Virtual reality-based stress paradigms and early adversity: a scoping review of mechanisms and stress-response systems.

BACKGROUND/

OBJECTIVES

Virtual reality (VR)-based stress paradigms are increasingly used to induce stress in controlled yet ecologically valid settings. However, the diversity of VR-based stress paradigms and their differential engagement of stress-response systems remain insufficiently synthesized. This scoping review aimed to map VR stress paradigms and examine how they engage subjective, autonomic, endocrine, neural, and behavioral responses, while considering the role of early adversity.

METHODS

A structured literature search was conducted across Web of Science, ScienceDirect, SpringerLink, and Google Scholar for studies published between January 2012 and June 2026. Eligible studies used VR to induce stress and assessed psychological and/or physiological outcomes. After screening, 21 studies were included and grouped into clusters based on shared mechanisms and methodological features.

RESULTS

Five clusters were identified: (1) social-evaluative, (2) cognitive/performance-based, (3) threat/fear-based, (4) analogue trauma, and (5) complex ecologically valid paradigms, with implications for stress-related behavioral outcomes, including eating behavior. VR consistently elicited subjective and autonomic responses, while endocrine and neural responses varied by paradigm type. Social-evaluative paradigms showed robust subjective and autonomic activation with variable hypothalamic-pituitary-adrenal axis responses. Threat-based paradigms elicited strong autonomic and affective responses, whereas cognitive paradigms were associated with performance-related stress and limited endocrine activation. Evidence on early adversity suggested differential sensitivity to specific stressor types; however, only a subset of studies directly assessed adverse childhood experiences or childhood trauma, and its role as a moderator of stress reactivity remains underexplored.

CONCLUSIONS

VR-based stress paradigms do not induce stress as a unitary construct but selectively engage distinct response systems depending on paradigm characteristics. Integrating early adversity may enhance the precision of VR-based stress research. This framework may support future investigations of stress-related behaviors, including eating behavior, in ecologically valid environments. It may also offer promising applications for personalized nutrition; however, these implications were not directly assessed in the included studies.