Virtual reality-assisted cognitive behavioural interventions for alcohol use disorder: a scoping review of therapeutic mechanisms with potential implications for anxiety, depression, and precision digital mental health

Abstract

Background: Alcohol use disorder (AUD) is a major public health concern frequently associated with anxiety and depressive disorders, highlighting the need for innovative and personalised mental health interventions. Virtual reality (VR) has emerged as a digital tool that may support cognitive behavioural therapy (CBT) by enabling immersive and controlled exposure to relevant stimuli. Methods: This scoping review aimed to map how VR is integrated into CBT-oriented interventions for adults with AUD, with a focus on therapeutic mechanisms and their potential relevance for precision digital mental health. The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed, CINAHL, and Psychology and Behavioural Sciences Collection for studies published in the last ten years in English, Portuguese, or Spanish. Two independent reviewers performed screening and data extraction. Results: Eight studies were included, encompassing approaches such as cue exposure, simulation of high-risk environments, and covert sensitisation. The studies explored mechanisms including craving induction and regulation, identification of individual triggers, emotional processing, and enhancement of self-efficacy. The evidence base was characterised by small sample sizes, heterogeneous designs, and limited longitudinal data. Conclusions: This review provides a structured mapping of current applications of VR within CBT frameworks for AUD and highlights key therapeutic mechanisms that may have transdiagnostic relevance. However, the existing evidence remains preliminary, and findings should be interpreted with caution. The results support the exploration of VR within emerging precision digital mental health approaches, while underscoring the need for further rigorous and standardised research.