Restricted accessReview articleFirst published online 2026-1
Influence of Virtual Reality on Negative Symptoms and Quality of Life of Patients With Schizophrenia: A Meta-Analysis: Influence de la réalité virtuelle sur les symptômes négatifs et la qualité de vie des patients atteints de schizophrénie : une méta-analyse
Schizophrenia brings about diverse challenges to patients, their families and society. It is up to the healthcare system to effectively resolve these concerns and benefit all involved parties. With the emerging development and adaptation of virtual reality (VR), this may offer a new direction and potential for treating people with schizophrenia. Our goal was to employ meta-analysis to evaluate the influence of VR on the clinical outcomes and quality of life in people with schizophrenia.
Methods
We performed an extensive screening of randomized controlled trials (RCTs) examining the effect of VR on the clinical outcomes in people with schizophrenia. Our search included the scientific databases PubMed, Embase, Web of Science and the Cochrane Library, and included RCTs from the date of database establishment till 1 June 2023 and we followed a strict study of inclusion and exclusion criteria. The meta-analysis was conducted in RevMan 5.4.
Results
We selected 963 patients from 10 RCTs. Relative to other forms of interventions, VR therapy considerably alleviated overall clinical (SMD = −4.33, 95% CI = [−6.92, −1.74], P = 0.001) and negative symptomology (SMD = −1.38, 95% CI = [−2.46, −0.30], P = 0.01) among in people with schizophrenia. In contrast, no significant improvements were observed in positive symptoms or quality of life among these patients. Further subgroup analyses of the results indicated that there were differences in the improvement of negative symptoms among patients across the different interventions (P = 0.01).
Conclusions
Based on our meta-analysis, VR-based treatment regimen significantly improves overall and negative symptoms in people with schizophrenia. Further exploration is warranted to elucidate the influence of VR on patient positive symptoms and quality of life.
GebreegziabhereYHabatmuKMihretuA, et al.Cognitive impairment in people with schizophrenia: an umbrella review [J]. Eur Arch Psychiatry Clin Neurosci. 2022;272(7):1139–1155.
4.
SuenderhaufCWalterALenzC, et al.Counter striking psychosis: commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies [J]. Neurosci Biobehav Rev. 2016;68:20–36.
5.
BouwmansCDe SonnevilleCMulderCL, et al.Employment and the associated impact on quality of life in people diagnosed with schizophrenia [J]. Neuropsychiatr Dis Treat. 2015;11:2125–2142.
6.
ChongHYTeohSLWuDB, et al.Global economic burden of schizophrenia: a systematic review [J]. Neuropsychiatr Dis Treat. 2016;12:357–373.
7.
MedaliaABeckATGrantPM. Cognitive therapies for psychosis: advances and challenges [J]. Schizophr Res. 2019;203:1–2.
8.
VitaABarlatiSCerasoA, et al.Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized clinical trials [J]. JAMA Psychiatry. 2021;78(8):848–858.
9.
BestMWBowieCR. A review of cognitive remediation approaches for schizophrenia: from top-down to bottom-up, brain training to psychotherapy [J]. Expert Rev Neurother. 2017;17(7):713–723.
10.
VälimäkiMHätönenHMLahtiME, et al.Virtual reality for treatment compliance for people with serious mental illness [J]. Cochrane Database Syst Rev. 2014;2014(10):Cd009928.
11.
LeeEA-LWongKW. Learning with desktop virtual reality: low spatial ability learners are more positively affected [J]. Comput Educ.2014;79:49–58.
12.
JahnFSSkovbyeMObenhausenK, et al.Cognitive training with fully immersive virtual reality in patients with neurological and psychiatric disorders: a systematic review of randomized controlled trials [J]. Psychiatry Res.2021;300:113928.
13.
TieriGMoroneGPaolucciS, et al.Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies [J]. Expert Rev Med Devices.2018;15(2):107–117.
HasanAA. The correlation between the quality of life and clinical variables among outpatients with schizophrenia [J]. Psychiatry Res. 2019;271:39–45.
16.
DongMLuLZhangL, et al.Quality of life in schizophrenia: a meta-analysis of comparative studies [J]. Psychiatr Q. 2019;90(3):519–532.
17.
The Whoqol G. The World Health Organization quality of life assessment (WHOQOL). Development and general psychometric properties [J]. Soc Sci Med.1998;46(12):1569–1585.
18.
EndicottJNeeJHarrisonW, et al.Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure [J]. Psychopharmacol Bull. 1993;29(2):321–326.
19.
KeetharuthADBrazierJConnellJ, et al.Recovering Quality of Life (ReQoL): a new generic self-reported outcome measure for use with people experiencing mental health difficulties [J]. Br J Psychiatry. 2018;212(1):42–49.
20.
PriebeSHuxleyPKnightS, et al.Application and results of the Manchester Short Assessment of Quality of Life (MANSA) [J]. Int J Soc Psychiatry. 1999;45(1):7–12.
21.
Attepe özdenSTekindalMTekindalMA. Quality of Life of people with schizophrenia: a meta-analysis [J]. Int J Soc Psychiatry. 2023;69(6):1444–1452.
22.
JansenJEGleesonJBendallS, et al.Acceptance- and mindfulness-based interventions for persons with psychosis: a systematic review and meta-analysis [J]. Schizophr Res. 2020;215:25–37.
23.
MakranskyGLilleholtL. A structural equation modeling investigation of the emotional value of immersive virtual reality in education [J]. Educ Technol Res Dev.2018;66(5):1141–1164.
24.
CummingsJJBailensonJN. How immersive is enough? A meta-analysis of the effect of immersive technology on user presence [J]. Media Psychol.2016;19(2):272–309.
25.
WuJMaYRenZ. Rehabilitative effects of virtual reality technology for mild cognitive impairment: a systematic review with meta-analysis [J]. Front Psychol. 2020;11:1811.
26.
ZhongDChenLFengY, et al.Effects of virtual reality cognitive training in individuals with mild cognitive impairment: a systematic review and meta-analysis [J]. Int J Geriatr Psychiatry. 2021;36(12):1829–1847.
27.
PapaioannouTVoinescuAPetriniK, et al.Efficacy and moderators of virtual reality for cognitive training in people with dementia and mild cognitive impairment: a systematic review and meta-analysis [J]. J Alzheimers Dis. 2022;88(4):1341–1370.
28.
ChenXLiuFLinS, et al.Effects of virtual reality rehabilitation training on cognitive function and activities of daily living of patients with poststroke cognitive impairment: a systematic review and meta-analysis [J]. Arch Phys Med Rehabil. 2022;103(7):1422–1435.
29.
CorriganNPăsăreluCRVoinescuA. Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis [J]. Virtual Reality. 2023;27:3545–3564.
30.
YenHYChiuHL. Virtual reality exergames for improving older Adults’ cognition and depression: a systematic review and meta-analysis of randomized control trials [J]. J Am Med Dir Assoc. 2021;22(5):995–1002.
31.
CarlESteinATLevihn-CoonA, et al.Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials [J]. J Anxiety Disord. 2019;61:27–36.
32.
Van LoenenIScholtenWMuntinghA, et al.The effectiveness of virtual reality exposure-based cognitive behavioral therapy for severe anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder: meta-analysis [J]. J Med Internet Res. 2022;24(2):e26736.
33.
WiebeAKannenKSelaskowskiB, et al.Virtual reality in the diagnostic and therapy for mental disorders: a systematic review [J]. Clin Psychol Rev. 2022;98:102213.
34.
ZekaFClemmensenLValmaggiaL, et al.The effectiveness of immersive virtual reality-based treatment for mental disorders: a systematic review with meta-analysis [J]. Acta Psychiatr Scand. 2025;151(3):210–230.
35.
SmithLCMateosACDueAS, et al.Immersive virtual reality in the treatment of auditory hallucinations: a PRISMA scoping review [J]. Psychiatry Res. 2024;334:115834.
36.
NovoAFonsêcaJBarrosoB, et al.Virtual reality rehabilitation's impact on negative symptoms and psychosocial rehabilitation in schizophrenia spectrum disorder: A systematic review [J]. Healthcare (Basel). 2021;9(11):1429.
37.
MirandaBMoreiraPMRomeroL, et al.Therapeutic use of VR serious games in the treatment of negative schizophrenia symptoms: a systematic review [J]. Healthcare (Basel). 2022;10(8):1497.
38.
SchroederAHBogieBJMRahmanTT, et al.Feasibility and efficacy of virtual reality interventions to improve psychosocial functioning in psychosis: systematic review [J]. JMIR Ment Health. 2022;9(2):e28502.
39.
HolopainenRTiihonenJLähteenvuoM. Efficacy of immersive extended reality (XR) interventions on different symptom domains of schizophrenia spectrum disorders. A systematic review [J]. Front Psychiatry. 2023;14:1208287.
40.
PageMJMckenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews [J]. Br Med J.2021;372:n71.
41.
HigginsJPAltmanDGGøtzschePC, et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials [J]. Br Med J.2011;343:d5928.
42.
DellazizzoLPotvinSPhraxayavongK, et al.One-year randomized trial comparing virtual reality-assisted therapy to cognitive–behavioral therapy for patients with treatment-resistant schizophrenia [J]. NPJ Schizophr.2021;7(1):9.
43.
FreemanDLambeSKabirT, et al.Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses [J]. Lancet Psychiatry.2022;9(5):375–388.
44.
Du SertOPPotvinSLippO, et al.Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: a pilot clinical trial [J]. Schizophr Res.2018;197:176–181.
45.
CraigTKRus-CalafellMWardT, et al.AVATAR Therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial [J]. Lancet Psychiatry. 2018;5(1):31–40.
46.
VassESimonVFeketeZ, et al.A novel virtual reality-based theory of mind intervention for outpatients with schizophrenia: a proof-of-concept pilot study [J]. Clin Psychol Psychother. 2021;28(3):727–738.
47.
VassESimonVCsuklyG, et al.Virtual reality-based theory of mind intervention in schizophrenia: preliminary efficacy results [J]. Compr Psychiatry. 2022;119:152350.
48.
LiSLiuRSunB, et al.Effect of virtual reality on cognitive impairment and clinical symptoms among patients with schizophrenia in the remission stage: a randomized controlled trial [J]. Brain Sci. 2022;12(11):1572.
49.
LiangNLiXGuoX, et al.Visual P300 as a neurophysiological correlate of symptomatic improvement by a virtual reality-based computer AT system in patients with auditory verbal hallucinations: a pilot study [J]. J Psychiatr Res.2022;151:261–271.
50.
Pot-KolderRMCAGeraetsCNWVelingW, 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 [J]. Lancet Psychiatry. 2018;5(3):217–226.
51.
NijmanSAPijnenborgGHMVermeerRR, et al.Dynamic interactive social cognition training in virtual reality (DiSCoVR) versus virtual reality relaxation (VRelax) for people with a psychotic disorder: a single-blind multicenter randomized controlled trial [J]. Schizophr Bull.2023;49(2):518–530.
52.
NieuwensteinMRAlemanADe HaanEH. Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and CPT studies. Wisconsin card sorting test. Continuous performance test [J]. J Psychiatr Res. 2001;35(2):119–125.
53.
TyburskiEMakMSokołowskiA, et al.Executive dysfunctions in schizophrenia: a critical review of traditional, ecological, and virtual reality assessments [J]. J Clin Med. 2021;10(13):2782.
54.
HowesODKapurS. The dopamine hypothesis of schizophrenia: version III–the final common pathway [J]. Schizophr Bull. 2009;35(3):549–562.
55.
MarderSRUmbrichtD. Negative symptoms in schizophrenia: newly emerging measurements, pathways, and treatments [J]. Schizophr Res. 2023;258:71–77.
56.
FreemanDRosebrockLWaiteF, et al.Virtual reality (VR) therapy for patients with psychosis: satisfaction and side effects [J]. Psychol Med.2023;53(10):4373–4384.
57.
BondJKennyAPinfoldV, et al.A safe place to learn: peer research qualitative investigation of game change virtual reality therapy [J]. JMIR Serious Games. 2023;11:e38065.
58.
BissoESignorelliMSMilazzoM, et al.Immersive virtual reality applications in schizophrenia spectrum therapy: a systematic review [J]. Int J Environ Res Public Health. 2020;17(17):6111.
59.
FreemanDListerRWaiteF, et al.Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses [J]. Lancet Psychiatry. 2023;10(11):836–847.
60.
Pot-KolderRGeraetsCNWVelingW, 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 [J]. Lancet Psychiatry. 2018;5(3):217–226.
61.
MontvidasJAdomaitienėVLeskauskasD, et al.Correlation of health-related quality of life with negative symptoms assessed with the self-evaluation of negative symptoms scale (SNS) and cognitive deficits in schizophrenia: A cross-sectional study in routine psychiatric care [J]. J Clin Med. 2023;12(3):901.
62.
GagiuCDionisieVManeaMC, et al.Internalised stigma, self-esteem and perceived social support as psychosocial predictors of quality of life in adult patients with schizophrenia [J]. J Clin Med. 2024;13(22):6959.
63.
ZhouDNYangXWangW, et al.Exploring the interplay of psychiatric symptoms, antipsychotic medications, side effects, employment status, and quality of life in chronic schizophrenia [J]. BMC Psychiatry. 2024;24(1):484.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
