Immersive Virtual Reality Simulation in Forensic Psychiatry and Adjacent Clinical Fields: A Review of Current Assessment and Treatment Methods for Practitioners

Abstract

Background: Research has indicated that interactive, computerized case simulations using immersive virtual reality (VR) technology may be beneficial in the augmentation of conventional methods of assessment and treatment in forensic psychiatry, primarily through providing an engaging and safe environment in which the user can practice and learn skills and behaviors. However, there does not appear to be an overview of current developments available in the field, which may be an obstacle to clinicians considering the use of VR in their clinical practice.Objectives: Current, clinically relevant assessment and treatment methods applying immersive VR in forensic or adjacent clinical settings, were analyzed.Methods: This review surveyed the practical use of immersive VR in forensic psychiatry and relevant adjacent psychiatric and forensic fields from 2016 to 2020 and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: Out of the 1,105 journal articles screened, 14 met criteria for inclusion. Four articles described VR interventions directly addressing forensic psychiatric settings (treatment of general aggression and assessment of sexual offenders against children). The majority of the remaining articles were in the clinical domain of psychosis treatment. Several interventions were designed as part of comprehensive treatment programs, and others were intended as one-off assessments or paired with pre-existing psychological treatment. The degree to which the VR simulations were individualized to the user appeared to be largely dependent upon the extent of provider input. A variety of research methodologies were used in the included articles and the majority had limitations common to small-scale, non-randomized studies. None of the studies reported serious adverse effects.Discussion: There is a lack of large randomized controlled trials of current assessments or treatments using VR simulation in forensic psychiatry, let alone those with long-term follow-up, showing clear advantages of VR over standard practice. The evidence thus far is insufficient to recommend immediate and large-scale implementation of any one VR intervention, however, several have been shown to be feasible and acceptable to the participants and to provide insights and inspiration for future research and development.

Use of Virtual Reality in Psychiatric Diagnostic Assessments: A Systematic Review

“…One feasibility study has been conducted in the field of forensic psychiatry since the first research by Renaud et al in offenders with a pedophilic disorder ( 46 , 47 ). In this study, Fromberger and colleagues tested, in pedophilic sex offenders, whether coping behaviors in VR risk scenarios—encountering children asking for help in a supermarket—can provide additional information for risk assessments ( 20 ).…”

New Developments in Virtual Reality-Assisted Treatment of Aggression in Forensic Settings: The Case of VRAPT

“…Interventions involving VR have been particularly emphasized as promising eHealth applications in forensic settings (Fromberger et al, 2014), and have been suggested to bridge the gap between real life and laboratory experiences and thus increase the ecological validity of psychological research (Kisker et al, 2019). A recent systematic review (Sygel and Wallinius, 2021) demonstrated promising developments in adjacent fields (e.g., treatment of psychosis), however only a few methods, focusing on simulations of realistic offenserelated stimuli in the assessment and treatment of deviant sexual interests (Renaud et al, 2005;Benbouriche et al, 2014;Renaud et al, 2014;Fromberger et al, 2018), have been evaluated for forensic settings so far. In relation to aggression, only two methods employing VR have been described: the VR Game for Aggressive Impulse Management VR-GAIME (Smeijers and Koole, 2019), developed as a complement to ART interventions, and the VR Aggression Prevention Training for forensic psychiatric patients (VRAPT; Tuente et al, 2018; described in detail below).…”

On the Practical Use of Immersive Virtual Reality for Rehabilitation of Intimate Partner Violence Perpetrators in Prison

“…A substantial amount of literature shows that participants exhibit realistic responses to virtual situations in terms of physiological, emotional, cognitive, and even behavioral reactions (for a review on the topic, see Slater and Sanchez-Vives, 2016 ). For this reason, VR is increasingly being used in psychological therapy (see Cieślik et al, 2020 , for a recent systematic review) and has even been used in the field of forensic psychology (see Sygel and Wallinius, 2021 for a recent review) and for work with sexual offenders ( Benbouriche et al, 2014 ). Recent work in our research group has investigated the use of VR in the area of intimate partner violence (IPV), with two main purposes.…”