The Journey From Nonimmersive to Immersive Multiuser Applications in Mental Health Care: Systematic Review

Background: Over the past 25 years, the development of multiuser applications has seen considerable advancements andchallenges. The technological development in this field has emerged from simple chat rooms through videoconferencing toolsto the creation of complex, interactive, and often multisensory virtual worlds. These multiuser technologies have gradually foundtheir way into mental health care, where they are used in both dyadic counseling and group interventions. However, somelimitations in hardware capabilities, user experience designs, and scalability may have hindered the effectiveness of theseapplications.Objective: This systematic review aims at summarizing the progress made and the potential future directions in this field whileevaluating various factors and perspectives relevant to remote multiuser interventions.Methods: The systematic review was performed based on a Web of Science and PubMed database search covering articles inEnglish, published from January 1999 to March 2024, related to multiuser mental health interventions. Several inclusion andexclusion criteria were determined before and during the records screening process, which was performed in several steps.Results: We identified 49 records exploring multiuser applications in mental health care, ranging from text-based interventionsto interventions set in fully immersive environments. The number of publications exploring this topic has been growing since2015, with a large increase during the COVID-19 pandemic. Most digital interventions were delivered in the form ofvideoconferencing, with only a few implementing immersive environments. The studies used professional or peer-supportedgroup interventions or a combination of both approaches. The research studies targeted diverse groups and topics, from nursingmothers to psychiatric disorders or various minority groups. Most group sessions occurred weekly, or in the case of the peer-supportgroups, often with a flexible schedule.Conclusions: We identified many benefits to multiuser digital interventions for mental health care. These approaches providedistributed, always available, and affordable peer support that can be used to deliver necessary help to people living outside ofareas where in-person interventions are easily available. While immersive virtual environments have become a common tool inmany areas of psychiatric care, such as exposure therapy, our results suggest that this technology in multiuser settings is still inits early stages. Most identified studies investigated mainstream technologies, such as videoconferencing or text-based support,substituting the immersive experience for convenience and ease of use. While many studies discuss useful features of virtualenvironments in group interventions, such as anonymity or stronger engagement with the group, we discuss persisting issues withthese technologies, which currently prevent their full adoption