Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation（ rTMS） combined with virtual reality（ VR） technology on psychological craving， anxiety symptoms， cognitive function， and relapse rates in alcohol dependence patients during the detoxification and rehabilitation period. Methods A total of 140 patients with alcohol dependence admitted to Hebei Mental Health Center between May 2023 and August 2024 were selected. Patients were randomly divided into a control group， rTMS group， VR group， and combination group using a block randomization method， with 35 cases in each group. A total of 127 cases completed the study（ 32 in the control group， 31 in the rTMS group， 33 in the VR group， and 31 in the combination group）. The control group received medication and rehabilitation training； the rTMS group received high-frequency rTMS on the basis of the control group； the VR group received VR therapy on the basis of the control group， and the combination group received rTMS combined with VR therapy on the basis of the control group. The treatment frequency was 5 times a week， for a total of 4 weeks. Psychological craving and anxiety symptoms were assessed using the Penn Alcohol Craving Scale（ PACS） and the Self-Rating Anxiety Scale（ SAS） at baseline， 2， 4， 8， and 12 weeks of treatment. Cognitive function was assessed using the Montreal Cognitive Assessment（ MoCA） at baseline， 4， 8， 12 and 24 weeks of treatment. Telephone follow-up was conducted at the end of the 12-week treatment period to assess relapse rates. Repeated measures analysis of variance（ ANOVA） was used to compare the main effects of group and time， as well as the group × time interaction effect. Pairwise comparisons were corrected using the Bonferroni method. Results There was no statistically significant difference in PACS total scores among the four groups at baseline（ P＞0.05）. After 2， 4， 8， and 12 weeks of treatment， repeated measures ANOVA showed that the group main effect， time main effect， and group × time interaction effect of the total score of PACS in the four groups were statistically significant （F=6.915，181.488， 8.134； all P＜0.001）. Over time， psychological cravings decreased across all four groups， but the combination group showed an earlier reduction compared to the other groups， with effects more pronounced than those observed in the VR and rTMS groups. There was no statistically significant difference in the total SAS scores among the four groups at baseline（ P＞0.05）. At the weekends of treatment 2， 4， 8， and 12， repeated measures analysis of variance revealed that the group main effect， time main effect， and time x group interaction were all statistically significant for the total SAS scores across the four groups（ F=11.503， 184.225， 16.640； all P＜ 0.001）. This indicated that over time， the VR group， the rTMS group， and the combined group all reduced patients' anxiety symptoms， and the combined group achieved this improvement earlier and with more significant effects than the VR group and rTMS group. There was no statistically significant difference in MoCA total scores among the four groups at baseline（ P ＞ 0.05）. After 4， 8， 12 and 24 weeks of treatment， repeated measures ANOVA revealed statistically significant main effects of group on MoCA total scores across the four groups （F=3.626， P=0.015）， as well as statistically significant main effects of time and a statistically significant group × time interaction effect（ F=48.970， 3.478； both P＜0.001）. In terms of the total score of the MoCA， simple effect analysis revealed that there were statistically significant differences between the combination group and the control group 8， 12 and 24 weeks of treatment（ all P＜0.05）. There was a statistically significant difference between the VR group and the control group at 12 and 24 weeks of treatment（ both P ＜ 0.001）， while there was no statistically significant difference between the rTMS group and the control group at each time period（ all P ＞ 0.05）. There was a statistically significant difference between the combination group and the rTMS group at 12 and 24 weeks of treatment（ both P ＜ 0.01）， while the combination group and the VR group only had a statistically significant difference at 24 weeks of treatment（ P=0.001）. There was a statistically significant difference in the relapse rate among the four groups（ χ2=8.234， P=0.041）. Conclusions Both combined and standalone applications of rTMS and VR can reduce psychological craving and anxiety symptoms， and improve cognitive function in alcohol dependence patients during the rehabilitation period. However， standalone rTMS shows limited efficacy in enhancing cognitive function， whereas combined application yields superior effects.