disorders. Journal Of Anxiety Disorders, 110. https:\/\/doi.org\/10.1016\/j.janxdis.2025.102974","DOI":"10.1016\/j.janxdis.2025.102974"},{"key":"2945_CR56","doi-asserted-by":"crossref","unstructured":"Kahlon S, Lindner P, Nordgreen T (2023) Gamified virtual reality exposure therapy for adolescents with public speaking anxiety: A four-armed randomized controlled trial. Frontiers In Virtual Reality 29;4. http:\/\/dx.doi.org\/10.3389\/frvir.2023.1240778","DOI":"10.3389\/frvir.2023.1240778"},{"key":"2945_CR57","doi-asserted-by":"publisher","unstructured":"Whiteside S, Brennan E, Biggs B, Vickers K, Hathaway J, Seifert S et al (2020) The feasibility of verbal and virtual reality exposure for youth with academic performance worry. Journal Of Anxiety Disorders. ;76. https:\/\/doi.org\/10.1016\/j.janxdis.2020.102298","DOI":"10.1016\/j.janxdis.2020.102298"},{"key":"2945_CR58","doi-asserted-by":"publisher","unstructured":"Beele G, Liesong P, Bojanowski S, Hildebrand K, Weingart M, Asbrand J et al (2024) Virtual reality exposure therapy for reducing school anxiety in adolescents:Pilot study. JMIR Mental Health 11. https:\/\/doi.org\/10.2196\/56235","DOI":"10.2196\/56235"},{"key":"2945_CR59","doi-asserted-by":"publisher","unstructured":"Kahlon S, Lindner P, Nordgreen T (2019) Virtual reality exposure therapy for adolescents with fear of public speaking: A non-randomized feasibility and pilot study. . Child and Adolescent Psychiatry And Mental Health 13(1). https:\/\/doi.org\/10.1186\/s13034-019-0307-y","DOI":"10.1186\/s13034-019-0307-y"},{"key":"2945_CR60","unstructured":"Wieczerkowski D, Nickel H, Janowski A, Fittkau B, Rauer W, Petermann F (2016) Angstfragebogen f\u00fcr Sch\u00fcler (AFS) (7. Aufl.). G\u00f6ttingen: Hogrefe."},{"key":"2945_CR61","unstructured":"D\u00f6pfner M, G\u00f6rtz-Dorten A, Lehmkuhl G (2017) Diagnostik-System f\u00fcr Psychische St\u00f6rungen Nach ICD-10 und DSDM-5 f\u00fcr Kinder und Jugendliche-III (DISYPS-III). Hogrefe: G\u00f6ttingen, Germany."},{"key":"2945_CR62","doi-asserted-by":"crossref","unstructured":"Sheehan D, Harnett-Sheehan K, Shytle R, Janavs J, Bannon Y, Rogers J, et al (2010) The mini-international neuropsychiatric interview for children and adolescents (MINI-KID): Validity and reliability. The Journal of clinical psychiatry. 71:313\u201326.","DOI":"10.4088\/JCP.09m05305whi"},{"key":"2945_CR63","doi-asserted-by":"publisher","unstructured":"Muris P, Schmidt H, Merckelbach H (2000) Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: the screen for child anxiety related emotional disorders and the Spence Children\u2019s Anxiety Scale. Personality and Individual Differences 28(2):333\u201346. https:\/\/doi.org\/10.1016\/S0191-8869(99)00102-6","DOI":"10.1016\/S0191-8869(99)00102-6"},{"key":"2945_CR64","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.paid.2016.01.026","volume":"94","author":"E Bartholomay","year":"2016","unstructured":"Bartholomay E, Houlihan D (2016) Public speaking anxiety scale: preliminary psychometric data and scale validation. Pers Individ Differ 94:211\u20135. https:\/\/doi.org\/10.1016\/j.paid.2016.01.026","journal-title":"Pers Individ Differ"},{"key":"2945_CR65","unstructured":"Wolpe J (1990) The practice of behavior therapy. Pergamon press"},{"issue":"1","key":"2945_CR66","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1037\/a0024544","volume":"24","author":"L Peters","year":"2012","unstructured":"Peters L, Sunderland M, Andrews G, Rapee RM, Mattick RP (2012) Development of a short form Social Interaction Anxiety (SIAS) and Social Phobia Scale (SPS) using nonparametric item response theory: the SIAS-6 and the SPS-6. Psychol Assess 24(1):66\u201376. https:\/\/doi.org\/10.1037\/a0024544","journal-title":"Psychol Assess"},{"key":"2945_CR67","unstructured":"Cohen J. (1988).Statistical power analysis for the behavioral sciences . L. Erlbaum Associates ."},{"issue":"3","key":"2945_CR68","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1162\/105474601300343603","volume":"10","author":"T Schubert","year":"2001","unstructured":"Schubert T, Friedmann F, Regenbrecht H (2001) The experience of presence: factor analytic insights. Presence Teleoperators Virtual Environ 10(3):266\u201381. https:\/\/doi.org\/10.1162\/105474601300343603","journal-title":"Presence Teleoperators Virtual Environ"},{"key":"2945_CR69","doi-asserted-by":"crossref","unstructured":"Hoeft R, Vogel J (2003) Kids get sick too: A proposed child simulator sickness questionnaire. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 47:2137\u201341. http:\/\/dx.doi.org\/10.1177\/154193120304702013","DOI":"10.1177\/154193120304702013"},{"key":"2945_CR70","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.ajo.2019.07.020","volume":"209","author":"L Tychsen","year":"2020","unstructured":"Tychsen L, Foeller P (2020) Effects of immersive virtual reality headset viewing on young children: visuomotor function, postural stability, and motion sickness. Am J Ophthalmol 209:151\u20139. https:\/\/doi.org\/10.1016\/j.ajo.2019.07.020","journal-title":"Am J Ophthalmol"},{"key":"2945_CR71","unstructured":"Meta. Meta Quest 3 [Internet]. (2024) [cited 2025 May 22]. Available from: https:\/\/www.meta.com\/de\/en\/quest\/quest-3\/?srsltid=AfmBOoqUEPITUCHkXXrNFhSjvfY-bhNV7H31mThR3VG-DGDLueWoZleo"},{"key":"2945_CR72","unstructured":"PlayStation. PlayStation VR2 Gebruiksaanwijzing Bedienungsanleitung \/ Manuale di istruzioni Mode d\u2019emploi [Internet]. (2024) [cited 2025 May 22]. Available from: https:\/\/www.playstation.com\/content\/dam\/global_pdc\/de\/corporate\/support\/manuals\/psvr2-docs\/CFI-ZVR1_PSVR2_IM$de.pdf"},{"key":"2945_CR73","doi-asserted-by":"publisher","unstructured":"Fleming TM, Bavin L, Stasiak K, Hermansson-Webb E, Merry SN, Cheek C et al (2017) Serious Games and Gamification for Mental Health: Current Status and Promising Directions. Frontiers in Psychiatry Volume 7-2016. https:\/\/doi.org\/10.3389\/fpsyt.2016.00215https:\/\/www.frontiersin.org\/journals\/psychiatry\/articles\/10.3389\/fpsyt.2016.00215","DOI":"10.3389\/fpsyt.2016.00215"},{"issue":"2","key":"2945_CR74","doi-asserted-by":"publisher","DOI":"10.2196\/games.8902","volume":"6","author":"G Pramana","year":"2018","unstructured":"Pramana G, Parmanto B, Lomas J, Lindhiem O, Kendall PC, Silk J (2018) Using mobile health gamification to facilitate cognitive behavioral therapy skills practice in child anxiety treatment: open clinical trial. JMIR Serious Games 6(2):e9. https:\/\/doi.org\/10.2196\/games.8902","journal-title":"JMIR Serious Games"},{"key":"2945_CR75","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.apnu.2022.07.003","volume":"41","author":"H Xie","year":"2022","unstructured":"Xie H (2022) A scoping review of gamification for mental health in children: uncovering its key features and impact. Arch Psychiatr Nurs 41:132\u201343. https:\/\/doi.org\/10.1016\/j.apnu.2022.07.003","journal-title":"Arch Psychiatr Nurs"},{"key":"2945_CR76","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.23470","author":"K Moses","year":"2022","unstructured":"Moses K, Gonsalvez C, Meade T (2022) Barriers to the use of exposure therapy by psychologists treating anxiety, obsessive-compuslive disorder, and posttraumatic stress disorder in an Australian sample J Clin Psychol. https:\/\/doi.org\/10.1002\/jclp.23470","journal-title":"J Clin Psychol"}],"container-title":["European Child &amp; Adolescent Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00787-025-02945-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00787-025-02945-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00787-025-02945-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T03:36:15Z","timestamp":1779939375000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00787-025-02945-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":76,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["2945"],"URL":"https:\/\/doi.org\/10.1007\/s00787-025-02945-w","relation":{},"ISSN":["1018-8827","1435-165X"],"issn-type":[{"value":"1018-8827","type":"print"},{"value":"1435-165X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]},"assertion":[{"value":"2 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}