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Deming JR, Dunbar KJ, Lueck JF, Oh Y. Virtual Reality Videos for Symptom Management in Hospice and Palliative Care. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:477-485. [PMID: 39360020 PMCID: PMC11446539 DOI: 10.1016/j.mcpdig.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Objective To learn more about the effect of virtual reality videos on patients' symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most. Patients and Methods We conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds. Fifteen patients also participated in a second session of viewing bucket-list video clips they selected. Symptoms were measured with the revised Edmonton Symptom Assessment Scale before, immediately after, and 2 days after each experience. Participants rated their bucket-list selections by level of previous experience, strength of connection, and overall video quality. Functional status was also recorded. Results Nature scenes significantly improved total symptom scores (30% decrease, P<.001), as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved (31% decrease, P=.03). Patients with lower functional status tended to have more symptoms beforehand and improve the most. Conclusion Serene nature head-mounted display virtual reality scenes safely reduce symptoms at the end of life. Bucket-list experiences may be effective if they are high-quality. More infirm patients may benefit the most.
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Affiliation(s)
- James R Deming
- Home Health and Hospice, Mayo Clinic Health System - Northwest Wisconsin region, Eau Claire, WI
| | - Kassie J Dunbar
- Home Health and Hospice, Mayo Clinic Health System - Northwest Wisconsin region, Eau Claire, WI
| | - Joshua F Lueck
- Home Health and Hospice, Mayo Clinic Health System - Northwest Wisconsin region, Eau Claire, WI
| | - Yoonsin Oh
- Department of Kinesiology, University of Wisconsin - Eau Claire, Eau Claire, WI
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Cox RC, Wright KP, Axelsson J, Balter LJT. Diurnal variation in anxiety and activity is influenced by chronotype and probable anxiety-related disorder status. Psychiatry Res 2024; 338:116006. [PMID: 38850890 DOI: 10.1016/j.psychres.2024.116006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/12/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
Anxiety symptoms vary moment-to-moment within a day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day, and evening chronotype is implicated in psychopathology, including anxiety-related disorders. However, it is unknown whether chronotype influences diurnal variation in anxiety symptoms and whether these effects are amplified in individuals with a probable anxiety-related disorder. We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) or obsessive-compulsive disorder (OCD) in a community sample of adults (N = 410). Evening chronotypes reported higher anxiety symptoms, particularly in the evening hours, and lower engagement in daily activities, predominantly in the morning hours. Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening. Our findings indicate that anxiety symptoms and engagement in daily activities fluctuate considerably across the day, and these patterns differ depending on chronotype. Evening chronotypes have more anxiety symptoms in the evening, despite preferring this time of day. Personalized treatment approaches that consider chronotype and target certain times of day may be efficient in alleviating peaks in anxiety symptoms.
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Affiliation(s)
- Rebecca C Cox
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - John Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 65, Sweden; Department of Psychology, Stress Research Institute, Stockholm University, Stockholm 114 19, Sweden
| | - Leonie J T Balter
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 65, Sweden; Department of Psychology, Stress Research Institute, Stockholm University, Stockholm 114 19, Sweden.
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Halámek F, Světlák M, Malatincová T, Halámková J, Slezáčková A, Barešová Z, Lekárová M. Enhancing patient well-being in oncology waiting rooms: a pilot field experiment on the emotional impact of virtual forest therapy. Front Psychol 2024; 15:1392397. [PMID: 38800677 PMCID: PMC11117429 DOI: 10.3389/fpsyg.2024.1392397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction This study explores the emotional impact of virtual forest therapy delivered through audio-visual recordings shown to patients in the oncology waiting rooms, focusing on whether simulated forest walks can positively influence patients' emotional states compared to traditional waiting room stimuli. Methods The study involved 117 participants from a diverse group of oncology patients in the outpatient clinic waiting room at the Masaryk Memorial Cancer Institute. Using a partially randomized controlled trial design, the study assessed basic emotional dimensions-valence and arousal-as well as specific psychological states such as thought control, sadness, anxiety, and pain. This assessment used the Self-Assessment Manikin and the modified Emotional Thermometer before and after participants watched three video types (forest, sea, news). Baseline stress levels were measured using the Kessler Psychological Distress Scale (K6). Results Participants exposed to forest and sea videos reported significant improvements in emotional valence and reduced arousal, suggesting a calming and uplifting effect. No significant changes were observed in the control and news groups. Secondary outcomes related to anxiety, sadness, and pain showed no significant interaction effects, though small but significant main effects of time on these variables were noted. Discussion The findings suggest that videos of forest and sea can be a beneficial intervention in the oncology waiting rooms by enhancing patients' emotional well-being. This pilot study underscores the potential for integrating virtual mental health support elements into healthcare settings to improve patient care experience.
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Affiliation(s)
- Filip Halámek
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Miroslav Světlák
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Tatiana Malatincová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jana Halámková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Alena Slezáčková
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdeňka Barešová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Monika Lekárová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
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Benedetti V, Giganti F, Cotugno M, Noferini C, Gavazzi G, Gronchi G, Righi S, Meneguzzo F, Becheri FR, Li Q, Viggiano MP. Interplay among Anxiety, Digital Environmental Exposure, and Cognitive Control: Implications of Natural Settings. Behav Sci (Basel) 2024; 14:323. [PMID: 38667119 PMCID: PMC11047410 DOI: 10.3390/bs14040323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
Inhibitory control performance may differ greatly as a function of individual differences such as anxiety. Nonetheless, how cognitive control proficiency might be influenced by exposure to various environments and how anxiety traits might impact these effects remain unexplored. A cohort of thirty healthy volunteers participated in the study. Participants performed a Go/No-Go task before exposure to a 'forest' and 'urban' virtual environment, in a counterbalanced design, before repeating the GNG task. The State-Trait Anxiety Inventory (STAI) was finally filled-in. Our findings unveiled an initial negative correlation between anxiety trait levels and GNG task performance, consistent with the established literature attributing difficulties in inhibitory functionality to anxiety. Additionally, different environmental exposures reported opposite trends. Exposure to the 'forest' environment distinctly improved the GNG performance in relation to anxiety traits, while the 'urban' setting demonstrated adverse effects on task performance. These results underscore the intricate relationship among cognitive control, environmental exposure, and trait anxiety. In particular, our findings highlight the potential of natural settings, such as forests, to mitigate the impact of anxiety on inhibition. This might have implications for interventions aimed at improving cognitive control.
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Affiliation(s)
- Viola Benedetti
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Fiorenza Giganti
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Maria Cotugno
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Chiara Noferini
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino, 50019 Florence, Italy
| | - Gioele Gavazzi
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Giorgio Gronchi
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Stefania Righi
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
| | - Francesco Meneguzzo
- Institute of Bioeconomy, National Research Council, 10 Via Madonna del Piano, Sesto Fiorentino, 50019 Florence, Italy;
- Central Scientific Committee, Italian Alpine Club, 19 Via E. Petrella, 20124 Milano, Italy
| | | | - Qing Li
- Department of Rehabilitation and Physical Medicine, Graduate School of Medicine—Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan;
| | - Maria Pia Viggiano
- Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 50135 Florence, Italy; (V.B.); (F.G.); (M.C.); (C.N.); (G.G.); (G.G.); (S.R.)
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Garcia P, Block A, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy. Cancer Nurs 2024:00002820-990000000-00209. [PMID: 38259094 PMCID: PMC11263502 DOI: 10.1097/ncc.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms. OBJECTIVES The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping. METHODS Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles. RESULTS Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment. CONCLUSIONS More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles. IMPLICATIONS FOR PRACTICE Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.
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Affiliation(s)
- Philip Garcia
- Author Affiliations: School of Nursing, University of California, San Francisco (Mr Garcia, Ms Block, and Drs Mark, Mackin, Paul, Cooper, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Miaskowski and Levine)
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Vermeesch AL, Ellsworth-Kopkowski A, Prather JG, Passel C, Rogers HH, Hansen MM. Shinrin-Yoku (Forest Bathing): A Scoping Review of the Global Research on the Effects of Spending Time in Nature. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241231258. [PMID: 38420597 PMCID: PMC10901062 DOI: 10.1177/27536130241231258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/11/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
Background This Scoping review (ScR) builds upon the 2017 review conducted by Hansen et al which contributed to evidence base shinrin-yoku (SY), also known as forest bathing (FB), has many positive health effects and is becoming a prescribed dose (specific time spent in nature) by health care providers. Practice and research regarding SY, has been historically based in Asian countries with a recent increase in Europe. The need and call for more research worldwide continues to further the evidence of SY as a health promotion modality. Through this ScR the authors identified programmatic components, health information monitored and screened, time spent in nature, geographical regions, trends, and themes in SY research worldwide. Methods Following PRISMA-ScR guidelines we searched across 7 electronic databases for SY or FB research articles from 2017 through 2022. PubMed, CINAHL, PsycInfo, ScienceDirect, SCOPUS, Embase, JSTOR were included due to the interdisciplinary nature of SY or FB research. Each database provided unique strengths ensuring a capture of a wide range of articles. The resulting articles were screened and extracted through Covidence. Results Database searches returned 241 results, with 110 references removed during the deduplication process, 131 were initially screened in the title and abstract review stage. Resulting in 82 unique results deemed relevant and screened in full text. During the final stage of the review, 63 articles met all inclusion criteria and were extracted for data. Conclusions The practice of SY has physiological (PHYS) and psychological (PSYCH) benefits across age groups. Research findings indicate either the natural or the virtual environment (VW) has significant health benefits. Continued research is encouraged globally for short- and long-term health outcomes for all individuals. The connection with nature benefits the mind, body and soul and is supported by Henry David Thoreau's philosophy: "Our livesneed the relief of where the pine flourishes and the jay still scream."
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Affiliation(s)
- Amber L. Vermeesch
- Family Nurse Practitioner Concentration Coordinator, UNC Greensboro School of Nursing, Greensboro, NC, USA
| | | | - Jenifer G. Prather
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, USA
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