Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients

Steffen Moritz*, Miriam Voigt, Ulf Köther, Lucy Leighton, Besiane Kjahili, Zehra Babur, David Jungclaussen, Ruth Veckenstedt, Karsten Grzella

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Background and objectives There is emerging evidence that the induction of doubt can reduce positive symptoms in patients with schizophrenia. Based on prior investigations indicating that brief psychological interventions may attenuate core aspects of delusions, we set up a proof of concept study using a virtual reality experiment. We explored whether feedback for false judgments positively influences delusion severity. Methods A total of 33 patients with schizophrenia participated in the experiment. Following a short practice trial, patients were instructed to navigate through a virtual street on two occasions (noise versus no noise), where they met six different pedestrians in each condition. Subsequently, patients were asked to recollect the pedestrians and their corresponding facial affect in a recognition task graded for confidence. Before and after the experiment, the Paranoia Checklist (frequency subscale) was administered. Results The Paranoia Checklist score declined significantly from pre to post at a medium effect size. We split the sample into those with some improvement versus those that either showed no improvement, or worsened. Improvement was associated with lower confidence ratings (both during the experiment, particularly for incorrect responses, and according to retrospect assessment). Limitations No control condition, unclear if improvement is sustained. Discussion The study tentatively suggests that a brief virtual reality experiment involving error feedback may ameliorate delusional ideas. Randomized controlled trials and dismantling studies are now needed to substantiate the findings and to pinpoint the underlying therapeutic mechanisms, for example error feedback or fostering attenuation of confidence judgments in the face of incomplete evidence.

Original languageEnglish
Pages (from-to)267-271
Number of pages5
JournalJournal of Behavior Therapy and Experimental Psychiatry
Issue number2
Publication statusPublished - Jun 2014
Externally publishedYes


  • Bias modification
  • Confidence
  • Error feedback
  • Schizophrenia
  • Virtual reality


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