Biosensor-Integrated Virtual Reality for Cognitive Behavioral Therapy in Psychosis: A Systematic Review of a New Therapeutic Frontier

Abstract

Psychosis presents significant treatment challenges, and standard Cognitive Behavioral Therapy for psychosis often faces limitations due to patient engagement issues and reliance on subjective self-reporting. The integration of Virtual Reality (VR), physiological biosensors, and artificial intelligence offers a transformative opportunity to address these challenges. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A thorough literature search was performed across seven databases. Twelve randomized controlled trials involving 1504 participants were included to assess VR-assisted CBT, VR treatment, and AVATAR therapy. Meta-analyses showed that VR interventions significantly decreased auditory verbal hallucinations (pooled SMD = −0.24, p = 0.0011) and paranoid thoughts (SMD = −0.26, p < 0.0001) compared to control conditions. This review supports integrating multi-modal biosensors to collect real-time, objective physiological data. Such integration enables the development of AI-driven, closed-loop systems that dynamically adjust the virtual environment based on the patient’s physiological state. VR-assisted therapies effectively reduce positive symptoms of psychosis. Incorporating biosensors is a crucial step toward a data-driven approach for personalized, closed-loop psychiatric care. Future efforts should focus on large-scale clinical trials, biomarker validation, and robust ethical frameworks to ensure safe and effective implementation.