Reducing Mental Health Stigmatization Among Healthcare Workers and Students Using a Virtual Reality Protocol: The VIRTUS Protocol (VIRTUS)

Reducing Mental Health Stigmatization Among Healthcare Workers and Students Using a Virtual Reality Protocol: The VIRTUS Protocol, a Randomized Controlled Trial

Schizophrenia is a chronic psychiatric disorder, frequently associated with stigma, including within healthcare settings, that significantly impairs quality of life and symptoms. Virtual Reality (VR), as an immersive tool, may allow healthy individuals to experience the first-person perspective of a patient undergoing psychotic symptoms. VR exposure may facilitate perspective-taking, fosters empathy, and studies suggest VR could be a valuable tool to reduce stigma. However, the findings remain incomplete, with considerable variation between protocols and no data on implicit stigma. This study is designed to evaluate the effectiveness of a VR protocol simulating psychotic symptoms on explicit and implicit stigma.

Methods and Analysis A randomized controlled trial involving 128 participants will be conducted. Participants will include healthcare workers and students (medicine, nursing, or psychology) recruited from CH Henri Laborit in Poitiers (France), Poitiers University Hospital, CH Nord-Deux-Sèvres in Thouars (France), and the University of Poitiers. Recruitment will take place over a two-year period. Participants will be randomly assigned to either the intervention group or the control group.

The protocol involves two short VR scenarios. In the intervention condition only, both scenarios will simulate auditory and visual hallucinations and persecutory delusions, to immerse participants in the experience of someone living with schizophrenia. Stigma will be assessed before the VR intervention, immediately afterward, and at one-month follow-up. Assessment will be conducted using self-report scales (Attribution Questionnaire-27 items by Corrigan et al., 2003 (AQ-27), Community Attitudes toward the Mentally Ill, Taylor & Dear 1981 (CAMI) and Reported and Intended Behavior Scale by Evans-Lacko et al., 2011 (RIBS) for explicit stigma, and a behavioural test (Implicit Association Task, Greenwald, McGhee et Schwartz en 1998 (IAT)) for the implicit stigma.

The primary outcome is the reduction in stigma toward individuals with schizophrenia, assessed with the AQ-27 scale, from baseline to the one-month follow-up, comparing the intervention and control groups. The expected result is a greater reduction in stigma in the intervention group compared to the control group. Secondary outcomes include a one-month reduction in implicit associations, immediate post-intervention effects on stigma, changes in self-reported prejudice and discrimination over time.

Ethics and Dissemination All participants receive both oral and written information and provided signed informed consent. The study is under review from the French Research Ethics Committee (reference number: 2025-A01472-47). Results will be disseminated through presentations, conferences, and publications in peer-reviewed scientific journals.

Study Overview

• Status: Not yet recruiting
• Conditions: Schizophrenia Disorder
• Intervention / Treatment: Other: VIRTUS; Other: VR Control

• Study Type: Interventional
• Enrollment (Estimated): 128
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Pierre-Marie LEBLANC, MD; Phone Number: +33549445801; Email: pierre-marie.leblanc@ch-poitiers.fr
• Study Contact Backup: Name: Armand Chatard, PhD; Email: armand.chatard@univ-poitiers.fr

Study Locations

• France
  • Poitiers, France, 86000
    • Unité de Recherche Clinique (URC), Centre Hospitalier Henri Laborit
    • Contact: Nicolas Langbour, PhD; Phone Number: +33516526118; Email: nicolas.langbour@ch-poitiers.Fr
    • Principal Investigator: Pierre-Marie LEBLANC, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• aged between 18 and 65
• currently employed as a healthcare professional or enrolled as a advanced-grade student in medicine, nursing, or psychology
• no history of psychiatric or addictive disorders (except for tobacco dependence)
• covered by French social security
• able to provide informed written consent after receiving appropriate information.

Exclusion Criteria:

• current or past psychiatric or addictive disorder (except tobacco dependence)
• use of antipsychotic medication; first-degree family history of schizophrenia; cognitive impairment
• susceptibility to cybersickness
• recent (<1 year) or acute neurological disorders
• history of epilepsy
• known otorhinolaryngologic conditions causing vertigo, nausea or vomiting
• pregnancy or breastfeeding
• legal protection measures
• any condition, in the investigator's opinion that would prevent valid questionnaire completion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Schizophrenia; The protocol involves two short VR scenarios. In the intervention condition only ("schizophrenia"), both scenarios will simulate auditory and visual hallucinations and persecutory delusions, to immerse participants in the experience of someone living with schizophrenia.	Other: VIRTUS; Participants will watch two brief VR videos. The first simulates an office environnement , the second simulates a university classroom environment. In the experimental group, psychotic-like phenomena commonly reported by individuals with schizophrenia during acute episodes (e.g., auditory hallucinations, visual hallucinations, paranoid ideation) will be incorporated into both videos. The purpose is to simulate the lived experience of schizophrenia. The two VR environnements were adapted form Marques (virtual Stroop test, Marques et al., 2022) and Abrams (University classroom, Abrams et al., 2024), and programmed using Unity2021.3.11 with C#. Some assets in scenes were developped with Blender 4.4. We used MetaQuest2 as headset VR.
Active Comparator: CONTROL; The protocol involves two short VR scenarios. In the control condition participant will see the same VR video, without auditory and visual hallucinations or persecutory delusions.	Other: VR Control; Participants will watch two brief VR videos. The first simulates an office environnement , the second simulates a university classroom environment. Contrary to the experimental group, psychotic-like phenomena (auditory hallucinations, visual hallucinations, paranoid ideation) will not be incorporated into videos. The two VR environnements are programmed using Unity2021.3.11 with C#. Some assets in scenes were developped with Blender 4.4. We used MetaQuest2 as headset VR.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Explicit stigma - 1 month follow up	Change from baseline to 1 month follow-up, in the Attribution Questionnaire-27 (AQ-27) total score, comparing the intervention and control groups. Higher scores indicate greater explicit stigma toward individuals with schizophrenia.	Baseline and 1 month after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Implicit stigma - 1 month follow up	Change from baseline in Implicit Association Test (IAT) score for the schizophrenia-violence association. Higher scores indicate a stronger implicit association in the direction defined by the scoring algorithm. A greater reduction in implicit associations, as measured by the IAT, is expected at one month in the intervention group compared with the control group.	Baseline and 1 month after intervention
Explicit stigma - Immediate effect	Change from baseline to immediate post-intervention, in the Attribution Questionnaire-27 (AQ-27) total score. Higher scores indicate greater explicit stigma toward individuals with schizophrenia. An immediate decrease in stigma scores on the AQ-27 in the intervention group compared to the control group is expected.	Baseline (pre-intervention) and immediately post-intervention (within 30 minutes after the session)
Implicit stigma - Immediate effect	Change from baseline to immediate post-intervention, in implicit association between schizophrenia and violence, measured by the Implicit Association Test (IAT) score (higher absolute score indicates stronger implicit association). A greater immediate reduction in implicit associations linking schizophrenia with violence is expected in the intervention group compared to controls.	Baseline (pre-intervention) and immediately post-intervention (within 30 minutes after the session)
Attitudes toward individuals with schizophrenia - 1 month follow up	Change from baseline to immediate post-intervention, in the Community Attitudes toward the Mentally Ill (CAMI) total score. Higher scores indicate more bad attitudes toward individuals with schizophrenia. An immediate decrease in stigma scores on the CAMI in the intervention group compared to the control group is expected.	Baseline and 1 month follow-up
Behaviors toward individuals with schizophrenia - 1 month follow up	Change from baseline to immediate post-intervention, in the Reported and Intended Behavior Scale (RIBS) total score. Higher scores indicate more bad behaviors toward individuals with schizophrenia. An immediate decrease in stigma scores on the RIBS in the intervention group compared to the control group is expected.	Baseline and 1 month follow-up
Attitudes toward individuals with schizophrenia - immediate effect	Change from baseline to immediate post-intervention, in the Community Attitudes toward the Mentally Ill (CAMI) total score. Higher scores indicate more bad attitudes toward individuals with schizophrenia. An immediate decrease in stigma scores on the CAMI in the intervention group compared to the control group is expected	Baseline (pre-intervention) and immediately post-intervention (within 30 minutes after the session)
Behaviors toward individuals with schizophrenia - immediate effect	Change from baseline to immediate post-intervention, in the Reported and Intended Behavior Scale (RIBS) total score. Higher scores indicate more bad behaviors toward individuals with schizophrenia. An immediate decrease in stigma scores on the RIBS in the intervention group compared to the control group is expected.	Baseline (pre-intervention) and immediately post-intervention (within 30 minutes after the session)

Collaborators and Investigators

• Sponsor: Centre Hospitalier Henri Laborit

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: January 12, 2026
• First Submitted That Met QC Criteria: January 21, 2026
• First Posted (Actual): January 29, 2026

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 21, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: virtual reality; stigma; empathy; implicit associations
• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Behavior; Social Behavior; Schizophrenia; Social Stigma
• Other Study ID Numbers: 2025-A01472-47

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (IPD) will be shared upon reasonable request for non-commercial research purposes.
• IPD Sharing Time Frame: Available starting 6 months after publication for 36 months.
• IPD Sharing Access Criteria: Requests reviewed by the study team; data use agreement and IRB/ethics approval required.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

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