Virtual reality therapy is a feasible and tolerable adjunct to ketamine treatment for PTSD and depression
Safa Rubaye, Aditya Shah, Waleed Aldulaimy, Ashley Hernandez
Discover Mental Health October 27, 2026 DOI: 10.1007/s44192-026-00643-w (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Patients who received a ketamine treatment course with or without adjunct virtual reality and had baseline and post-treatment symptom assessments |
| Interventions | Ketamine Virtual reality |
| Measures | PHQ-9, GAD-7, PCL-5, PSS |
| Topics | Depression Esketamine Ketamine PTSD |
| Key findings | Adjunct virtual reality during ketamine treatment was associated with low rates of adverse effects and a treatment course length comparable to treatment without VR. Within the VR group, all symptom measures improved significantly from baseline, but between-group comparisons showed no significant differences after correction for multiple testing, suggesting clinical outcomes were broadly comparable with and without VR. |
Abstract
Ketamine is an important intervention for severe depression and trauma-related psychopathology, but the optimal way to provide therapeutic support during treatment remains unclear. Although ketamine-assisted psychotherapy is clinically appealing, maintaining therapist presence throughout every dosing session can be logistically difficult. Virtual reality (VR) may offer a structured, scalable, therapist-sparing adjunct delivered during ketamine sessions while preserving a therapeutic frame. This retrospective chart review evaluated the feasibility and tolerability of adjunct VR during ketamine treatment and examined exploratory clinical outcomes relative to treatment without VR. Patients were included if they received a ketamine treatment course with or without VR and had both baseline and post-treatment symptom assessments. Of 69 patients with a documented ketamine course, 28 met this requirement and formed the analytic cohort: 19 treated with VR and 9 without VR. Primary outcomes were feasibility and tolerability, assessed using treatment-course burden and chart-documented adverse effects, with vital signs monitored during each session. Secondary outcomes were changes in PHQ-9, GAD-7, PCL-5, and PSS scores from baseline to follow-up. Within-group change was tested with Wilcoxon signed-rank tests, and between-group comparisons used Mann-Whitney U tests. Adjunct VR was associated with low rates of adverse effects and a treatment course length comparable to the no-VR group. Within the VR cohort, significant improvement was observed across all symptom measures. Between-group analyses did not show significant differences after correction for multiple testing. These findings suggest that VR is a feasible and tolerable adjunct to ketamine treatment, with clinical outcomes broadly comparable to treatment without VR. Not applicable.
Comparable studies
Other observational and cohort studies on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault | 2008 | Observational cohort | n = 6 |
| An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... | 2017 | Observational study using ambulatory polysomnography | n = 35 |
| Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares | 2004 | Observational cohort | n = 44 |
| Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs | 2001 | Observational study | |
| Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD | 2018 | Retrospective review | n = 37 |