Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference

Raga Bhairavi in virtual reality reduces stress-related psychophysiological markers

The effects of classical music on psychophysiological parameters are not well understood. This study aimed to investigate the impact of listening to raga Bhairavi, an Indian Classical Music for six days on anxiety, stress, depression, and heart rate variability (HRV) parameters. Forty-four individuals were randomly assigned to either the intervention group (VR-raga), where they listened to raga Bhairavi via 360° video in a virtual reality environment, or the control group, where there was no exposure to raga Bhairavi for six days. Before allocation, the HRV baselines (relax-baseline and stress-baseline) were recorded on the first day. On the first and sixth days of the intervention, HRV was monitored, and the Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was administered before and after the intervention. After six days, all DASS-21 subscales were significantly reduced in the VR-raga group. A similar trend was observed in the seven HRV parameters evaluated in this study, which demonstrated reduced physiological stress and enhanced autonomic balance following the six-day intervention. The findings collectively indicated the efficacy of the VR-based raga Bhairavi intervention in reducing psychological stress markers and highlighted the potential applications of utilizing the VR-based raga intervention for improving mental well-being in the real-world context.

Virtual reality-guided mindfulness intervention to enhance psychosocial well-being in caregivers of end-stage kidney disease patients: protocol for a mixed-methods pilot randomised controlled trial

INTRODUCTION

Caregivers of patients with end-stage kidney disease (ESKD) face significant challenges that contribute to caregiver burden, negatively impacting their psychosocial well-being. Virtual-reality (VR)-guided mindfulness interventions have shown promise in reducing stress, anxiety and depression in various populations.

METHODS AND ANALYSIS

This pilot study aims to evaluate the efficacy and feasibility of a VR-guided mindfulness intervention for ESKD caregivers. A single-centre, single-blind, parallel-group pilot randomised controlled trial will be conducted. Thirty ESKD caregivers will be randomly allocated to either the VR-guided mindfulness intervention group or the sham VR control group. The intervention group will receive a 6 week home-based VR-guided mindfulness programme, while the control group will view relaxing nature videos without mindfulness content. Participants will be assessed at baseline, post-intervention (6 weeks) and follow-up (12 weeks) using validated questionnaires for caregiver burden (Zarit Burden Interview (ZBI)), stress, anxiety, depression (Depression Anxiety Stress Scale-21 (DASS-21)), quality of life (36-Item Short Form Health Survey (SF-36)) and mindfulness (Five Facet Mindfulness Questionnaire (FFMQ)). Feasibility outcomes include accrual rates, retention, adherence, questionnaire completion and side effect rates. Semi-structured interviews will explore participants' experiences with the intervention.

ETHICS AND DISSEMINATION

The study has been approved by the NHG Domain Specific Review Board (Reference: 2024-3940-APP1). The results of this pilot study will be reported in peer-reviewed open-access journals and shared with participants and stakeholders.

TRIAL REGISTRATION

NCT06479200.

Ego-depletion and motor skill performance under pressure-experimental effects of a short term virtual-reality based mindfulness breathing meditation with integrated biofeedback

Ego-depletion describes a state of mind, where the capacity for self-control is temporarily depleted after a primary self-control action. The aim of this study was to investigate whether a brief virtual reality-based mindfulness breathing meditation with integrated biofeedback can be considered an effective strategy to counteract the detrimental effects of ego depletion on motor skill performance under pressure. The study included two experiments, each of them designed as counterbalanced cross-over trials and based on an a priori sample-size calculation. Within each experiment, participants completed two appointments in a randomly assigned order, during which they were asked to perform 20 basketball free throws (N = 18; Experiment 1) or 20 penalty kicks at a football goal in four target squares (N = 16; Experiment 2) under pressure pre and post the following conditions: Stroop-test-induced ego depletion followed by a 15 min resting break, Stroop-test-induced ego depletion followed by a 15 min virtual reality-based mindfulness breathing meditation with integrated biofeedback. Results indicate that, in comparison to a resting break, a brief virtual reality-based mindfulness meditation with integrated biofeedback can counteract the detrimental effects of ego-depletion (Experiment 2) and enhance motor skill performance under pressure (Experiment 1, 2) Implications for researchers and practitioners are derived in light of the identified methodological limitations.

Mental health in the virtual world: Challenges and opportunities in the metaverse era

Current rates of mental illness are worrisome. Mental illness mainly affects females and younger age groups. The use of the internet to deliver mental health care has been growing since 2020 and includes the implementation of novel mental health treatments using virtual reality, augmented reality, and artificial intelligence. A new three dimensional digital environment, known as the metaverse, has emerged as the next version of the Internet. Artificial intelligence, augmented reality, and virtual reality will create fully immersive, experiential, and interactive online environments in the metaverse. People will use a unique avatar to do anything they do in their "real" lives, including seeking and receiving mental health care. In this opinion review, we reflect on how the metaverse could reshape how we deliver mental health treatment, its opportunities, and its challenges.

The role of arts therapies in mitigating Sleep Initiation and Maintenance Disorders: a systematic review

Introduction

Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.

Methods

Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.

Results

Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.

Discussion

The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.

Systematic review registration

PROSPERO, ID: CRD42024506393.

The Use of Immersive Virtual Reality in Sensory Sessions on a Specialist Dementia Unit: Service Evaluation of Feasibility and Acceptability

This service evaluation reviewed inclusion of Immersive Virtual Reality (iVR) relaxation activities as part of routine occupational therapy sensory sessions on a specialist dementia unit. Twenty-five sessions were completed over 13 wk with 14 participants. Nine participants chose to engage in multiple sessions. Feasibility was assessed through participant engagement and tolerability. Modal first session length was in the range 30 s to 2 min. This increased to over 2 min on second sessions. There was a lack of significant adverse effects measured by direct questioning, neuropsychiatric assessment before vs. after sessions and adverse incident reporting. Acceptability was assessed via structured review of user and staff feedback which noted positive experiences such as relaxation, openness to discussion, reminiscence, wider engagement and interest in future use. Further work is required to explore efficacy and use in other settings.

The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy.

METHODS

Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety.

RESULTS

Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001).

CONCLUSIONS

Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.

Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis

BACKGROUND

Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis.

METHODS

We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses.

RESULTS

In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

CONCLUSIONS

Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.

Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review

Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.

Feasibility and effectiveness study of applying a hallucinogen harm reduction and integration model to a mindfulness thinking intervention using virtual reality: A randomized controlled trial

Objective

The purpose of this study was to investigate whether a virtual reality (VR) program designed and developed based on the hallucinogenic harm reduction and integration (PHRI) clinical model could be more effective in guiding positive thinking training, improving positive thinking awareness and ability, and, to some extent, facilitating personal efficacy and emotional state compared to a traditional VR program that places users in a virtual natural ecological environment to guide positive thinking training. We also sought to understand the factors that may influence the effectiveness of VR interventions and user experience.

Method

Seventy-six randomly recruited participants were divided into a control group and an experimental group of 38 participants, each according to a random number table, and were trained in VR meditation for eight weeks. The experimental group used a PHRI-based mindfulness program, while the control group used a traditional mindfulness meditation program. We used The Mindful Attention Awareness Scale and the PAD emotional three-dimensional scale to assess the level of state mindfulness and changes in the emotional state before and at the end of the experiment. The Immersive Tendencies Questionnaire measured the user's sense of presence and immersion in the virtual environment. The Five Facet Mindfulness Questionnaires and the Depression Anxiety and Stress Scale (DASS-21) were used at the baseline assessment stage before and at the 4-week follow-up after the experiment to assess the change in trait mindfulness levels due to the mindfulness training. The Five Facet Mindfulness Questionnaires and the DASS-21 were used to assess changes in mindfulness and mental health trait levels.

Results

At the end of the experiment, the MMSQ score was significantly lower in the control group than in the experimental group, while the ITQ score was significantly higher than in the experimental group, and both scores were statistically significant (p < 0.05). In the follow-up assessment four weeks after the end of the experiment, the FFMQ-15 score and the DASS-21 were significantly and statistically higher in the experimental group than in the control group (p < 0.05). Since the scores of the PAD scale did not obey a normal distribution, we used the Wilcoxon signed-rank test to assess the results, which proved that the experimental group had higher levels of emotional activation and arousal.

Conclusion

The VR positive thinking program developed based on PHRI can significantly increase the positive thinking state and emotional arousal and activation of the general population participants but does not directly lead to the growth of positive emotions. Moreover, this detached psychedelic scene brings users a weaker sense of presence and presence than traditional natural space scenes. Furthermore, it does not bring any intense simulator motion sickness symptoms. These findings suggest that VR programs developed based on PHRI have a more positive facilitation effect on the positive state and that this increase lasts longer than conventional VR-positive programs.

Effect of virtual reality-based mindfulness training model on anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy

BACKGROUND

Although the prognosis of ovarian cancer can be significantly improved through standardized surgery and chemotherapy, 70% of epithelial ovarian cancer (EOC) patients would suffer from drug resistance and recurrence during the long chemotherapy cycle.

OBJECTIVE

To explore the impact of a training mode based on the integration of virtual reality technology and mindfulness on anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy.

METHOD

Through virtual reality technology, a mindfulness training software was designed and developed, and a mindfulness training mode based on virtual reality technology was constructed. Using a self-controlled design, 48 ovarian cancer patients undergoing chemotherapy who were hospitalized in a tertiary hospital in Beijing from August 2022 to May 2023 were conveniently selected as the research subjects. The patients were subjected to four weeks of mindfulness training based on virtual reality technology, and the acceptance of the mindfulness training mode using virtual reality technology was evaluated. The Hospital Anxiety and Depression Scale (HADS) and Cancer Related Fatigue Scale (CRF) were used to evaluate the anxiety, depression, and fatigue of patients before and after intervention.

RESULTS

The virtual reality based mindfulness training mode includes four functional modules: personalized curriculum, intelligent monitoring, emotion tracking, and Funny Games. 48 patients had a high acceptance score (139.21 ± 10.47), and after using mindfulness training mode based on virtual reality technology, anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy were significantly reduced, with a statistically significant difference (p< 0.001).

CONCLUSION

Ovarian cancer patients during chemotherapy have a high acceptance of virtual reality based mindfulness training mode. The application of this mode can reduce the psychological problems of anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy, and is worth promoting and using.

Immersive Technologies in Healthcare: An In-Depth Exploration of Virtual Reality and Augmented Reality in Enhancing Patient Care, Medical Education, and Training Paradigms

BACKGROUND

Virtual reality (VR) and augmented reality (AR) are rapidly gaining traction in healthcare, offering transformative opportunities for patient care, medical education, and therapeutic interventions. Despite their potential, challenges remain regarding the implementation and integration of these technologies into existing healthcare practices.

OBJECTIVE

This review aims to explore the current applications of VR and AR in healthcare, particularly focusing on their roles in enhancing patient care and medical training, as well as identifying research gaps that hinder their widespread adoption.

METHODS

A comprehensive literature search was conducted across 2 primary databases, PubMed, and Google Scholar. The search was restricted to peer-reviewed articles, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) published from 2000 to 2024. Reference lists of included articles were also examined for additional relevant studies. Inclusion criteria focused on empirical studies addressing the use of VR and/or AR in patient care or medical training, while editorial pieces, non-peer-reviewed sources, and unrelated studies were excluded. A total of 17 900 search results were identified on Google Scholar and 300 on PubMed, leading to the inclusion of 89 articles in this review.

RESULTS

The findings indicate that VR and AR technologies significantly enhance patient experiences and medical training, providing immersive and interactive environments for learning and practice. However, notable challenges include integration issues with existing electronic health record systems, the need for appropriate implementation models, and a lack of substantial evidence supporting the clinical efficacy of AR-assisted procedures.

CONCLUSION

While VR and AR hold considerable promise in revolutionizing healthcare practices, further research is essential to address existing gaps, particularly regarding implementation strategies, user acceptance, and empirical evaluation of patient outcomes and training effectiveness. Understanding the needs of healthcare professionals and patients will be critical to maximizing the impact of these technologies in clinical settings.

Psychological and physiological health outcomes of virtual reality-based mindfulness interventions: A systematic review and evidence mapping of empirical studies

Objective

In the past two decades, mindfulness, rooted in Buddhist traditions, has gained considerable scientific interest. Virtual reality (VR) technology, in particular head-mounted displays, offers immersive experiences and is examined in this systematic review in terms of VR-based mindfulness interventions and their effects on psychological and physiological health outcomes.

Methods

Using the Preferred Reporting Items for Systematic Review and Meta Analyses guidelines, a systematic search was conducted with the following search terms: [(mindful* OR "meditat*") AND ("virtual reality" OR "VR") AND (health OR physio* OR psycho* OR mental OR physical)]. Considering critiques of methodological quality in existing systematic reviews, this study adopts Boell and Cecez-Kecmanovic's hermeneutic approach, critically evaluating research outcomes.

Results

Psychological benefits include improved anxiety, mindfulness, emotions, disease patterns, affect, stress, (presleep) arousal, meditation and others. Physiological effects focus on neurobiological markers, heart rate/heart rate variability, pain, blood pressure, cortisol and galvanic skin resistance. Evidence mapping shows that more research has been conducted in the last 6 years, particularly by North American and South Korean authors, and points to gaps in study methodology. In addition, attention regulation is identified as a primary mindfulness mechanism in VR scenarios, often in nature-based virtual environments, with mainly single-session studies lasting 5 or 10 minutes.

Discussion

Critical mapping reveals the need for additional studies to support and extend initial findings in this emerging research field. Methodologically, there is a call for more true-experimental studies to enhance rigor. From a content perspective, VR protocols are currently still strongly characterized by single-session interventions, which makes it especially difficult to make a dose-response statement regarding long-term effects.

Conclusion

In summary, the studies provide important initial findings on psychological and physiological effects of VR-based mindfulness interventions on health. In addition, the need for more methodologically rigorous studies was emphasized, along with other methodological adjustments that must be carefully considered in the planning of future studies.

Immersive virtual reality or computerised mindfulness meditation for improving mood? Preliminary efficacy from a pilot randomised trial

Introduction

Mindfulness interventions are effective in improving mood, reducing stress, and increasing quality of life. New developments in technology bring important channels to deliver mindfulness interventions that can increase accessibility, such as the Internet, computerised interventions, mobile apps and recently, virtual reality (VR). The aim of the present study is to enhance our current understanding of the use of VR in mindfulness, namely we examined in a pilot randomised trial the efficacy of an immersive VR-based mindfulness approach compared to an active control (computerised-based mindfulness meditation) on improving mood. A secondary objective was to examine whether VR use resulted in simulator sickness which could affect user engagement.

Methods

Forty-seven (Mage = 29.22 years) healthy participants were randomly assigned to the experimental or control group.

Results

A mixed 2X3 ANOVA showed a significant Time effect. Namely, negative emotions were reduced in both groups, with non-significant differences between groups. For positive emotions, on the other hand, our results showed no significant impact. Simulator sickness in VR was not present, according to t-test, making VR a safe delivery method.

Discussion

Future research should investigate VR dosage and combine VR with other interventions (e.g., blended with face-to-face mindfulness interventions, with Internet-delivered interventions).

Study protocol for virtual leisure investigating the effect of virtual reality-delivered stress reduction, entertainment and distraction on the use of coercion and need-based medication and patient satisfaction at a closed psychiatric intensive care unit - a mixed-methods pilot clinical trial

INTRODUCTION

The environment at a psychiatric inpatient ward can lead to emotional distress and behavioural deviations in vulnerable individuals potentially resulting in conflicts, increased use of need-based medication and coercive actions, along with low satisfaction with treatment. To accommodate these challenges, recreational and entertaining interventions are recommended. The tested interventions have, however, shown varying effects and demand a high degree of planning and staff involvement while being difficult to adapt to individual needs. Virtual reality (VR) may help overcome these challenges.

METHODS AND ANALYSIS

The study is a mixed-methods clinical trial with a target sample of 124 patients hospitalised at a closed psychiatric ward in the capital region of Denmark. Outcomes (eg, coercion, need-based medication and perceived stress) for a 12-month period where all patients are offered VR-based recreational experiences during their hospitalisation will be compared with outcomes for a 12-month period where VR is not offered. Feasibility and acceptability will be explored with qualitative interviews supplemented with non-participant observations and focus groups. The study began on 1 January 2023, and we expect to complete data collection by 31 December 2024.

ETHICS AND DISSEMINATION

The study is registered at Danish Data Protection Agency (j.no P-2022-466) and is approved by the Committee on Health Research Ethics of the capital region of Denmark (j.no 22013313). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations.

TRIAL REGISTRATION NUMBER

NCT05654740.

Creating Custom Immersive 360-Degree Videos for Use in Clinical and Nonclinical Settings: Tutorial

The use of virtual reality (VR) stimulation in clinical settings has increased in recent years. In particular, there has been increasing interest in the use of VR stimulation for a variety of purposes, including medical training, pain therapy, and relaxation. Unfortunately, there is still a limited amount of real-world 360-degree content that is both available and suitable for these applications. Therefore, this tutorial paper describes a pipeline for the creation of custom VR content. It covers the planning and designing of content; the selection of appropriate equipment; the creation and processing of footage; and the deployment, visualization, and evaluation of the VR experience. This paper aims to provide a set of guidelines, based on first-hand experience, that readers can use to help create their own 360-degree videos. By discussing and elaborating upon the challenges associated with making 360-degree content, this tutorial can help researchers and health care professionals anticipate and avoid common pitfalls during their own content creation process.

Counseling Psychological Understanding and Considerations of the Metaverse: A Theoretical Review

The COVID-19 pandemic has triggered the interest in and demand for online platforms that can replace traditional face-to-face activities. Accordingly, metaverses have been increasingly used across society, especially in the Mental health field. This broad use of metaverses is now recognized as a major trend that will drive various industries across healthcare and society. In response to this societal change, this study provides a theoretical framework for understanding and applying metaverses as therapeutic spaces in mental health fields through a conceptualization and characterization of metaverses for a range of technologies and services. The value of metaverses as a human-centered "field of experience" was identified and proposed based on the essential aspect of the user, the human being, rather than from the technology used. According to existing psychotherapeutic theories, four therapeutic concepts for the metaverse were proposed: metaverse as an "average expectable environment" in the developmental and therapeutic categories of the self, a transitional stage for adaptation to reality, a creative space for memory and communication for the self, and an expanded or "surplus" reality. This work is expected to be a useful basis for expanding new psychotherapeutic strategies and methods as therapeutic spaces for maintaining mental health through the metaverse.

Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial

Background

Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health.

Methods

We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital.

Data analysis

Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ).

Discussion

Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Immersive virtual reality: An effective strategy for reducing stress in young adults

Background:

Psychological stress is ubiquitous in young adults, but traditional relaxation strategies such as mindfulness or meditation are not consistently utilised. Immersive virtual reality (VR) is being increasingly used in mental health contexts with improved clinical outcomes. However, there is limited research exploring the perceived usefulness of VR for individuals without a mental health diagnosis.

Aim:

To identify if an immersive VR experience was effective in reducing stress for young adults and to explore the experience of the participants.

Methods:

Twenty-one young adults aged 18–25 years participated in an immersive VR experience. Heart rate was measured pre- and post-test to objectively establish the efficacy of VR to facilitate relaxation. Participants were invited to participate in a semi-structured interview ( n = 18) to gain a rich understanding of their experience.

Results:

Four themes emerged from analysis of the interviews: I felt relaxed and calm, It was time-efficient and easy to use, It took me to another place and It was different than I thought it would be. Heart rate reduced during the immersive VR experience.

Conclusion:

These findings suggest that immersive VR can reduce psychological stress, and it is perceived by young adults as a useful and time-effective strategy to reduce psychological stress.

Mindfulness training for community-based psychotherapists: a feasibility study

BACKGROUND

While mindfulness training's feasibility has been assessed in many health care settings, the feasibility of teaching mindfulness to psychotherapists of various orientations for both self- and patient-care has not been explored. The objectives of this feasibility assessment were to determine the degree to which clinic psychotherapists were willing to complete a skills-based mindfulness training program; evaluate the acceptability of integrating mindfulness interventions into an urban community mental health clinic; examine the training's influence on both personal mindfulness practice and integration into patient care; and explore the impact of a support group following the training.

METHODS

Data on six aspects of feasibility were gathered through quantitative surveys, semi-structured qualitative interviews, and group observation and feedback, analyzed using grounded theory.

RESULTS

Sixteen therapists and one administrator attended at least one session of this voluntary program and responded to the associated surveys. At 1-year post-training, 7 participants had attended one or more group support sessions, and 4 more than 50% of sessions. The following factors were identified as contributing to the training's success: significant interest on the part of clinic staff to receive the training; diversity of the teaching staff, buy-in from clinic administration, provision of meditation scripts, role-play exercises, the variety of practices taught, and case presentations. Therapists indicated that the training helped them create a personal mindfulness practice, and several proceeded to integrate mindfulness into client sessions. A bi-weekly support group organized after the training encompassed group practice, discussion, case presentations, and information about trauma-sensitive mindfulness. Clinicians identified the following challenges to integrating mindfulness into sessions: lack of scripts in client languages other than English, the unacceptability of mindfulness to some clients' religious beliefs, the lack of appropriateness for clients facing ongoing psychosocial crises, the lack of interest on the part of some clients, and the time constraints posed by brief therapy sessions.

CONCLUSIONS

These findings indicate that such training may be feasible in community mental health settings given support from leadership and the presence of qualified facilitators within the organization. Adaptations to the training based on participant feedback can inform a larger scale trial that compares our protocol with another intervention in the treatment of a psychological disorder or condition identified by the participants as having responded favorably to the program.

The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis

Background

Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown.

Objective

Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction.

Methods

In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible.

Results

A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as “Low risk” and “Some concerns” for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference –1.81, 95% CI –2.04 to –1.57; P<.001) and the active period (standardized mean difference [SMD] –0.41, 95% CI –0.68 to –0.14; P=.003); reduce anxiety (SMD –1.39, 95% CI –1.99 to –0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD –1.12, 95% CI –2.38 to 0.13; P=.08) and second (SMD –0.22, 95% CI –0.67 to 0.24; P=.35) stages of labor were not statistically significant.

Conclusions

VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes.

Trial Registration

PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410

How Virtual Reality Technology Has Changed Our Lives: An Overview of the Current and Potential Applications and Limitations

Despite virtual reality (VR) being initially marketed toward gaming, there are many potential and existing VR applications in various sectors and fields, including education, training, simulations, and even in exercise and healthcare. Unfortunately, there is still a lack of general understanding of the strengths and limitations of VR as a technology in various application domains. Therefore, the aim of this literature review is to contribute to the library of literature concerning VR technology, its applications in everyday use, and some of its existing drawbacks. Key VR applications were discussed in terms of how they are currently utilized or can be utilized in the future, spanning fields such as medicine, engineering, education, and entertainment. The main benefits of VR are expressed through the text, followed by a discussion of some of the main limitations of current VR technologies and how they can be mitigated or improved. Overall, this literature review shows how virtual reality technology has the potential to be a greatly beneficial tool in a multitude of applications and a wide variety of fields. VR as a technology is still in its early stages, but more people are becoming interested in it and are optimistic about seeing what kind of changes VR can make in their everyday lives. With how rapidly modern society has adapted to personal computers and smartphones, VR has the opportunity to become the next big technological turning point that will eventually become commonplace in most households.

The Effectiveness of Immersive Virtual Reality (VR) Based Mindfulness Training on Improvement Mental-Health in Adults: A Narrative Systematic Review

OBJECTIVE

In recent years, digital techniques, such as virtual reality (VR) has been employed in tandem with more traditional psychological interventions. The aim of this study is to investigate whether VR-based mindfulness training can improve mental health outcomes, and notably mindfulness levels amongst adults. In addition, this review seeks to summarise the various designed VR scenarios, as well as those elements around VR that may assist people in practising mindfulness and meditation.

METHODS

The search for eligible studies for inclusion was conducted via the following databases: the Applied Social Science Index & Abstract (ASSIA), PsychINFO, Medline, EMBASE, and the Web-of-Science Core Collection. Only experimental studies were eligible for inclusion, and specifically, those that compared the effectiveness of mindfulness training using immersive VR (on the one hand) with a control condition.

RESULTS

This search generated 2523 articles published between 2016 and 2022, and of these, 106 were assessed for eligibility. This review included seven studies, with a collective total of 798 participants. VR-based mindfulness training has been shown to be more effective than conventional mindfulness - it improves levels of mindfulness and meditation experience; but also shown to reduce anxiety, depression, improve sleep quality, emotion regulation, and generate mood improvement. VR-based mindfulness training frequently contains natural 'environmentally relevant' elements, such as forest, grassland, caves, sea, etc. CONCLUSIONS: This review suggests that using VR to assist mindfulness training is an effective and innovative way to improve mental health conditions within the adult population. Further directions and limitations are discussed.

Virtual Reality to Support Inpatient Addiction Treatment: Patients Are Ready, What About Therapists? A Feasibility Study

This study aimed to identify facilitators and barriers for implementation of virtual reality therapy (VRT), used to train communication and problem-solving skills aiding relapse prevention, when integrated with addiction treatment (Treatment as Usual; TAU). Mixed methods were used in an observational, partly prospective, design. A total of 21 therapists and 113 patients from three inpatient addiction clinics were assessed. Therapists filled in questionnaires to gauge expectancies and experiences regarding facilitators and barriers at baseline, after a try-out period, halfway, and at the end of the pilot lasting 6-12 months. They also participated in focus-group interviews. Patients filled in similar questionnaires before an initial, and after they finished a third, VRT session. In addition, nine patients were interviewed. All VRT sessions were logged, with patients answering additional questions. Acceptability of VRT was high in both groups. It was feasible to integrate VRT with TAU and integration showed potential effectiveness. Barriers included incidental motion sickness, technical difficulties, costs, and device setup time. Both therapists and patients advocated VRT use to augment addiction treatment. Findings suggest a clinical effectiveness study is warranted.

Mediating Mindfulness-Based Interventions with Virtual Reality in Non-Clinical Populations: The State-of-the-Art

Mindfulness is one of the most popular psychotherapeutic techniques that help to promote good mental and physical health. Combining mindfulness with immersive virtual reality (VR) has been proven to be especially effective for a wide range of mood disorders for which traditional mindfulness has proven valuable. However, the vast majority of immersive VR-enhanced mindfulness applications have focused on clinical settings, with little evidence on healthy subjects. This narrative review evaluates the real effectiveness of state-of-the-art mindfulness interventions mediated by VR systems in influencing mood and physiological status in non-clinical populations. Only studies with an RCT study design were considered. We conclude that most studies were characterized by one single meditation experience, which seemed sufficient to induce a significant reduction in negative mood states (anxiety, anger, depression, tension) combined with increased mindfulness skills. However, physiological correlates of mindfulness practices have scarcely been investigated. The application of VR-enhanced mindfulness-based interventions in non-clinical populations is in its infancy since most studies have several limitations, such as the poor employment of the RCT study design, the lack of physiological measurements (i.e., heart rate variability), as well as the high heterogeneity in demographical data, technological devices, and VR procedures. We thus concluded that before applying mindfulness interventions mediated by VR in clinical populations, more robust and reliable methodological procedures need to be defined.

The Feasibility and Effectiveness of Virtual Reality Meditation on Reducing Chronic Pain for Older Adults with Knee Osteoarthritis

There is an urgent need for safe and effective non-pharmacologic approaches to treat chronic knee pain in older adults. Although virtual reality (VR) has shown some effectiveness for acute pain, there is limited evidence on the effects of VR on chronic pain particularly with older adult populations. This single application, within-subject pilot study evaluated the feasibility and effectiveness of VR as a clinical treatment for older adults with chronic osteoarthritis knee pain. Nineteen participants aged 60+ years old participated in a 10-minute VR meditation program. Data on pain and affect were collected immediately prior to, post, and 24-48 hours after the VR. Results suggest that VR meditation had significant moderate-large analgesic effects on knee pain intensity, primarily during VR (d = 1.10) and post VR (d = .99), with some lasting effects into next day (d = .58). The findings also suggest VR meditation intervention had a positive effect on affect, with a significant large decrease in negative affect scores pre to post VR (d = 1.14). The significant moderate to large decreases in pain interference for normal work (d = .71), mood (d = .53), sleep (d = .67), and enjoyment of life (d = .72) suggest that older adults may have a higher ability to participate in meaningful daily activities up to 24-48 hours after VR meditation. VR appears to be a feasible and effective nonpharmacological tool for older adults to treat chronic overall & knee-specific pain.

"Room to Reflect": A Pilot Workplace Resiliency Intervention for Nurses

Rising workload demands for nurses necessitate the implementation of easily accessible and innovative clinician well-being resources on health care units. This pre/post pilot study sought to measure the impact of a mobile workplace intervention, “Room to Reflect” on staff nurse and nurse manager resilience. A mobile toolbox with a sound machine, Virtual Reality headset, and associated Quick Response code audio/video offerings, and a paper Pocket Guide of mindful restoration practices were provided to 7 health care units for a 3 month period. Pre/post questionnaires assessed perceived resilience using the Connor-Davidson Resilience scale, and intervention feasibility (ease of use), accessibility (spaces used), and effectiveness (restoration). Data analysis consisted of descriptive statistics, paired and independent samples t-tests, and Wilcoxon Signed Rank tests. From the pre (n = 97) to post (n = 57) intervention period, there was a significant difference in resilience for Clinician 3 staff nurses. A mean increase in resilience was noted among nurse managers following participation in the intervention, z = −2.03, p < 0.05. The Pocket Guide was the easiest offering to use, while VR offerings were accessed the most through Quick Response code. Space and time were the most common barriers to Room to Reflect use. Staff nurses felt supported by managers to use the program, and managers perceived that the program improved nurse job satisfaction.

The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation

Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.

A virtual reality home-based training for the management of stress and anxiety among healthcare workers during the COVID-19 pandemic: study protocol for a randomized controlled trial

Background

Healthcare workers represent one of the most affected categories by the adverse effects of the COVID-19 pandemic on mental health. Excessive stress and anxiety are critical factors that could compromise work performance. Besides, high levels of stress and anxiety may have long-term physical and psychological consequences. Recent studies investigated virtual reality to reduce stress and anxiety among healthcare workers during the COVID-19 pandemic. However, the proposed virtual reality interventions have important limitations related to their location (i.e., research lab and hospitals) and content (i.e., virtual experiences only for relaxation). Within this context, this randomized controlled trial aims to investigate the efficacy and acceptability of a brief home-based virtual reality training for managing stress and anxiety during the COVID-19 crisis in a sample of Italian healthcare workers.

Methods

The study is a randomized controlled trial. It includes two groups of 30 individuals recruited from healthcare workers: (1) the experimental group and (2) the control group. Participants in the experimental group will receive a training consisting of three home sessions performed in a week. In each session, participants will try through an immersive virtual reality standalone system (i.e., Oculus Quest 2) a virtual psychoeducation experience on stress and anxiety (i.e., MIND-VR). Subsequently, they will try the virtual relaxation content (i.e., The Secret Garden). The control group will receive no training and will be reassessed one week and one month after the initial evaluation.

Discussion

If the proposed brief home-based virtual reality training will result helpful and easy to use, it could become an empirically assessed viable option for protecting healthcare workers’ mental health both during the COVID-19 pandemic and once it will be over. Furthermore, the intervention might be easily adapted for other categories of people who need support in managing stress and anxiety.

Trial registration

ClinicalTrials.gov NCT04611399.

Facilitating relaxation and stress reduction in healthy participants through a virtual reality intervention: study protocol for a non-inferiority randomized controlled trial

BACKGROUND

Repeated or chronic stress is considered a major source of disease, in terms of both somatic and mental illnesses. The prevention of stress-related disease by interventions for relaxation has thus increased societal relevance. In this randomized controlled non-inferiority trial, we will compare a newly developed virtual reality (VR) environment for relaxation to an active control group applying a freely chosen relaxation method. To test if our VR environment supports relaxation in a situation of acute stress, a standardized stress induction protocol will precede the relaxation phase.

METHODS

One hundred healthy participants will be recruited from the University of Siegen and randomly assigned to the VR or the active control group that will be free to choose their own relaxation strategy. The multi-sensory VR includes visual, acoustic, and haptic features to induce a strong feeling of presence. The laboratory testing will comprise a baseline measurement, a stress induction, a relaxation intervention, and a recovery measurement. The primary outcomes are self-reported stress and relaxation measured with a visual analog scale (VAS) at pre- and post-baseline, at the start, middle, and end of the stress induction, at pre- and post-relaxation, at pre- and post-recovery, and in the evening of testing. Secondary outcomes are the physiological parameters, namely heart rate and heart rate variability, tonic skin conductance level as well as the number of non-specific skin conductance responses, systolic and diastolic blood pressure and respiratory rate recorded during the four experimental phases as well as state mood, and state rumination assessed at four time points (pre- and post-stress, post-relaxation, and in the evening of testing). Finally, post-event processing will be assessed after relaxation and in the evening of testing. Repeated measures ANOVAs will be performed to test for statistical effects of group, time, and group × time interaction.

DISCUSSION

The newly developed, multi-sensory VR offers an intervention for relaxation without prior training. Its immersive character might increase efficacy compared to other relaxation methods, especially in situations of acute stress. Future directions could be the development of a mobile version of the VR to enhance accessibility for users. To achieve a transfer of training effects to real life, VR components should successively be eliminated until relaxation is practiced without guidance by the VR.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN11162338 . Retrospectively registered on January 22, 2021.

Virtual Reality-Based Mindfulness for Chronic Pain Management: A Scoping Review

OBJECTIVES

To identify and synthesize the scientific literature on virtual reality (VR)-based mindfulness applications for the management of chronic pain in adults.

DESIGN

A scoping review methodology was followed and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline.

DATA SOURCES

Combinations of key words related to "virtual reality", "mindfulness", and "chronic pain" were searched for in PubMed, CINAHL, EMBASE, Scopus, and the Cochrane library databases. Title, abstracts, and full-text articles were screened against inclusion criteria.

REVIEW/ANALYSIS METHODS

Braun and Clarke's thematic analysis approach was used.

RESULTS

Seven studies were included in the review and their findings synthesized into three overarching themes: (1) physical and mental health benefits; (2) treatment engagement and satisfaction; and (3) intervention usability. The last theme had four subthemes which were cybersickness, physical limitations, technical support, and personalized design.

CONCLUSIONS

While studies suggested VR could improve chronic pain management by enhancing the practice of mindfulness, weak study designs and small sample sizes limited the utility of the review results. Future research should rigorously co-design and test VR-based mindfulness applications with people with chronic pain to assess if they improve health and other outcomes.

Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing

Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing.

Virtual reality during work breaks to reduce fatigue of intensive unit caregivers: A crossover, pilot, randomised trial

PURPOSE

Intensive care unit (ICU) caregivers are exposed to high levels of stress. Work-related stress can impact quality of life and may lead to burnout. Virtual reality (VR) simulates a person's presence in a pleasant and enjoyable artificial environment. Thus, VR may be used to improve breaktime efficacy during the work shift of ICU caregivers.

OBJECTIVE

The study objectives were to evaluate the feasibility and efficacy of VR to decrease stress, anxiety, and fatigue, as well as to increase work disconnection during the breaktime.

METHODS

We conducted a prospective, monocentric, open-label, crossover, randomised study comparing a half an hour breaktime including an 8-min-long VR session and a usual breaktime among ICU caregivers, on two consecutive work shifts. Participants were evaluated before and after the breaktime as well as at the end of the work shift for stress, anxiety, fatigue, and work disconnection using visual analog scales.

RESULTS

For the 88 participants, VR was easy to use. VR induced a significantly higher reduction in the fatigue score after the breaktime. Individual changes in the fatigue score were +0.17 (1.87) vs. -0.33 (1.87). A significantly higher feeling of disconnection from the work environment at the end of the breaktime was also observed with VR: 5.98 (3.04) vs. 4.20 (2.64). No significant difference was observed for other parameters, in particular at the end of the shift.

CONCLUSION

VR sessions could improve the efficacy of breaktimes among ICU caregivers and contribute to a better quality of work life; repeated or longer sessions may be required to induce sustained effects.

An Exploratory Study on the Effectiveness of Virtual Reality Analgesia for Children and Adolescents with Kidney Diseases Undergoing Venipuncture

The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent patients with kidney disease undergoing venipuncture. Patients at an Italian Children’s hospital (N = 82, age range 7–17 years) undergoing venipuncture were randomly assigned to a No VR group (non-medical conversation) vs. a Yes VR group (VR analgesia). After the procedure, patients gave 0–10 Verbal Numeric Pain Scale ratings. Compared with patients in the No VR Group, patients in the Yes VR group reported significantly lower “Pain intensity”(No VR mean = 2.74, SD = 2.76 vs. Yes VR mean = 1.56, SD = 1.83) and the VR group also rated “Pain unpleasantness” significantly lower than the No VR group (No VR mean = 2.41, SD = 0.94 vs. Yes VR mean = 1.17, SD = 1.80). Patients distracted with VR also reported having significantly more fun during the venipuncture procedure. No side effects emerged. In addition to reducing pain intensity, VR has the potential to make venipuncture a more fun and less unpleasant experience for children with CKD, as measured in the present study for the first time. Finally, in exploratory analyses, children aged 7–11 in the VR group reported 55% lower worst pain than control subjects in the same age range, whereas children aged 12 to 17 in the VR group only reported 35% lower worst pain than control subjects. Additional research and development using more immersive VR is recommended.

Application of Artificial Intelligence on Psychological Interventions and Diagnosis: An Overview

BACKGROUND

Innovative technologies, such as machine learning, big data, and artificial intelligence (AI) are approaches adopted for personalized medicine, and psychological interventions and diagnosis are facing huge paradigm shifts. In this literature review, we aim to highlight potential applications of AI on psychological interventions and diagnosis.

METHODS

This literature review manifest studies that discuss how innovative technology as deep learning (DL) and AI is affecting psychological assessment and psychotherapy, we performed a search on PUBMED, and Web of Science using the terms "psychological interventions," "diagnosis on mental health disorders," "artificial intelligence," and "deep learning." Only studies considering patients' datasets are considered.

RESULTS

Nine studies met the inclusion criteria. Beneficial effects on clinical symptoms or prediction were shown in these studies, but future study is needed to determine the long-term effects.

LIMITATIONS

The major limitation for the current study is the small sample size, and lies in the lack of long-term follow-up-controlled studies for a certain symptom.

CONCLUSIONS

AI such as DL applications showed promising results on clinical practice, which could lead to profound impact on personalized medicine for mental health conditions. Future studies can improve furthermore by increasing sample sizes and focusing on ethical approvals and adherence for online-therapy.

Virtual reality as a tool to promote wellbeing in the workplace

Background

NHS staff are disproportionately impacted by workplace stress, threatening not only quality of service delivery, but the sustainability, of this vital healthcare system. There is an urgent need for accessible and cost-effective interventions that promote the wellbeing of this integral workforce.

Aim

The aim of this study was to explore the potential propensity of a short virtual reality (VR) nature experience, delivered during the workday, to induce positive mood states NHS clinicians.

Method

NHS clinicians working in a fast-paced trauma service were offered the opportunity to take part in a short virtual reality (VR) relaxation session, during their working day, in which they were able to explore the “Green Meadows” experience available within the Nature Treks application. An indication of physiological arousal (heart rate) was obtained, and subjective measures of emotional state were employed to assess the effect of the intervention on participants’ mood. Further, feedback was gathered to provide an initial indication of the acceptability of the experience.

Results

Analysis of data from 39 clinicians revealed that, following the VR experience, participants reported significantly increased feelings of happiness (p < 0.001) and relaxation (p < 0.001), and significantly decreased feelings of sadness (p = 0.003), anger (p < 0.001) and anxiety (p < 0.001). No significant differences in reported levels of surprise (p = 0.603) or vigour (p = 0.566) were found. Further, the experience was associated with a significant reduction in heart-rate (p = 0.025), and had high acceptability ratings, despite participants’ varied experience with computers and VR technology.

Conclusions

The findings of this study indicate that the administration of VR for the promotion of NHS staff wellbeing in the workplace is a potentially fruitful avenue of exploration that warrants further investigation.

On the usability of digital sleep interventions in sports

High sleep quality is highly related to better health and peak performance. Nowadays, multiple applications and platforms are available to track activity, to monitor heart rate, or to evaluate sleep quality. While activity tracking and heart rate monitoring are widely used, little is known about the potentials of digital tools to optimize sleep quality. Especially among athletes, who often suffer from reduced sleep quality because of full schedules and high competition performance pressure, interventions to maximize performance by optimizing recovery and sleep quality seem to be promising. In the present paper, we give an overview on existing research focusing on the potentials of digital interventions to enhance sleep quality among athletes. In particular, mindfulness-based digital interventions seem to be promising as they evidently foster high sleep quality and related health and performance patterns. Further, athletes can time- and cost-effectively integrate them into their daily routines. Future research is needed to empirically test the usability of digital features and suitable interventions to optimize sleep.

Cognitive Effect Following a Blended (Face to Face and Videoconference-Delivered) Format Mindfulness Training

While evidence supports the feasibility of online mindfulness training (MT), the effect of this approach on cognition remains unclear. The present study investigated changes in cognition following a newly developed 6-week videoconference-delivered MT program on cognitive function in two groups. The first group (n = 17) had two baseline assessments prior to MT [3 weeks after group two (n = 15)] to allow for evaluation of practice and learning effects. Four participants from each group were excluded from the final analysis due to missing data. Following MT, there was an improvement in switching of attention, working memory, executive function, and social cognition, but some of these effects were not easily accounted for by learning or practice effects. No significant changes were found on tasks measuring sustained attention, cognitive flexibility and inhibition, information processing, and sensory-motor function. Our findings suggest that domain-specific cognition might be enhanced by a brief videoconference-delivered MT, and larger, controlled studies to delineate the effects of online MT on subdomains of cognition are needed.

REALIDADE VIRTUAL NA PRÁTICA DE MINDFULNESS EM PSICOTERAPIA: UMA REVISÃO NARRATIVA

A associação entre mindfulness (MF) e Realidade Virtual (RV) é recente. O MF vem sendo utilizado na psicoterapia em razão dos efeitos terapêuticos observados. Entretanto, não são todos os pacientes que conseguem obter o benefício desse recurso, sendo a RV uma via para o trabalho com o MF por facilitar o sentido de presença. Este artigo teve como objetivo realizar uma revisão narrativa da literatura sobre a utilização terapêutica da RV na prática de MF. Foram analisados 23 artigos completos, sendo os principais focos de pesquisa: o aprimoramento dos ecossistemas imersivos e dos recursos terapêuticos no contexto do MF em relação à experiência do usuário; o desenvolvimento de recursos tecnológicos econômicos; material de fácil manuseio para facilitar a experiência do usuário. Concluímos que a RV pode ser facilitadora como ferramenta no tratamento de pacientes cujo perfil se enquadra em terapia mediada por MF, embora sejam necessários estudos controlados que permitam compreender as especificidades da RV e as variáveis com valor terapêutico.

Exploring the Potential Impact of a Virtual Body Scan Meditation Exercise Conducted With Pet Dogs on Recipients and Facilitators

Numerous recent studies have shown that COVID-19 and the accompanying mandated lifestyle changes have resulted in significant negative effects on people's mental health. To meet the increased need for mental health support, while also maintaining physical safety, a variety of telehealth services have been created or expanded. A body scan mindfulness program is an intervention that can easily be modified to be offered virtually. This study was designed to determine if a virtual body scan mindfulness exercise, with participants' holding their dog or a pillow/blanket, could reduce their stress and anxiety as well as that of the facilitators. Significant differences in pre/post-State Anxiety Assessment scores for participants and facilitators were found. These results are discussed within the framework of the human animal bond and the potential of this form of intervention as a useful virtual tool for participants and facilitators alike.

Spanish-Speaking Therapists Increasingly Switch to Telepsychology During COVID-19: Networked Virtual Reality May Be Next

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (χ² = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z = -3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z = -3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Exploring the Use of Virtual Reality for the Delivery and Practice of Stress-Management Exercises

Background

Mindfulness-based interventions may benefit healthcare professionals with burnout symptoms. Virtual reality (VR) may reduce initial difficulty of engaging in mindfulness exercises and increase participants’ engagement through immersion and presence.

Aim

The aim was to investigate how VR affects participants’ experience of engagement with mindfulness practice, and its impact on quality of practice and negative mood states.

Methods

Fifty-one healthcare professionals were randomized to receive either a visualization or non-visualization mindfulness practice, to compare the quality of practice through the use of audio only vs. with a virtual reality interface. Selected self-reported measures were collected during the session (immersion, quality and difficulty of practice, mood states and likelihood for future practice).

Results

Results showed that order instead of type of modality administered made a difference in quality of mindfulness practice. A greater sense of presence was reported with VR if administered after audio (F = 4.810, p = 0.033, Partial η² = 0.093). Further, participants described difficulty practicing with audio if administered after VR (F = 4.136, p = 0.048, Partial η² = 0.081). Additionally, lower mood disturbance was reported with VR if administered after audio (F = 8.116, p = 0.006, Partial η² = 0.147). Qualitative responses echoed a preference for VR to engage better, in addition to improved mood states after practice.

Conclusion

Findings suggest that VR has the potential to provide healthcare professionals with an alternative or a supplement to conventional mindfulness practice.

Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study

The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and physical (pain) outcomes. Participants were 62 children to young adults with IBD (M = 15.6 years; 69.4% Crohn's disease; 58% male) recruited from an outpatient pediatric IBD clinic. Participants completed a baseline assessment, underwent the 6-min MBVR intervention, completed a post-intervention assessment and study satisfaction survey, and provided qualitative feedback. Results suggest strong feasibility and acceptability. Participants reported high levels of satisfaction with MBVR including high levels of enjoyment (M = 4.38; range 1-5) and relaxation (M = 4.35; range 1-5). Qualitative data revealed several key themes including participants interest in using MBVR in IBD medical settings (e.g., hospitalizations, IBD procedures, IBD treatments), as well as in their daily lives to support stress and symptom management. Preliminary analyses demonstrated improvements in anxiety (t = 4.79, p = 0.001) and pain (t = 3.72, p < 0.001) following MBVR. These findings provide initial support for the feasibility and acceptability of MBVR among children and young adults with IBD. Results also suggest MBVR may improve key IBD outcomes (e.g., anxiety, pain) and highlight the importance of conducting a randomized controlled trial and more rigorous research to determine intervention efficacy.

Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial

OBJECTIVES

To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention.

METHODS

This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to 'MBP', 'MBP + VR', or 'Relaxation' (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme.

RESULTS

Both 'MBP' (B = -2.77, d = -0.72, p = .006) and 'MBP + VR' (B = -2.44, d = -0.59, p = .014) were superior to 'Relaxation' in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the 'MBP + VR' group, with higher retention rates and session attendance (p < .001).

CONCLUSIONS

This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03771300.

Meditating in Virtual Reality 3: 360° Video of Perceptual Presence of Instructor

Objectives

The need for remote delivery of mental health interventions including instruction in meditation has become paramount in the wake of the current global pandemic. However, the support one may usually feel within the physical presence of an instructor may be weakened when interventions are delivered remotely, potentially impacting one's meditative experiences. Use of head-mounted displays (HMD) to display video-recorded instruction may increase one's sense of psychological presence with the instructor as compared to presentation via regular flatscreen (e.g., laptop) monitor. This research therefore evaluated a didactic, trauma-informed care approach to instruction in mindfulness meditation by comparing meditative responses to an instructor-guided meditation when delivered face-to-face vs. by pre-recorded 360° videos viewed either on a standard flatscreen monitor (2D format) or via HMD (i.e., virtual reality [VR] headset; 3D format).

Methods

Young adults (n = 82) were recruited from a university introductory course and experienced a 360° video-guided meditation via HMD (VR condition, 3D format). They were also randomly assigned to practice the same meditation either via scripted face-to-face instruction (in vivo [IV] format) or when viewed on a standard laptop display (non-VR condition, 2D format). Positive and negative affect and meditative experience ratings were self-reported and participants' maintenance of focused attention to breathing (i.e., meditation breath attention scores [MBAS]) were recorded during each meditation.

Results

Meditating in VR (3D format) was associated with a heightened experience of awe overall. When compared to face-to-face instruction (IV format), VR meditation was rated as less embarrassing but also less enjoyable and more tiring. When compared to 2D format, VR meditations were associated with greater experiences of relaxation, less distractibility from the process of breathing, and less fatigue. No differences were found between VR and non-VR meditation in concentration (MBAS). Baseline posttraumatic stress symptoms were risk factors for experiencing distress while meditating in either (VR and non-VR) instructional format. Of those who reported a preference for one format, approximately half preferred the VR format and approximately half preferred the IV format.

Conclusions

Recorded 360° video instruction in meditation viewed with a HMD (i.e., VR/3D format) appears to offer some experiential advantage over instructions given in 2D format and may offer a safe-and for some even preferred-alternative to teaching meditation face-to-face.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-021-01612-w.

Influences of a Virtual Reality Experience on Dissociation, Mindfulness, and Self-Efficacy

An experiment on a nonclinical sample to investigate influences of virtual reality (VR) on dissociation, mindfulness, and self-efficacy is reported. The participants were immersed for 20 minutes with a VR system in a large virtual apartment and have been charged to look around and find a set of objects previously observed on pictures. Questionnaires pre- and postimmersion were administered to measure the levels of such psychological constructs; cybersickness was assessed as well. Results showed an upward trend in dissociation and a significant increase of mindfulness after immersion in the VR environment. No influences on self-efficacy were found. Findings are discussed with reference to past studies, where a different picture emerged, by considering possible differences due to changes in technology and context.

A single mindfulness session with informal caregivers of seniors living with dementia: a pilot qualitative descriptive study

BACKGROUND

Evidence suggests that informal caregivers who are providing care for seniors with dementia experience daily stressors due to their demanding caregiving roles. Current research recognizes the positive impact of mindfulness on caregivers' well-being. However, there is an existing gap in the current literature about informal caregivers' own perceptions and understanding of mindfulness intervention.

OBJECTIVE

To address this gap, this pilot study aims to explore informal caregivers' experience of a single mindfulness session and the feasibility of mindfulness to be integrated into their daily lives.

METHODS

Six informal caregivers who are providing care for seniors living with dementia participated in this qualitative descriptive study. Thematic analysis was used to derive themes to understand the participants' experience of a brief mindfulness session.

RESULTS

The findings of the study generated five major themes: (1) Comparison of mindfulness with other relaxation techniques; (2) Single mindfulness session as a social learning opportunity; (3) Positive impact of practicing mindfulness; (4) Perception about barriers to practicing mindfulness; and (5) Perception of self-efficacy to practice mindfulness in the future.

DISCUSSION

The study participants perceived mindfulness to be beneficial for their overall well-being. In addition, as participants were beginners of mindfulness, they considered mindfulness technique to be easy to learn through single practice session and feasible to be integrated into their daily lives.

CONCLUSION

This qualitative study highlights that as little as brief 15 min of mindfulness session is perceived positively by informal caregivers. There is a need for further research on the long-term outcomes of practicing mindfulness among informal caregivers of seniors.

Therapists Make the Switch to Telepsychology to Safely Continue Treating Their Patients During the COVID-19 Pandemic. Virtual Reality Telepsychology May Be Next

Before COVID-19, most therapists had concerns about telepsychology, and only treated patients in person. During the COVID-19 lockdown, patients still needed therapy, but in-person therapy sessions became unsafe. The current study measured how many therapists are using online therapy before vs. during COVID-19, how much training they have received, and their knowledge about legal restrictions on using telepsychology. A sample of 768 U.S.A. mental health professionals completed a 29-item online survey. Results show that before COVID-19, most therapists only saw their patients in person (e.g., at the therapists office), but during the COVID-19 pandemic, nearly all therapists used a wide range of telecommunication technologies to communicate with their quarantined patients, including texting, telephones, video conferences, and even virtual reality. According to within-subject related samples comparisons, 39% of survey respondents used telepsychology before COVID-19, vs. 98% during COVID-19 (χ² = 450.02, p< 0.001). Therapists reported high treatment effectiveness using telepsychology (7.45 on 0-10 scale). However, overall, on a 0-10 scale, therapists reported a significant increase in feeling burned out during the COVID-19 pandemic, Mean = 3.93 (SD = 1.93) before vs. 6.22 (SD = 2.27) during the pandemic (Z = -18.57, p < 0.001). Although the APA ethics guidelines encourage therapists to use telepsychology with their patients during the crisis, gaps in respondents' knowledge identify a need for increased specialized training and education. Although the current study showed that virtual reality is rarely used by the therapists surveyed, virtual reality is a promising new telepsychology technology. Billions of dollars are currently being invested in mass producing immersive virtual reality systems. In the future, as networked immersive Virtual Reality becomes more widely available, therapists and patients in physically different locations will be able to "meet" in a shared computer-generated world designed for therapy sessions, potentially including group sessions. Telepsychology and virtual reality have the potential to be increasingly valuable tools to help therapists mitigate the consequences of COVID-19. Research, development and training is recommended.

The impact of virtual reality meditation on college students’ exam performance

Advocates of meditation claim that it can improve various aspects of life, including health, attention, thinking, and learning. The purpose of this empirical, quantitative, between-subject study was twofold. First, it compared the effectiveness of meditation delivered through virtual reality versus video, as measured by students’ test scores. Second, the study provided insights on the use of meditation, whether via virtual reality or video, as a way to positively affect well-being. T-test analysis showed virtual reality meditation to be significantly more beneficial than video meditation. Students reported that meditation techniques delivered using either medium to be helpful in decreasing their pre-exam anxiety. This study has practical implications and offers evidence on the beneficial impact of VR meditation on students’ exam performance and anxiety levels.