JMIR Publications

ABSTRACT

Background:

Social-cognitive biases constitute an important therapeutic target among individuals with schizophrenia in forensic psychiatry. However, addressing these biases in treatment is challenging because they arise in context-specific situations and debiasing strategies can be difficult for patients to implement without support. The use of immersive technologies offers an opportunity to recreate ecologically valid situations in therapy, enabling the assessment and remediation of these biases. Nevertheless, creating such scenarios proves to be a challenge. Social cues must be carefully selected, balanced, and placed within the environment, otherwise the ambiguity of the scenario is lost. The end-users’ perspective should be taken into account throughout the design process to ensure that the scenarios elicit the expected reactions. There are few examples of participatory design approaches in forensic psychiatry, particularly when it comes to developing immersive scenarios.

Objective:

This project aims at proposing a thoughtful approach to the development of immersive scenarios for social cognitive training in forensic psychiatry and documenting participants' perceptions of this process.

Methods:

A codesign process was developed and implemented with a group of patients and a group of mental health practitioners. Various strategies were proposed to facilitate participant engagement in the process (brainstorming sessions, sketching the best ideas, staging of scenarios, etc.). The process was documented in a research journal, and participants’ experiences were explored through interviews at the end of the process.

Results:

The design process took a full year to complete and resulted in the creation of 3 immersive scenarios depicting ambiguous everyday situations that could lead to violence if misinterpreted. The design process was appreciated by all participants. Several patients have reported benefits from participating in the design process and most believe they have influenced the development of the scenarios.

Conclusions:

This project shows that developing ambiguous immersive scenarios for forensic psychiatry clients can be a long and demanding process. Nevertheless, it can lead to the creation of scenarios that are evocative and conducive to clinical work.