JMIR Publications

ABSTRACT

Background:

Stress is a key transdiagnostic factor in the onset and recurrence of psychiatric disorders. Virtual reality (VR) in mental healthcare, particularly virtual nature environments, shows promising results in creating relaxation, such as VRelax. While initial studies have demonstrated VRelax its efficacy, further implementation in routine mental healthcare requires systematic exploration of patient perspectives on its use. Understanding these perspectives can help tailor VR tools to meet the needs of users better and enhance their effectiveness in clinical settings.

Objective:

This study aims to identify patient-perceived barriers and facilitators to using VR relaxation as a self-management relaxation tool to aid implementation in mental healthcare.

Methods:

Four focus groups were conducted with 19 participants with a wide range of psychiatric problems, including burnout complaints, attention deficit hyperactivity, anxiety, depressive, bipolar, obsessive-compulsive, and posttraumatic stress disorders. Participants were recruited via a network of people with lived experience, healthcare professionals, and social media. Semi-structured interview guides with open-ended questions were used to investigate barriers and facilitators. People with psychiatric problems were instructed to use VRelax at home at least three times before the focus group discussions. Thematic analysis was used to identify barriers and facilitators.

Results:

The focus group discussions generated seven themes with various subthemes. Sense of autonomy was identified as a facilitator, indicating the experience of users to feel in control and independent, allowing them to manage and operate VRelax on their own. On the other hand, participants indicated that for optimal long-term use, there should be a balance between autonomy and structured guidance and integration in therapy. Perceived usefulness, ease of use, and immersive factors were identified as both a barrier and a facilitator. Participants had positive initial experiences with VRelax, but also reported that the effects of virtual nature environments may diminish with continued use. Usefulness may also vary by phase of the psychiatric disorder and the individual’s momentary emotional state. Participants saw the plug-and-play design of VRelax as helpful, but also indicated the importance of easy navigation within the program, including quickly finding specific virtual nature environments. Three barriers were identified: shortcomings in user guidance, perceived problems in transition back to reality, and physical hindrances such as discomfort of the VR glasses.

Conclusions:

For optimal implementation of VR relaxation in mental healthcare, personalized VR experiences, for example, by offering a specific selection of virtual nature environments based on the momentary emotional state, should be facilitated, and user autonomy fostered. Integration of VR tools in ongoing treatment is important, aligning with shared decision-making principles. In addition, reducing the steps to get started and in the closing process is crucial, alongside addressing challenges like physical discomfort and inadequate instructions.