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Tracking Symptom Change Across Therapy Sessions in Virtual Reality Cognitive Behavioral Therapy Versus Cognitive Behavioral Therapy for Paranoid Ideation: A Secondary Analysis of a Randomized Controlled Trial.

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Title: Tracking Symptom Change Across Therapy Sessions in Virtual Reality Cognitive Behavioral Therapy Versus Cognitive Behavioral Therapy for Paranoid Ideation: A Secondary Analysis of a Randomized Controlled Trial.
Authors: Berkhof M; Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands., Van Der Stouwe ECD; Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands., Veling W; Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands., Geraets CNW; Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
Source: Schizophrenia bulletin [Schizophr Bull] 2026 Apr 10; Vol. 52 (3).
Publication Type: Journal Article; Randomized Controlled Trial; Comparative Study
Language: English
Journal Info: Publisher: Oxford University Press Country of Publication: United States NLM ID: 0236760 Publication Model: Print Cited Medium: Internet ISSN: 1745-1701 (Electronic) Linking ISSN: 05867614 NLM ISO Abbreviation: Schizophr Bull Subsets: MEDLINE
Imprint Name(s): Publication: 2005- : Cary, NC : Oxford University Press
Original Publication: [Chevy Chase, Md., For sale by the Supt. of Docs., U. S. Govt. Print. Off. Washington]
MeSH Terms: Paranoid Disorders*/therapy , Paranoid Disorders*/physiopathology , Cognitive Behavioral Therapy*/methods , Psychotic Disorders*/therapy , Virtual Reality Exposure Therapy*/methods , Outcome Assessment, Health Care*, Humans ; Adult ; Female ; Male ; Middle Aged ; Young Adult ; Adolescent ; Aged
Abstract: Study Design: In this secondary analysis of a randomized controlled trial, individuals aged 18-65 with a psychotic disorder and paranoid ideation were recruited. Ninety-eight participants were randomized to maximally 16 sessions of VR-CBTp (n = 48) or CBTp (n = 50). Self-rated symptom severity, functional impairment, and clinician-rated illness severity were assessed at each therapy session. Analyses on change scores between the first and final session were performed to assess overall improvement, and multilevel regression models explored in-depth session differences.
Study Results: Clinician-rated paranoia and avoidance improved more rapidly in VR-CBTp than CBTp, with differences emerging from session 3. Patients reported similar progress in both groups over time on symptoms and functional impairment. A greater proportion of VR-CBTp participants completed treatment early, requiring fewer sessions than the CBTp group.
Conclusions: Therapists observed faster symptom recovery in paranoia and avoidance in VR-CBTp while requiring fewer sessions than standard CBTp. These findings suggest that VR-CBTp may be more efficient in duration, while broader effects on access and therapist workload remain to be determined.
(© The Author(s) 2026. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)
References: Psychol Med. 2025 Jul 07;55:e188. (PMID: 40619608)
Br J Clin Psychol. 2019 Mar;58(1):19-34. (PMID: 30028025)
Front Psychiatry. 2020 May 05;11:402. (PMID: 32431633)
Schizophr Bull. 2011 Sep;37 Suppl 2:S122-8. (PMID: 21860041)
Acta Psychiatr Scand. 2025 Mar;151(3):293-303. (PMID: 38853472)
Cogn Behav Ther. 2023 Jul;52(4):347-379. (PMID: 36974519)
Schizophr Bull. 2010 Jan;36(1):94-103. (PMID: 19955388)
Schizophrenia (Heidelb). 2022 Mar 1;8(1):10. (PMID: 35232972)
Psychol Med. 2023 Oct;53(13):6183-6193. (PMID: 36510471)
J Clin Epidemiol. 2016 Aug;76:108-17. (PMID: 26931293)
Psychol Med. 2024 Nov;54(15):4173-4181. (PMID: 39552390)
Psychiatry (Edgmont). 2007 Jul;4(7):28-37. (PMID: 20526405)
Lancet Psychiatry. 2016 Jul;3(7):685-92. (PMID: 27371990)
Cyberpsychol Behav. 2007 Oct;10(5):722-4. (PMID: 17927544)
Psychol Med. 2008 Jan;38(1):101-11. (PMID: 17903336)
Br J Clin Psychol. 2002 Nov;41(Pt 4):331-47. (PMID: 12437789)
Int Rev Psychiatry. 2011 Aug;23(4):379-87. (PMID: 22026495)
Health Technol Assess. 2025 Nov;29(53):1-115. (PMID: 41217072)
Curr Opin Psychol. 2021 Oct;41:40-45. (PMID: 33714892)
Schizophr Bull. 2026 Jan 16;52(1):. (PMID: 41391104)
Front Psychiatry. 2019 Oct 25;10:773. (PMID: 31708821)
Clin Psychol Rev. 2022 Apr;93:102132. (PMID: 35316672)
Lancet Psychiatry. 2018 Mar;5(3):217-226. (PMID: 29429948)
Int Clin Psychopharmacol. 2008 Mar;23(2):70-83. (PMID: 18301121)
Acta Psychiatr Scand Suppl. 2003;(416):16-23. (PMID: 12755850)
JMIR Form Res. 2023 Oct 16;7:e47443. (PMID: 37843884)
J Ment Health. 2014 Aug;23(4):162-5. (PMID: 24433132)
Nat Med. 2025 Oct;31(10):3425-3439. (PMID: 40804323)
Schizophr Res. 2024 Oct;272:98-103. (PMID: 39214023)
Eur Psychiatry. 2016 Oct;38:31-39. (PMID: 27642702)
Int J Ment Health Syst. 2023 Mar 31;17(1):8. (PMID: 37004066)
Aust N Z J Psychiatry. 2017 Mar;51(3):289-290. (PMID: 28218055)
J Affect Disord. 2026 May 01;400:121225. (PMID: 41577045)
World Psychiatry. 2018 Jun;17(2):123-132. (PMID: 29856567)
Schizophr Res Cogn. 2016 Mar;3:33-38. (PMID: 27990352)
Br J Psychiatry. 2016 Jul;209(1):62-7. (PMID: 27151071)
Dialogues Clin Neurosci. 2020 Jun;22(2):169-177. (PMID: 32699517)
BMC Psychiatry. 2021 Oct 11;21(1):496. (PMID: 34635063)
Psychol Med. 2001 Oct;31(7):1293-306. (PMID: 11681555)
Schizophr Bull. 2026 Jan 16;52(1):. (PMID: 40574663)
Grant Information: HA2017.01.04 Dutch Brain Foundation
Contributed Indexing: Keywords: cognitive behavioral therapy; exposure; paranoia; psychosis; session; virtual reality
Entry Date(s): Date Created: 20260509 Date Completed: 20260716 Latest Revision: 20260818
Update Code: 20260818
PubMed Central ID: PMC13156502
DOI: 10.1093/schbul/sbag068
PMID: 42104804
Database: MEDLINE
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  Data: Tracking Symptom Change Across Therapy Sessions in Virtual Reality Cognitive Behavioral Therapy Versus Cognitive Behavioral Therapy for Paranoid Ideation: A Secondary Analysis of a Randomized Controlled Trial.
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  Data: Study Design: In this secondary analysis of a randomized controlled trial, individuals aged 18-65 with a psychotic disorder and paranoid ideation were recruited. Ninety-eight participants were randomized to maximally 16 sessions of VR-CBTp (n = 48) or CBTp (n = 50). Self-rated symptom severity, functional impairment, and clinician-rated illness severity were assessed at each therapy session. Analyses on change scores between the first and final session were performed to assess overall improvement, and multilevel regression models explored in-depth session differences.<br />Study Results: Clinician-rated paranoia and avoidance improved more rapidly in VR-CBTp than CBTp, with differences emerging from session 3. Patients reported similar progress in both groups over time on symptoms and functional impairment. A greater proportion of VR-CBTp participants completed treatment early, requiring fewer sessions than the CBTp group.<br />Conclusions: Therapists observed faster symptom recovery in paranoia and avoidance in VR-CBTp while requiring fewer sessions than standard CBTp. These findings suggest that VR-CBTp may be more efficient in duration, while broader effects on access and therapist workload remain to be determined.<br /> (© The Author(s) 2026. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)
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  Data: Psychol Med. 2025 Jul 07;55:e188. (PMID: <searchLink fieldCode="PM" term="%2240619608%22">40619608)</searchLink><br />Br J Clin Psychol. 2019 Mar;58(1):19-34. (PMID: <searchLink fieldCode="PM" term="%2230028025%22">30028025)</searchLink><br />Front Psychiatry. 2020 May 05;11:402. (PMID: <searchLink fieldCode="PM" term="%2232431633%22">32431633)</searchLink><br />Schizophr Bull. 2011 Sep;37 Suppl 2:S122-8. (PMID: <searchLink fieldCode="PM" term="%2221860041%22">21860041)</searchLink><br />Acta Psychiatr Scand. 2025 Mar;151(3):293-303. (PMID: <searchLink fieldCode="PM" term="%2238853472%22">38853472)</searchLink><br />Cogn Behav Ther. 2023 Jul;52(4):347-379. (PMID: <searchLink fieldCode="PM" term="%2236974519%22">36974519)</searchLink><br />Schizophr Bull. 2010 Jan;36(1):94-103. (PMID: <searchLink fieldCode="PM" term="%2219955388%22">19955388)</searchLink><br />Schizophrenia (Heidelb). 2022 Mar 1;8(1):10. (PMID: <searchLink fieldCode="PM" term="%2235232972%22">35232972)</searchLink><br />Psychol Med. 2023 Oct;53(13):6183-6193. (PMID: <searchLink fieldCode="PM" term="%2236510471%22">36510471)</searchLink><br />J Clin Epidemiol. 2016 Aug;76:108-17. (PMID: <searchLink fieldCode="PM" term="%2226931293%22">26931293)</searchLink><br />Psychol Med. 2024 Nov;54(15):4173-4181. (PMID: <searchLink fieldCode="PM" term="%2239552390%22">39552390)</searchLink><br />Psychiatry (Edgmont). 2007 Jul;4(7):28-37. (PMID: <searchLink fieldCode="PM" term="%2220526405%22">20526405)</searchLink><br />Lancet Psychiatry. 2016 Jul;3(7):685-92. (PMID: <searchLink fieldCode="PM" term="%2227371990%22">27371990)</searchLink><br />Cyberpsychol Behav. 2007 Oct;10(5):722-4. (PMID: <searchLink fieldCode="PM" term="%2217927544%22">17927544)</searchLink><br />Psychol Med. 2008 Jan;38(1):101-11. (PMID: <searchLink fieldCode="PM" term="%2217903336%22">17903336)</searchLink><br />Br J Clin Psychol. 2002 Nov;41(Pt 4):331-47. (PMID: <searchLink fieldCode="PM" term="%2212437789%22">12437789)</searchLink><br />Int Rev Psychiatry. 2011 Aug;23(4):379-87. (PMID: <searchLink fieldCode="PM" term="%2222026495%22">22026495)</searchLink><br />Health Technol Assess. 2025 Nov;29(53):1-115. (PMID: <searchLink fieldCode="PM" term="%2241217072%22">41217072)</searchLink><br />Curr Opin Psychol. 2021 Oct;41:40-45. (PMID: <searchLink fieldCode="PM" term="%2233714892%22">33714892)</searchLink><br />Schizophr Bull. 2026 Jan 16;52(1):. (PMID: <searchLink fieldCode="PM" term="%2241391104%22">41391104)</searchLink><br />Front Psychiatry. 2019 Oct 25;10:773. (PMID: <searchLink fieldCode="PM" term="%2231708821%22">31708821)</searchLink><br />Clin Psychol Rev. 2022 Apr;93:102132. (PMID: <searchLink fieldCode="PM" term="%2235316672%22">35316672)</searchLink><br />Lancet Psychiatry. 2018 Mar;5(3):217-226. (PMID: <searchLink fieldCode="PM" term="%2229429948%22">29429948)</searchLink><br />Int Clin Psychopharmacol. 2008 Mar;23(2):70-83. (PMID: <searchLink fieldCode="PM" term="%2218301121%22">18301121)</searchLink><br />Acta Psychiatr Scand Suppl. 2003;(416):16-23. (PMID: <searchLink fieldCode="PM" term="%2212755850%22">12755850)</searchLink><br />JMIR Form Res. 2023 Oct 16;7:e47443. (PMID: <searchLink fieldCode="PM" term="%2237843884%22">37843884)</searchLink><br />J Ment Health. 2014 Aug;23(4):162-5. (PMID: <searchLink fieldCode="PM" term="%2224433132%22">24433132)</searchLink><br />Nat Med. 2025 Oct;31(10):3425-3439. (PMID: <searchLink fieldCode="PM" term="%2240804323%22">40804323)</searchLink><br />Schizophr Res. 2024 Oct;272:98-103. (PMID: <searchLink fieldCode="PM" term="%2239214023%22">39214023)</searchLink><br />Eur Psychiatry. 2016 Oct;38:31-39. (PMID: <searchLink fieldCode="PM" term="%2227642702%22">27642702)</searchLink><br />Int J Ment Health Syst. 2023 Mar 31;17(1):8. (PMID: <searchLink fieldCode="PM" term="%2237004066%22">37004066)</searchLink><br />Aust N Z J Psychiatry. 2017 Mar;51(3):289-290. (PMID: <searchLink fieldCode="PM" term="%2228218055%22">28218055)</searchLink><br />J Affect Disord. 2026 May 01;400:121225. (PMID: <searchLink fieldCode="PM" term="%2241577045%22">41577045)</searchLink><br />World Psychiatry. 2018 Jun;17(2):123-132. (PMID: <searchLink fieldCode="PM" term="%2229856567%22">29856567)</searchLink><br />Schizophr Res Cogn. 2016 Mar;3:33-38. (PMID: <searchLink fieldCode="PM" term="%2227990352%22">27990352)</searchLink><br />Br J Psychiatry. 2016 Jul;209(1):62-7. (PMID: <searchLink fieldCode="PM" term="%2227151071%22">27151071)</searchLink><br />Dialogues Clin Neurosci. 2020 Jun;22(2):169-177. (PMID: <searchLink fieldCode="PM" term="%2232699517%22">32699517)</searchLink><br />BMC Psychiatry. 2021 Oct 11;21(1):496. (PMID: <searchLink fieldCode="PM" term="%2234635063%22">34635063)</searchLink><br />Psychol Med. 2001 Oct;31(7):1293-306. (PMID: <searchLink fieldCode="PM" term="%2211681555%22">11681555)</searchLink><br />Schizophr Bull. 2026 Jan 16;52(1):. (PMID: <searchLink fieldCode="PM" term="%2240574663%22">40574663)</searchLink>
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        Text: English
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