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

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.