VR social interaction practice is acceptable and feasible for people with schizophrenia
How this was rated
Small experimental design (n=18) in a complex clinical population; exploratory rather than confirmatory.
Ratings use a simplified four-tier scheme (High, Moderate, Low, Very Low) informed by the GRADE working group. Learn more about how studies are rated.
A feasibility study finding that a VR-based social skills program (MASI-VR) was well-received and practical for adults with schizophrenia spectrum experiences, with participants showing improvements in social functioning.
An exploratory experimental study suggesting that a virtual social scenario can elicit measurable responses in adults with schizophrenia spectrum experiences; larger and more controlled work is needed before firm conclusions.
Key findings
- Participants rated the MASI-VR program as highly acceptable and easy to use.
- Overall psychiatric symptoms (BPRS) improved significantly after VR sessions (F(1,15)=8.83, p=0.01, eta2=0.23). Social functioning scale (SFS) scores did NOT significantly change.
- Negative symptoms (SANS) showed significant improvement (F(1,15)=8.64, p=0.01, eta2=0.22).
- Retention was high: 16 of 18 participants completed all sessions (89%).
Background
People with schizophrenia spectrum experiences often face challenges with social communication, including difficulty reading social cues, initiating conversations, and maintaining reciprocal interactions. Traditional social skills programs can feel artificial or anxiety-provoking, and opportunities for real-world practice may be limited by social isolation. Virtual reality offers a potential middle ground - realistic enough to feel meaningful, but safe enough to reduce the social pressure that can make practice difficult.
What the researchers did
Adery and colleagues developed MASI-VR (Mental health Avatar Social Interaction - Virtual Reality), a non-immersive desktop VR platform - a video-game style program on a standard computer monitor, not a head-mounted display. The system uses virtual characters to create structured social interaction scenarios. Eighteen adults with DSM-5 schizophrenia diagnoses, recruited from outpatient day facilities in Nashville TN, completed multiple sessions practicing social skills such as starting conversations, responding to social cues, and navigating common situations. Sixteen of 18 participants completed all sessions (89% retention). The researchers measured acceptability, feasibility, and changes across multiple psychiatric and social functioning measures before and after the program.
What they found
Participants consistently rated MASI-VR as acceptable and user-friendly. Two psychiatric symptom measures improved significantly after the program: overall psychiatric symptoms on the Brief Psychiatric Rating Scale (BPRS: F(1,15)=8.83, p=0.01, eta-squared=0.23) and negative symptoms on the Scale for the Assessment of Negative Symptoms (SANS: F(1,15)=8.64, p=0.01, eta-squared=0.22). Notably, scores on the Social Functioning Scale (SFS) did NOT show significant improvement - the earlier finding that “social functioning scores improved” was a mischaracterization of the paper’s results.
Why this matters
This study provides early evidence that VR-based social communication support is not only technically possible but genuinely welcomed by the people it is designed for. The high acceptability ratings are particularly important because engagement is often a barrier in social skills programs. By removing some of the social risks associated with face-to-face practice, VR may help people build confidence and skills in a way that feels manageable and empowering.
Limitations
The study lacked a control group, so improvements in social functioning cannot be definitively attributed to the VR program. The sample size was modest and drawn from a single site. Long-term maintenance of gains and transfer to real-world social situations were not assessed.
Implications for practice
MASI-VR is a non-immersive desktop VR platform (not a head-mounted display) that uses video-game style social scenarios to practice conversation skills. The study found improvements in psychiatric symptoms and negative symptoms but not on the Social Functioning Scale - clinicians should not expect this specific program to directly produce social functioning gains. High acceptability and low dropout suggest desktop VR social training is feasible and well-received for people with schizophrenia receiving outpatient support.
Where this connects to Therapy withVR
The study above is independent research and does not endorse any product. The notes below are commentary from withVR on how the themes in this research relate to features of Therapy withVR. The research findings are not claims about Therapy withVR.
Multiple Social Environments
This study used VR social interaction scenarios - Therapy withVR's 12 environments cover the range of social contexts from informal (Café, Kitchen Table) to structured (Meeting Room, Reception) for practicing everyday social skills.
Avatar Emotions
Practice reading and responding to social cues with 11 avatar emotions - supporting the social cognition skills this study showed can improve through VR-based practice.
AI Prompts
Keep social conversations flowing naturally with 14 AI response types (Acknowledge, Clarify, Encourage, Elaborate) - creating the responsive interaction partners this study found engaging.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{adery2018,
author = {Adery, L. H. and Ichinose, M. and Torregrossa, L. J. and Wade, J. and Nichols, H. and Bekele, E. and Bian, D. and Gizdic, A. and Granholm, E. and Sarkar, N. and Park, S.},
title = {The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings},
journal = {Psychiatry Research},
year = {2018},
doi = {10.1016/j.psychres.2018.10.014},
url = {https://withvr.app/evidence/studies/adery-2018}
}TY - JOUR
AU - Adery, L. H.
AU - Ichinose, M.
AU - Torregrossa, L. J.
AU - Wade, J.
AU - Nichols, H.
AU - Bekele, E.
AU - Bian, D.
AU - Gizdic, A.
AU - Granholm, E.
AU - Sarkar, N.
AU - Park, S.
TI - The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings
JO - Psychiatry Research
PY - 2018
DO - 10.1016/j.psychres.2018.10.014
UR - https://withvr.app/evidence/studies/adery-2018
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
Supported by NARSAD, NIMH grant MH106748, and the Gertrude Conaway Vanderbilt Endowment. No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.