Identifying the Added Value of Virtual Reality for Treatment in Forensic Mental Health: A Scenario-Based, Qualitative Approach

Abstract

Background: Although literature and practice underline the potential of virtual reality (VR) for forensic mental healthcare, studies that explore why and in what way VR can be of added value for treatment of forensic psychiatric patients is lacking. Goals: This study aimed to identify (1) points of improvements in existing forensic mental health treatment of in- and outpatients, (2) possible ways of using VR that can improve current treatment, and (3) positive and negative aspects of the use of VR for the current treatment according to patients and therapists. Methods: Two scenario-based methods were used. First, semi-structured interviews were conducted with eight therapists and three patients to elicit scenarios from them. Based on these results, six scenarios about possibilities for using VR in treatment were created and presented to 89 therapists and 19 patients in an online questionnaire. The qualitative data from both methods were coded independently by two researchers, using the method of constant comparison. Results: In the interviews, six main codes with accompanying sub codes emerged. Ideas for improvement of treatment were grouped around the unique characteristics of the forensic setting, characteristics of the complex patient population, and characteristics of the type of treatment. For possibilities of VR, main codes were skills training with interaction, observation of situations or stimuli without interaction, and creating insight for others into the patient. The questionnaire resulted in a broad range of insights into potential positive and negative aspects of VR related to the current treatment, the patient, the content of a VR application, and practical matters. Conclusion: VR offers a broad range of possibilities for forensic mental health. Examples are offering training of behavioral and cognitive skills in a realistic context to bridge the gap between a therapy room and the real world, increasing treatment motivation, being able to adapt a VR application to individual patients, and providing therapists with new insights into a patient. These findings can be used to ground the development of new VR applications. Nevertheless, we should remain critical of when in the treatment process and for whom VR could be of added value.

Putting the Value in VR

“…Indeed, VR interventions prove to be efficacious and promising forms of psychological treatment in general [20]. While very little is known about VR in forensic mental health, there are many possible advantages [14][15][16][17]. For example, inpatients often reside in secured settings for longer periods of time, which makes it difficult for them to practice skills in a realistic way [17].…”

“…To illustrate, inpatients are often not allowed to go outside, which results in difficulties with exposure therapy for fear of heights. Also, it might be helpful to expose addicted patients to drugs, but showing real narcotics for this provides ethical and practical issues [17]. Most of these advantages are potential, since not much research on the use of VR in forensic mental health has been published [14].…”

“…Since providing concrete examples has proven to be more suitable for eliciting participants' opinion, as opposed to merely asking them for it [5], six short videos on possible applications of VR in forensic mental health were created by a multidisciplinary project group, consisting of two patients, three therapists, two researchers and a manager. The ideas were based on earlier research that took place in the larger project: the team based the ideas on the outcomes of a previously conducted interview study on the possibilities of VR [17], focus groups and literature research on existing VR applications. All videos took between one and two minutes and contained a brief explanation of the goal of the VR application, the embedment in the existing treatment, an example to illustrate the idea, and an explanation of the desired outcomes.…”

“…Values state what a technology should achieve according to a stakeholder and can serve as the foundation for a technology throughout the development process [3,6]. In this study we showed how we formulated values using abstract codes of data from questionnaires and interviews that were conducted in a previous phase of the project [17]. In comparable studies, user expressions from interviews were directly used to ground values and requirements [6,32,38].…”

“…Multiple studies indeed point out the added value of VR for forensic patients [14][15][16]. A recent qualitative study we conducted showed a broad range of potential advantages of VR for forensic mental healthcare [17]. Important advantages are the emphasis on practicing skills instead of abstract talking, the use of VR as a bridge between a closed therapy room and the outside world and the possibility of exposing patients to offense-related situations to create new insights for therapists and patients themselves.…”