What Are the Ethical Issues Surrounding Extended Reality in Mental Health? A Scoping Review of the Different Perspectives.

As extended reality (XR) technologies such as virtual and augmented reality rapidly enter mental health care, ethical considerations lag behind and require urgent attention to safeguard patient safety, uphold research integrity, and guide clinical practice. This scoping review aims to map the current understanding regarding the main ethical issues arising on the use of XR in clinical psychiatry. METHODS: Searches were conducted in 5 databases and included 29 studies. Relevant excerpts discussing ethical issues were documented and then categorized. RESULTS: The analysis led to the identification of 5 core ethical challenges: (i) Balancing beneficence and non-maleficence as a question of patient safety, (ii) Altering autonomy by altering reality and information, (iii) data privacy risks and confidentiality concerns, (iv) clinical liability and regulation, and v) fostering inclusiveness and equity in XR development. Most authors have stated ethical concerns primarily for the first two topics, whereas the remaining four themes were not consistently addressed across all papers. CONCLUSIONS: There remains a great research void regarding such an important topic due the limited number of empirical studies, the lack of involvement of those living with a mental health issue in the development of these XR-based technologies, and the lack of clear clinical and ethical guidelines regarding their use. Identifying broader ethical implications of such novel technology is crucial for best mental healthcare practices.