The utilization of virtual reality in the training of de-escalation of aggression for both providers and users of public and healthcare services from the new millennium to the COVID-19 era: a systematic review

Introduction: Virtual reality (VR) is a promising modality for the effective delivery of training in the de-escalation of aggression. This review aims to assess how VR has been utilized in training for the de-escalation of aggression among both providers and users of public and healthcare services from the new millennium to the COVID-19 era (2000-2022). Methods: A systematic review was conducted in accordance with a pre-registered protocol and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven key databases were searched, yielding 2373 studies for screening, of which 15 were included. Quality appraisal was performed using the widely used Critical Appraisal Skills Programme (CASP) tool. Results: VR training for the de-escalation of aggression was implemented using a variety of approaches, ranging from verbal interaction and emotion-recognition tasks to selection from multiple-choice response menus. Most studies assessed participants' responses to the intervention, but none evaluated whether VR training had an impact at the organizational level. Overall, VR training content, modes of interaction, and reported improvements in participants' confidence were viewed positively. However, some studies reported limitations related to the emotional impact, realism of virtual characters, and learning effectiveness. Additional features that may enhance the VR experience were discussed, with personalized, context-specific scenarios identified as an important area for development. Conclusion: Larger-scale studies are required to determine which specific training domains may benefit most from VR-based approaches, given the heterogeneity of populations and methodologies across studies conducted between 2000 and 2022. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022307138, identifier CRD42022307138.