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Virtual reality assisted cognitive behavioral therapy improves theory of mind and decreases paranoia in patients with schizophrenia: a randomized controlled trial.

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Title: Virtual reality assisted cognitive behavioral therapy improves theory of mind and decreases paranoia in patients with schizophrenia: a randomized controlled trial.
Authors: Monaghesh E; Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran., Farhang S; Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, Postbus, 30.001, HPC CC72, Groningen, RB 9700, Netherlands., Samad-Soltani T; Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: taha.soltany@gmail.com.
Source: Journal of behavior therapy and experimental psychiatry [J Behav Ther Exp Psychiatry] 2025 Dec; Vol. 89, pp. 102055. Date of Electronic Publication: 2025 Aug 23.
Publication Type: Journal Article; Randomized Controlled Trial
Language: English
Journal Info: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0245075 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-7943 (Electronic) Linking ISSN: 00057916 NLM ISO Abbreviation: J Behav Ther Exp Psychiatry Subsets: MEDLINE
Imprint Name(s): Publication: Amsterdam : Elsevier
Original Publication: [Elmsford, N.Y.] Pergamon Press.
MeSH Terms: Schizophrenia*/complications , Schizophrenia*/therapy , Cognitive Behavioral Therapy*/methods , Theory of Mind*/physiology , Paranoid Disorders*/therapy , Paranoid Disorders*/etiology , Virtual Reality Exposure Therapy*/methods , Virtual Reality*, Humans ; Female ; Male ; Adult ; Treatment Outcome ; Middle Aged ; Young Adult ; Psychiatric Status Rating Scales
Abstract: Introduction: patients with schizophrenia have deficits in social cognition and functioning. Virtual reality is a 3D real-world simulation created by a computer. Virtual reality-based cognitive behavioral therapy might increase effectiveness and acceptability of treatment for these patients. This study investigated the efficacy of VR-CBT compared to traditional CBT in improving these outcomes in patients with recent-onset schizophrenia.
Methods: In this open-label, randomized controlled trial, 60 patients with schizophrenia (36 men, 24 women) were randomized to receive either four sessions of VR-CBT or traditional CBT, in addition to pharmacological treatment. The VR environment simulated a bus trip with 11 neutral-faced avatars. Outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS; positive symptom subscale), the Green Paranoid Thoughts Scale (GPTS), and the Reading the Mind in the Eyes Test (Eyes Test) at baseline and post-treatment. Data were analyzed using repeated measures ANOVA.
Results: Both groups showed significant improvements in all measures (p < 0.05). However, the VR-CBT group demonstrated significantly greater reductions in PANSS (p < 0.001) and GPTS scores (p < 0.001), and a significantly greater increase in Eyes Test scores (p < 0.002) compared to the CBT group. No adverse effects were reported.
Conclusion: VR-CBT appears to be a promising adjunct to standard treatment for recent-onset schizophrenia, offering superior improvements in positive symptoms, paranoia, and ToM compared to traditional CBT. Further research is warranted to examine the long-term effects and underlying mechanisms of VR-CBT in this population.
(Copyright © 2025. Published by Elsevier Ltd.)
Competing Interests: Declaration of competing interest None.
Contributed Indexing: Keywords: Cognitive behavioral therapy; Paranoia; Schizophrenia; Theory of mind; Treatment; Virtual reality
Entry Date(s): Date Created: 20250825 Date Completed: 20250826 Latest Revision: 20250910
Update Code: 20260130
DOI: 10.1016/j.jbtep.2025.102055
PMID: 40854622
Database: MEDLINE
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  Data: Virtual reality assisted cognitive behavioral therapy improves theory of mind and decreases paranoia in patients with schizophrenia: a randomized controlled trial.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Monaghesh+E%22&quot;&gt;Monaghesh E&lt;/searchLink&gt;; Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Farhang+S%22&quot;&gt;Farhang S&lt;/searchLink&gt;; Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, Postbus, 30.001, HPC CC72, Groningen, RB 9700, Netherlands.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Samad-Soltani+T%22&quot;&gt;Samad-Soltani T&lt;/searchLink&gt;; Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: taha.soltany@gmail.com.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%220245075%22&quot;&gt;Journal of behavior therapy and experimental psychiatry&lt;/searchLink&gt; [J Behav Ther Exp Psychiatry] 2025 Dec; Vol. 89, pp. 102055. &lt;i&gt;Date of Electronic Publication: &lt;/i&gt;2025 Aug 23.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Schizophrenia%22&quot;&gt;Schizophrenia*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Schizophrenia+complications%22&quot;&gt;complications&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Schizophrenia%22&quot;&gt;Schizophrenia*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Schizophrenia+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cognitive+Behavioral+Therapy%22&quot;&gt;Cognitive Behavioral Therapy*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cognitive+Behavioral+Therapy+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Theory+of+Mind%22&quot;&gt;Theory of Mind*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Theory+of+Mind+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Paranoid+Disorders%22&quot;&gt;Paranoid Disorders*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Paranoid+Disorders+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Paranoid+Disorders%22&quot;&gt;Paranoid Disorders*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Paranoid+Disorders+etiology%22&quot;&gt;etiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Virtual+Reality+Exposure+Therapy%22&quot;&gt;Virtual Reality Exposure Therapy*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Virtual+Reality+Exposure+Therapy+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Virtual+Reality%22&quot;&gt;Virtual Reality*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adult%22&quot;&gt;Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Treatment+Outcome%22&quot;&gt;Treatment Outcome&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Middle+Aged%22&quot;&gt;Middle Aged&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Young+Adult%22&quot;&gt;Young Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Psychiatric+Status+Rating+Scales%22&quot;&gt;Psychiatric Status Rating Scales&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: patients with schizophrenia have deficits in social cognition and functioning. Virtual reality is a 3D real-world simulation created by a computer. Virtual reality-based cognitive behavioral therapy might increase effectiveness and acceptability of treatment for these patients. This study investigated the efficacy of VR-CBT compared to traditional CBT in improving these outcomes in patients with recent-onset schizophrenia.&lt;br /&gt;Methods: In this open-label, randomized controlled trial, 60 patients with schizophrenia (36 men, 24 women) were randomized to receive either four sessions of VR-CBT or traditional CBT, in addition to pharmacological treatment. The VR environment simulated a bus trip with 11 neutral-faced avatars. Outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS; positive symptom subscale), the Green Paranoid Thoughts Scale (GPTS), and the Reading the Mind in the Eyes Test (Eyes Test) at baseline and post-treatment. Data were analyzed using repeated measures ANOVA.&lt;br /&gt;Results: Both groups showed significant improvements in all measures (p&#160;&amp;lt;&#160;0.05). However, the VR-CBT group demonstrated significantly greater reductions in PANSS (p&#160;&amp;lt;&#160;0.001) and GPTS scores (p&#160;&amp;lt;&#160;0.001), and a significantly greater increase in Eyes Test scores (p&#160;&amp;lt;&#160;0.002) compared to the CBT group. No adverse effects were reported.&lt;br /&gt;Conclusion: VR-CBT appears to be a promising adjunct to standard treatment for recent-onset schizophrenia, offering superior improvements in positive symptoms, paranoia, and ToM compared to traditional CBT. Further research is warranted to examine the long-term effects and underlying mechanisms of VR-CBT in this population.&lt;br /&gt; (Copyright &#169; 2025. Published by Elsevier Ltd.)
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  Data: Declaration of competing interest None.
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      – TitleFull: Virtual reality assisted cognitive behavioral therapy improves theory of mind and decreases paranoia in patients with schizophrenia: a randomized controlled trial.
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