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Persecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning.To test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure).Conviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed.In comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8).Cognitive therapy using virtual reality could prove highly effective in treating delusions.

Original publication




Journal article


The British journal of psychiatry : the journal of mental science

Publication Date





62 - 67


Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK


Humans, Delusions, Paranoid Disorders, Cognitive Therapy, Implosive Therapy, User-Computer Interface, Adult, Middle Aged, Outcome Assessment (Health Care), Female, Male