From more than 10 leading companies that provide VR and metaverse based mental health solution, we chose three companies based on the following criteria.

Each company represents a unique approach to virtual therapy. XRHealth focuses on immersive environments for rehabilitation ¹ , Innerworld emphasizes peer-led support groups through an immersive platform ² , PsyTechVR uses CB, exposure therapy and mindfulness training approaches for various mental disorders, providing a broad spectrum of VR applications within mental health ³ .

Preference was given to companies that have substantiated the effectiveness of their technologies through rigorous testing, including clinical trials and peer-reviewed research, ensuring that the analysis is grounded in verified results [12] - [14] .

The global reach and scalability of the companies’ solutions were considered, as this affects the broader impact of VR therapies on mental health care practices worldwide [15] [16] .

The global reach and scalability of the companies’ solutions were considered, as this affects the broader impact of VR therapies on mental health care practices worldwide [17] .

Exclusion criteria eliminated companies whose solutions focused solely on physical rehabilitation without a mental health component, wellness-oriented VR apps lacking clinical validation (e.g., meditation-only platforms), and technologies unrelated to anxiety, PTSD, or broader mental health disorders.

Table 1 lists the VR-based mental health platforms which are considered for the study. Focusing on three representative companies based on the above criteria allowed for a detailed analysis of therapeutic, clinical, and economic implications.

To ensure a comprehensive analysis, multiple data sources were used.

Peer-reviewed journals were the primary source of theoretical and empirical research. Articles were selected for their relevance to evaluating the effectiveness, accessibility, and safety of VR therapies [12] - [14] .

Reviewed all information published from the companies, including their website, white papers, case studies to gain insights into their operational models, target demographics, and strategic objectives ⁴ .

A comparative analysis was developed to evaluate the selected companies against the established criteria mentioned above.

Examining hardware and software requirements, cost implications, and geographic distribution to assess how accessible the VR solutions are to a broad range of users.

Evaluating the frequency, severity, and management of any physical and psychological side effects as reported in clinical trials and user feedback.

Analyzing how each company handles sensitive data, including adherence to healthcare privacy laws and measures taken to mitigate potential breaches.

Measuring the therapeutic outcomes based on improvements in mental health conditions as detailed in clinical trials and user testimonials.

These parameters ensure a detailed and reliable evaluation of the impacts and challenges associated with implementing VR in mental health treatments.

XRHealth specializes in immersive, at-home VR therapy and real-time data analytics to provide personalized and interactive treatments for patients and healthcare providers. Their VR applications are designed to improve mental health treatment through interactive experiences that encourage user participation and incorporate movement-based activities. For patients, XRHealth’s operating model is that the VR headset is sent to your home for the VR mental health therapy sessions and for tasks in between the sessions ⁵ . Specifically, XR Health is implementing metaverse therapy sessions ( Figure 2 ). In these sessions, the therapists and clients create their avatars and gather in 360-degree virtual rooms ⁶ . The avatars help add a level of anonymity that allow people to overcome hesitation, making it easier to share personal experiences and challenges. The therapists can still initiate exercises requiring physical engagement such as throwing and catching a ball.

Additionally, XRHealth has a variety of VR applications (Mindset, Luna, and Relax8) ⁷ , each designed to address specific mental health needs. Mindset is a healing media center app that includes meditation and relaxation techniques. In the app, users can select different experiences such as Dolphins Healing Experience, Everest Experience, and Seals Healing Experience. Additionally, the users can select different paths such as calm, introspect, sleep, renewal, and energize. Luna helps with symptom management with CBT. It engages the brain using an AI therapist to assist in the mitigation of pain, hot flashes, and physical discomfort through distraction and supporting exercises. Relax8 focuses on breathing techniques and guided meditations for relaxation. For example, in the app, the user can practice tracing a specific path to help relieve stress. Each of these FDA registered applications use an immersive virtual environment along with an interactive game to help treat different aspects of mental health.

For healthcare professionals, XRHealth offers the eXperience Space, a VR environment that integrates VR technology with advanced data analytics to enhance patient care. The environment facilitates timely and effective relaxation and comfort for patients in stressful settings, such as hospital settings, by immersing them in calm virtual environments. eXperience Space also assists in reducing clinical burdens and improving patient outcomes by distracting and engaging content delivered at various stages of care to assist in diverting patients’ attention away from body pain ⁸ . XRHealth’s system has real-time analytics which monitors a patient’s physiological and emotional responses throughout VR sessions. Such technologies provide valuable insights on processing speed, attention, decision-making process, and memory span, enabling providers to adjust treatment plans based on individual progress.

Innerworld uses the metaverse to deliver Cognitive Behavioral Immersion (CBI), its flagship group-based cognitive behavioral skills training program. CBI was developed to overcome barriers such as stigma, access, and cost, and integrates evidence-based CBT best practices with immersive technology to create a virtual support community ⁹ . Users join live group classes with trained coaches, where they learn CBT skills to enable them to manage depression, anxiety, and other mental illnesses. The platform allows users to attend CBI sessions through VR headsets for a fully immersive experience or through flat-screen devices like computers and smartphones. Anonymity features, such as the option to design avatars and select usernames, allow for a stigma-free space in which users can openly share experiences and practice therapy skills ( Figure 3 ) [17] . With daily sessions and availability on several devices, CBI provides an interactive and flexible virtual mental health support system.

Innerworld has conducted an observational study to evaluate how effective CBI is in reducing symptoms of depression and anxiety. The study included 127 participants who had depression or anxiety and attended at least two sessions. The results were that depression symptoms decreased from an average score of 16.44 at the first session to 11.62 by the tenth session. [13] Additionally, anxiety symptoms dropped from an average score of 14.79 at the first session to 11.29 by the tenth session as shown in Figure 4 .

PsyTechVR utilizes CBT and Eye Movement Desensitization and Reprocessing (EMDR) evidence-based VR solutions to support broad range of mental health issues. Their operating model integrates virtual coaching, guided therapeutic environments, and psychoeducational simulations based on modern psychological principles and neurocognitive research. The platform is designed by psychologists, neuroscientists, and educators, ensuring that its applications are both scientifically grounded and user centric [18] . One of PsyTechVR’s main features is the “Travel Therapy” module, which allows users to immerse themselves in tranquil, nature-based environments such as beaches, mountains, or forests. This approach uses environmental psychology to promote relaxation, reduce anxiety, and alleviate stress. These experiences serve as a therapeutic adjunct to structured programs such as CBT or mindfulness-based interventions [19] .

PsyTechVR also offers interactive CBT-based simulations that allow users to confront phobias, practice social interactions, and build coping strategies in a controlled virtual environment. For instance, users with social anxiety can participate in graded exposure scenarios, such as attending a virtual meeting or engaging in conversation with a virtual stranger, helping them gradually reduce avoidance behaviors. PsyTechVR is unique in its hybrid use of micro-training modules and LMS-integrated educational paths, which helps users with psychological literacy. These modules are accessible via VR headsets and can be used by professionals in clinical, educational, or research settings ¹⁰ . Unlike some VR companies focused on highly clinical conditions like psychosis, PsyTechVR emphasizes a broad-spectrum approach—targeting everyday stress, emotional resilience, self-regulation, and burnout.

The platform is designed to be highly scalable and accessible. It supports multi-device access (standalone VR, desktop, and mobile), making it easier for therapists, educators, and individuals to adopt the technology globally. PsyTechVR also includes built-in analytics for tracking progress and customizing therapy, allowing real-time adaptation of difficulty, duration, or type of intervention ( Table 2 ).

XRHealth offers two VR Headset Options. One option is to loan the headset for $150 per month to use the services and then the headset is returned once the services are completed. The other option is to buy a VR headset and 12 months of XRHealth monthly therapy support applications access and tech assistance for $1440 ¹¹ . This cost is high for everyday users and therefore limits accessibility. However, reducing the number of sessions from 12 traditional CBT sessions to 8 VR and CBT sessions can result in a cost saving of $600 per patient.

Innerworld offers a subscription for $20 a week, which includes experienced personalized support through groups led by licensed therapists. There are 60-minute weekly sessions designed for small groups and aim to align with the person’s unique needs. Additionally, Innerworld has a licensed therapist-led membership plan called Membership Plus, where users gain access to Inner Circle, a feature offering four therapist-led skills groups each month. Innerworld offers three tiers of membership—free, membership, and membership plus—ranging from zero to $120 a month for users to choose the plan that best fits their budget and needs [20] . This price is significantly lower than traditional therapy sessions, which typically cost $100 to $200 per session.

PsyTechVR offers subscription-based access to its VR mental health therapy platform at $199/month, positioning itself as a tech-forward alternative to traditional therapy. PsyTechVR primarily delivers self-guided, immersive VR experiences developed in collaboration with mental health professionals. PsyTechVR’s single-tier model focuses on scalable virtual exposure therapy using a unique, gamified approach suited for those preferring independent, technology-driven treatment ¹² .

XRHealth’s users are mainly between the ages of 65 - 75. In Australia, most of its treatment is focused on autism and ASD. Additionally, in America, it has seen interest among Gen-Z for mental health challenges and anxiety. It is also deployed in European markets in Spain and has expanded to the UK [21] .

Innerworld has broad appeal across various demographics but is particularly effective in engaging populations hesitant to seek traditional therapy due to stigma or cost concerns. The anonymity provided by avatars lowers barriers for individuals who may feel intimidated in traditional therapeutic settings. However, the platform explicitly states that it is not a substitute for therapy and does not cater to individuals under 18 or those requiring crisis intervention ¹³ . This limitation excludes certain vulnerable groups who may benefit from more intensive or immediate support.

PsyTechVR represents a significant advancement in making mental health therapy more accessible through technology. Accessing PsyTechVR requires a compatible VR headset, such as the Meta Quest, and a subscription fee of $120 per month or buying the complete bundle cost more than $2000. However, physical requirements, potential sensory discomfort, financial costs, the need for professional oversight, and limited clinical validation are factors that may affect its accessibility and effectiveness for some users [18] .

Data privacy is an important concern in the adoption of VR and metaverse-based mental health therapy. All three companies comply with standard healthcare data regulations such as HIPPA and GDPR. However, there are differences in implementation and transparency.

XRHealth performs the functions of both a data processor and data controller. It collects biometric data, usage information, and billable data. The company informs users of their rights based on privacy laws around the world. XRHealth claims to secure user data in accordance with third-party contractual agreements, and they use several secure protocols. The concern is that the use of third-party processors puts user data in a precarious situation, which gives rise to trust issues.

Innerworld’s privacy policy is designed to safeguard user information. The website collects personally identifiable information (PII) such as names, email addresses, and IP addresses to provide and improve its services. Innerworld does not sell or trade user data but may share it with third-party service providers when necessary to finish its services or meet legal requirements. Additionally, the website uses cookies and tracking technologies to improve the user experience and grants users’ access to, correction of, or erasure of their data on request ¹⁴ .

PsyTechVR collects data when users are participating in therapy such as health inputs and session logs. While not directly selling user data, PsyTechVR may share it with third-party providers or in the event of corporate restructuring. Security measures like encryption are used to protect data, though users are reminded that no online system is entirely secure. Users retain rights to access, correct, or delete their data and may contact the company with privacy concerns ¹⁵ .

Some of the virtual environments in XRHealth, such as the floating meditation environment, have the potential to induce cybersickness in some patients. This risk is avoided by XRHealth through its patented biometric feedback system, which real-time adjusts parameters like brightness and contrast to enhance the comfort of the user and restrict cybersickness. The system is an extension of XRHealth’s overall strategy towards personalizing VR for therapy, as detailed in their patent [22] .

Innerworld’s use of calming virtual environments, such as lakes and campfires, reduces the risk of cybersickness compared to more action-oriented VR environments. These fixed, visually soothing environments are designed to encourage relaxation and limit sensory conflict that might cause discomfort from lengthy usage [17] .

PsyTechVR designs its therapy environments with clinical guidance to enhance comfort and minimize cybersickness. The VR experiences prioritize safety and realism, simulating real-life therapeutic scenarios with controlled movement and sensory input to reduce overload. While formal trial results like are not widely published, PsyTechVR highlights strong engagement through its collaborations with doctors and mental health professionals, suggesting positive reception and usability in practice [23] .

For XRHealth, its virtual immersive environments, similar to those that are used for treating PTSD, sometimes induce augmented physiological responses, including the elevated heart rate among older patients. It is a risk because VR exposure therapy’s vivid and realistic simulations expose the patient to trauma stimuli ¹⁶ . However, XRHealth reduces such risks by allowing therapists to control the level and pace of exposure such that patients are not overwhelmed or overexposed. Experiments have shown that gradual and controlled exposure reduces the risk of re-traumatization while enhancing therapeutic gains, as evidenced by clinical trials conducted jointly with the U.S. Veterans Association [24] .

Innerworld’s peer-supported mental well-being platform uses anonymous avatars to foster connectedness while avoiding social anxiety. However, for those with severe anxiety or PTSD, unmoderated peer spaces can potentially be distressing if the interactions or discussions are too much or triggering in nature [17] . To offer a solution to this, Innerworld offers guided environments like mindfulness sessions and guide-led groups that are trained through its Membership Plus membership level. These structured sessions aim to provide the users with greater psychological distress tendencies a safer and more supportive environment.

PsyTechVR applies evidence-based therapeutic techniques, including CBT, to treat mental health issues like phobias, anxiety, and PTSD through immersive VR scenarios. These environments—designed in collaboration with medical professionals—expose users to controlled, fear-inducing stimuli (e.g., confined spaces or public speaking), which may cause short-term physiological responses like elevated heart rate ( Table 3 ). To manage these reactions, PsyTechVR provides guided, gradual exposure within its modules, prioritizing patient safety and comfort ¹⁷ .

To increase access and improve affordability, corporations must make partnerships with public health systems, non-profits, and insurers to create subsidized pricing models. Public health systems like the NHS can negotiate bulk license agreements or co-fund infrastructure to lower cost while insurers can expand reimbursement channels such as Medicare’s coverage for VR-based therapies like AppliedVR’s RelieVRx. Nonprofit organizations can help offset costs for poor patients by securing grants or providing free or low-cost hardware via community programs [25] . Additionally, investing in a lighter, cheaper headsets can help reduce the technological divide for underserved communities. Easy controls, such as voice commands and big, high-contrast screens, would eliminate technical barriers for the technologically illiterate [26] . Community-based solutions to this technology divide can help as well. Having VR booths with guided software in places such as libraries and community centers can deliver treatments to low-income communities without requiring them to own hardware [27] .

VR and metaverse therapy can help prevent cybersickness by using adaptive technology like XRHealth’s biometric feedback system. This system adjusts brightness, sensitivity, and latency based on user feedback to avoid discomfort. Research shows that the provision of stable reference points and the diminishment of visual motion can significantly lower the chances of nausea [28] . PsyTechVR uses gradual immersion protocols, starting with short sessions and gradually increasing in duration [III]. Such protocols are particularly beneficial for individuals new to VR therapy or those with heightened sensitivity to immersive experiences. Physical safety protocols are also important, including clear therapy rooms, headset adjustments, regular session breaks, and ergonomic options. In patients prone to motion sickness, anti-nausea medication like meclizine or Dramamine may be administered under the supervision of a doctor to minimize symptoms [29] . XRHealth’s real-time analytics also allow therapists to monitor physiological responses. Additionally, psychological readiness assessments are used to identify vulnerabilities and support users with debriefing practices. These protocols enhance safety and reduce emotional distress in VR-based mental health interventions.

To ensure data security in VR therapy, organizations like XRHealth and PsyTechPR can use encryption algorithms like AES-256 and multi-factor authentication (MFA) to protect sensitive patient data [30] . User-managed privacy controls, such as Innerworld’s ability to edit, delete, or limit data, can provide patients with control over their data. Furthermore, integrating interactive mechanisms—such as videos or quizzes educating users on privacy threats—can bridge the gap between informed consent and actual awareness of data implications, resolving immersive technology-specific challenges. Regular audits and incident response measures are crucial for maintaining security integrity, including risk analysis, policy audits, and employee training on cybersecurity best practices. Incident response strategies should have specific procedures for detection, containment, and recovery from intrusions as well as adherence to regulatory requirements [31] .

AI-individualized treatment plans are revolutionizing VR therapy by utilizing machine learning algorithms to create tailored therapeutic environments based on patient information such as heart rate, behavioral characteristics, and session outcome [32] . These systems can prescribe calming simulations for anxiety and structured cognitive-behavioral therapy scenes for depression. Therapists can use XRHealth’s AI Reports & Analysis to get tangible data from sessions to better personalize the treatment. Additionally, real-time emotional feedback systems based on AI, such as facial recognition and voice analysis, help therapists measure patient emotions in real-time, helping them develop more effective treatments [33] . Another way AI can be used is AI virtual coaches, which deliver customized CBT content in interactive VR environments. They guide patients through exposure therapy situations to address conditions like social anxiety or phobias. Integrating these systems with empathetic interaction capabilities—such as human-like dialogue simulation and emotional response—can enhance the experience to be more engaging and supportive [34] . These AI-based coaches reduce reliance on human therapists while maintaining high efficacy in treatment outcomes.

Strict clinical trials are crucial for establishing trust in VR and metaverse-based psychiatric therapies. Models like the VR-CORE model, aligned with the FDA’s Phase I-III framework, introduce scientific rigor through VR1 studies, VR2 feasibility and proof of concept trials, and VR3 randomized controlled trials [35] . Large-scale trials, such as OxfordVR’s gameChange program, validate therapeutic efficacy and build confidence among clinicians, patients, and regulators [12] . Additionally, utilizing validated tools like the PHQ-9 in depression or GAD-7 in anxiety provides consistency from trial to trial as shown in tests for mental health promotion in pregnant women [36] . Compliance with global standards such as HIPAA and GDPR for protecting data again assures stakeholders about the confidentiality of patients and ethical basis [37] . Furthermore, the application of blockchain technology for encrypting clinical trial data further makes the information more transparent, tamper-resistant, and unauthorized access-resistant [38] . Such steps together improve the credibility of VR and metaverse therapies in mental health treatment ( Table 4 ).

The analysis of XRHealth, Innerworld, and PsyTechVR highlights the potential of VR in mental health treatment but also highlights limitations that need to be addressed for widespread adoption. XRHealth, while innovative in its inclusion of biometric feedback, may trigger distress in PTSD simulations and lacks controlled trials for clinical validation. Innerworld creates calm, avatar-based social spaces, but unmoderated interactions may unsettle anxious users. PsyTechVR emphasizes gradual exposure and professional guidance, while Innerworld relies on secondary research without controlled trials. Pricing influences accessibility, with Innerworld offering budget-friendly options and XRHealth relying on advanced hardware and higher subscription fees. All platforms adhere to GDPR and HIPAA standards, but third-party processors introduce potential vulnerabilities. To overcome challenges, actionable measures include reducing hardware costs, enhancing device compatibility, and integrating AI-based personalization. Ethical concerns like privacy and data protection must be addressed through robust encryption methods and user-controlled privacy settings. The establishment of global mental health communities in the metaverse could revolutionize support networks.

The finding relies heavily on company-sponsored studies and limited independent research, which may introduce bias. XRHealth has FDA registration only for select therapies, while PsyTechVR and Innerworld primarily report outcomes from internal or small-scale studies. Robust, independent clinical trials and regulatory validation remain limited, and future work should prioritize external evidence to corroborate reported outcomes.

VR and metaverse technologies offer a scalable and personalized solution to traditional mental health barriers, such as stigma, cost, and long wait times. With a national median wait time of 67 days, these technologies have the potential to become mainstream care delivery solutions [39] . However, challenges like affordability, access, side effects, privacy, and clinical efficacy need to be addressed. Collaboration among clinicians, researchers, policymakers, and developers can revolutionize mental health care by leveraging AI-enabled personalization and metaverse-enabled worldwide networks.