Transforming Mental Health Care: The Role of VR in a New Era of Mental Health Treatment by Dr Farah Shiraz

Photo: Therapist and patient using HEKA VR software in Clinical practice.

We are honored to welcome Dr. Farah Shiraz as a guest contributor to VRforHealth. This is her first article for our platform, and what an impactful debut it is. With over 20 years of experience in mental health — spanning clinical practice, academia, and digital innovation — Dr. Shiraz brings deep insight and clarity to one of today’s most pressing healthcare challenges. In the article below, she explores how virtual reality is transforming mental health care, from Virtual Reality Exposure Therapy to Immersive Avatar Therapy for schizophrenia and beyond.

With thoughtful references to leading researchers and real-world applications, she illustrates how VR can not only enhance traditional methods, but also create more personalized, accessible, and effective treatments for those who need it most. It was a true pleasure to exchange with Dr. Shiraz during the preparation of this piece. Her warmth, professionalism, and passion for bridging science and practice shine through every paragraph. We are grateful for her contribution, and look forward to out continuing partnership with HEKA VR. Denise Silber

Article by Dr Farah Shiraz, Chief Scientific Officer, HEKA VR.

The Mental Health “Dinosaur”

Mental health disorders represent one of the most pressing public health challenges of our time. According to the World Health Organization (WHO), by 2030, mental health disorders are projected to become the leading cause of disease burden globally, with conditions such as depression and psychosis already accounting for approximately 14% of the global disease burden (WHO, 2024). These figures highlight the urgent need for more effective, scalable, and accessible solutions to address the growing demand for mental health care.

Despite growing awareness, mental health remains a dinosaur in the field of healthcare, slow to evolve and under-equipped to meet the urgent and complex needs of today. Traditional services are overwhelmed, outdated, and often inaccessible, leaving millions without adequate support. The field is in need of innovation, new solutions, technologies, and care pathways that can bridge the gap between demand and delivery. One exciting prospect that has been gaining traction  is the use of Virtual Reality (VR), which is emerging as a powerful tool within mental health care. From immersive therapy sessions to anxiety-reducing environments and scalable training tools for professionals, VR offers a way to make treatment more engaging, effective, and widely accessible.

Is it time to reimagine mental healthcare and embrace technologies that can transform how we care for the mind? This article discusses the how virtual reality is changing the mental health landscape providing some examples of how VR is being currently being used within the field of mental health.

The Role of Virtual Reality (VR) in mental health

The use of Virtual Reality (VR) in mental health care can be traced back to the mid-1990s, when researchers began exploring its potential as a tool for psychological treatment. One of the earliest and most influential applications was developed by Dr. Barbara Rothbaum and Dr. Larry Hodges at Emory University, who used VR to conduct exposure therapy for individuals with acrophobia (fear of heights). Patients were gradually exposed to height simulations in a controlled environment using Virtual Reality allowing for desensitization without real-world risk. This pioneering study demonstrated that VR could offer a safe, controlled, and immersive environment for gradual exposure to feared stimuli, marking a significant advancement in the field of anxiety treatment. This study began a wave of research and is considered a landmark moment as it proved that VR could be used as a clinical tool in psychology, not just a tech novelty.

Applications of VR in Mental Health Treatment.

Virtual Reality is opening up powerful new pathways in mental health care, particularly for anxiety-related conditions. By immersing individuals in lifelike, interactive environments, VR enables safe and controlled exposure to anxiety-provoking situations. This approach, known as Virtual Reality Exposure Therapy (VRET), helps patients gradually confront and manage their fears. For example, individuals with social anxiety can practice public speaking or navigating social interactions in virtual settings, while those with fear of flying or agoraphobia can simulate airports, planes, or crowded public spaces without ever leaving the therapy room. These simulations are designed to feel real enough to activate the same emotional responses as real-world experiences, but within a secure and therapeutic environment. Over time, repeated exposure leads to reduced avoidance, increased confidence, and improved coping mechanisms. VR also allows therapists to tailor scenarios to individual needs and progress, making treatment more personalized and engaging. This flexibility and realism make VR a uniquely powerful tool in helping people regain control over their anxiety.

It is exciting to see the research is building beyond anxiety related conditions, and we are seeing a significant uprise in Virtual reality used across the mental health spectrum.

Professor Daniel Freeman has been a pioneer in the field of Virtual Reality therapy in mental health, particularly in the treatment of anxiety disorders and psychosis. His research has demonstrated the powerful potential of VR to reach individuals who are often considered difficult to engage through traditional therapy methods. In one of his most influential studies (Freeman et al., 2022), he and his team developed an automated VR therapy program guided by a virtual coach, designed specifically for people with agoraphobic avoidance and persecutory delusions, a common presentation in psychosis. The program immersed patients in virtual environments such as buses, cafés, or busy streets, where they could safely confront anxiety-inducing scenarios. The virtual coach provided guidance and cognitive-behavioral strategies in real time, helping users reframe their thoughts, manage their emotional responses, and reduce avoidance behavior. The therapy required no live therapist, making it highly scalable and cost-effective, a significant advantage in mental health systems stretched by workforce shortages. Freeman’s work not only confirmed that VR can deliver measurable clinical improvements, but also shifted perceptions about how immersive technology can support people with severe mental health challenges. His research opens new avenues for delivering evidence-based interventions at scale, increasing accessibility and engagement, and ultimately transforming how care is provided for some of the most underserved populations in mental health.

Another interesting use case of Virtual reality within the mental health space has been using Virtual Reality for Avatar Therapy. In 2013, Professor Julian Leff introduced the concept of avatar therapy which was a novel way to support individuals with medication-resistant auditory hallucinations (hearing voices). The therapeutic process involved co-creating a 2D digital avatar that embodies the voice the patient hears, including its tone, content, and personality. The therapist, using voice modulation technology, speaks through the avatar in real-time, facilitating a structured dialogue between the patient and the representation of their hallucinated voice. The therapy aimed to promote emotional regulation, insight, and empowerment by enabling patients to engage with their hallucinations in 2D in a safe and controlled environment. Over therapeutic sessions, the interaction with the avatar is designed to shift the avatar’s tone from hostile to supportive, reinforcing the patient’s sense of agency and reducing the voice’s perceived dominance. Leff and colleagues found avatar therapy demonstrated significant reductions in the frequency and intensity of the voices, as well as their perceived power and malevolence. Notably, several individuals experienced a complete cessation of their auditory hallucinations after just a few sessions (Craig, 2015, Garety, 2024).

Building on the foundational work of Professor Julian Leff and his team, HEKA VR developed a platform in Virtual Reality to expand on this foundation by adding  the possibility of a fully immersive environment  which deepens the sense of presence and emotional engagement during avatar therapy. Instead of interacting with a 2D avatar on a screen, patients can meet and speak with lifelike avatars in a 3D space that feels real, enhancing both the emotional intensity and therapeutic impact. This immersive quality may improve outcomes by making the interaction more immediate, personal, and embodied, potentially increasing treatment effectiveness and accessibility for those who need it most.

By combining the immersive power of VR with the psychological framework of avatar therapy, HEKA VR is not only extending the reach of this innovative treatment but also enhancing its emotional realism and therapeutic potential. This approach holds particular promise for individuals with treatment-resistant schizophrenia (Smith et al, Vass 2024) opening new pathways for recovery, empowerment, and improved quality of life, but studies are also currently being conducted in OCD (Willie et al 2025) and eating disorders.

Conclusions on VR Therapy

Virtual Reality therapy is more than just a futuristic idea, it’s a bold new concept in mental health care. While it’s not a replacement for traditional therapy, it adds a powerful tool to the clinician’s toolbox, one that can personalize care, boost engagement, and reach people who might otherwise fall through the cracks. By combining the best of pharmacology, psychology, and technology, we can begin to offer treatments that are not only more effective, but also more human.

But innovation alone isn’t enough. To truly unlock VR’s potential, we need smart implementation: well-trained professionals, rigorous research, and equitable access to evidence-based tools. If we get that right, VR therapy could become a cornerstone of modern mental health care—one that empowers both patients and providers, and brings help within reach for millions around the world.

References

• Craig TK, Rus-Calafell M, Ward T, et al. The effects of an Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR therapy): study protocol for a randomised controlled trial. Trials 2015; 16: 349

• Freeman, D., Altunkaya, J., et al. (2022) ‘Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses’, The Lancet Psychiatry, 9(5), pp. 375–388.

• Garety, P.A., Edwards, C.J., Jafari, H. et al. Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial. Nat Med 30, 3658–3668 (2024). https://doi.org/10.1038/s41591-024-03252-8

• Hodges, Larry & Kooper, Rob & Opdyke, D & Williford, J.S. & North, M.M.. (1995). Effectiveness of Computer-generated (virtual reality) graded exposure in the treatment of acrophobia. The American journal of psychiatry. 152. 626-8. 10.1176/ajp.152.4.626.

• Leff J, Williams G, Huckvale MA, Arbuthnot M, Leff AP. Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study. Br J Psychiatry 2013; 202: 428–33. 11

• Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J. S., & North, M. (1995). Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. The American Journal of Psychiatry, 152(4), 626–628.

• Smith, S., et al. (2023) ‘The potential of avatar therapy in treating auditory hallucinations: A systematic review’, Psychological Medicine, 53(5), pp. 1853-1862

• Wille, L., Lohse, L., Jelinek, L., Moritz, S., Schultz, J., Borsutzky, S., Yassari, A. H., Mariegaard, L., Vernal, D. L., Bekker, S. H., Glenthøj, L. B., & Miegel, F. (2025). Enhancing insight in patients with obsessive-compulsive disorder: A case study on avatar therapy using virtual reality. Journal of Clinical Psychology

Previously, Dr Shiraz was as an Assistant Professor, at the National University of Singapore, leading international research in global mental health. This academic expertise, combined with years of clinical experience, provides a unique foundation for navigating the intersection of science, technology, and patient care. Committed to driving progress in mental health, she continues to focus on developing innovative digital therapeutics that are both scientifically rigorous and accessible, aiming to improve the lives of individuals affected by severe mental health conditions.

About HEKA VR

HEKA VR is a Danish healthtech company that leverages virtual reality (VR) to transform mental health treatment. Specializing in immersive therapies for conditions like psychosis, OCD and eating disorders, HEKA VR combines cutting-edge VR technology with psychological research to offer effective, evidence-based solutions. Their flagship VR avatar therapy software helps patients with auditory hallucinations by externalizing their voices through avatars, significantly reducing distress. The development of this solution is underpinned by direct patient involvement, ensuring the technology meets real-world needs and improves outcomes. The team at HEKA VR is multidisciplinary, drawing on expertise from mental health, commercial experts, software developers, and project managers, ensuring that the product is clinically relevant, technically advanced, and practically deployable. Through collaboration with healthcare providers, HEKA VR aims to make mental health care more accessible, efficient, and impactful, particularly in underserved areas.

This article was originally published on vrforhealth