Use of recreational virtual reality for stress reduction in a psychiatric intensive care unit: findings from a mixed-methods pilot clinical trial.

Abstract

To explore implementation processes, acceptability among participants who engaged with virtual reality (VR), recruitment feasibility and exploratory within-session effects of recreational VR programmes in a closed psychiatric intensive care unit (PICU). The qualitative component focused on patients' and professionals' experiences of VR use, while quantitative measures examined inclusion rates, exploratory within-session changes in emotional distress and descriptive trends in coercive events, pro re nata (PRN) medication, perceived stress and length of hospitalisation during a year with versus a year without VR. Parallel mixed-methods pilot clinical trial with qualitative priority (QUAL-quan). A Danish closed PICU. All admitted patients who consented to participate during a 2-year period were eligible. Qualitative data included semi-structured individual patient interviews (n=9), a focus group discussion with professionals (n=4) and non-participant observations (8 sessions × 20 min). Quantitative data were collected by ward professionals and via electronic health record extraction. A total of 26 patients were included during the VR year and 9 during the control year, reflecting substantial under-recruitment relative to the planned sample (35/124). VR programmes for stress reduction, mindfulness, entertainment and distraction, including passive and active activities. Three overarching themes were generated in a qualitative content analysis: (1) <i>Agency in a restrictive environment</i> (categories: Own symptom mastering, A broader clinical toolbox and Connection through a shared third), (2) <i>Escaping and expanding reality</i> (categories: A refuge from distress and A gateway to inaccessible experiences) and (3) <i>Professional readiness and implementation challenges</i> (categories: The know-why gap and The know-how gap). Participants who engaged with VR described experiences of reduced distress, improved mood and greater calmness and perceived VR as a valuable addition to care, supporting autonomy and strengthening therapeutic relationships. However, knowledge and trust gaps, along with insufficient training, limited use. Quantitative measures partly corroborated these findings: an exploratory within-session analysis showed that emotional distress was lower after VR use than before use (95% CI -3.46 to -0.81, p=0.003). However, under-recruitment limited statistical power for between-period comparisons. Among participants who engaged with VR, the use of VR programmes was generally perceived as acceptable and potentially useful in selected clinical situations. However, recruitment feasibility was not achieved, and the study design does not permit conclusions regarding effects on coercion, PRN medication, perceived stress or length of hospitalisation. Integration into standard care appeared possible under selected clinical circumstances, offering therapeutic value for patients and professionals, but it depended on adequate theoretical understanding and training of professionals. NCT05654740.