BackgroundApproach and avoidance bias (AAB) describes automatic behavioral tendencies to react toward environmental stimuli regarding their emotional valence. Traditional setups have provided evidence but often lack ecological validity. The study of the AAB in naturalistic contexts has recently increased, revealing significant methodological challenges. This systematic review evaluates the use of virtual reality (VR) and real-world setups to study the AAB, summarizing methodological innovations and challenges.MethodsWe systematically reviewed peer-reviewed articles employing VR and real-world setups to investigate the AAB. We analyzed experimental designs, stimuli, response metrics, and technical aspects to assess their alignment with research objectives and identify limitations.ResultsThis review included 21 studies revealing diverse methodologies, stimulus types, and novel behavioral responses, highlighting significant variability in design strategies and methodological coherence. Several studies used traditional reaction time measures yet varied in their application of VR technology and participant interaction paradigms. Some studies showed discrepancies between simulated and natural bodily actions, while others showcased more integrated approaches that preserved their integrity. Only a minority of studies included control conditions or acquired (neuro)physiological data.ConclusionsVR offers a potential ecological setup for studying the AAB, enabling dynamic and immersive interactions. Our results underscore the importance of establishing a coherent framework for investigating the AAB tendencies using VR. Addressing the foundational challenges of developing baseline principles that guide VR-based designs to study the AAB within naturalistic contexts is essential for advancing the AAB research and application. This will ultimately contribute to more reliable and reproducible experimental paradigms and develop effective interventions that help individuals recognize and change their biases, fostering more balanced behaviors.