Social disconnection, covering loneliness and social isolation, might be associated with the development of paranoid thoughts. Differential effects of loneliness and social isolation on the occurrence of paranoia have not been tested so far. Moreover, the role of cognitive mechanisms in these associations remains unknown. This study aimed to investigate differential associations of loneliness and social isolation with paranoid thoughts in the general population, considering the role of cognitive mechanisms.

Altogether, 3,275 individuals, enrolled from the general population, completed baseline and follow-up assessments spanning 6–7 months. Cognitive biases (rejection sensitivity, attributional biases, and safety behaviors), social cognitive problems, and subjective cognitive problems were measured. The cross-lagged panel network (CLPN) analysis was performed, controlling for the effects of sociodemographic characteristics, psychiatric treatment, substance use, depressive, and anxiety symptoms. Additionally, mediation was tested for the CLPN paths linking social disconnection with paranoid ideation, with one intermediary node representing cognitive processes.

Loneliness was the most important node in terms of predicting other network variables. It was bidirectionally associated with paranoid thoughts. Cognitive processes mediated these associations (partial mediation for ideas of reference and full mediation for ideas of persecution). In turn, social isolation predicted paranoid thoughts through the effects on loneliness. It was also predicted by paranoid thoughts through attributional biases.

Social disconnection might be bidirectionally associated with paranoid thoughts. However, loneliness is more closely tied to paranoid thoughts compared to social isolation. Cognitive processes might mediate the association of social disconnection with paranoid thoughts.

No studies have investigated the effects of virtual reality (VR) on the persecutory idea of reference (IOR) or delusions of reference (DOR) in patients with psychosis. This study examined the efficacy and safety of VR therapy in stable outpatients with psychosis and explored relationships between primary outcomes and psychological factors using path analysis.

Seventy-eight patients were randomly assigned to either the VR-treatment (VR-T) or VR-control (VR-C) group. The VR-T group viewed three 360° 3D videos or four animated videos; the VR-C group viewed the same seven videos with muted voices or 11 360° 3D videos of natural scenes. Pre- and post-assessments were performed using the Psychotic Symptom Rating Scale-Delusions (PSYRATS-D) and Revised Green et al. Paranoid Thought Scale (R-GPTS) as a primary outcome measure. Several self-rating scales measuring schema, depression, brooding, negative evaluation, attribution bias, and self-esteem were administered. Safety was assessed after sessions 1 and 10, and path models were constructed.

Between-group analysis showed a significant improvement in PSYRATS-D scores in the VR-T group compared with the VR-C group. Regarding self-rating scales, the between-group analysis revealed a significant group × time interaction only for the Social and Occupational Functioning Assessment Scale (SOFAS) score. The frequency of VR sickness was high, but its severity was mild. Fear of Negative Evaluation Scale and Beck Depression Inventory scores were found to have mediating roles.

VR therapy effectively reduced delusions in young, stable psychosis patients with mild and tolerable side effects. Future studies should develop diverse VR content for older populations.