Abstract
BACKGROUND: Virtual reality (VR) technology is increasingly being explored as a tool to help reduce aggressive behavior in forensic psychiatric settings. This study aimed to explore the experiences of therapists and ward staff participating in a pilot study of a VR-assisted aggression treatment within a Swedish maximum-security forensic psychiatric clinic. METHODS: A qualitative, descriptive, and exploratory design was employed. Semi-structured interviews were conducted with five therapists and seven ward staff members who participated in the pilot of the newly revised Virtual Reality Aggression Prevention Training (VRAPT). The data, consisting of pre-transcribed interviews, were analyzed using reflexive thematic analysis, carried out separately for each professional group. RESULTS: The analysis resulted in eight overarching themes. Among therapists, five themes were identified: (1) Navigating treatment in the context of low patient motivation; (2) The perceived value of role-play in VRAPT; (3) Observed patient progress; (4) Structural and procedural barriers to implementation; and (5) Suggestions for future development. Among ward staff, three themes emerged: (1) Perspectives on patient behavior in forensic psychiatry; (2) Experiences of VRAPT in practice; and (3) Perceived opportunities provided by the intervention. CONCLUSIONS: Participants described VRAPT as a promising and engaging method, highlighting its role-play as a particular strength. Nonetheless, technical challenges and contextual limitations were also noted. The study emphasizes the importance of individualizing the intervention to better address patient needs and enhance engagement, therapeutic motivation, and treatment outcomes. By integrating the perspectives of both therapists and ward staff, the findings provide valuable insights into the clinical application of VR-assisted interventions in forensic psychiatric settings. CLINICAL TRIAL NUMBER: Not applicable.