Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality on the wards at-a-glance

Virtual reality headsets with relaxing scenarios introduced to six wards to reduce stress and anxiety in service users with complex and serious mental health needs
Research has shown that virtual reality has enormous potential to aid relaxation and improve outcomes. The team was inspired by pioneering work in the Netherlands using virtual reality with outpatients and wants to pilot this approach with inpatients in south London.
• Reduced anxiety and stress, helping people to manage their mental health conditions.
• Reduced levels of stress and challenging behaviour on wards.
• Better environment for both service users and staff.
• Fewer incidents of challenging behaviour and a positive effect on reducing staff stress and burn-out.
• Reduction in the need for seclusion.
• Parity of esteem, ensuring that mental health service users benefit from the latest technology.


Virtual reality on acute wards to help people with complex mental health conditions

Service users on psychiatric wards often report high levels of stress and difficulties regulating emotions, which can lead to violence and aggression toward staff and others. A team at South London and Maudsley (SLaM) NHS Foundation Trust plans to address this through pioneering use of virtual reality.

Funded by the HIN Innovation Grants, this project aims to evaluate the implementation of a new virtual reality (VR) technology, VRelax, to reduce stress and arousal in service users with complex mental health conditions. The VR headsets allow people to experience calming and relaxing environments. Previously, the NHS typically asked people to think of positive mental imagery, which requires more concentration and imagination and can be challenging to sustain. Virtual reality will give people the chance to feel immersed in a more calming environment.

The team will introduce 12 new VRelax headsets and assess their effectiveness in reducing service user stress and associated risks (violence, aggression and seclusion) on six acute psychiatric wards within SLaM. VRelax consists of 360 degree videos of calm, natural environments. This includes a scuba diving experience with wild dolphins, a sunny meadow in the Alps, a coral reef, a drone flight, a sunny mountain meadow with animals, a guided mindfulness meditation on the beach or a wide range of other options, all shown in a VR headset. The team will train the nursing staff on the software and nurses will then be able to decide how and when to offer this to their patients, as an additional option that complements existing relaxation techniques.

Heightened stress reactivity is not good for individuals: it’s related to recurrence of mood, anxiety as well as psychotic disorders and it’s not good for staff or ward environments: difficulties regulating emotions can increase risk of violence and aggression, which put both service users and staff at risk. This can result in seclusion being necessary, with isolation potentially increasing service user stress and costs. A previous randomised cross-over trial of VRelax with 50 psychiatric outpatients showed strong immediate effects on stress level, and on negative and positive mood states. The team at SLaM wants to bring these promising findings to service users on acute wards in the UK.

In addition to improving care for service users, VR has the potential to have a real impact on the overall ward environment. By reducing stress and anxiety, the project hopes to reduce violence and aggression. This will create a better environment for both staff and service users.
The project has collaboration at its heart. The team will link three main institutions – SLaM, University Hospital Lewisham, King’s College London and University Medical Center Groningen, in the Netherlands.

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Dr Simon Riches, Highly Specialist Clinical Psychologist, South London and Maudsley NHS Foundation Trust said:

“At a relatively low cost, this technology could have a major impact on the ward environment and the people in our care. Service users will have the chance to feel immersed in a more calming environment, meaning that both staff and service users can benefit from reduced levels of stress and challenging behaviour.

“We’ve brought a lot of people together for the project who are very passionate about digital health, including international colleagues. It’s still very new and the opportunity to collaborate on this emerging area of research is exciting.”

Dr Freya Rumball, Clinical Psychologist, South London and Maudsley NHS Foundation Trust, said:

“There is strong evidence that relaxation and grounding techniques can have a positive impact on stress and anxiety, and we will be among the first teams to test this exciting new technology on acute wards in SLaM. Our pilot will advance the evidence base and we are keen to disseminate our findings as widely as possible.

“Innovating in the NHS can be challenging, as it can be hard to find the time to think about things from a fresh perspective. However, we’re really passionate about bringing new technology to the forefront of our clinical work and are actively supported in this by our management and leadership.”

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