Effects of an Interpersonal Caring Virtual Reality Exergame on Negative Symptoms and Depressive Symptoms in Patients with Schizophrenia: A Mixed-Methods Study

Purpose: This study developed and implemented an InterPersonal Caring virtual reality exergame (IPC-exergame) for patients with schizophrenia in closed wards and evaluated its effects and the participants' experiences.Methods: The program was developed using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model, integrating interpersonal caring behaviors with a small-group virtual reality exergame. The program consisted of 24 sessions conducted three times per week for 8 weeks. The participants were 53 patients (experimental group, n=27; control group, n=26), and in-depth interviews were conducted with seven participants from the experimental group. A concurrent embedded mixed-methods design was employed to evaluate the effectiveness of the program. Quantitative data were analyzed using SPSS version 27.0, and qualitative data were examined through content analysis.Results: The experimental group showed significantly greater improvement in negative symptoms than the control group (F=7.36, p=.009), while no significant between-group difference was found in depressive symptoms (F=0.07, p=.798). The qualitative analysis yielded three categories: "Revitalized Body and Mind," "Discovery of an Active Self," and "Dynamic Interpersonal Processes."Conclusion: The IPC-exergame may serve as an effective intervention for improving negative symptoms in patients with schizophrenia by integrating interpersonal caring behaviors with a small-group virtual reality exergame.