Effectiveness of Augmented and Virtual Reality-Based Interventions in Improving Knowledge, Attitudes, Empathy and Stigma Regarding People with Mental Illnesses-A Scoping Review

Mental illnesses affect approximately 11% of the global population and are a major contributor to disability-adjusted life years. People with mental illness often face discrimination, highlighting the importance of mental health literacy—knowledge and awareness concerning prevention, identification, and management—which is associated with better help-seeking, recovery, adherence, therapeutic alliance, and reduced severity. Empathy, the ability to understand others’ experiences, can help destigmatize mental illness. Stigma comprises negative beliefs and attitudes that contribute to discrimination and exclusion. Augmented reality (AR) and virtual reality (VR) are increasingly used in healthcare and education, offering immersive, realistic simulations that facilitate learning and training. While VR has broad therapeutic use across multiple psychiatric conditions, fewer studies have evaluated AR/VR as psychoeducational tools to improve knowledge, attitudes, empathy, and stigma regarding people with mental illnesses. This scoping review aims to evaluate the effectiveness (as indicated by improvements in ratings) of AR/VR-based interventions on these outcomes.

AR blends digital and real-world information, while VR presents entirely virtual environments (desktop or fully immersive). AR/VR technologies are widely used in healthcare education due to their capacity for realistic simulations that enhance motivation, engagement, and deeper learning, potentially outperforming traditional methods. VR has been used therapeutically for neurodevelopmental disorders, anxiety disorders (including phobias), OCD, PTSD, and cognitive impairments in older adults. Prior research suggests AR/VR can improve knowledge and attitudes toward mental illness and reduce stigma, though evidence is less extensive compared to therapeutic applications. Theoretical and empirical literature indicates that immersive experiences and perceived affinity with virtual characters can influence empathy, while stigma is multifactorial and shaped by micro-, meso-, and macro-level factors. Earlier reviews in dementia education suggest AR/VR may enhance knowledge and attitudes among healthcare trainees.

This scoping review followed the Joanna Briggs Institute (JBI) methodology and a modified Arksey and O’Malley framework (as updated by Levac et al.). Research question: What is the effectiveness (evidenced by improved ratings) of AR/VR-based interventions on knowledge, attitudes, empathy, and stigma related to people with mental illness? Searches were conducted across CINAHL, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, ScienceDirect, and Scopus from inception to April 2022. Search terms included combinations of ‘virtual reality’ or ‘augmented reality’ with ‘knowledge’, ‘attitude’, ‘empathy’, ‘stigma’, ‘social distance’, and specific conditions (depression, schizophrenia, bipolar disorder). Inclusion criteria: primary research studies on AR/VR-based interventions reporting relevant outcomes related to people with mental illnesses, published in English, with no population restrictions. Exclusion criteria: non-empirical papers, opinion articles, dissertations, or studies lacking the primary outcomes. Two independent reviewers screened titles and abstracts, with disagreements resolved by discussion and a third reviewer. Data extraction included author, year, participant characteristics, intervention details, and main findings. Results were charted and summarized; a PRISMA flow diagram was used. Risk of bias was assessed using Cochrane’s tool (summarized in Appendix A).

- Sixteen studies were included. Sample sizes ranged from 16 to 579 per group, encompassing undergraduates (68.8%), high school students, patients, caregivers, and the public. Designs included 4 RCTs, 10 quasi-experiments, 1 descriptive study, and 1 prospective cohort. Most studies were from Western countries; conditions examined included psychotic disorders, dementia, anxiety, and depression. One study used AR; the rest used VR. - Knowledge (9 studies): Two-thirds (6/9) reported increased knowledge about mental illness after VR interventions. Improvements were noted in understanding psychosis, hallucinations, and dementia; mixed results for dementia knowledge were reported across two Virtual Dementia Tour studies. A VR medication adherence task improved understanding of adherence-related cues (e.g., reminder notes, clocks). - Attitudes (8 studies): Over half (5/8) reported improved attitudes toward people with mental illness post-intervention. Positive changes were observed for psychotic disorders and dementia; some studies using serious games (e.g., Stigma-Stop) showed participants felt more able to help characters with various conditions. - Empathy (7 studies): All studies reported improvements in empathy toward individuals with dementia or psychosis following AR/VR exposure, measured via validated empathy scales (e.g., Clinical Empathy Scale, Comprehensive State Empathy Scale). Some improvements were specific to subscales (e.g., perspective-taking). - Stigma (7 studies): Most (5/7) reported reduced stigma within or between groups for dementia, psychotic disorders, and mixed anxiety/depression. Two studies found increased stigma post-intervention—one AR simulation of hallucinations with medical students and one VR contact scenario compared with video control. - Overall synthesis: Across included studies, improvements were observed in knowledge (66.7% of knowledge studies), attitudes (62.5% of attitude studies), empathy (100%), and stigma reduction (71.4% of stigma studies).

The review indicates that AR/VR-based interventions can enhance mental health literacy (knowledge), foster more positive attitudes, increase empathy, and generally reduce stigma toward people with mental illness. Mechanistically, immersive simulations and experiential learning allow participants to better understand symptoms (e.g., hallucinations) and daily challenges, thereby improving engagement and learning outcomes. Empathy gains appeared robust across different VR modalities, with evidence suggesting that character-participant affinity may be more influential than specific design features. However, stigma outcomes were mixed: while many interventions reduced stigma, two increased it, possibly due to limited opportunities for participants to reflect and contextualize simulated experiences, the complex multi-level nature of stigma, perceived character likeability/affinity, and discomfort or overwhelm caused by VR that may hinder engagement. These findings support AR/VR as valuable adjuncts in education and public engagement regarding mental illness, while underscoring the need to carefully design interventions to avoid unintended increases in stigma.

In a limited but growing evidence base, AR/VR interventions show promise in improving knowledge, attitudes, empathy, and in reducing stigma concerning people with mental illnesses. Future work should compare AR versus VR modalities, assess durability of effects over time and across different mental conditions, and evaluate scalability among diverse populations including healthcare professionals, trainees, and international cohorts using standardized outcome measures.

- Most studies were conducted in Western settings and among undergraduate populations, limiting generalizability. - Many studies had small to modest sample sizes, heterogeneous outcome measures, and methodological limitations (e.g., lack of control groups, randomization, or blinding). - No restrictions by population increased heterogeneity. - Interventions varied widely in hardware (headsets) and content (AR/VR modality and design), complicating cross-study comparisons.