Mechanisms and clinical potential of combined tDCS and virtual reality in psychiatric disorders: a systematic review

Although seven small, heterogeneous studies indicate that combined tDCS-VR is feasible and shows preliminary therapeutic promise-most consistently in PTSD and, to a lesser extent, in specific phobias-the overall evidence base remains limited. Mechanistic findings suggesting modulation of medial and ventromedial prefrontal-amygdala circuits are still exploratory. Given substantial methodological heterogeneity, small sample sizes, and risk of bias, tDCS-VR should be regarded as experimental. The larger, well‑designed, disorder‑tailored randomized controlled trials using standardized stimulation/VR protocols, mechanistic outcome measures, and efforts to identify predictors of response are required before routine clinical implementation.