Virtual Reality Schema Therapy Exercises With Parent and Child Modes (VR-STEM)

VR-STEM: Virtual Reality Schema Therapy Exercises With Parent and Child Modes

The goal of this clinical trial is to develop a Virtual Reality version of a Schema Therapy exercise and test its feasibility, acceptability and potential usefulness in people with psychiatric disorders (age 18-65). The main questions the investigators aim to answer are:

1. Are dialogue exercises with virtual reality mode avatars feasible, acceptable and useful?
2. How do patients experience VR schema therapy exercises (in terms of immersion, elicited emotions, therapeutic relationship or subjective efficacy) and are the exercises potentially effective (in terms of schema mode scores, self-criticism, self-compassion and self-esteem)?
3. In case of a potential 'effect', is this moderated by mental imagery ability?

The investigators hypothesize that 1) dialogue exercises with virtual reality mode avatars are feasible, ac-ceptable and useful according the Technology Acceptance Model (TAM; Davis, 1989); 2) patients experience high levels of immersion, elicited emotions and subjective efficacy, a strong therapeutic relationship, and show effects on schema mode scores and self-compassion and self-esteem scores; and 3) these effects are moderated by patients' mental imagery ability in such a way that patients with less mental imagery abilities benefit most.

The development of the VR version of the exercise will be done in collaboration with patients and therapists.

To test its feasibility, acceptability and potential usefulness, participants will be invited to receive one session of the exercise. During this session, they will complete some questionnaires before and after the exercise, and they will be asked about their opinions about and experiences of the exercise.

Study Overview

• Status: Recruiting
• Conditions: Psychiatric Disorders
• Intervention / Treatment: Behavioral: VR Schema Therapy Chairwork Exercise

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elise C. D. van der Stouwe, PhD; Phone Number: +31 (0)6 39199758; Email: e.c.d.van.der.stouwe@umcg.nl

Study Locations

• Netherlands
  • Provincie Groningen
    • Groningen, Provincie Groningen, Netherlands, 9713GZ
      • Recruiting
      • University Medical Centre Groningen
      • Contact: Elise C.D. van der Stouwe, PhD; Phone Number: +31 (0)6 39199758; Email: e.c.d.van.der.stouwe@umcg.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 18-65 years of age
• In treatment at a tertiary treatment facility (UCP, UMCG)
• Whose current psychological distress is related to early life experiences as indicated by a clinician
• Score of >3 on one of three schema modes on the SMI (Lobbestael et al., 2010)

Exclusion Criteria:

• Insufficient command of the Dutch language
• Primary diagnosis of a substance use disorder, or organic brain disease (such as dementia)
• Unable to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: VR Schema Therapy Chairwork Exercise; The intervention consists of a schema therapy chairwork exercise in Virtual Reality	Behavioral: VR Schema Therapy Chairwork Exercise; VR Schema Therapy chairwork exercise

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Screened and enrolled patients per month	The amount of screened and enrolled patients per month will be registered to evaluate feasibility and acceptability.	From start to end of recruitment (+/- 10 months)
Drop-outs	Total number of drop-outs will be registered to evaluate feasibility and acceptability.	From start to end of recruitment (+/- 10 months)
Reasons for withdrawal	Reasons for withdrawal from the study will be registered to evaluate feasibility and acceptability	From start to end of recruitment (+/- 10 months)
Total and types of adverse events	The total number and types of adverse events will be registered to evaluate feasibility and acceptability.	From start to end of recruitment (+/- 10 months)
Experienced issues during sessions	Experienced issues during sessions will be registered to evaluate feasibility and acceptability	During the 2-hour sessions (From start to end of recruitment [+/- 10 months])
Evaluative questions	A questionnaire based on the Technology Acceptance Model (TAM) will be completed by patients to evaluate their feedback, perceived usefulness, the added value, and their attitude towards VR schema therapy. This measure is used to evaluate feasibility and acceptability. It consists of 16 questions, divided into two subsections: subjective experience (8 questions) and Technology Acceptance Model (TAM) (8 questions). Questions are scored on a Likert scale ranging from 1 to 7 (total min. 16, max. 112; per subsection min. 8, max. 56). A lower score means a lower evaluation/more negative experience of the intervention, and a higher score means a higher evaluation/more positive experience with the intervention.	At the end of the 2-hour intervention session (at post-intervention assessment)
Patients qualitative first experiences	Patients qualitative first experiences with the Virtual Reality intervention will be measured using a qualitative, semi-structured interview at the end of each session, to evaluate feasibility and acceptability. Standard questions are: How did you find the exercise?; What did you find positive about the exercise? (how can we make the positive aspects even more positive?); What is missing from the exercise? (what can we improve?) The questions are intended as a guiding structure rather than a fixed questionnaire, and allow for additional follow-up questions to explore relevant topics further.	At the end of the 2-hour intervention session, after the post-intervention assessment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Momentary Schema Modes Questionnaire (MSMQ)	The Momentary Schema Modes Questionnaire (MSMQ) will be completed by patients during the session. Difference scores will be used for evaluation of preliminary effects. The MSMQ consists of 35 questions measuring the present-moment level of 11 schema modes. The questions are rated on a Visual Analogue Scale ranging from 0-100 (total min. 0, max. 3500). Lower scores represent a lower presence of a certain schema mode.	At the start (baseline) and at the end of the single session of 2 hours (pre- and post-intervention)
Visual Analogue Scales	Visual Analogue Scales will be used to measure affect and self-esteem. The questionnaire is derived from previous ESM studies, and consists of 12 questions divided over 3 subscales: positive affect (3 questions), negative affect (3 questions), self-esteem (6 questions). Each question is scored on a scale ranging from 0-100. Difference scores for each subscale are used to evaluate preliminary effects. Higher scores represent higher levels of the measured variable (positive affect [min. 0, max. 300], negative affect [min. 0, max. 300], self-esteem [min. 0, max. 600]).	At the start (baseline) and at the end of the single session of 2 hours (pre- and post-intervention)
Self-Compassion and self-Criticism Scales (SCCS)	The Self-Compassion and self-Criticism Scales (SCCS) is a questionnaire that measures levels of self-criticism and self-compassion. It consists of 5 situations, for which participants have to score to what extent they would respond to themselves in a reassuring, soothing, contemptuous, compassionate, critical, and harsh way. For the current study, each of the reactions is scored on a Visual Analogue Scale ranging from 0-100 (Self-criticism scale min. 0, max. 1500; self-compassion scale min. 0, max. 1500). Higher scores on the self-criticism scale represent higher levels of self-criticism, whereas higher scores on the self-compassion scale represent higher levels of self-compassion. Difference scores for each scale will be used to evaluate preliminary effects.	At the start (baseline) and at the end of the single session of 2 hours (pre- and post-intervention)
Immersion	Two questions from the Igroup Presence Questionnaire (IPQ) will be used to assess immersion into Virtual Reality (VR). Both questions are scored on a Visual Analogue Scale ranging from 0-100 (total min. score 0, max. 200). Lower scores represent lower levels of immersion into the VR environment.	At the end of the 2-hour intervention session (at post-intervention assessment)
Therapeutic relationship	The Session Rating Scale (SRS) will be used to assess working alliance/therapeutic relationship. The SRS consists of 4 questions which are scored on a Visual Analogue Scale ranging from 0-100 (total min. 0, max. 400). Lower scores represent lower levels of experienced therapeutic relationship/working alliance during the intervention session.	At the end of the 2-hour intervention session (post-intervention asessment)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vividness of Visual Imagery Questionnaire (VVIQ)	The Vividness of Visual Imagery Questionnaire (VVIQ) consists of 16 items assessing mental imagery ability. Each question is scored on a Likert scale ranging from 1 to 5, where higher scores represent lower ability of mental imagery. For purposes of interpretation, the scale is recoded in the current study, so that higher scores represent a higher ability of mental imagery.	At the start of the single intervention session of 2 hours (pre-intervention assessment)
Visualizer-Verbalizer Questionnaire (VVQ)	The Visualizer-Verbalizer Questionnaire (VVQ) consists of 30 items used in this study to assess mental imagery ability. The 30 items are divided over 3 subscales (10 items per subscale), namely visual, verbal, and dream items. These items measure a preference for either a visual or verbal learning style, and vividness of dreams. A more visual learning style and higher vividness of dreams is associated with mental imagery ability. Each question is scored on a binary scale choosing whether a statement is true or false for them. Total scores for each subscale are calculated (min. 0, max. 10), to assess the participants preference for either a visual or verbal learning style, and vividness of dreams. Higher scores represent a higher preference for a learning style or higher vividness of dreams.	At the start of the single intervention session of 2 hours (pre-intervention assessment)
Schema Mode Inventory (SMI)	The Schema Mode Inventory (SMI) will be used to screen participants for participation in the study. The SMI consists of 118 items assessing levels of presence of 14 schema modes. Questions are scored on a Likert scale ranging from 1 (never or almost never) to 6 (always). Mean scores are calculated for each schema mode (min. 1, max. 6). A score of >3 on one of three schema modes (demanding parent, punitive parent, and/or vulnerable child) is used as a cut-off for inclusion in the study. Higher levels on the schema modes represent a higher level of presence of the schema mode.	Screening before start of intervention (+/- 1 week before)
Young Schema Questionnaire - Short Form version 3 (YSQ-SF)	The Young Schema Questionnaire - Short Form version 3 (YSQ-SF) will be used to assess schemas (core self-beliefs). The YSQ-SF consists of 90 statements (assessing 18 schemas, 5 questions each) which participants rate to what extent the statement is true for them (Likert scale 1 to 6). Mean scores are calculated for each schema (min. 1, max. 6). Higher scores represent a stronger presence of a schema.	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Age	Age in years (min. 18, max. 65)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Biological sex	Biological sex	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Education	Educational level of the participant (highest completed)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Working status	Working status; (employed, looking for a job [unemployed], student, receiving benefits, other)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Living situation	Living situation, possible options: alone, with partner, with family/parents, supported/assisted living, other	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Diagnosis	Primary diagnosis (according to the Diagnostic and Statistical Manual of mental disorders, 5th edition [DSM-5]). Open-ended question.	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Illness duration	Illness duration (in years and months)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Previous psychological treatment	Previous received psychological treatment (Psychological treatment, inpatient psychiatric hospitalization, and/or day treatment)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Current psychological treatment	Currently receiving psychological treatment (Yes/no, if yes: type, duration and frequency)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)
Current medication	Currently taking any medication (yes/no, if yes: type and dosage)	At the start of the single intervention session of 2 hours (at pre-intervention; baseline)

Collaborators and Investigators

• Sponsor: University Medical Center Groningen

Study record dates

Study Major Dates

• Study Start (Actual): February 14, 2026
• Primary Completion (Estimated): September 15, 2026
• Study Completion (Estimated): April 30, 2027

Study Registration Dates

• First Submitted: September 8, 2025
• First Submitted That Met QC Criteria: January 22, 2026
• First Posted (Actual): January 28, 2026

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Virtual Reality Schema Therapy
• Additional Relevant MeSH Terms: Mental Disorders
• Other Study ID Numbers: 22811

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will be shared upon reasonable request after publication of the manuscript
• IPD Sharing Time Frame: Upon publication of the manuscript
• IPD Sharing Access Criteria: Data will be shared upon reasonable request after publication of the manuscript

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No