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Exposure therapie

VR-CBT: VR based cognitive behavioral therapy

Of all people with a psychotic disorder 70% experiences paranoid delusions. People with paranoid delusions can be sure that they are at risk of harm, even if this is not actually the case. Such extreme paranoia causes fear and distress and results in avoidance of social situations. Everyday activities such as grocery shopping, walking in the street or taking the bus become hard or are avoided.

Therapy for paranoia

They psychological therapy for paranoid delusions is cognitive behavioral therapy (CBT). With CBT people learn to challenge and adjust their paranoid ideations. An important part of the therapy exists of practicing with everyday life situations in which they experience paranoid ideations or anxiety. CBT works well, although there is room for improvement. Often people are still too afraid to practice new behavior, or the situations someone wants to practice with do not occur in the real world, as we cannot influence the world around us. For example, as a therapist you cannot adjust the crowdedness in a supermarket. Furthermore, feedback or advice is given retrospectively, as therapists are not present during exercises in the real world.

VR based therapy

Because of the limitations listed above, we developed a VR based CBT (VR-CBT) for social avoidance and paranoia. With VR-CBT people can practice within a virtual supermarket, shopping street, bus or café. Although VR situations are not real, it does result in similar physical and psychological reactions, comparable to the reactions in the real world. This enables practicing situations in a safe VR environment, even situations that may be too challenging in the real world. Moreover, situations can be completely personalized; e.g., a therapist can choose and adapt the virtual environment (e.g., supermarket), the crowdedness of situations, and what a virtual character will say. Also the therapist is present during the VR-exercises. In this way the therapist can provide immediate feedback to the person.


Our research in 116 people with a psychotic disorder showed that the VR therapy is indeed effective. After VR-CBT people experienced less paranoid ideation and anxiety in everyday social situations compared to people who did not receive VR-CBT. Some people were able to go to the supermarket again, or take the bus to visit family or friends for the first time in years.

In the next years we will continue our work with VR-CBT for psychosis and anxiety. The next step will be to study whether VR-CBT is more effective and/or efficient than regular CBT.


Rijksuniversiteit Groningen