Virtual Reality for the Treatment of Auditory Hallucinations in Schizophrenia Spectrum Disorders: a Systematic Review and Meta-Analysis

AI Summary

VR interventions, primarily avatar therapy, significantly reduced auditory hallucination severity post-treatment (Hedges' g = −0.41) and at follow-up (g = −0.28).
Eight studies (n = 1004) contributed to the meta-analysis; most employed avatar therapy, one used a VR mindfulness intervention.
Evidence limited by small sample sizes, study heterogeneity and intervention homogeneity; larger randomised controlled trials are needed before clinical implementation.

Schizophr Bull. 2026 Apr 10;52(3):sbag052. doi: 10.1093/schbul/sbag052.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Auditory hallucinations (AHs) are debilitating symptoms of schizophrenia spectrum disorders (SSDs) associated with several negative outcomes. AHs are often resistant to existing pharmacological and psychological interventions. Virtual reality (VR) has emerged as a promising intervention for AHs. This systematic review and meta-analysis aimed to assess the effectiveness of VR interventions in treating AHs in SSDs.

STUDY DESIGN: A comprehensive literature search was conducted on Embase, APA PsycINFO, and MEDLINE via the Ovid Database. Studies with a randomized controlled trial (RCT) or randomized cross-over trial design that had treatment and active or treatment-as-usual control conditions were included. Random-effects meta-analyses compared the change in the primary outcome of AH severity from baseline to post-treatment and at follow-up between the groups.

STUDY RESULTS: Eight studies (n = 1004) met the criteria for the meta-analyses. Eight studies used avatar therapy (AT), and 1 study used a VR-based mindfulness intervention. Random-effects meta-analyses found that VR interventions were more effective than the control conditions in reducing AH severity immediately post-intervention (Hedges’ g = -0.41, 95% CI [-0.62, -0.20], P < .01) and at follow-up (Hedges’ g = -0.28, 95% CI [-0.40, -0.17], P < .001).

CONCLUSION: This review was limited by a small sample size, study heterogeneity, and intervention homogeneity. Future research should prioritize larger RCTs of VR-based interventions for psychosis before VR can be reliably used in clinical settings. Overall, the results of this meta-analysis suggest that VR-based AT may be a promising avenue to improve AHs in SSDs.

PMID:42084440 | DOI:10.1093/schbul/sbag052

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