Post-traumatic stress disorder (PTSD) is one of the most common mental comorbidities among participants in armed conflicts; a significant portion of patients do not reach remission after standard therapeutic protocols. VRET technology (virtual reality exposure therapy) combines the principles of classical exposure therapy with a multisensory immersive environment and is considered a reasonable alternative or supplement to existing methods.

The aim of this systematic review is to analyze the evidence base for the effectiveness of VRET in veterans with PTSD and to examine the neurobiological and psychophysiological mechanisms that determine clinical outcomes. According to established criteria, 19 sources from the PubMed database from 2009—2024 were selected. VRET shows a statistically significant advantage over control conditions within a ‘moderate-to-large’ effect, is as effective as or exceeds prolonged exposure in patients with treatment-resistant PTSD, is characterized by an acceptable tolerability profile and potentially higher patient engagement. Cortisol levels during sessions and features of autonomic reactivity are significant predictors of therapeutic outcomes. Dissociative symptoms and factitious disorder are key limitations of the method that need to be considered when planning the course.