Do virtual reality-based therapies affect symptomatology and psychosocial functioning in schizophrenia spectrum disorders: systematic review and meta-analysis

Background Virtual reality is a promising intervention for schizophrenia spectrum disorders (SSDs), offering immersive environments to support therapy. However, evidence for its effectiveness across symptom domains remains inconsistent. Aims To assess the effectiveness of virtual reality-based therapies (VRT) for SSDs on symptomatology and psychosocial functioning compared with control conditions. Method A systematic review and meta-analysis of controlled trials using virtual reality for individuals with SSDs was conducted. Searches were conducted across PubMed, PsychINFO, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials, from inception to March 2025. Random-effects models estimated pooled effect sizes (Hedges’ g ) across outcomes, including Positive and Negative Symptom Scale, depression, paranoia and cognition. Risk of bias was assessed using the Joanna Briggs Institute Risk of Bias Tool. Results From 2878 unique studies, 9 trials were eligible for meta-analysis. VRT was significantly more effective than control conditions in reducing overall psychotic symptoms (Hedges’ g = 0.53, p = 0.037). No significant effects were found for other domains (positive, negative, depressive or paranoia symptoms). Conclusions Virtual reality therapies are moderately effective at reducing overall psychotic symptoms. Unlike prior reviews, this study did not find significant effects on positive symptoms, possibly due to the heterogeneity of outcomes reported in existing interventions. Trial registration PROSPERO: CRD42023470849