Post-traumatic stress disorder (PTSD) is a mental health condition triggered by extremely stressful or terrifying events — either being part of or witnessing them [9]. Symptoms may include flashbacks, nightmares, severe anxiety, or uncontrollable thoughts about the event [9]. Among the many events that can lead to PTSD, road traffic accidents (RTA) account for a significant share. Current solutions for PTSD include psychotherapies, pharmacotherapy, cognitive behavioral therapy, and prolonged exposure therapy [7]. While these methods have proven to be effective, studies have demonstrated that some participants find the treatments to be “too stressful [6].” A few other barriers to traditional PTSD therapies include limited access to therapists trained in trauma-focused therapy, survivors who may not wish to use conventional treatments, or cost and insurance coverage concerns [6]. This study introduces a Unity-powered virtual reality rehabilitation game that integrates the MDA (mechanics-dynamics-aesthetics) framework to create a safe, controllable, and immersive environment for individuals with PTSD to undergo gradual trauma recovery. Unlike existing virtual reality exposure therapy (VRET) systems, gamified experiences are used effectively to target psychological responses to trauma — specifically, to create a sense of safety and controllability alongside manageable anxiety. Four versions of the game were tested on 14 healthy participants: a complete MDA version as well as three variants lacking one framework element each. Quantitative results show that the full MDA version achieved the lowest mean anxiety level and the highest reported safety and self-efficacy. These findings demonstrate that the MDA framework serves as an effective tool for structuring therapeutic VR experiences, laying the necessary groundwork for its future application in clinical PTSD treatment.

Kaili Wang. The Effect of VR Games and MDA Framework on Post-Traumatic Stress Disorder (PTSD) after Car Accidents. Academic Journal of Medicine & Health Sciences (2026), Vol. 7, Issue 3: 73-82. https://doi.org/10.25236/AJMHS.2026.070310.

[1] Mayo Foundation for Medical Education and Research. Post-traumatic stress disorder (PTSD). Mayo Clinic, 2024. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/ symptoms-causes/syc-20355967

[2] Bedaso, A., Kediro, G., Ebrahim, J., Tadesse, F., Mekonnen, S., Gobena, N., & Gebrehana, E. Prevalence and determinants of post-traumatic stress disorder among road traffic accident survivors: A prospective survey at selected hospitals in southern Ethiopia. BMC Emergency Medicine, 2020, 20(1), 1–9.

[3] BrainLine. Virtual reality exposure therapy (VRET). BrainLine, 2024. https://www.brainline.org/treatment-hub-treating-brain-injury-and-ptsd/virtual-reality-exposure-therapy-vret

[4] Cheng, C., & Ebrahimi, O. V. Gamification: A novel approach to mental health promotion. Current Psychiatry Reports, 2023, 25(11), 577–586.

[5] The Recovery Village Drug and Alcohol Rehab. Important facts and statistics about PTSD (post-traumatic stress disorder). The Recovery Village, 2024. https://www.therecoveryvillage.com/mental-health/ptsd/ptsd-statistics/

[6] Insidea. Virtual reality treatment for PTSD: Innovative therapy solutions. XRHealth, 2024. https://www.xr.health/us/blog/virtual-reality-treatment-for-ptsd/

[7] Kazlauskas, E. Challenges for providing health care in traumatized populations: Barriers for PTSD treatments and the need for new developments. Global Health Action, 2017, 10(1), 1–4.

[8] Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O. The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harvard Review of Psychiatry, 2017, 25(3), 103–113.

[9] National Institute of Mental Health. Post-traumatic stress disorder (PTSD). NIMH, n.d. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd

[10] Hunicke, R., LeBlanc, M., & Zubek, R. MDA: A formal approach to game design and game research. Proceedings of the AAAI Workshop on Challenges in Game AI, 2004, 1–5.

[11] Medical News Today. VR therapy for phobias, depression, PTSD, and more. Medical News Today, n.d. https://www.medicalnewstoday.com/articles/vr-therapy#how-it-works

[12] Post-traumatic stress disorder among road traffic accident survivors: A systematic review and meta-analysis. ScienceDirect, 2025. https://www.sciencedirect.com/science/article/pii/S2590198225000533

[13] Sullivan, G. M., & Neria, Y. Pharmacotherapy of PTSD: Current status and controversies. Psychiatric Annals, 2009, 39(6), 1–8.

[14] Tao, G., Garrett, B., Taverner, T., Cordingley, E., & Sun, C. Immersive virtual reality health games: A narrative review of game design. Journal of Neuroengineering and Rehabilitation, 2021, 18(1), 1–14.

[15] U.S. Department of Health and Human Services. Post-traumatic stress disorder (PTSD). National Institute of Mental Health, n.d. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd

[16] VA.gov. How Common is PTSD in Adults? U.S. Department of Veterans Affairs, 2018. https://www.ptsd.va.gov/understand/common/common_adults.asp

[17] Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. Virtual reality exposure therapy in anxiety disorders: A quantitative meta‐analysis. Depression and Anxiety, 2012, 29(2), 85–93.

[18] World Health Organization. Post-traumatic stress disorder. WHO, n.d. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder

[19] Yang, D.-J., Lu, M.-Y., Chen, C.-W., Liu, P.-C., & Hou, I.-C. Development of a therapeutic video game with the MDA framework to decrease anxiety in preschool-aged children with acute lymphoblastic leukemia: Mixed Methods Approach. JMIR Serious Games, 2022, 10(3), e34167.

[20] Zhang, C., Yu, S., & Ji, J. CFI: A VR motor rehabilitation serious game design framework integrating rehabilitation function and game design principles with an upper limb case. Journal of Neuroengineering and Rehabilitation, 2024, 21(1), 1–15.

[21] Department of Neurology Nursing Department. Prevalence of posttraumatic stress disorder among road traffic accident survivors: A systematic review and meta-analysis. Medicine, 2018, 97(1), e9590.