Exploring the Therapeutic Potential of Virtual Reality: A Review on the Simulation of Psychedelic Effects for Treating Psychological Disorders

Round 1

Reviewer 1 Report

 Exploring the Therapeutic Potential of Virtual Reality: A Review on the Simulation of Psychedelic Effects for Treating Psychological Disorders 

This review aims to assess the current state of the art concerning the utilization of VR and psychedelic simulations for treating psychological disorders. The findings clarify the potential of an emerging treatment: the simulation of psychedelic states through Virtual Reality. This treatment has been shown to improve cognitive flexibility and executive functions and, as a result, could be used to prevent conditions such as mild cognitive impairment and dementia. Furthermore, this treatment facilitates the activation of other constructs in the subject, such as creativity, joy, pleasure, and relaxation, which can act as mediators in the treatment of various psychopathological disorders. This review attempts to broaden knowledge regarding the simulation of psychedelic states through Virtual Reality, exposing the results in a clinical setting and highlighting the need for further studies.

Overall, the study is well-written and contributes to the existing literature, providing valuable information, particularly regarding the available commercial applications of a promising new technology in virtual reality. However, in my personal opinion, several areas require improvement.

Additionally, although the theme of «creativity, joy, pleasure, and relaxation» through virtual reality is reiterated in the summary, I generally believe that there is insufficient discussion in the manuscript.

While the topic of «preventing conditions such as mild cognitive impairment and dementia» is discussed in the abstract, I did not find sufficient reference or justification within the body of the text. Although there is relevant research on this topic, it is not adequately addressed.

The authors state that a growing body of research suggests that psychedelic substances, such as psilocybin, have significant therapeutic potential for a range of mental health disorders, including depression, anxiety, post-traumatic stress disorder, eating disorders, and various forms of addiction. However, based on the title of the paper, as a review study, more works should be presented on this topic, or the studies mentioned in this paper should be highlighted better.

I consider that the paper overemphasises the description of commercial applications/software available featuring psychedelic scenarios for virtual reality. Ideally, based on the title of the paper, it should better showcase studies that demonstrate the value of psychedelic therapy as a transformative approach to mental health care, in the discussion section.

I believe that the paper should also present the effectiveness and documentation of the applications of virtual reality. For example, do they improve indicators such as quality of life, depression, anxiety, confidence, self esteem, etc? Is this new technology accepted by patients? Is this technology user-friendly and preferred by users? I am aware that there are studies that demonstrate and substantiate the above, and relevant references should be included, to improve the quality of the paper.

As a review study, perhaps including a relevant table could make the results of this study clearer.

I hope the following review studies in the area will be helpful.

Park et al., (2019) A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations. Front. Psychiatry 10:505. doi: 10.3389/fpsyt.2019.00505

Kim, S., & Kim, E. (2019). The Use of Virtual Reality in Psychiatry: A Review. Journal of the Korean Academy of Child and Adolescent Psychiatry, 31(1), 26-32. https://doi.org/10.5765/jkacap.190037

Cieślik, et al., (2020). Virtual reality in psychiatric disorders: A systematic review of reviews. Complementary Therapies in Medicine, 52, 102480. https://doi.org/10.1016/j.ctim.2020.102480

Exploring the Therapeutic Potential of Virtual Reality: A Review on the Simulation of Psychedelic Effects for Treating Psychological Disorders 

This review aims to assess the current state of the art concerning the utilization of VR and psychedelic simulations for treating psychological disorders. The findings clarify the potential of an emerging treatment: the simulation of psychedelic states through Virtual Reality. This treatment has been shown to improve cognitive flexibility and executive functions and, as a result, could be used to prevent conditions such as mild cognitive impairment and dementia. Furthermore, this treatment facilitates the activation of other constructs in the subject, such as creativity, joy, pleasure, and relaxation, which can act as mediators in the treatment of various psychopathological disorders. This review attempts to broaden knowledge regarding the simulation of psychedelic states through Virtual Reality, exposing the results in a clinical setting and highlighting the need for further studies.

Overall, the study is well-written and contributes to the existing literature, providing valuable information, particularly regarding the available commercial applications of a promising new technology in virtual reality. However, in my personal opinion, several areas require improvement.

Additionally, although the theme of «creativity, joy, pleasure, and relaxation» through virtual reality is reiterated in the summary, I generally believe that there is insufficient discussion in the manuscript.

While the topic of «preventing conditions such as mild cognitive impairment and dementia» is discussed in the abstract, I did not find sufficient reference or justification within the body of the text. Although there is relevant research on this topic, it is not adequately addressed.

The authors state that a growing body of research suggests that psychedelic substances, such as psilocybin, have significant therapeutic potential for a range of mental health disorders, including depression, anxiety, post-traumatic stress disorder, eating disorders, and various forms of addiction. However, based on the title of the paper, as a review study, more works should be presented on this topic, or the studies mentioned in this paper should be highlighted better.

I consider that the paper overemphasises the description of commercial applications/software available featuring psychedelic scenarios for virtual reality. Ideally, based on the title of the paper, it should better showcase studies that demonstrate the value of psychedelic therapy as a transformative approach to mental health care, in the discussion section.

I believe that the paper should also present the effectiveness and documentation of the applications of virtual reality. For example, do they improve indicators such as quality of life, depression, anxiety, confidence, self esteem, etc? Is this new technology accepted by patients? Is this technology user-friendly and preferred by users? I am aware that there are studies that demonstrate and substantiate the above, and relevant references should be included, to improve the quality of the paper.

As a review study, perhaps including a relevant table could make the results of this study clearer.

I hope the following review studies in the area will be helpful.

Park et al., (2019) A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations. Front. Psychiatry 10:505. doi: 10.3389/fpsyt.2019.00505

Kim, S., & Kim, E. (2019). The Use of Virtual Reality in Psychiatry: A Review. Journal of the Korean Academy of Child and Adolescent Psychiatry, 31(1), 26-32. https://doi.org/10.5765/jkacap.190037

Cieślik, et al., (2020). Virtual reality in psychiatric disorders: A systematic review of reviews. Complementary Therapies in Medicine, 52, 102480. https://doi.org/10.1016/j.ctim.2020.102480

Author Response

Exploring the Therapeutic Potential of Virtual Reality: A Review on the Simulation of Psychedelic Effects for Treating Psychological Disorders 

This review aims to assess the current state of the art concerning the utilization of VR and psychedelic simulations for treating psychological disorders. The findings clarify the potential of an emerging treatment: the simulation of psychedelic states through Virtual Reality. This treatment has been shown to improve cognitive flexibility and executive functions and, as a result, could be used to prevent conditions such as mild cognitive impairment and dementia. Furthermore, this treatment facilitates the activation of other constructs in the subject, such as creativity, joy, pleasure, and relaxation, which can act as mediators in the treatment of various psychopathological disorders. This review attempts to broaden knowledge regarding the simulation of psychedelic states through Virtual Reality, exposing the results in a clinical setting and highlighting the need for further studies.

Overall, the study is well-written and contributes to the existing literature, providing valuable information, particularly regarding the available commercial applications of a promising new technology in virtual reality. However, in my personal opinion, several areas require improvement.

Additionally, although the theme of «creativity, joy, pleasure, and relaxation» through virtual reality is reiterated in the summary, I generally believe that there is insufficient discussion in the manuscript.

Thank you for your insightful comments. In response to your suggestions, we have expanded the discussion on these topics, providing additional examples to support our statements. We trust that these revisions will address your concerns and enhance the clarity of our work. Thank you once again for your valuable input.

While the topic of «preventing conditions such as mild cognitive impairment and dementia» is discussed in the abstract, I did not find sufficient reference or justification within the body of the text. Although there is relevant research on this topic, it is not adequately addressed.

We concur with your observation. We have addressed the lack of references and justification in the main body of the text by adding more information. 
Additionally, we have included the following references:

• Zhong D, Chen L, Feng Y, et al. Effects of virtual reality cognitive training in individuals with mild cognitive impairment: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021; 36(12): 1829-1847. https://doi.org/10.1002/gps.5603
• de Souza LC, Volle E, Bertoux M, Czernecki V, Funkiewiez A, Allali G, Leroy B, Sarazin M, Habert MO, Dubois B, Kas A, Levy R. Poor creativity in frontotemporal dementia: a window into the neural bases of the creative mind. Neuropsychologia. 2010 Nov;48(13):3733-42. doi: 10.1016/j.neuropsychologia.2010.09.010. Epub 2010 Sep 22. PMID: 20868703.
• Price KA, Tinker AM. Creativity in later life. Maturitas. 2014 Aug;78(4):281-6. doi: 10.1016/j.maturitas.2014.05.025. Epub 2014 Jun 7. PMID: 24974278.

Thank you once again for bringing this aspect to our attention.

The authors state that a growing body of research suggests that psychedelic substances, such as psilocybin, have significant therapeutic potential for a range of mental health disorders, including depression, anxiety, post-traumatic stress disorder, eating disorders, and various forms of addiction. However, based on the title of the paper, as a review study, more works should be presented on this topic, or the studies mentioned in this paper should be highlighted better.

We didn't explore it as we felt it might stray off-topic, but thanks to your careful observation, we have enhanced the section on psychedelic therapies with some additional elements. 

I consider that the paper overemphasises the description of commercial applications/software available featuring psychedelic scenarios for virtual reality. Ideally, based on the title of the paper, it should better showcase studies that demonstrate the value of psychedelic therapy as a transformative approach to mental health care, in the discussion section.

We greatly appreciate your consideration as it enables us to significantly improve our paper. In fact, we have streamlined the section describing the applications, thus placing greater emphasis on the evidence supporting the efficacy of the studies, where available.

I believe that the paper should also present the effectiveness and documentation of the applications of virtual reality. For example, do they improve indicators such as quality of life, depression, anxiety, confidence, self esteem, etc? Is this new technology accepted by patients? Is this technology user-friendly and preferred by users? I am aware that there are studies that demonstrate and substantiate the above, and relevant references should be included, to improve the quality of the paper.

Thank you for your note. Thanks to this, we have been able to incorporate such information, which we already possessed, and deemed it appropriate to include it in the "Possibilities and Boundaries of VR" section.

As a review study, perhaps including a relevant table could make the results of this study clearer.

Thank you for your suggestion. You can find in the supplementary material a data extraction table summarizing the characteristics of the studies and the main outcomes.

I hope the following review studies in the area will be helpful.
 
Park et al., (2019) A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations. Front. Psychiatry 10:505. doi: 10.3389/fpsyt.2019.00505

Kim, S., & Kim, E. (2019). The Use of Virtual Reality in Psychiatry: A Review. Journal of the Korean Academy of Child and Adolescent Psychiatry, 31(1), 26-32. https://doi.org/10.5765/jkacap.190037

Cieślik, et al., (2020). Virtual reality in psychiatric disorders: A systematic review of reviews. Complementary Therapies in Medicine, 52, 102480. https://doi.org/10.1016/j.ctim.2020.102480
 
Thank you very much for the highly valuable references you recommended. We found them to be very interesting, to the extent that we incorporated them into our paper and made them a part of our work.

Reviewer 2 Report

Dear authors,

Psychology International is a journal that publishes original articles and reviews in the field of psychology, aiming to contribute to a comprehensive understanding of human behavior and mental processes. As it provides a platform for the dissemination of high-quality research across various subfields, the current paper is well-aligned with the scope of the journal.

The topic of psychological research on the therapeutic potential of virtual reality is relevant and contributes to a greater understanding of this emerging therapeutic approach.

I believe that some of the keywords used in the paper may be redundant, and authors should consider focusing on the main keywords addressed in the manuscript.

While this comprehensive review aimed to provide a deeper understanding of the current state of the art, it did not fully follow to the guidelines of the journal. Despite the presence of a supplementary file with data extraction, the inclusion of a Materials and Methods section is crucial for the publication of the paper. Furthermore, in the discussion and conclusions sections, the paper falls short of its aim to offer insights into the future possibilities of VR in mental health treatment. In my opinion, these insights were poorly addressed, leaving the discussion somewhat lacking in depth.

Therefore, I strongly recommend that the article should be edited carefully before resubmission to Psychology International.

Author Response

Major comments

Dear authors,
Psychology International is a journal that publishes original articles and reviews in the field of psychology, aiming to contribute to a comprehensive understanding of human behavior and mental processes. As it provides a platform for the dissemination of high-quality research across various subfields, the current paper is well-aligned with the scope of the journal.
The topic of psychological research on the therapeutic potential of virtual reality is relevant and contributes to a greater understanding of this emerging therapeutic approach.

Thank you for kind words and compliments, we agree with you.

Detail comments

I believe that some of the keywords used in the paper may be redundant, and authors should consider focusing on the main keywords addressed in the manuscript.
While this comprehensive review aimed to provide a deeper understanding of the current state of the art, it did not fully follow to the guidelines of the journal. Despite the presence of a supplementary file with data extraction, the inclusion of a Materials and Methods section is crucial for the publication of the paper. Furthermore, in the discussion and conclusions sections, the paper falls short of its aim to offer insights into the future possibilities of VR in mental health treatment. In my opinion, these insights were poorly addressed, leaving the discussion somewhat lacking in depth.
Therefore, I strongly recommend that the article should be edited carefully before resubmission to Psychology International.

We appreciate your kind words. 
Firstly, we have modified the keywords as recommended to improve coherence with the paper. Additionally, As suggested, we have included a Methodology section where the procedure for writing this literature review is more thoroughly described. In doing so, we adhere to the guidelines of the journal regarding this type of paper ("Review sections: a literature review organized logically within specific sections and subsections (optional)"). Thus, we believe we have addressed the concern you raised.
Regarding the future implications of VR, research in this field still has many steps to take before considering many of the existing results reliable. Nevertheless, we have speculated on some future applications of VR that could enhance the treatment of mental disorders, incorporating them into both the Discussion and Conclusion sections.

Round 2

Reviewer 1 Report

No comments

No comments

Reviewer 2 Report

Dear authors,

I appreciate the enormous effort that you have taken to improve the overall quality of the manuscript and to respond to the reviewers' questions and concerns in order to explore the therapeutic potential of VR trough the assessment of the current state of the art on the topic.

In my opinion the paper is now suitable for publication.

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