Document Type : Scientific Research

Authors

• Hadiseh Eyvazzadeh Gharajeh ¹
• Farshid Fathy Karkaragh ²
• Mohammad Ali Besharat ³
• Mohammad Narimani ⁴

¹ M.Sc in Clinical Psychology, Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

² Ph.D. Student in Health Psychology, Department of Psychology, Faculty of Educational Sciences and Psychology, University of Tehran, Tehran, Iran.

³ Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, University of Tehran, Tehran, Iran

⁴ Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

Abstract

Objective: Schizophrenia is a complex psychiatric disorder frequently associated with profound and multifaceted challenges that encompass a wide spectrum of internal experiences and interpersonal functioning. Among the most prominent of these difficulties is the chronic experience of loneliness, exacerbated by paranoid ideation, struggles in initiating and maintaining interpersonal relationships, and a pervasive sense of alienation from oneself and others. Furthermore, patients diagnosed with schizophrenia significantly grapple with challenges in emotion regulation; this includes an impaired ability to identify, understand, and effectively manage emotional responses to both external and internal stimuli, leading to mood instability, irritability, and disproportionate reactions. This study aimed to investigate the effectiveness of VR-based therapy in reducing loneliness, improving emotion regulation, and enhancing executive functions in patients with schizophrenia. Method: This quasi-experimental study was conducted with a pretest-posttest design and a three-month follow-up, utilizing an active control group. Sampling was performed purposefully; after obtaining the necessary permissions and coordinating with the Ardabil City Psychiatric and Rehabilitation Center for psychiatric patients, a list of patients diagnosed with schizophrenia based on the assessment of a psychiatrist and clinical psychologist was prepared. In total, 60 eligible patients were selected after a thorough review based on the determined inclusion and exclusion criteria. Inclusion criteria included: eligible patients aged 18 to 50 years who had a definitive diagnosis of schizophrenia according to DSM-5 by the center’s psychiatrist, had at least a high school education (sikl), had been on stable medication for the past three months, did not have acute neurological diseases or severe brain injury, were able to verbally communicate and participate in sessions, and had achieved the necessary score in the basic cognitive assessment for participation in the virtual reality intervention, were purposefully selected after completing the informed consent form. Exclusion criteria also included: the occurrence of acute physical or psychological complications preventing the continuation of the intervention, significant changes in the medication regimen during treatment, absence from more than two consecutive sessions (for the virtual reality group), the occurrence of severe side effects from virtual reality, or the personal withdrawal of the patient or their legal guardian, were considered as exclusion criteria. Results: The results indicated that the virtual reality (VR) intervention significantly reduced loneliness scores, emotion regulation difficulties, and executive function deficits in patients with schizophrenia. The repeated‑measures ANOVA revealed significant main effects of time and group, as well as a significant time × group interaction effect for all three variables, demonstrating greater reductions in scores for the VR group compared to the control group and the stability of this effect at the three‑month follow‑up.  Statistical assumptions for ANOVA—including data normality (Shapiro–Wilk test, p > .05), sphericity (Mauchly’s test, p = .18), and homogeneity of variances (Levene’s test, p > .05)—were met. Post‑hoc tests confirmed that the VR group showed significantly greater improvements than the control group at both post‑test and follow‑up (p < .001), and that these effects were maintained over time, while the control group showed no significant changes (p > .05).  Effect sizes (η² ranging from 0.25 to 0.44) further indicated strong and meaningful impacts of the therapeutic interventions, particularly the VR‑based method. Overall, these findings confirm the superior and sustained effectiveness of virtual reality in improving the assessed indicators in patients with schizophrenia.Conclusion: Overall, the statistical analyses indicate that virtual reality therapy is significantly effective in reducing loneliness, decreasing emotion‑regulation difficulties, and improving executive functions in patients with schizophrenia. Despite these promising findings, several limitations may affect the generalizability of the results. One major limitation is the use of purposive sampling, which restricts the ability to generalize the findings to broader populations or different clinical groups. Additionally, the relatively small sample size (60 participants) may reduce the statistical power of the study. Future research should therefore employ larger and more diverse samples to enhance the validity and reliability of the results. Another limitation concerns the focus on only one type of intervention. Evaluating VR therapy in comparison with other psychological or pharmacological treatments could provide a more comprehensive understanding of its relative effectiveness. Future studies are encouraged to incorporate randomized sampling methods to improve generalizability and to include longer follow‑up periods to assess the durability of observed improvements over time. Moreover, examining the cost‑effectiveness and practical feasibility of VR‑based interventions in real clinical settings would offer valuable insights for clinical implementation. From an applied perspective, the findings of this study highlight the potential of VR therapy as a complementary tool within psychological interventions for individuals with schizophrenia. Given the observed improvements in reducing loneliness and enhancing executive functioning, integrating VR into therapeutic programs may offer meaningful benefits for patient care and treatment outcomes.

Keywords

• Schizophrenia
• Virtual Reality
• Loneliness
• Emotion Regulation
• Executive Function

Main Subjects

• A