Background Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. Objective This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. Methods This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. Results A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. Conclusions VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life.

BACKGROUND Recovery for people with psychosis remains a challenge despite psychiatric care and rehabilitation interventions aimed at improving functional outcomes. Cognitive, social, and vocational skills are strong predictors for quality of life and deficits in these areas may persist despite current treatments for psychosis. Recent advances in virtual reality applications have enabled the development of realistic environments wherein individuals with psychosis can receive rehabilitation treatments that are more ecological than traditional clinical settings. Therefore, virtual reality rehabilitation interventions may increase the transfer of skills to real-world environments and improve recovery for individuals with psychosis. OBJECTIVE This systematic review synthesized the current evidence on the feasibility and efficacy of virtual reality as a rehabilitation intervention for individuals with psychosis. METHODS This research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in PubMed and PsycINFO using the following search strategy: (“cognitive” or “cognition”) OR ("social") OR ("vocational") AND (“training” or “remediation” or “rehabilitation” or “enhancement”) AND “schizophrenia” or "schizoaffective" or "psychosis" AND "virtual reality”. English peer-reviewed studies were included and divided into three categories: (1) cognitive rehabilitation studies; (2) social skills rehabilitation studies; and (3) vocational rehabilitation studies. RESULTS Nine studies were included in this systematic review. Four were single arm studies, four were randomized controlled trials, and one was a non-randomized controlled trial. A total of 257 individuals with psychosis were included across all studies. All the studies that evaluated feasibility showed that virtual reality rehabilitation interventions were feasible and enjoyable for individuals with psychosis. Preliminary evidence suggests that rehabilitation interventions using virtual reality can increase cognitive, social, and vocational skills in these individuals. In six studies, rehabilitation interventions using virtual reality also improved functional outcomes, such as autonomy, managing housework, and work performance. CONCLUSIONS Virtual reality rehabilitation interventions represent a promising avenue to improve cognitive, social, and vocational deficits in individuals with psychosis. Most studies we identified were conducted using small sample sizes and with no active control group. Therefore, more rigorous research in this area is warranted. Nevertheless, our findings show that virtual reality rehabilitation interventions may represent a promising adjunctive therapy for improving recovery in people with psychosis.