Metaverse ve Psikiyatri: Bir Gözden Geçirme

Öz

Günümüzde teknolojinin gelişimiyle birlikte sanal dünya kavramı giderek önem kazanmaktadır. Son yıllarda popüler hale gelen "Metaverse" ise, dijital dünyada insanların sanal olarak etkileşimde bulunabilecekleri, iş yaptığı, eğlendiği ve hatta yaşadığı bir ortam sunmayı hedeflemektedir. Son yıllarda giderek popülerleşen Metaverse, ruh sağlığı alanında da birçok farklı kullanım alanı sunmaktadır. Ancak, bu teknolojinin ruh sağlığı üzerindeki etkileri hakkında henüz yeterli bilgiye sahip değiliz. Metaverse'in ruh sağlığı üzerindeki etkisi, psikolojik rahatsızlıkların tedavisi, stres azaltma, özgüven kazandırma, sosyal etkileşim becerilerinin geliştirilmesi gibi alanlarda kullanılabileceği yönünde birçok araştırmaya konu olmuştur. Metaverse'in psikiyatrik tedavi için kullanımının en büyük avantajı, sanal dünyanın gerçek dünyadan ayrılmış olmasıdır. Bu nedenle, tedavi sırasında yaşanan stres, kaygı ve diğer duygusal tepkilerin gerçek hayatta olabilecek sonuçları yoktur. Ayrıca, sanal dünyada terapiste erişim daha kolaydır ve hastaların tedaviye daha kolay uyum sağlamalarına yardımcı olabilir. Ancak, Metaverse'in psikiyatrik tedavi için kullanımının bazı dezavantajları da vardır. Örneğin, bu tedavi yöntemi bazı hastalar için gerçeklikten kopuk bir deneyim olabilir ve bazıları için de yeterince etkili olmayabilir. Ayrıca, bu tedavi yöntemi, yüksek maliyetli ekipman ve teknoloji gerektirdiğinden, erişilebilirliği sınırlıdır. Özellikle psikiyatrik hastalıkların tanı ve tedavisinde Metaverse kullanımıyla ilişkisi hakkında yeterli araştırma yapılmamıştır. Metaverse'in ruh sağlığı üzerindeki etkisi hakkında daha fazla araştırmaya ihtiyaç vardır. Özellikle, uzun vadeli etkileri ve farklı insanlar üzerindeki etkileri konusunda daha fazla çalışma yapılması gerekmektedir. Bu derlemede, Metaverse teknolojisi ile psikiyatri arasındaki potansiyel ilişkiyi inceleyerek, bu teknolojinin psikiyatrik alanda nasıl kullanılabileceğini araştıran çalışmalar gözden geçirilmiştir.

Anahtar Kelimeler

• metaverse
• psikiyatrik bozukluklar
• ruh sağlığı
• yapay zekâ

Metaverse and Psychiatry: A Review

Abstract

Today, with the development of technology, the concept of the virtual world is gaining more and more importance. "Metaverse", which has become popular in recent years, aims to provide an environment where people can interact, do business, have fun and even live in the digital world. Metaverse, which has become increasingly popular in recent years, offers many different uses in the field of mental health. However, we do not yet have enough information about the effects of this technology on mental health. The effect of Metaverse on mental health has been the subject of many researches that it can be used in areas such as the treatment of psychological disorders, stress reduction, self-confidence, and development of social interaction skills. The biggest advantage of using Metaverse for psychiatric treatment is that the virtual world is separated from the real world. Therefore, the stress, anxiety and other emotional reactions experienced during treatment have no real-life consequences. In addition, the therapist is easier to access in the virtual world and can help patients adapt to treatment more easily. However, the use of Metaverse for psychiatric treatment also has some disadvantages. For example, this method of treatment may be an unrealistic experience for some patients and not effective enough for others. Also, this treatment modality has limited accessibility as it requires high cost equipment and technology. In particular, there has not been enough research on the relationship between the use of Metaverse in the diagnosis and treatment of psychiatric diseases. More research is needed on the effect of Metaverse on mental health. In particular, more studies are needed on its long-term effects and effects on different people. In this review, studies investigating the potential relationship between Metaverse technology and psychiatry and how this technology can be used in the psychiatric field are reviewed.

Keywords

• metaverse
• psychiatric disorders
• mental health
• artificial intelligence

Kaynakça

1. Abbas L, Dodeen H (2022) Body dysmorphic features among snapchat users of “Beauty-Retouching of Selfies” and its relationship with quality of life. Media Asia, 49:196-212.
2. Ahmadi M, Peyravi M, Shaygani F (2022) A revolution in health: Opportunities and challenges of the Metaverse. EXCLI J, 21:791-792.
3. Anderson PL, Price M, Edwards SM, Obasaju MA, Schmertz SK, Zimand E et al. (2013) Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol, 81:751-760.
4. Andrews C, Southworth MK, Silva JNA, Silva JR (2019) Extended reality in medical practice. Curr Treat Options Cardiovasc Med, 21:1-12.
5. Antão J, Abreu LC, Barbosa RTA, Crocetta TB, Guarnieri R, Massetti T et al. (2020) Use of augmented reality with a motion-controlled game utilizing alphabet letters and numbers to improve performance and reaction time skills for people with autism spectrum disorder. Cyberpsychol Behav Soc Netw, 23:16-22.
6. Balasubramanian S (2021) The next frontier for healthcare: Augmented reality, virtual reality, and the metaverse. https://www.forbes.com/sites/saibala/2021/11/29/the-next-frontier-for-healthcareaugmented-reality-virtual-reality-and-the-metaverse/?sh=11b7f67c2894 (Accessed 07.04.2023)
7. Bansal G, Rajgopal K, Chamola V, Xiong Z, Niyato D (2022) Healthcare in metaverse: a survey on current metaverse applications in healthcare. IEEE Access, 10:119914-119946.
8. Bell IH, Nicholas J, Alvarez-Jimenez M, Thompson A, Valmaggia L (2022) Virtual reality as a clinical tool in mental health research and practice. Dialogues Clin Neurosci, 22:169-177.

9. Benrimoh D, Chheda FD, Margolese HC (2022) The best predictor of the future the metaverse, mental health, and lessons learned from current technologies. JMIR Ment Health, 9:e40410.
10. Blanke O, Slater M, Serino A (2015) Behavioral, neural, and computational principles of bodily self-consciousness. Neuron, 88:145-166.
11. Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R (2017) Recent progress in virtual reality exposure therapy for phobias: a systematic review. Curr Psychiatry Rep, 19:42.
12. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, et al. (2019) Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. J Anxiety Disord, 61:27-36.
13. Cerasa A, Gaggioli A, Marino F, Riva G, Pioggia G (2022) The promise of the metaverse in mental health: the new era of MEDverse. Heliyon, 8:e11762.
14. Chang YJ, Kang YS, Huang PC (2013) An augmented reality (AR)-based vocational task prompting system for people with cognitive impairments. Res Dev Disabil, 34:3049-3056.
15. Ciążyńska J, Maciaszek J (2022) Various types of virtual reality-based therapy for eating disorders: a systematic review. J Clin Med, 11:4956.
16. Clark A (2013) Whatever next? Predictive brains, situated agents, and the future of cognitive science. Behav Brain Sci, 36:181-204.
17. Clus D, Larsen ME, Lemey C, Berrouiguet S (2018) The use of virtual reality in patients with eating disorders: systematic review. J Med Internet Res, 20:e157.
18. Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C et al. (2020) Stanford accelerated intelligent neuromodulation therapy for treatment-resistant depression. Am J Psychiatry, 177:716-726.
19. Cottraux J, Note I, Yao SN, de Mey-Guillard C, Bonasse F, Djamoussian D et al. (2008) Randomized controlled comparison of cognitive behavior therapy with Rogerian supportive therapy in chronic post-traumatic stress disorder: a 2-year follow-up. Psychother Psychosom, 77:101-110.
20. Crowell C, Sayis B, Benitez JP, Pares N (2020) Mixed reality, full-body interactive experience to encourage social initiation for autism: Comparison with a control nondigital intervention. Cyberpsychol Behav Soc Netw, 23:5-9.
21. Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M (2021) Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder. J Anxiety Disord, 80:102404.
22. Dellazizzo L, Potvin S, Luigi M, Dumais A (2020) Evidence on virtual reality-based therapies for psychiatric disorders: Meta-review of meta-analyses. J Med Internet Res, 22:e20889..
23. Deng W, Hu D, Xu S, Liu X, Zhao J, Chen Q et al. (2019) The efficacy of virtual reality exposure therapy for PTSD symptoms: A systematic review and meta-analysis. J Affect Disord, 257:698-709.
24. Díaz-Chieng LY, Auza-Santiváñez JC, Castillo JIR (2022) The future of health in the metaverse. Metaverse Basic and Applied Research, 1:1.
25. Difede J, Hoffman HG (2002) Virtual reality exposure therapy for world trade center post-traumatic stress disorder: A case report. Cyberpsychol Behav, 5:529-535.
26. Dwivedi YK, Hughes L, Baabdullah AM, Ribeiro-Navarrete S, Giannakis M, Al-Debei MM et al. (2022) Metaverse beyond the hype: Multidisciplinary perspectives on emerging challenges, opportunities, and agenda for research, practice and policy. Int J Inf Manage, 66:102542.
27. Emmelkamp PMG, Meyerbröker K, Morina N (2020) Virtual reality therapy in social anxiety disorder. Curr Psychiatry Rep, 22:32.
28. Ferrand M, Ruffault A, Tytelman X, Flahault C, Négovanska V (2015) A cognitive and virtual reality treatment program for the fear of flying. Aerosp Med Hum Perform, 86:723-727.
29. Freeman D, Bradley J, Antley A, Bourke E, DeWeever N, Evans N et al. (2016) Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction. Br J Psychiatry, 209:62-67.
30. Freeman D, Reeve S, Robinson A, Ehlers A, Clark D, Spanlang B et al. (2017) Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol Med, 47:2393-2400.
31. Garden G (2005) Physical examination in psychiatric practice. Adv Psychiatr Treat, 11:142-149.
32. Georgescu R, Fodor LA, Dobrean A, Cristea IA (2020) Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. Psychol Med, 50:1795-1807.
33. Goharinejad S, Goharinejad S, Hajesmaeel-Gohari S, Bahaadinbeigy K (2022) The usefulness of virtual, augmented, and mixed reality technologies in the diagnosis and treatment of attention deficit hyperactivity disorder in children: an overview of relevant studies. BMC Psychiatry, 22:4.
34. Good A, Gnanayutham P, Sambhanthan A, Panjganj V (2013) HCI considerations in designing a second life virtual therapeutic community for the support & treatment of people with borderline personality disorder. arXiv, doi: arXiv.1302.5497.
35. Groft SC, Posada M, Taruscio D (2021) Progress, challenges and global approaches to rare diseases. Acta Paediatr, 110:2711-2716.
36. Heo S, Park JH (2022) Effects of virtual reality-based graded exposure therapy on ptsd symptoms: a systematic review and meta-analysis. Int J Environ Res Public Health, 19:15911.
37. Hervás R, Bravo J, Fontecha J (2014) An assistive navigation system based on augmented reality and context awareness for people with mild cognitive impairments. IEEE J Biomed Health Inform, 18:368-374.
38. Hohwy J (2013) The Predictive Mind. Oxford, Oxford University Press.
39. Hugues O, Fuchs P, Nannipieri O (2011) New augmented reality taxonomy: Technologies and features of augmented environment. In Handbook of Augmented Reality (Ed B Furht): 47-63. New York, Springer.
40. Hutson J (2022) Social virtual reality: neurodivergence and inclusivity in the metaverse. Societies, 12:102.
41. Javaherirenani R, Mortazavi SS, Shalbafan M, Ashouri A, Farani AR (2022) Virtual reality exposure and response prevention in the treatment of obsessive-compulsive disorder in patients with contamination subtype in comparison with in vivo exposure therapy: a randomized clinical controlled trial. BMC Psychiatry, 22:740.
42. Kahan M, Tanzer J, Darvin D, Borer F (2000) Virtual reality-assisted cognitive-behavioral treatment for fear of flying: acute treatment and follow-up. Cyberpsychol Behav, 3:387-392.
43. Kandalaft MR, Didehbani N, Krawczyk DC, Allen TT, Chapman SB (2013) Virtual reality social cognition training for young adults with high-functioning autism. J Autism Dev Disord, 43:34-44.
44. Kaplan A, Haenlein M (2019) Siri, siri, in my hand: who’s the fairest in the land? on the interpretations, illustrations, and implications of artificial intelligence. Bus Horiz, 62:15-25.
45. Kim J (2021) Advertising in the metaverse: research agenda. Journal of Interactive Advertising, 21:141-144.
46. Korte M (2022) The impact of the digital revolution on human brain and behavior: where do we stand? Dialogues Clin Neurosci, 22:101-111.
47. Kumar P, Chauhan S, Awasthi LK (2023) Artificial intelligence in healthcare: review, ethics, trust challenges & future research directions. Eng Appl Artif Intell, 120:105894.
48. Le DN, Van Le C, Tromp JG, Nguyen GN (2018) Emerging Technologies For Health And Medicine: Virtual Reality, Augmented Reality, Artificial Intelligence, Internet of Things, Robotics, Industry 4.0. Hoboken, NJ, Wiley.
49. Lee J, Lee TS, Lee S, Jang J, Yoo S, Choi Y et al. (2022) Development and application of a metaverse-based social skills training program for children with autism spectrum disorder to improve social interaction: protocol for a randomized controlled trial. JMIR Res Protoc, 11:e35960.
50. Lee LH, Braud T, Zhou P, Wang L, Xu D, Lin Z et al. (2021) All one needs to know about metaverse: a complete survey on technological singularity, virtual ecosystem, and research agenda. Journal of Latex Class Files, 14:1-66.
51. Liang H, Li J, Wang Y, Pan J, Zhang Y, Dong X (2023) Metaverse virtual social center for the elderly communication during the social distancing. Virtual Reality & Intelligent Hardware, 5:68-80.
52. Lin HT, Li YI, Hu WP, Huang CC, Du YC (2019) A scoping review of the efficacy of virtual reality and exergaming on patients of musculoskeletal system disorder. J Clin Med, 8:791.
53. Liu Z, Ren L, Xiao C, Zhang K, Demian P (2022) Virtual reality aided therapy towards health 4.0: a two-decade bibliometric analysis. Int J Environ Res Public Health, 19:1525.
54. Logeswaran A, Munsch C, Chong YJ, Ralph N, McCrossnan J (2021) The role of extended reality technology in healthcare education: towards a learner-centred approach. Future Healthc J, 8:79-84.
55. López-Ojeda W, Hurley RA (2023) The medical metaverse, part 1: introduction, definitions, and new horizons for neuropsychiatry. J Neuropsychiatry Clin Neurosci, 35:1-4.
56. Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B et al. (2022) The Lancet Commission on the future of care and clinical research in autism. Lancet, 399:271-334.
57. Maples-Keller JL, Bunnell BE, Kim SJ, Rothbaum BO (2017) The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry, 25:103-113.
58. Matamala-Gomez M, Maselli A, Malighetti C, Realdon O, Mantovani F, Riva G (2021) Virtual body ownership illusions for mental health: a narrative review. J Clin Med, 10:139.
59. Matsangidou M, Otkhmezuri B, Ang CS, Avraamides M, Riva G, Gaggioli A et al. (2022) “Now i can see me” designing a multi-user virtual reality remote psychotherapy for body weight and shape concerns. Hum Comput Interact, 37:314-340.
60. Meyerbröker K, Morina N (2021) The use of virtual reality in assessment and treatment of anxiety and related disorders. Clin Psychol Psychother, 28:466-476.
61. Michaliszyn D, Marchand A, Bouchard S, Martel MO, Poirier-Bisson J (2010) A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia. Cyberpsychol Behav Soc Netw, 13:689-695.
62. Mirelman A, Rochester L, Reelick M, Nieuwhof F, Pelosin E, Abbruzzese G et al. (2013) V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial. BMC Neurol, 13:15.
63. Noben L, Goossens SMTA, Truijens SEM, Van Berckel MMG, Perquin CW, Slooter, GD et al. (2019) A virtual reality video to improve information provision and reduce anxiety before cesarean delivery: randomized controlled trial. JMIR Mental Health, 6:e15872.
64. Park MJ, Kim DJ, Lee U, Na EJ, Jeon HJ (2019) A literature overview of virtual reality (VR) in treatment of psychiatric disorders: recent advances and limitations. Front Psychiatry, 10:505.
65. Paulus MP, Feinstein JS, Khalsa SS (2019) An active inference approach to interoceptive psychopathology. Annu Rev Clin Psychol, 15:97-122.
66. Petrigna L, Musumeci G (2022) The metaverse: a new challenge for the healthcare system: a scoping review, J Funct Morphol Kinesiol, 7:63.
67. Rayan RA, Tsagkaris C, Zafar I (2021) IoT-integrated robotics in the health sector. In Robotic Technologies in Biomedical and Healthcare Engineering (Eds D Gupta, M Sharma, V Chaudhary, A Khanna): 1-11. Oxon, CRC Press.
68. Rebbani Z, Azougagh D, Bahatti L, Bouattane O (2021) Definitions and applications of augmented/virtual reality: A survey. Int . Emer. Trends Eng, 9:279-285.
69. Rimer E, Husby LV, Solem S (2021) Virtual reality exposure therapy for fear of heights: clinicians’ attitudes become more positive after trying VRET. Front Psychol, 12:671871.
70. Riva G, Dakanalis A (2018) Altered processing and integration of multisensory bodily representations and signals in eating disorders: a possible path toward the understanding of their underlying causes. Front Hum Neurosci, 12:49.
71. Riva G, Di Lernia D, Sajno E, Sansoni M, Bartolotta S, Serino S et al. (2021a) Virtual reality therapy in the metaverse: merging VR for the outside with VR for the inside. Annual Review of Cybertherapy and Telemedicine, 19:3-8.
72. Riva G, Serino S, Di Lernia D, Pagnini F (2021b) Regenerative virtual therapy: the use of multisensory technologies and mindful attention for updating the altered representations of the bodily self. Front Syst Neurosci, 15:749268.
73. Riva G, Wiederhold BK (2022) What the metaverse is (really) and why we need to know about it. Cyberpsychol Behav Soc Netw, 25:355-359.
74. Riva G, Wiederhold BK, Chirico A, Di Lernia D, Mantovani F, Gaggioli A (2018) Brain and virtual reality: what do they have in common and how to exploit their potential. Annual Review of CyberTherapy and Telemedicine, 16:3-7.
75. Rohrbach N, Gulde P, Armstrong AR, Hartig L, Abdelrazeq A, Schröder S et al. (2019) An augmented reality approach for ADL support in Alzheimer’s disease: a crossover trial. J Neuroeng Rehabil, 16:66.
76. Rothbaum BO, Hodges L, Alarcon R, Ready D, Shahar F, Graap K et al. (1999) Virtual reality exposure therapy for PTSD Vietnam veterans: a case study. J Trauma Stress, 12:263-271.
77. Rothbaum BO, Rizzo AS, Difede J (2010) Virtual reality exposure therapy for combat‐related posttraumatic stress disorder. Ann N Y Acad Sci, 1208:126-132.
78. Rus-Calafell M, Garety P, Sason E, Craig TJK, Valmaggia LR (2018) Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychol Med, 48:362-391.
79. Rus-Calafell M, Gutiérrez-Maldonado J, Ribas-Sabaté J (2014) A virtual reality-integrated program for improving social skills in patients with schizophrenia: a pilot study. J Behav Ther Exp Psychiatry, 45:81-89.
80. Sandrone S (2022) Medical education in the metaverse. Nat Med, 28:2456-2457.
81. Sandrone S, Carlson C (2021) Gamification and game-based education in neurology and neuroscience: Applications, challenges, and opportunities. Brain Disorders, 1:100008.
82. Schall MC, Jr Rusch ML, Lee JD, Dawson JD, Thomas G, Aksan N et al. (2013) Augmented reality cues and elderly driver hazard perception. Hum Factors, 55:643-658.
83. Scheurich JA, Beidel DC, Vanryckeghem M (2019) Exposure therapy for social anxiety disorder in people who stutter: an exploratory multiple baseline design. J Fluency Disord, 59:21-32.
84. Schulte J, Schulz C, Wilhelm S, Buhlmann U (2020) Treatment utilization and treatment barriers in individuals with body dysmorphic disorder. BMC Psychiatry, 20:69.
85. Slater M, Gonzalez-Liencres C, Haggard P, Vinkers C, Gregory-Clarke R, Jelley S et al. (2020) The ethics of realism in virtual and augmented reality. Front Virtual Real, 1:1.
86. Sridhar A, Shiliang Z, Woodson R, Kwan L (2020) Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study. Eur J Contracept Reprod Health Care, 25:480-483.
87. Stephenson N (1992) Snow Crash. New York, Bantam Books.
88. Stultz DJ, Osburn S, Burns T, Pawlowska-Wajswol S, Walton R (2020) Transcranial magnetic stimulation (TMS) safety with respect to seizures: a literature review. Neuropsychiatr Dis Treat, 16:2989-3000.
89. Tarnanas I, Manos G (2004) A clinical protocol for the development of a virtual reality behavioral training in disaster exposure and relief. Annual Review of CyberTherapy and Telemedicine, 2:71-83.
90. Thomason J (2021) Ethics in the metaverse: maximizing benefit and minimizing harm. Corp Invest Times, 12:67-70.
91. Torous J, Bucci S, Bell IH, Kessing LV, Faurholt‐Jepsen M, Whelan P et al. (2021) The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry, 20:318-335.
92. Trapp NT, Williams NR (2021) The future of training and practice in neuromodulation: an interventional psychiatry perspective. Front Psychiatry, 12:734487.
93. Usmani SS, Sharath M, Mehendale M (2022) Future of mental health in the metaverse. Gen Psychiatr, 35:e100825.
94. Üzümcü E, Akın B, Nergiz H, İnözü M, Çelikcan U (2018) Anksiyete bozukluklarında sanal gerçeklik. Psikiyatride Güncel Yaklaşımlar, 10:99-117.
95. Veling W, Pot-Kolder R, Counotte J, van Os J, van der Gaag M (2016) Environmental social stress, paranoia and psychosis liability: a virtual reality study. Schizophr Bull, 42:1363-1371.
96. Wald J, Taylor S (2003) Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia. Cyberpsychol Behav, 6:459-465.
97. Wiederhold BK, Bouchard S (2014) Virtual reality for posttraumatic stress disorder. In Advances in Virtual Reality and Anxiety Disorders (Eds. BK Wiederhold, S Bouchard): 211-233, Boston, Springer.
98. Wood DP, Murphy JA, Center KB, Russ C, McLay RN, Reeves D et al. (2008) Combat related post traumatic stress disorder: a multiple case report using virtual reality graded exposure therapy with physiological monitoring. Stud Health Technol Inform, 132:556-561.
99. Yagol P, Ramos F, Trilles S, Torres-Sospedra J, Perales FJ (2018) New trends in using augmented reality apps for smart city contexts. ISPRS International Journal of Geo-Information, 7:478.
100. Yellowlees PM, Cook JN (2006) Education about hallucinations using an internet virtual reality system: a qualitative survey. Acad Psychiatry, 30:534-539.
101. Yilmaz F, Mete AH, Türkön BF, Özgür İ (2022) Sağlık hizmetlerinin geleceğinde metaverse ekosistemi ve teknolojileri: uygulamalar, fırsatlar ve zorluklar. Eurasian Journal of Health Technology Assessment, 6:12-34.
102. Yilmaz NÖ, Duran F, Fidan U (2021) Virtual reality and augmented reality in psychiatric disorders. Gazi University Journal of Science Part C: Design and Technology, 9:516-532.
103. Yuen EK, Herbert JD, Forman EM, Goetter EM, Comer R, Bradley JC (2013) Treatment of social anxiety disorder using online virtual environments in second life. Behav Ther, 44:51-61.
104. Zhang M, Ding H, Naumceska M, Zhang Y (2022) Virtual reality technology as an educational and intervention tool for children with autism spectrum disorder: current perspectives and future directions. Behav Sci, 12:138.
105. Ziv A, Wolpe PR, Small SD, Glick S (2003) Simulation-based medical education: an ethical imperative. Acad Med, 78:783-788.