{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:47:38Z","timestamp":1790765258538,"version":"4.1.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dutch Brain Foundation","award":["HA2017.01.04"],"award-info":[{"award-number":["HA2017.01.04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>In this secondary analysis of a randomized controlled trial, individuals aged 18-65 with a psychotic disorder and paranoid ideation were recruited. Ninety-eight participants were randomized to maximally 16 sessions of VR-CBTp (n\u2009=\u200948) or CBTp (n\u2009=\u200950). Self-rated symptom severity, functional impairment, and clinician-rated illness severity were assessed at each therapy session. Analyses on change scores between the first and final session were performed to assess overall improvement, and multilevel regression models explored in-depth session differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Results<\/jats:title>\n                    <jats:p>Clinician-rated paranoia and avoidance improved more rapidly in VR-CBTp than CBTp, with differences emerging from session 3. Patients reported similar progress in both groups over time on symptoms and functional impairment. A greater proportion of VR-CBTp participants completed treatment early, requiring fewer sessions than the CBTp group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Therapists observed faster symptom recovery in paranoia and avoidance in VR-CBTp while requiring fewer sessions than standard CBTp. These findings suggest that VR-CBTp may be more efficient in duration, while broader effects on access and therapist workload remain to be determined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/schbul\/sbag068","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T11:37:54Z","timestamp":1775907474000},"source":"Crossref","is-referenced-by-count":1,"title":["Tracking Symptom Change Across Therapy Sessions in Virtual Reality Cognitive Behavioral Therapy Versus Cognitive Behavioral Therapy for Paranoid Ideation: A Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.1093","volume":"52","author":[{"given":"Maureen","family":"Berkhof","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Groningen, University Medical Center Groningen , 9700 RB Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth Christine Doroth\u00e9e","family":"Van Der Stouwe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Groningen, University Medical Center Groningen , 9700 RB Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Veling","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Groningen, University Medical Center Groningen , 9700 RB Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6401-2073","authenticated-orcid":false,"given":"Chris Neeltje Wil","family":"Geraets","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Groningen, University Medical Center Groningen , 9700 RB Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"2026050903574291700_ref1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/bjc.12199","article-title":"Paranoia and interpersonal functioning across the continuum from healthy to pathological \u2013 network analysis","volume":"58","author":"Hajd\u00fak","year":"2019","journal-title":"Br J Clin Psychol"},{"key":"2026050903574291700_ref2","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.scog.2015.11.002","article-title":"Paranoid individuals with schizophrenia show greater social cognitive bias and worse social functioning than non-paranoid individuals with schizophrenia","volume":"3","author":"Pinkham","year":"2016","journal-title":"Schizophr Res Cogn"},{"key":"2026050903574291700_ref3","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3109\/09540261.2011.606801","article-title":"Schizophrenia guidelines across the world: a selective review and comparison","volume":"23","author":"Gaebel","year":"2011","journal-title":"International Review of Psychiatry"},{"key":"2026050903574291700_ref4","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1177\/0004867416678457","article-title":"Commentary on RANZCP clinical practice guidelines for the management of schizophrenia and related disorders","volume":"51","author":"Galbally","year":"2017","journal-title":"Aust N Z J Psychiatry"},{"key":"2026050903574291700_ref5","volume-title":"PRACTICE GUIDELINE FOR THE Treatment of Patients with Schizophrenia","author":"American Psychiatric Association","year":"2021"},{"key":"2026050903574291700_ref6","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1093\/schbul\/sbp130","article-title":"The schizophrenia patient outcomes research team (PORT): updated treatment recommendations 2009","volume":"36","author":"Kreyenbuhl","year":"2010","journal-title":"Schizophr Bull"},{"key":"2026050903574291700_ref7","article-title":"Psychosis and schizophrenia in adults: prevention and management","author":"National Institute for Health and Care Excellence (NICE)","journal-title":"NICE guideline CG178"},{"key":"2026050903574291700_ref8","volume-title":"Psychose","author":"GGZ Standaarden","year":"2017"},{"key":"2026050903574291700_ref9","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13033-023-00576-9","article-title":"International rates of receipt of psychological therapy for psychosis and schizophrenia: systematic review and meta-analysis","volume":"17","author":"Burgess-Barr","year":"2023","journal-title":"Int J Ment Health Syst"},{"key":"2026050903574291700_ref10","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1038\/s41537-022-00226-y","article-title":"Non-pharmacological interventions for schizophrenia\u2014analysis of treatment guidelines and implementation in 12 southeast European countries","volume":"8","author":"Stevovi\u0107","year":"2022","journal-title":"Schizophrenia."},{"key":"2026050903574291700_ref11","doi-asserted-by":"publisher","first-page":"162","DOI":"10.3109\/09638237.2013.869571","article-title":"An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia","volume":"23","author":"Haddock","year":"2014","journal-title":"J Ment Health"},{"key":"2026050903574291700_ref12","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-30521-9","volume-title":"Brief interventions for Psychosis: A Clinical Compendium","author":"Naeem","year":"2016"},{"key":"2026050903574291700_ref13","doi-asserted-by":"publisher","first-page":"402","DOI":"10.3389\/fpsyt.2020.00402","article-title":"Efficacy and moderators of cognitive behavioural therapy for psychosis versus other psychological interventions: an individual-participant data meta-analysis","volume":"11","author":"Turner","year":"2020","journal-title":"Front Psychiatry"},{"key":"2026050903574291700_ref14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.eurpsy.2016.05.004","article-title":"What is the minimal dose of cognitive behavior therapy for psychosis? An approximation using repeated assessments over 45 sessions","volume":"38","author":"Lincoln","year":"2016","journal-title":"European Psychiatry"},{"key":"2026050903574291700_ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/NCFR5074","article-title":"Treatment effect modifiers of cognitive behaviour therapy in people with psychosis: an individual participant data meta-analysis of RCTs","volume":"29","author":"Varese","year":"2025","journal-title":"Health Technol Assess (Rockv)"},{"key":"2026050903574291700_ref16","doi-asserted-by":"publisher","first-page":"e188","DOI":"10.1017\/S0033291725100949","article-title":"Virtual-reality cognitive behavior therapy versus cognitive behavior therapy for paranoid ideation: a pragmatic, single-blind, multicenter randomized clinical superiority trial","volume":"55","author":"van der Stouwe","year":"2025","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref17","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/S2215-0366(18)30053-1","article-title":"Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial","volume":"5","author":"Pot-Kolder","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2026050903574291700_ref18","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1192\/bjp.bp.115.176438","article-title":"Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction","volume":"209","author":"Freeman","year":"2016","journal-title":"Br J Psychiatry"},{"key":"2026050903574291700_ref19","volume-title":"Gedachten Uitpluizen: Cognitief Gedragstherapeutische Protocollen Bij Psychotische Klachten","author":"van der Gaag"},{"key":"2026050903574291700_ref20","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1186\/s12888-021-03473-y","article-title":"Virtual reality cognitive-behavioural therapy versus cognitive-behavioural therapy for paranoid delusions: a study protocol for a single-blind multi-centre randomised controlled superiority trial","volume":"21","author":"Berkhof","year":"2021","journal-title":"BMC Psychiatry"},{"key":"2026050903574291700_ref21","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1017\/S003329170100455X","article-title":"Persecutory delusions: developing the understanding of belief maintenance and emotional distress","volume":"31","author":"Freeman","year":"2001","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref22","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1348\/014466502760387461","article-title":"A cognitive model of persecutory delusions","volume-title":"British Journal of Clinical Psychology","author":"Freeman","year":"2002"},{"key":"2026050903574291700_ref23","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/acps.13713","article-title":"Exploring the role of clinical and demographic characteristics on the effects of virtual reality cognitive behavioral therapy for psychosis: a moderator analysis","volume":"151","author":"Berkhof","year":"2025","journal-title":"Acta Psychiatr Scand"},{"key":"2026050903574291700_ref24","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.schres.2024.08.005","article-title":"Relations between changes in safety behavior, paranoid ideations, cognitive biases, and clinical characteristics of patients with a psychotic disorder over time","volume":"272","author":"Berkhof","year":"2024","journal-title":"Schizophr Res"},{"key":"2026050903574291700_ref25","doi-asserted-by":"publisher","first-page":"3425","DOI":"10.1038\/s41591-025-03880-8","article-title":"Virtual reality-based versus standard cognitive behavioral therapy for paranoia in schizophrenia spectrum disorders: a randomized controlled trial","volume":"31","author":"Jeppesen","year":"2025","journal-title":"Nat Med"},{"key":"2026050903574291700_ref26","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaf083","article-title":"Learning how to improve the treatment of persecutory delusions: using a principal trajectories analysis to examine differential effects of two psychological interventions (feeling safe, befriending) in distinct groups of patients","volume":"52","author":"Jenner","year":"2025","journal-title":"Schizophr Bull"},{"key":"2026050903574291700_ref27","doi-asserted-by":"publisher","first-page":"4173","DOI":"10.1017\/S0033291724002113","article-title":"Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes","volume":"54","author":"Jenner","year":"2024","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref28","doi-asserted-by":"publisher","first-page":"121225","DOI":"10.1016\/j.jad.2026.121225","article-title":"Associations of prior treatment, waiting time, symptom severity, and session frequency with symptom change in CBT for depression and anxiety in primary care","volume":"400","author":"Mikkonen","year":"2026","journal-title":"J Affect Disord"},{"key":"2026050903574291700_ref29","doi-asserted-by":"publisher","first-page":"6183","DOI":"10.1017\/S0033291722003403","article-title":"Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems","volume":"53","author":"Skelton","year":"2023","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaf150","article-title":"Trajectories of change within cognitive behavioral therapy for psychosis","volume":"52","author":"Ludwig","year":"2026","journal-title":"Schizophr Bull"},{"key":"2026050903574291700_ref31","doi-asserted-by":"publisher","first-page":"S122","DOI":"10.1093\/schbul\/sbr063","article-title":"The role of motivation for treatment success","volume":"37","author":"Medalia","year":"2011","journal-title":"Schizophr Bull"},{"key":"2026050903574291700_ref32","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1017\/S0033291707001638","article-title":"Measuring ideas of persecution and social reference: the Green et\u00a0al. paranoid thought scales (GPTS)","volume":"38","author":"Green","year":"2008","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref33","volume-title":"Gedachten Uitpluizen: Cognitief Gedragstherapeutische Protocollen Bij Psychotische Klachten","author":"van der","year":"2013"},{"key":"2026050903574291700_ref34","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/YIC.0b013e3282f2b4d6","article-title":"Assessing treatment effects in clinical trials with the discan metric of the Sheehan disability scale","volume":"23","author":"Sheehan","year":"2008","journal-title":"Int Clin Psychopharmacol"},{"key":"2026050903574291700_ref35","first-page":"28","article-title":"The clinical global impressions scale: applying a research tool in clinical practice","volume":"4","author":"Busner","year":"2007","journal-title":"Psychiatry (Edgmont)"},{"key":"2026050903574291700_ref36","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1034\/j.1600-0447.107.s416.5.x","article-title":"The clinical global impression\u2013schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia","volume":"107","author":"Haro","year":"2003","journal-title":"Acta Psychiatr Scand"},{"key":"2026050903574291700_ref37","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1002\/wps.20513","article-title":"Experience sampling methodology in mental health research: new insights and technical developments","volume":"17","author":"Myin-Germeys","year":"2018","journal-title":"World Psychiatry"},{"key":"2026050903574291700_ref38","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1017\/S003329170100455X","article-title":"The safety behaviours questionnaire - persecutory beliefs","volume":"31","author":"Freeman","year":"2001","journal-title":"Psychol Med"},{"key":"2026050903574291700_ref39","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jclinepi.2016.01.034","article-title":"Change score or follow-up score? Choice of mean difference estimates could impact meta-analysis conclusions","volume":"76","author":"Fu","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2026050903574291700_ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S1754470X22000484","article-title":"Reliable change and the reliable change index: still useful after all these years?","volume":"15","author":"Blampied","year":"2022","journal-title":"Cogn Behav Therap"},{"key":"2026050903574291700_ref41","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S2215-0366(16)00066-3","article-title":"Persecutory delusions: a cognitive perspective on understanding and treatment","volume":"3","author":"Freeman","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"2026050903574291700_ref42","doi-asserted-by":"publisher","first-page":"e47443","DOI":"10.2196\/47443","article-title":"Patient perceptions of in vivo versus virtual reality exposures for the treatment of anxiety disorders: cross-sectional survey study","volume":"7","author":"Levy","year":"2023","journal-title":"JMIR Form Res"},{"key":"2026050903574291700_ref43","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1080\/17522439.2017.1295098","article-title":"A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials","volume":"9","author":"Morrison","year":"2017","journal-title":"Psychosis."},{"key":"2026050903574291700_ref44","volume-title":"Protocollaire Behandelingen Voor Volwassenen Met Psychische Klachten. Deel 2","author":"van der Gaag","year":"2017","edition":"2nd"},{"key":"2026050903574291700_ref45","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1089\/cpb.2007.9962","article-title":"Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias","volume":"10","author":"Garcia-Palacios","year":"2007","journal-title":"CyberPsychol Behav"},{"key":"2026050903574291700_ref46","doi-asserted-by":"publisher","first-page":"169","DOI":"10.31887\/DCNS.2020.22.2\/lvalmaggia","article-title":"Virtual reality as a clinical tool in mental health research and practice","volume":"22","author":"Bell","year":"2020","journal-title":"Dialogues Clin Neurosci"},{"key":"2026050903574291700_ref47","doi-asserted-by":"publisher","first-page":"773","DOI":"10.3389\/fpsyt.2019.00773","article-title":"Using virtual reality exposure therapy to enhance treatment of anxiety disorders: identifying areas of clinical adoption and potential obstacles","volume":"10","author":"Boeldt","year":"2019","journal-title":"Front Psychiatry"},{"key":"2026050903574291700_ref48","doi-asserted-by":"publisher","first-page":"102132","DOI":"10.1016\/j.cpr.2022.102132","article-title":"Correlates of therapist drift in psychological practice: a systematic review of therapist characteristics","volume":"93","author":"Speers","year":"2022","journal-title":"Clin Psychol Rev"},{"key":"2026050903574291700_ref49","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1080\/16506073.2023.2191824","article-title":"Therapist factors associated with intent to use exposure therapy: a systematic review and meta-analysis","volume":"52","author":"Langthorne","year":"2023","journal-title":"Cogn Behav Ther"},{"key":"2026050903574291700_ref50","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.copsyc.2021.02.004","article-title":"Advances in immersive virtual reality interventions for mental disorders: a new reality?","volume":"41","author":"Geraets","year":"2021","journal-title":"Curr Opin Psychol"}],"container-title":["Schizophrenia Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/schizophreniabulletin\/article-pdf\/52\/3\/sbag068\/68257838\/sbag068.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/schizophreniabulletin\/article-pdf\/52\/3\/sbag068\/68257838\/sbag068.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T07:57:50Z","timestamp":1778313470000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/schizophreniabulletin\/article\/doi\/10.1093\/schbul\/sbag068\/8674791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,5,9]]},"published-print":{"date-parts":[[2026,4,10]]}},"URL":"https:\/\/doi.org\/10.1093\/schbul\/sbag068","relation":{},"ISSN":["0586-7614","1745-1701"],"issn-type":[{"value":"0586-7614","type":"print"},{"value":"1745-1701","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,10]]},"article-number":"sbag068"}}