Treatment of cognitive deficits in schizophrenia using a new technique of Cognitive Training in Virtual Reality: a pilot study

Background: Cognitive impairments, prevalent in 75-80% of schizophrenia patients, severely impact rehabilitation and quality of life. Current therapies, including antipsychotics, have limited success in addressing these deficits. Virtual reality (VR) offers a promising avenue for cognitive training by providing realistic, interactive scenarios for skill application. Objective: This study evaluates the efficacy of a novel VR-based cognitive training intervention in improving cognitive deficits in schizophrenia compared to standard treatment as usual (TAU). Methods: A randomized clinical trial was conducted with 16 inpatients diagnosed with schizophrenia. Participants were allocated to either a VR intervention group, receiving six weekly sessions of VR cognitive training, or a control group undergoing TAU. Pre- and post-intervention assessments included the Trail Making Test, Positive and Negative Syndrome Scale, Frontal Assessment Battery, and Tower of London test. Two VR scenarios, "Supermarket" and "Beach," were developed to target working memory, attention, and executive functioning. Data were analyzed using t-tests and linear mixed-effects models. Results: The VR intervention group showed significant improvements in frontal lobe functioning as measured by the Frontal Assessment Battery (FAB) and trends toward better executive function and attention. Scenario-specific analyses revealed reduced errors, omissions, and execution times across sessions. However, broader cognitive and psychiatric symptom improvements were limited and did not persist after multiple-comparison corrections. Conclusion: VR cognitive training shows potential as an innovative tool for enhancing executive functioning in schizophrenia patients. While immediate task performance improved, broader cognitive impacts and psychiatric symptom reductions were minimal. Future research should focus on long-term efficacy, functional outcomes, and scalability of VR interventions.