JMIR Publications

ABSTRACT

Background. Reducing aggression through stress reduction is an important part of forensic psychiatric treatment. As opposed to many cognitively focused interventions, DEEP, an experience-based VR-intervention, uses biofeedback to diaphragmatic breathing and reduce stress. This study evaluated DEEP's effectiveness in supporting patients regulate stress, emotional tension, and anger. Methods. A mixed-methods, alternating treatment, single-case experimental design was conducted with six Dutch forensic inpatients. Participants engaged in four DEEP-sessions, with experience sampling for continuous monitoring. Semi-structured interviews were conducted with participants and therapists. The data was analysed using visual analyses and a repeated linear mixed model. Results. Differences were observed between quantitative and qualitative results. Two patients reported effectiveness in interviews despite no significant quantitative changes. Two others displayed short-term significant changes in ESM data, with mixed interview reports. The final two patients showed significant changes in ESM data, aligning with their interview reports. Three participants were unsure about applying techniques during conflicts. Therapists reported a relaxing effect of DEEP in their patients, but did not expect many long-term effects. Discussion. DEEP shows promise in teaching deep breathing techniques to forensic psychiatric inpatients, potentially decreasing stress, emotional tension, and anger in some patients. To enhance effectiveness and skill transfer, structural integration into treatment programs is recommended.