{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:31:32Z","timestamp":1787315492374,"version":"build-2736575974"},"reference-count":84,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,6]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Objectives<\/jats:title>\n To explore implementation processes, acceptability among participants who engaged with virtual reality (VR), recruitment feasibility and exploratory within-session effects of recreational VR programmes in a closed psychiatric intensive care unit (PICU). The qualitative component focused on patients\u2019 and professionals\u2019 experiences of VR use, while quantitative measures examined inclusion rates, exploratory within-session changes in emotional distress and descriptive trends in coercive events, pro re nata (PRN) medication, perceived stress and length of hospitalisation during a year with versus a year without VR.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Parallel mixed-methods pilot clinical trial with qualitative priority (QUAL-quan).<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A Danish closed PICU.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n All admitted patients who consented to participate during a 2-year period were eligible. Qualitative data included semi-structured individual patient interviews (n=9), a focus group discussion with professionals (n=4) and non-participant observations (8 sessions \u00d7 20\u2009min). Quantitative data were collected by ward professionals and via electronic health record extraction. A total of 26 patients were included during the VR year and 9 during the control year, reflecting substantial under-recruitment relative to the planned sample (35\/124).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n VR programmes for stress reduction, mindfulness, entertainment and distraction, including passive and active activities.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Three overarching themes were generated in a qualitative content analysis: (1)\n Agency in a restrictive environment<\/jats:italic>\n (categories: Own symptom mastering, A broader clinical toolbox and Connection through a shared third), (2)\n Escaping and expanding reality<\/jats:italic>\n (categories: A refuge from distress and A gateway to inaccessible experiences) and (3)\n Professional readiness and implementation challenges<\/jats:italic>\n (categories: The know-why gap and The know-how gap). Participants who engaged with VR described experiences of reduced distress, improved mood and greater calmness and perceived VR as a valuable addition to care, supporting autonomy and strengthening therapeutic relationships. However, knowledge and trust gaps, along with insufficient training, limited use. Quantitative measures partly corroborated these findings: an exploratory within-session analysis showed that emotional distress was lower after VR use than before use (95%\u2009CI \u22123.46 to \u22120.81, p=0.003). However, under-recruitment limited statistical power for between-period comparisons.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Among participants who engaged with VR, the use of VR programmes was generally perceived as acceptable and potentially useful in selected clinical situations. However, recruitment feasibility was not achieved, and the study design does not permit conclusions regarding effects on coercion, PRN medication, perceived stress or length of hospitalisation. Integration into standard care appeared possible under selected clinical circumstances, offering therapeutic value for patients and professionals, but it depended on adequate theoretical understanding and training of professionals.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT05654740<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114385","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:05:28Z","timestamp":1784829928000},"page":"e114385","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Use of recreational virtual reality for stress reduction in a psychiatric intensive care unit: findings from a mixed-methods pilot clinical trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05654740","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05654740","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3137-7265","authenticated-orcid":false,"given":"Katrine","family":"Rasmussen","sequence":"first","affiliation":[{"name":"VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Alexander Thorup","family":"Arnfred","sequence":"additional","affiliation":[{"name":"VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gry","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Clemmensen","sequence":"additional","affiliation":[{"name":"VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Turgut","sequence":"additional","affiliation":[{"name":"Mental Health Center Glostrup, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina Plamb\u00f8ck","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Mental Health Center Glostrup, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2381-2127","authenticated-orcid":false,"given":"Julie","family":"Midtgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"},{"name":"Mental Health Center Glostrup, Copenhagen University Hospital - Amager and Hvidovre, Center for Applied Research in Mental Health Care (CARMEN), Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3621-8450","authenticated-orcid":false,"given":"Louise Birkedal","family":"Glenth\u00f8j","sequence":"additional","affiliation":[{"name":"VIRTU Research Group, Mental Health Center Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"},{"name":"Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026072311051930000_16.7.e114385.1","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2021.41","article-title":"Interventions to reduce self-harm on in-patient wards: systematic review","volume":"7","author":"Nawaz","year":"2021","journal-title":"BJPsych Open"},{"key":"2026072311051930000_16.7.e114385.2","doi-asserted-by":"publisher","DOI":"10.1111\/jpm.12129"},{"key":"2026072311051930000_16.7.e114385.3","unstructured":"National Institute for Health and Care Excellence . 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