Mental healing through immersive play: An umbrella review

Abstract This umbrella review explores the effects of Extended Reality (XR) and Game-Based Interventions (GBI) on anxiety, depression, and stress, covering augmented (AR), virtual (VR), and mixed reality (MR), along with serious games, gamification, game-based learning and training, exergames, and commercial video games. Following PRISMA and AMSTAR 2 guidelines, 201 articles were screened, with 16 reports selected (nine meta-analyses, six systematic reviews, and one scoping review). Findings highlight XR-GBI’s potential as a promising, flexible, and replicable intervention, demonstrating significant preliminary mental health improvement across children, adolescents, adults, and older people. Regarding anxiety, VR aids preoperative and procedural anxiety, promotes distraction and relaxation, and supports VR exposure therapy (VRET), matching Cognitive Behavioral Therapy (CBT) effectiveness with higher engagement. For depression, VRET reduces symptoms, while VR exergames combining physical activity and engagement show strong antidepressant effects. Stress management remains less explored, though AR video games enhance cognitive and social well-being, and VRET alleviates stress symptoms. Despite the XR-GBI promise, research is still emerging, with publications only beginning to expand recently, few randomized controlled trials, and methodological limitations. From our findings, we highlight practical and theoretical implications by showing how XR-GBI rely on core technical features and proposing a five-pathway theoretical model (cognitive, emotional, bodily, social, and motivational) that systematizes their potential for mental health, guiding future design, evaluation, and research. Further research should also expand on AR, MR, gamification, game-based learning and training, biofeedback, neurophysiological assessment, and social dynamics, while integrating artificial intelligence, digital mental health literacy, and psychoeducation to enhance XR-GBI’s impact.