Adding virtual-reality-based cognitive behavioral therapy (VR-CBT) to standard treatment may reduce paranoid ideation and momentary anxiety in patients with psychotic disorders, according to results published in the Lancet Psychiatry.

The study included outpatients age 18 to 65 with a DSM-IV-diagnosed psychotic disorder and paranoid ideation in the past month at 7 mental health centers in The Netherlands (N=116). Participants were randomly assigned to VR-CBT in addition to treatment as usual (n=58) or the waiting list control group of treatment as usual (n=58).

VR-CBT consisted of sixteen 1-hour individual therapy sessions. The researchers assessed participants at baseline, 3 months after treatment, and at a 6-month follow-up visit. The primary outcomes were social participation (the amount of time they spent with other people), momentary paranoia, perceived social threat, and momentary anxiety.

The VR-CBT consisted of 4 virtual social environments in which the participants could move around. The environments contained human avatars, and the therapist could vary the number, characteristics, and response to the patient of the avatars to match the paranoid fears of the participant.

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Participants in the VR-CBT group had significantly reduced momentary paranoid ideation (b=–0.331 [95% CI, –0.432 to –0.230], P <.0001; effect size –1.49) and momentary anxiety (–0.288 [95% CI, –0.438 to –0.1394]; P =.0002; effect size –0.75) compared with the control group at post-treatment assessment. These improvements were still present at the 6-month follow-up.

VR-CBT did not significantly increase the amount of time spent with other people at the post-treatment assessment when compared with the control group.


Pot-Kolder RMCA, Geraets CNW, Veling W, et al. Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial [published online February 8, 2018]. Lancet Psychiatry. doi:10.1016/ S2215-0366(18)30053-1