Psychache refers to intensely painful psychological suffering and is a major factor leading to emotional withdrawal and avoidance of mental healthcare, especially among urban youth. Despite the rapid growth of digital mental health interventions, many distressed individuals still feel psychologically unprepared to seek professional support, which maintains a continuous gap between experiencing distress and seeking help. Psychological distress is often characterised by emotional avoidance, stigma, and internal cognitive resistance, which delay engagement with professional mental health support (Gulliver et al., 2010; Parkar et al., 2023). Shneidman’s theory of psychache conceptualises intense psychological pain as a central driver of emotional withdrawal and cognitive constriction, limiting individuals’ ability to perceive coping alternatives or seek support (Shneidman, 1993). This paper presents a conceptual framework that repositions Virtual Reality as a pre-therapeutic digital health tool rather than a treatment modality. Using a narrative thematic synthesis of literature on psychache, help-seeking behaviour, and immersive digital technologies, the paper introduces the Digital Gateway Model. The model conceptualises Virtual Reality as an upstream engagement tool that facilitates emotional readiness, reduces cognitive constriction, and enhances readiness for human-led psychological care (Rizzo Zhao et al., 2025). Instead of replacing traditional therapy, the Digital Gateway Model integrates Virtual Reality into a comprehensive digital clinical continuum, preserving the importance of the therapeutic alliance. This framework advances digital mental health research by highlighting the help-seeking phase before therapy and proposes future research directions for designing engagement-focused systems for urban youth.
Rai et al. (Tue,) studied this question.