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Primavera D, Urban A, Cantone E, Nonnis M, Aviles Gonzalez CI, Perra A, Tusconi M, Sancassiani F. The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial. J Clin Med 2024; 13:4203. [PMID: 39064243 PMCID: PMC11277986 DOI: 10.3390/jcm13144203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Antonio Urban
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- University Hospital of Cagliari, 09042 Cagliari, Italy
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Marcello Nonnis
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | | | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
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García-González J, Martínez-Navarro A, Romero-Del Rey R, Requena-Mullor M, Zheng R, Lopez-Villen A, Alarcon-Rodriguez R. State-trait anxiety levels and vital signs of pregnant women following intervention with virtual reality during the nonstress test: A randomized controlled trial. J Affect Disord 2024; 355:308-314. [PMID: 38548203 DOI: 10.1016/j.jad.2024.03.148] [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: 05/26/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Pregnant women often experience anxiety due to pregnancy, negatively impacting their and their fetus' health. Non-pharmacological interventions, such as virtual reality (VR), could reduce anxiety levels, potentially impacting non-stress tests or the physiological responses of the pregnant woman and the fetus. METHODS A randomized clinical trial conducted between February and December 2022 involved 286 term pregnant women. They were divided into a VR intervention group (146 women) and a control group (140 women). The intervention consisted of 20 min of 3D glasses with images and sounds during a third-trimester nonstress test. Anxiety was measured using the Spielberg State-Trait Anxiety Inventory (STAI), alongside physiological parameters. RESULTS The VR group exhibited lower anxiety levels compared to controls (STAI score: Rosenthal's r: -0.54, p = 0.01; state anxiety: Rosenthal's r: -0.40, p = 0.001; trait anxiety: Rosenthal's r: -0.41, p = 0.001). Within the VR group, there was a significant reduction in trait anxiety (Rosenthal's r, 1.27; p < 0.001) and total anxiety (Rosenthal's r, 1.63; p < 0.001) post-intervention, along with decreased systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), and maternal heart rate (p = 0.02). LIMITATIONS Future research could explore additional pregnancy-related variables, such as postpartum anxiety. CONCLUSIONS The results confirm that the use of VR is beneficial for pregnant women and their fetuses, as it decreases anxiety levels, and improves physiological parameters such as blood pressure and maternal heart rate during the nonstress test. VR is a technique that is easy to integrate into the healthcare system due to its non-invasive and non-pharmacological nature.
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Affiliation(s)
- Jessica García-González
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | | | - Raúl Romero-Del Rey
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | - Ruirui Zheng
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain.
| | - Antonia Lopez-Villen
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain; Torrecárdenas Hospital, 04009 Almería, Spain
| | - Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
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Pardini S, Kim S, de Jesus B, Lopes MKS, Leggett K, Falk TH, Smith C, Appel L. SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards. BMJ Open Qual 2024; 13:e002769. [PMID: 38834370 PMCID: PMC11163655 DOI: 10.1136/bmjoq-2024-002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Aggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as 'Calm Down Methods'. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards. OBJECTIVES The present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit. METHODS An exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada). RESULTS A chronological overview of the design process, adaptations and description of the user experience is reported. CONCLUSION 'SafeVRwards' introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.
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Affiliation(s)
- Susanna Pardini
- Bruno Kessler Foundation, Trento, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Shua Kim
- University Health Network, Toronto, Ontario, Canada
| | - Belmir de Jesus
- Institut national de la recherche scientifique, Quebec City, Quebec, Canada
| | - Marilia K S Lopes
- Institut national de la recherche scientifique, Quebec City, Quebec, Canada
| | | | - Thiago H Falk
- Institut national de la recherche scientifique, Quebec City, Quebec, Canada
| | - Christopher Smith
- Michael Garron Hospital Foundation, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lora Appel
- University Health Network, Toronto, Ontario, Canada
- Michael Garron Hospital Foundation, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
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Riches S, Taylor L, Jeyarajaguru P, Veling W, Valmaggia L. Virtual reality and immersive technologies to promote workplace wellbeing: a systematic review. J Ment Health 2024; 33:253-273. [PMID: 36919828 DOI: 10.1080/09638237.2023.2182428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/30/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Work-related stress negatively impacts employee wellbeing. Stress-management interventions that reduce workplace stress can be challenging. Immersive technologies, such as virtual reality (VR), may provide an alternative. AIMS This systematic review aimed to evaluate feasibility, acceptability, and effectiveness of immersive technologies to promote workplace wellbeing (PROSPERO 268460). METHODS Databases MEDLINE, Web of Science, PsycINFO and Embase were searched until 22nd July 2021. Studies were included if they tested a workforce or were designed for a workplace. Effective Public Health Practice Project quality assessment tool (EPHPP) was used for quality ratings. RESULTS There were 17 studies (N = 1270), published 2011-2021. Over half were conducted in Europe. Eight studies were controlled trials. Most studies involved brief, single sessions of immersive VR and provided evidence of feasibility, acceptability, and effectiveness when measuring wellbeing-related variables such as stress, relaxation, and restoration. VR environments included relaxation tasks such as meditation or breathing exercises, and nature-based stimuli, such as forests, beaches, and water. Studies tested office workers, healthcare professionals, social workers, teachers, and military personnel. EPHPP ratings were "strong" (N = 1), "moderate" (N = 13), and "weak" (N = 3). CONCLUSIONS VR relaxation appears helpful for workplaces. However, limited longer-term data, controlled trials, and naturalistic studies mean conclusions must be drawn cautiously.
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Affiliation(s)
- Simon Riches
- Department of Psychology, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lawson Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Priyanga Jeyarajaguru
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Lucia Valmaggia
- Department of Psychology, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Lee LJ, Son EH, Farmer N, Gerrard C, Tuason RT, Yang L, Kohn-Godbout J, Stephens C, Nahm ES, Smith L, Risch S, Wallen GR. Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol. Front Psychiatry 2024; 15:1295097. [PMID: 38516258 PMCID: PMC10954866 DOI: 10.3389/fpsyt.2024.1295097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Millions of family members and/or friends in the U.S. serve as unpaid caregivers for individuals with chronic conditions, such as cancer. Caregiving for someone undergoing an intense allogeneic hematopoietic stem cell transplant (HSCT) is particularly demanding, with accompanying physical and psychological stress. Increased stress and stress-related symptoms could make it difficult for caregivers to fulfill their roles and could negatively impact the health status and quality of life of themselves and the recipients. Virtual reality (VR) is a promising technology increasingly used for treatment and wellness in various medical settings. There is growing evidence that studies have reported the positive effects of the VR intervention in managing and reducing stress among diverse populations in various clinical scenarios; however, no published studies have focused on family caregivers of patients with cancer. The study aims to assess the feasibility and acceptability of a four-week nature-based VR intervention and to examine the effectiveness of the VR intervention on stress in HSCT caregivers. This study comprises two phases. Phase I of the study will be a single-arm pre-post design focused on assessing the feasibility and acceptability of the VR intervention. Phase II of the study will be a prospective randomized controlled group design to examine the effectiveness of the VR intervention on perceived stress. Adults (≥ 18 years) who serve as primary caregivers for a person who will undergo an allogeneic HSCT will be recruited. Fifteen participants will be enrolled for Phase I and 94 participants for Phase II (Active VR arm N=47; Sham VR arm N=47). The nature-based immersive VR program contains 360° high-definition videos of nature scenes along with nature sounds through a head-mounted display (HMD) for 20 minutes every day for four weeks. Primary outcome is perceived stress measured by the Perceived Stress Scale. Secondary/exploratory outcomes are stress-related symptoms (e.g., fatigue, sleep disturbance) and physiological biomarkers (e.g., cortisol, alpha-amylase). The importance and innovativeness of this study consist of using a first-of-its-kind, immersive VR technology to target stress and investigating the health outcomes assessed by validated objective biomarkers as well as self-report measures of the nature-based intervention in the caregiver population. Clinical trial registration ClinicalTrials.gov, identifier NCT05909202.
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Affiliation(s)
- Lena J. Lee
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Elisa H. Son
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Nicole Farmer
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Chantal Gerrard
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Ralph Thadeus Tuason
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Li Yang
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Julie Kohn-Godbout
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Cory Stephens
- University of Maryland Baltimore, School of Nursing, Baltimore, MD, United States
| | - Eun-Shim Nahm
- University of Maryland Baltimore, School of Nursing, Baltimore, MD, United States
| | - Leslie Smith
- National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD, United States
| | - Steve Risch
- National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD, United States
| | - Gwenyth R. Wallen
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
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Valls-Ontañón A, Vandepputte SS, de la Fuente C, Giralt-Hernando M, Molins-Ballabriga G, Cigarrán-Mensa M, Sabbagh A, Hernández-Alfaro F. Effectiveness of virtual reality in relieving anxiety and controlling hemodynamics during oral surgery under local anesthesia: A prospective randomized comparative study. J Craniomaxillofac Surg 2024; 52:273-278. [PMID: 38326127 DOI: 10.1016/j.jcms.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/29/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
It was the aim of the study to evaluate the contribution of a relaxing immersive experience with virtual reality (VR) goggles in reducing patient anxiety related to wisdom tooth extraction under local anesthesia. A prospective randomized comparative study in consecutive patients scheduled for bilateral wisdom tooth extraction under local anesthesia was carried out between March and December 2022. Both sides were operated upon in the same surgery, but on one side VR goggles were applied (VR), while on the other they were not (noVR). Anxiety was evaluated both subjectively (State-Trait Anxiety Inventory [STAI] and visual analogue scale [VAS]) and objectively (measuring heart rate, blood pressure [BP] and blood oxygen saturation) before (T1) and after each surgical step (T2VR and T2noVR). The study sample consisted of 27 patients: 9 men and 18 women, with an average age of 25.8 ± 6.5 years (range: 18-43). Anxiety as assessed by the STAI and VAS decreased from T1 to T2 (p < 0.001 and p < 0.001, respectively), although to a similar degree regardless of whether VR was used or not. Heart rate showed significant differences influenced by RV exposure (p = 0.013): it increased +2.5 ± 8.8 bpm in the control group and decreased -2.22 ± 7.55 bpm with VR (p = 0.013). Both minimum and maximum BP after surgery were significantly higher in the noVR group (p = 0.002 and p = 0.040, respectively). Regarding minimum BP, VR proved more effective among male patients (p = 0.057) and on starting the procedure using VR (p = 0.055). The results provided evidence of meaningful control of the hemodynamic variables, but less predictable performance in the subjective evaluation of anxiety.
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Affiliation(s)
- Adaia Valls-Ontañón
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain.
| | - Sarah Sophie Vandepputte
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | | | - Maria Giralt-Hernando
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain
| | | | | | - Ali Sabbagh
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Federico Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain
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Park SA, Lee J, Kim HY. Virtual reality education program for women with uterine tumors treated by high-intensity focused ultrasound. Heliyon 2024; 10:e23759. [PMID: 38226233 PMCID: PMC10788432 DOI: 10.1016/j.heliyon.2023.e23759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
This study aimed to develop and determine the effects of a nursing education program using virtual reality (VR) for women with uterine tumors undergoing treatment with high-intensity focused ultrasound (HIFU). Various nursing education methods need to be developed alongside new treatment methods and their effects should be clinically verified. Nursing intervention using VR has recently been attempted. The study comprises a pre- and post-test design with a non-equivalent control group. We assigned 54 women to experimental (n = 26) and control (n = 28) groups. The patients were diagnosed with benign uterine tumors and were treated with HIFU at two women's hospitals in D city. Data collected from these hospitals were analyzed using descriptive statistics, a pre-test of homogeneity, independent t-tests, and repeated measures analysis of variance. In the experimental group, uncertainty (t = 4.26, p < 0.001) and anxiety (t = 4.09, p < 0.001) were significantly lower compared to the control group. However, nursing satisfaction was significantly higher in the experimental group than in the control group (t = -4.50, p < 0.001). The VR education program is an educational nursing intervention that reduces uncertainty and anxiety and improves nursing satisfaction among women with uterine tumors treated by HIFU. We suggest that future nursing research integrates and converges disciplines according to progressive treatment methods and technological advancements for patients.
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Affiliation(s)
- Seo A Park
- Dept. of Nursing, Kyungwoon University, 730, Gangdong-ro, Gumi, 39160, Republic of Korea
| | - Jumi Lee
- Dept. of Nursing, Ulsan University, 93, Daehak-ro, Ulsan, 44610, Republic of Korea
| | - Hye Young Kim
- College of Nursing, Keimyung University, 1095, Dalgubeol-daero, Daegu, 42601, Republic of Korea
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Ilioudi M, Wallström S, Steingrimsson S, Lindner P, Thunström AO, Ali L. Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients. BMJ Open 2023; 13:e076285. [PMID: 38101823 PMCID: PMC10729110 DOI: 10.1136/bmjopen-2023-076285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS 20 adult patients (12 women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
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Affiliation(s)
- Maria Ilioudi
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
| | - Sara Wallström
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Forensic Psychiatry, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Almira Osmanovic Thunström
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mitsea E, Drigas A, Skianis C. Digitally Assisted Mindfulness in Training Self-Regulation Skills for Sustainable Mental Health: A Systematic Review. Behav Sci (Basel) 2023; 13:1008. [PMID: 38131865 PMCID: PMC10740653 DOI: 10.3390/bs13121008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The onset of the COVID-19 pandemic has led to an increased demand for mental health interventions, with a special focus on digitally assisted ones. Self-regulation describes a set of meta-skills that enable one to take control over his/her mental health and it is recognized as a vital indicator of well-being. Mindfulness training is a promising training strategy for promoting self-regulation, behavioral change, and mental well-being. A growing body of research outlines that smart technologies are ready to revolutionize the way mental health training programs take place. Artificial intelligence (AI); extended reality (XR) including virtual reality (VR), augmented reality (AR), and mixed reality (MR); as well as the advancements in brain computer interfaces (BCIs) are ready to transform these mental health training programs. Mindfulness-based interventions assisted by smart technologies for mental, emotional, and behavioral regulation seem to be a crucial yet under-investigated issue. The current systematic review paper aims to explore whether and how smart technologies can assist mindfulness training for the development of self-regulation skills among people at risk of mental health issues as well as populations with various clinical characteristics. The PRISMA 2020 methodology was utilized to respond to the objectives and research questions using a total of sixty-six experimental studies that met the inclusion criteria. The results showed that digitally assisted mindfulness interventions supported by smart technologies, including AI-based applications, chatbots, virtual coaches, immersive technologies, and brain-sensing headbands, can effectively assist trainees in developing a wide range of cognitive, emotional, and behavioral self-regulation skills, leading to a greater satisfaction of their psychological needs, and thus mental wellness. These results may provide positive feedback for developing smarter and more inclusive training environments, with a special focus on people with special training needs or disabilities.
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Affiliation(s)
- Eleni Mitsea
- Net Media Lab & Mind & Brain R&D, Institute of Informatics & Telecommunications, National Centre of Scientific Research ‘Demokritos’ Athens, Agia Paraskevi, 15341 Athens, Greece;
- Department of Information and Communication Systems Engineering, University of Aegean, 82300 Mytilene, Greece;
| | - Athanasios Drigas
- Net Media Lab & Mind & Brain R&D, Institute of Informatics & Telecommunications, National Centre of Scientific Research ‘Demokritos’ Athens, Agia Paraskevi, 15341 Athens, Greece;
| | - Charalabos Skianis
- Department of Information and Communication Systems Engineering, University of Aegean, 82300 Mytilene, Greece;
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Riches S, Nicholson SL, Fialho C, Little J, Ahmed L, McIntosh H, Kaleva I, Sandford T, Cockburn R, Odoi C, Azevedo L, Vasile R, Payne-Gill J, Fisher HL, van Driel C, Veling W, Valmaggia L, Rumball F. Integrating a virtual reality relaxation clinic within acute psychiatric services: A pilot study. Psychiatry Res 2023; 329:115477. [PMID: 37802013 DOI: 10.1016/j.psychres.2023.115477] [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: 05/18/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023]
Abstract
People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists' (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre- and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients' relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards.
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Affiliation(s)
- Simon Riches
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom.
| | - Sarah L Nicholson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Carolina Fialho
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Jordan Little
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lava Ahmed
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Harley McIntosh
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Ina Kaleva
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Tom Sandford
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Rebecca Cockburn
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Clarissa Odoi
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lisa Azevedo
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Ruxandra Vasile
- The Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust and University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - James Payne-Gill
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; ESRC Centre for Society and Mental Health, King's College London, London WC2B 6NR, United Kingdom
| | - Catheleine van Driel
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; KU Leuven, Department of Clinical Psychiatry, Leuven, Belgium
| | - Freya Rumball
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; Oxleas Adult Autism Service, Oxleas NHS Foundation Trust, Kent DA2 7WG, United Kingdom
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Freeman D, Lister R, Waite F, Galal U, Yu LM, Lambe S, Beckley A, Bold E, Jenner L, Diamond R, Kirkham M, Twivy E, Causier C, Carr L, Saidel S, Day R, Beacco A, Rovira A, Ivins A, Nah R, Slater M, Clark DM, Rosebrock L. Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses. Lancet Psychiatry 2023; 10:836-847. [PMID: 37742702 DOI: 10.1016/s2215-0366(23)00257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Persecutory delusions are a major psychiatric problem that often do not respond sufficiently to standard pharmacological or psychological treatments. We developed a new brief automated virtual reality (VR) cognitive treatment that has the potential to be used easily in clinical services. We aimed to compare VR cognitive therapy with an alternative VR therapy (mental relaxation), with an emphasis on understanding potential mechanisms of action. METHODS THRIVE was a parallel-group, single-blind, randomised controlled trial across four UK National Health Service trusts in England. Participants were included if they were aged 16 years or older, had a persistent (at least 3 months) persecutory delusion held with at least 50% conviction, reported feeling threatened when outside with other people, and had a primary diagnosis from the referring clinical team of a non-affective psychotic disorder. We randomly assigned (1:1) patients to either THRIVE VR cognitive therapy or VR mental relaxation, using a permuted blocks algorithm with randomly varying block size, stratified by severity of delusion. Usual care continued for all participants. Each VR therapy was provided in four sessions over approximately 4 weeks, supported by an assistant psychologist or clinical psychologist. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 2 (therapy mid-point), 4 (primary endpoint, end of treatment), 8, 16, and 24 weeks. The primary outcome was persecutory delusion conviction, assessed by the Psychotic Symptoms Rating Scale (PSYRATS; rated 0-100%). Outcome analyses were done in the intention-to-treat population. We assessed the treatment credibility and expectancy of the interventions and the two mechanisms (defence behaviours and safety beliefs) that the cognitive intervention was designed to target. This trial is prospectively registered with the ISRCTN registry, ISRCTN12497310. FINDINGS From Sept 21, 2018, to May 13, 2021 (with a pause due to COVID-19 pandemic restrictions from March 16, 2020, to Sept 14, 2020), we recruited 80 participants with persistent persecutory delusions (49 [61%] men, 31 [39%] women, with a mean age of 40 years [SD 13, range 18-73], 64 [80%] White, six [8%] Black, one [1%] Indian, three [4%] Pakistani, and six [8%] other race or ethnicity). We randomly assigned 39 (49%) participants assigned to VR cognitive therapy and 41 (51%) participants to VR mental relaxation. 33 (85%) participants who were assigned to VR cognitive therapy attended all four sessions, and 35 (85%) participants assigned to VR mental relaxation attended all four sessions. We found no significant differences between the two VR interventions in participant ratings of treatment credibility (adjusted mean difference -1·55 [95% CI -3·68 to 0·58]; p=0·15) and outcome expectancy (-0·91 [-3·42 to 1·61]; p=0·47). 77 (96%) participants provided follow-up data at the primary timepoint. Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater improvement in persecutory delusions (adjusted mean difference -2·16 [-12·77 to 8·44]; p=0·69). Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater reduction in use of defence behaviours (adjusted mean difference -0·71 [-4·21 to 2·79]; p=0·69) or a greater increase in belief in safety (-5·89 [-16·83 to 5·05]; p=0·29). There were 17 serious adverse events unrelated to the trial (ten events in seven participants in the VR cognitive therapy group and seven events in five participants in the VR mental relaxation group). INTERPRETATION The two VR interventions performed similarly, despite the fact that they had been designed to affect different mechanisms. Both interventions had high uptake rates and were associated with large improvements in persecutory delusions but it cannot be determined that the treatments accounted for the change. Immersive technologies hold promise for the treatment of severe mental health problems. However, their use will likely benefit from experimental research on the application of different therapeutic techniques and the effects on a range of potential mechanisms of action. FUNDING Medical Research Council Developmental Pathway Funding Scheme and National Institute for Health and Care Research Oxford Health Biomedical Research Centre.
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Affiliation(s)
- Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Rachel Lister
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Black Country Healthcare NHS Foundation Trust, Dudley, UK
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ushma Galal
- Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sinéad Lambe
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ariane Beckley
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Emily Bold
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Lucy Jenner
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rowan Diamond
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Miriam Kirkham
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Eve Twivy
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Chiara Causier
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Lydia Carr
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Simone Saidel
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rebecca Day
- Northamptonshire Healthcare NHS Foundation Trust, Kettering, UK
| | - Alejandro Beacco
- Event Lab, Faculty of Psychology Spain, University of Barcelona, Barcelona, Spain; Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Aitor Rovira
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Annabel Ivins
- Northamptonshire Healthcare NHS Foundation Trust, Kettering, UK
| | - Ryan Nah
- Northamptonshire Healthcare NHS Foundation Trust, Kettering, UK; Central and North West London NHS Foundation Trust, London, UK
| | - Mel Slater
- Event Lab, Faculty of Psychology Spain, University of Barcelona, Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Laina Rosebrock
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Humbert A, Kohls E, Baldofski S, Epple C, Rummel-Kluge C. Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic. Front Psychiatry 2023; 14:1271702. [PMID: 37953932 PMCID: PMC10634536 DOI: 10.3389/fpsyt.2023.1271702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. Objective The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. Methods The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. Results In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). Conclusion A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. Clinical trial registration https://clinicaltrials.gov/, DRKS00027911.
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Affiliation(s)
- Annika Humbert
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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13
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Clemmensen L, Jørgensen G, Gundersen KB, Smith LC, Midtgaard J, Bouchard S, Thomsen CP, Turgut L, Glenthoj LB. 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. BMJ Open 2023; 13:e070566. [PMID: 37739476 PMCID: PMC10533807 DOI: 10.1136/bmjopen-2022-070566] [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: 11/27/2022] [Accepted: 08/25/2023] [Indexed: 09/24/2023] Open
Abstract
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.
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Affiliation(s)
- Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Gry Jørgensen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Kristina Ballestad Gundersen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Lisa Charlotte Smith
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Julie Midtgaard
- Centre for applied research in mental health care (CARMEN), Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | | | | | - Louise Birkedal Glenthoj
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Kaleva I, Riches S. Stepping inside the whispers and tingles: multisensory virtual reality for enhanced relaxation and wellbeing. Front Digit Health 2023; 5:1212586. [PMID: 37534028 PMCID: PMC10390721 DOI: 10.3389/fdgth.2023.1212586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Ina Kaleva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Baysan A, Çonoğlu G, Özkütük N, Orgun F. Come and see through my eyes: A systematic review of 360-degree video technology in nursing education. NURSE EDUCATION TODAY 2023; 128:105886. [PMID: 37390520 DOI: 10.1016/j.nedt.2023.105886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Viewers can watch 360-degree videos from any angle, like a panorama, and experience the virtual environment directly. Recently, there has been a growing interest in immersive and interactive technologies in education, and the use of 360-degree videos has become popular. This systematic review was conducted to present the current use of 360-degree videos in nursing education. DESIGN Systematic review. DATA SOURCES In addition to screening the Google Scholar, MEDLINE, SCOPUS, and EBSCO databases, we also performed hand searching. REVIEW METHODS Relevant keywords were used to identify trials published in the above-mentioned databases from inception to March 1, 2023. In the first step, the titles, abstracts, and full texts of the retrieved studies were independently reviewed by two authors according to the inclusion criteria. Studies on which there was disagreement were reviewed by all authors, and a consensus decision was reached. The data from the studies included in the review were analyzed and reported using the PRISMA 2020 checklist. RESULTS Twelve articles that met the inclusion criteria were reviewed. It was determined that 360-degree video scenarios used in nursing education were mostly related to mental health nursing, and the videos were mostly viewed through head-mounted displays, without any interactive features. Most difficulties encountered in the use of these videos were related to motion sickness. The main implications of the reviewed studies were that 360-degree videos contributed to the development of students' knowledge, skills, and attitudes and that the use of these videos was recommended. CONCLUSIONS As an innovative application the use of 360-degree videos in nursing education was examined from various perspectives in this review. The results showed that the use of such videos was convenient and effective for nursing education.
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Affiliation(s)
- Aydan Baysan
- Department of Nursing Education, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey.
| | - Gülsüm Çonoğlu
- Department of Nursing, Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Turkey.
| | - Nilay Özkütük
- Department of Nursing Education, Faculty of Nursing, Ege University, İzmir, Turkey.
| | - Fatma Orgun
- Department of Nursing Education, Faculty of Nursing, Ege University, İzmir, Turkey.
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Lundin RM, Yeap Y, Menkes DB. Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review. JMIR Ment Health 2023; 10:e43240. [PMID: 37145841 DOI: 10.2196/43240] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) are emerging treatment modalities in psychiatry, which are capable of producing clinical outcomes broadly comparable to those achieved with standard psychotherapies. OBJECTIVE Because the side effect profile associated with the clinical use of VR and AR remains largely unknown, we systematically reviewed available evidence of their adverse effects. METHODS A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across 3 mental health databases (PubMed, PsycINFO, and Embase) to identify VR and AR interventions targeting mental health diagnoses. RESULTS Of 73 studies meeting the inclusion criteria, 7 reported worsening clinical symptoms or an increased fall risk. Another 21 studies reported "no adverse effects" but failed to identify obvious adverse effects, mainly cybersickness, documented in their results. More concerningly, 45 of the 73 studies made no mention of adverse effects whatsoever. CONCLUSIONS An appropriate screening tool would help ensure that VR adverse effects are correctly identified and reported.
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Affiliation(s)
- Robert M Lundin
- Change to Improve Mental Health, Mental Health Drugs and Alcohol Services, Barwon Health, Geelong, Australia
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Yuhern Yeap
- Mental Health and Addictions, Waikato District Health Board, Hamilton, New Zealand
| | - David B Menkes
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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Meins IA, Muijsson-Bouwman DC, Nijman SA, Greaves-Lord K, Veling W, Pijnenborg GHM, van der Stouwe ECD. VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis: a study protocol for a single-blind multi-centre randomized controlled trial. Trials 2023; 24:278. [PMID: 37061694 PMCID: PMC10105944 DOI: 10.1186/s13063-023-07241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/13/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT). METHODS A total of 116 participants (age 18-40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1-4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up. DISCUSSION If VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders. TRIAL REGISTRATION On the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784 .
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Affiliation(s)
- Ivo Alexander Meins
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands.
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands.
| | | | - Saskia Anne Nijman
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
| | | | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
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Nijman SA, Pijnenborg GHM, Vermeer RR, Zandee CER, Zandstra DC, van der Vorm D, de Wit-de Visser AC, Meins IA, Geraets CNW, Veling W. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) versus Virtual Reality Relaxation (VRelax) for People With a Psychotic Disorder: A Single-Blind Multicenter Randomized Controlled Trial. Schizophr Bull 2023; 49:518-530. [PMID: 36413388 PMCID: PMC10016415 DOI: 10.1093/schbul/sbac166] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND HYPOTHESIS Social cognition training (SCT), an intervention for social cognition and social functioning, might be improved by using virtual reality (VR), because VR may offer better opportunities to practice in a potentially more realistic environment. To date, no controlled studies have investigated VR-SCT. This study investigated a VR-SCT, "DiSCoVR". We hypothesized that DiSCoVR would improve social cognition and social functioning. STUDY DESIGN Participants were randomized to DiSCoVR (n = 41) or VR relaxation ('VRelax', n = 40), an active control condition, and completed 16 twice-weekly sessions. Three assessments (baseline, posttreatment, and 3-month follow-up) were performed by blinded assessors. The primary outcome was social cognition (emotion perception and theory of mind). Secondary outcomes included social functioning (measured with an interview and experience sampling), psychiatric symptoms, information processing, and self-esteem. Data were analyzed using mixed-models regression analysis. Treatment effects were evaluated by the time by condition interaction terms. STUDY RESULTS No significant time by condition interactions were found for any of the outcome variables, indicating an absence of treatment effects. Between-group effect sizes ranged from negligible to moderate (Cohen's d < |0.53|). Main effects of time were found for several outcomes. CONCLUSIONS These results suggest that DiSCoVR was not effective, possibly because of inadequate simulation of emotional expressions in VR. This lack of efficacy may indicate that current SCT protocols are relatively unsuitable for improving social functioning. Previous studies showed small to moderate effects on higher order social cognition, but the SCT approach may need critical reevaluation, as it may not sufficiently lead to functional improvement.
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Affiliation(s)
- S A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - R R Vermeer
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - C E R Zandee
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - D C Zandstra
- Zeeuwse Gronden, Axelsestraat 8/A, 4537 AJ, Terneuzen, The Netherlands
| | - D van der Vorm
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands
| | - A C de Wit-de Visser
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, PO Box 90153, 5000LE Tilburg, The Netherlands
| | - I A Meins
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - C N W Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - W Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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19
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Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review. Brain Sci 2023; 13:brainsci13030471. [PMID: 36979281 PMCID: PMC10046161 DOI: 10.3390/brainsci13030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Virtual reality (VR) has emerged as a safe and non-invasive technology for the assessment of psychotic symptoms, social and cognitive impairments, and psychosocial intervention in improving outcomes in psychosis. This study systematically reviewed the current state of evidence in applying semi- and fully immersive VR for assessing and treating patients with psychosis. A systematic review was conducted adhering to the PRISMA statement and was conducted in Embase, PsycINFO, and PubMed databases for articles published between January 2013 and April 2022, which identified 28 eligible studies, including 12 for assessment and 16 for intervention. In the assessment studies, not all VR tasks could distinguish the differences between patients and healthy controls regarding their physiological responses, paranoid ideation, and certain aspects of cognitive functioning such as memory bias on the object tasks. Comparatively, VR-based interventions are more promising, especially for improving cognitive impairments, social skills, agoraphobic avoidance, negative and positive affective states, auditory verbal hallucination, paranoid ideation and persecutory delusions, and other psychiatric symptoms in patients. We conclude that more rigorous studies are needed to confirm treatment effectiveness and to understand the underlying mechanism of VR-based intervention for psychotic disorders. Future studies should also improve the reliability and validity of VR-based assessments for psychotic disorders.
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20
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Browning MHEM, Shin S, Drong G, McAnirlin O, Gagnon RJ, Ranganathan S, Sindelar K, Hoptman D, Bratman GN, Yuan S, Prabhu VG, Heller W. Daily exposure to virtual nature reduces symptoms of anxiety in college students. Sci Rep 2023; 13:1239. [PMID: 36690698 PMCID: PMC9868517 DOI: 10.1038/s41598-023-28070-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
Exposure to natural environments offers an array of mental health benefits. Virtual reality provides simulated experiences of being in nature when outdoor access is limited. Previous studies on virtual nature have focused mainly on single "doses" of virtual nature. The effects of repeated exposure remain poorly understood. Motivated by this gap, we studied the influence of a daily virtual nature intervention on symptoms of anxiety, depression, and an underlying cause of poor mental health: rumination. Forty college students (58% non-Hispanic White, median age = 19) were recruited from two U.S. universities and randomly assigned to the intervention or control group. Over several weeks, anxious arousal (panic) and anxious apprehension (worry) decreased with virtual nature exposure. Participants identifying as women, past VR users, experienced with the outdoors, and engaged with the beauty in nature benefited particularly strongly from virtual nature. Virtual nature did not help symptoms of anhedonic depression or rumination. Further research is necessary to distinguish when and for whom virtual nature interventions impact mental health outcomes.
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Affiliation(s)
- Matthew H E M Browning
- Virtual Reality and Nature Lab, Clemson University, Clemson, SC, USA.
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA.
| | - Seunguk Shin
- Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gabrielle Drong
- College of Education, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Olivia McAnirlin
- Virtual Reality and Nature Lab, Clemson University, Clemson, SC, USA
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Ryan J Gagnon
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Shyam Ranganathan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | | | | | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA, USA
| | - Shuai Yuan
- Virtual Reality and Nature Lab, Clemson University, Clemson, SC, USA
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Vishnunarayan Girishan Prabhu
- Virtual Reality and Nature Lab, Clemson University, Clemson, SC, USA
- Systems Engineering and Engineering Management, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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21
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Riches S, Jeyarajaguru P, Taylor L, Fialho C, Little J, Ahmed L, O’Brien A, van Driel C, Veling W, Valmaggia L. Virtual reality relaxation for people with mental health conditions: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-022-02417-5. [PMID: 36658261 PMCID: PMC9852806 DOI: 10.1007/s00127-022-02417-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Vulnerability to stress is linked to poor mental health. Stress management interventions for people with mental health conditions are numerous but they are difficult to implement and have limited effectiveness in this population. Virtual reality (VR) relaxation is an innovative intervention that aims to reduce stress. This review aimed to synthesize evidence of VR relaxation for people with mental health conditions (PROSPERO 269405). METHODS Embase, Medline, PsycInfo, and Web of Science were searched until 17th September 2021. The review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Effective Public Health Practice Project (EPHPP) tool assessed methodological quality of studies. RESULTS Searching identified 4550 studies. Eighteen studies (N = 848) were included in the review. Studies were published between 2008 and 2021. Eleven were conducted in Europe. Thirteen studies were controlled trials. Participants were mostly working-age adult outpatients experiencing anxiety or stress-related conditions. Other conditions included eating disorders, depression, bipolar disorder, and psychosis. Five studies tested inpatients. All studies used a range of nature-based virtual environments, such as forests, islands, mountains, lakes, waterfalls, and most commonly, beaches to promote relaxation. Studies provided evidence of the feasibility, acceptability, and short-term effectiveness of VR relaxation to increase relaxation and reduce stress. EPHPP ratings were 'strong' (N = 11), 'moderate' (N = 4), and 'weak' (N = 3). CONCLUSIONS VR relaxation has potential as a low-intensity intervention to promote relaxation and reduce stress for adults with mental health conditions, especially anxiety and stress-related problems. Further research is warranted on this promising intervention.
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Affiliation(s)
- Simon Riches
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK. .,Social Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, BR3 3BX, UK.
| | - Priyanga Jeyarajaguru
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Lawson Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Carolina Fialho
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Jordan Little
- South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
| | - Lava Ahmed
- South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
| | | | - Catheleine van Driel
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | - Wim Veling
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | - Lucia Valmaggia
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK ,South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
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22
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Orsolini L, Appignanesi C, Pompili S, Volpe U. The role of digital tools in providing youth mental health: results from an international multi-center study. Int Rev Psychiatry 2022; 34:809-826. [PMID: 36786119 DOI: 10.1080/09540261.2022.2118521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Since the traditional mental health system showed significant limitations in the early identification, diagnosis and treatment of the current new youth psychopathological trajectories, by substantially failing in targeting the needs of the current young generation, there is the demand to redesign and digitally adapt youth mental health care and systems. Indeed, the level of digital literacy and the level of digital competency and knowledge in the field of digital psychiatry is still under-investigated among mental health professionals, particularly in youth mental health. Therefore, we aimed at: (a) carrying out a post-hoc analysis of an international multi-centre study, to investigate the opinions of mental health professionals regarding the feasibility, efficacy and clinical experience in delivering digital mental health interventions (DMHIs) in youths; (b) providing a comprehensive overview on the integrated digitally-based youth mental health care models and innovations. Mental health professionals declared the lack of a formal training in digital psychiatry, particularly in youth mental health. Subjects who received a formal theoretical/practical training on DMHIs displayed a statistical trend towards a positive feasibility of digital psychiatry in youth mental health (p = 0.053) and a perceived increased efficacy of digital psychiatry in youths (p = 0.051). Respondents with higher Digital Psychiatry Opinion (DPO) scores reported a positive perceived feasibility of DMHIs in youths (p < 0.041) and are more prone to deliver DMHIs to young people (p < 0.001). Respondents with higher knowledge scores (KS) declared that DMHIs are more effective in youth mental health (p < 0.001). Overall, the digitalisation indeed allowed young people to keep in touch with a mental health professional, facilitating a more dynamic and fluid mental health care access and monitoring, generally preferred and considered more feasible by post-Millennial youngsters. Accordingly, our findings demonstrated that mental health professionals are more prone to offer DMHIs in youth mental health, particularly whether previously trained and knowledgeable on the topic.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Cristina Appignanesi
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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23
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Jóźwik S, Wrzeciono A, Cieślik B, Kiper P, Szczepańska-Gieracha J, Gajda R. The Use of Virtual Therapy in Cardiac Rehabilitation of Male Patients with Coronary Heart Disease: A Randomized Pilot Study. Healthcare (Basel) 2022; 10:745. [PMID: 35455922 PMCID: PMC9031657 DOI: 10.3390/healthcare10040745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
The study aimed to evaluate the effectiveness of virtual reality therapy (VRT) in the treatment of anxiety-depressive disorders and in reducing stress levels in a group of men with coronary heart disease (CHD) participating in cardiac rehabilitation (CR). The study included 34 men with CHD who were assigned to the experimental group (EG) or the control group (CG). CR in the EG was supported by 8 VRT sessions, while CR in the CG was supplemented with 8 SAT sessions. Anxiety-depressive disorders were assessed using the Hospital Anxiety and Depression Scale (HADS). Perceived stress was assessed using the Perception of Stress Questionnaire (PSQ). In the EG, all measured parameters improved after the intervention. Significant reductions in HADS total score, the HADS-A, general stress score, emotional tension, and the external stress were obtained. In the CG, a deterioration in all measured parameters was observed. Significant changes were obtained in the general stress score and intrapsychic stress. The analysis between groups showed that the effectiveness of psychological interventions significantly differed between groups. The study results confirmed that supplementing standard CR with VRT leads to an improvement in the mental state of the patients and thus has a positive effect on the course of CR. However, the small sample size and high withdrawal rate prompt cautious interpretation of the results.
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Affiliation(s)
- Sandra Jóźwik
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (S.J.); (A.W.); (J.S.-G.)
| | - Adam Wrzeciono
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (S.J.); (A.W.); (J.S.-G.)
| | - Błażej Cieślik
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Częstochowa, 42-200 Częstochowa, Poland;
| | - Paweł Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy;
| | - Joanna Szczepańska-Gieracha
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (S.J.); (A.W.); (J.S.-G.)
| | - Robert Gajda
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Częstochowa, 42-200 Częstochowa, Poland;
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pultusk, 06-102 Pultusk, Poland
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24
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Son H, Ross A, Mendoza-Tirado E, Lee LJ. Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing. JMIR Nurs 2022; 5:e34036. [PMID: 35293870 PMCID: PMC8968556 DOI: 10.2196/34036] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Hyojin Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Alyson Ross
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Elizabeth Mendoza-Tirado
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Lena Jumin Lee
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
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25
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Sekula AD, Downey L, Puspanathan P. Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy. Front Psychol 2022; 13:813746. [PMID: 35310225 PMCID: PMC8931418 DOI: 10.3389/fpsyg.2022.813746] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.
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Affiliation(s)
- Agnieszka D. Sekula
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Enosis Therapeutics Pty. Ltd., Melbourne, VIC, Australia
- *Correspondence: Agnieszka D. Sekula,
| | - Luke Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
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26
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Rault O, Lamothe H, Pelissolo A. Therapeutic use of virtual reality relaxation in schizophrenia: A pilot study. Psychiatry Res 2022; 309:114389. [PMID: 35042064 DOI: 10.1016/j.psychres.2022.114389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/04/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
Virtual reality can be used for psychotherapeutic purposes. Our main objective is to assess the feasibility and the tolerance of a relaxation therapy in virtual reality from patients suffering from schizophrenia, by studying the risks of symptoms of depersonalization or cybersickness. It is a prospective, open, five-week clinical study. Evaluations were carried out before and after each session. They were 13 patients aged 18 to 65. Analyzes showed a good tolerance and acceptance regarding virtual reality and anxiolytic effects have been observed between baseline values and those obtained after the first session and after the fifth session (p < 0.05).
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Affiliation(s)
- Ophélie Rault
- Psychiatry and Addictology Service, AP-HP, Hôpital Paul Brousse, Univ Paris-Saclay, Villejuif 94800, France.
| | - Hugues Lamothe
- Department of Psychiatry, AP-HP, Hôpital Henri-Mondor, Univ Paris Est Creteil, IMRB Translational Neuropsychiatry Lab, Créteil F-94010, France
| | - Antoine Pelissolo
- Department of Psychiatry, AP-HP, Hôpital Henri-Mondor, Univ Paris Est Creteil, IMRB Translational Neuropsychiatry Lab, Créteil F-94010, France
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27
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Réalité virtuelle et santé des personnes âgées institutionnalisées. Vers un EHPAD 2.0 ? PRAT PSYCHOL 2022. [DOI: 10.1016/j.prps.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Behrens SC, Streuber S, Keizer A, Giel KE. How immersive virtual reality can become a key tool to advance research and psychotherapy of eating and weight disorders. Front Psychiatry 2022; 13:1011620. [PMID: 36405894 PMCID: PMC9668851 DOI: 10.3389/fpsyt.2022.1011620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Immersive virtual reality technology (VR) still waits for its wide dissemination in research and psychotherapy of eating and weight disorders. Given the comparably high efforts in producing a VR setup, we outline that the technology's breakthrough needs tailored exploitation of specific features of VR and user-centered design of setups. In this paper, we introduce VR hardware and review the specific properties of immersive VR versus real-world setups providing examples how they improved existing setups. We then summarize current approaches to make VR a tool for psychotherapy of eating and weight disorders and introduce user-centered design of VR environments as a solution to support their further development. Overall, we argue that exploitation of the specific properties of VR can substantially improve existing approaches for research and therapy of eating and weight disorders. To produce more than pilot setups, iterative development of VR setups within a user-centered design approach is needed.
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Affiliation(s)
- Simone C Behrens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Max Planck Institute for Intelligent Systems, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Streuber
- Department of Electrical Engineering and Computer Science, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Anouk Keizer
- Department of Experimental Psychology, University of Utrecht, Utrecht, Netherlands
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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29
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Knaust T, Felnhofer A, Kothgassner OD, Reinke M, Browning M, Höllmer H, Schulz H. Nature videos for PTSD: protocol for a mixed-methods feasibility study. Eur J Psychotraumatol 2022; 13:2101765. [PMID: 35936870 PMCID: PMC9347465 DOI: 10.1080/20008198.2022.2101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Background: Given the prevalence of post-traumatic stress disorder (PTSD), particularly among military personnel, new treatment approaches are needed. One may be virtual relaxation interventions, especially 360-degree nature videos, since studies have demonstrated their relaxation effects for healthy participants. If these relaxation effects can be reproduced in patients with PTSD, they may offer a viable tool to reduce distress and hyperarousal. Objective: This research protocol describes a planned study that will examine the relaxation effects of 360-degree nature videos for patients with PTSD. It will also investigate whether these relaxation effects differ depending on the hardware immersion level (head-mounted display [HMD] vs. PC screen) in comparison to a control condition in which patients only listen to natural sounds and do not view a video. Finally, the effect of each intervention's dose duration (five vs. ten minutes) will be explored. Method: A counterbalanced, randomised, controlled, within-subject experiment will be conducted (sample size N = 36). Only soldiers aged 18 years or older with a primary diagnosis of PTSD will be included. Those with psychosis, substance dependence, a change in psychiatric medication within the last month, suicidal intent, and motion sickness will be excluded. All patients will experience the HMD, PC, and control conditions once for five or ten minutes. Self-reported relaxation measures will be collected before and after, and patients' skin conductance level, heart rate, and heart rate variability will be assessed during each condition. Semi-structured interviews will be conducted to examine the patients' experiences in detail. Conclusions: This feasibility study will provide initial evidence of whether viewing 360-degree nature videos via HMD or PC screen is relaxing for patients with PTSD and whether the effects are greater compared with the control condition. The study will also validate the dose duration and thereby informing a subsequent confirmatory interventional trial. Trial registration: DRKS00020277. HIGHLIGHTS This randomised controlled feasibility study will examine whether 360-degree nature videos are a suitable relaxation intervention for military personnel with post-traumatic stress disorder.
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Affiliation(s)
- Thiemo Knaust
- Center for Mental Health, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
| | | | - Max Reinke
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew Browning
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Helge Höllmer
- Center for Mental Health, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Chung OS, Johnson AM, Dowling NL, Robinson T, Ng CH, Yücel M, Segrave RA. Are Australian Mental Health Services Ready for Therapeutic Virtual Reality? An Investigation of Knowledge, Attitudes, Implementation Barriers and Enablers. Front Psychiatry 2022; 13:792663. [PMID: 35185649 PMCID: PMC8854652 DOI: 10.3389/fpsyt.2022.792663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/14/2022] [Indexed: 12/18/2022] Open
Abstract
Therapeutic virtual reality (VR) has the potential to address the challenges of equitable delivery of evidence-based psychological treatment. However, little is known about therapeutic VR regarding the perspectives and needs of real-world service providers. This exploratory study aimed to assess the acceptability, appropriateness, and feasibility of therapeutic VR among clinicians, managers, and service staff working in mental healthcare and explore potential implementation barriers and enablers. Eighty-one staff from a network of private psychiatric hospitals in Victoria, Australia (aged M + SD: 41.88 + 12.01 years, 71.6% female; 64% clinical staff) completed an online survey, which included the Acceptability of Intervention Measure (AIM), Appropriateness of Intervention Measure (IAM), and Feasibility of Intervention Measure (FIM). While 91% of participants had heard about VR technology, only 40% of participants had heard of therapeutic VR being used in mental healthcare, and none had used therapeutic VR in a clinical setting. Most participants perceived VR to be acceptable (84%), appropriate (69%), and feasible (59%) to implement within their role or service and envisioned a range of possible applications. However, participants expressed concerns regarding safety, efficacy, and logistical challenges across clinical settings. Findings suggest a strong interest for therapeutic VR among Australian mental health providers working in the private system. However, dissemination efforts should focus on addressing identified barriers to ensure mental health providers are adequately informed and empowered to make implementation decisions.
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Affiliation(s)
- Olivia S Chung
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Alisha M Johnson
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Nathan L Dowling
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracy Robinson
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia
| | - Chee H Ng
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
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Pawassar CM, Tiberius V. Virtual Reality in Health Care: Bibliometric Analysis. JMIR Serious Games 2021; 9:e32721. [PMID: 34855606 PMCID: PMC8686483 DOI: 10.2196/32721] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with. OBJECTIVE We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords. METHODS Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer. RESULTS The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than "virtual" and "reality" are "training," "trial," and "patients." The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames. CONCLUSIONS The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability.
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Affiliation(s)
| | - Victor Tiberius
- Faculty of Economics and Social Sciences, University of Potsdam, Potsdam, Germany
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Nijland JWHM, Veling W, Lestestuiver BP, Van Driel CMG. Virtual Reality Relaxation for Reducing Perceived Stress of Intensive Care Nurses During the COVID-19 Pandemic. Front Psychol 2021; 12:706527. [PMID: 34659021 PMCID: PMC8511693 DOI: 10.3389/fpsyg.2021.706527] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022] Open
Abstract
During the COVID-19 pandemic ICU nurses endure high levels of stress. VR relaxation (VRelax, containing 360° immersive environments) provides an easy-to-use and effective means to induce positive affect and reduce perceived stress. We investigated feasibility and immediate effect on perceived stress of VRelax use by ICU nurses during work shifts. ICU nurses working with COVID-19 patients in an academic hospital could use VRelax as a 10-min break during their shift. Primary outcome was the difference between perceived stress immediately before and after VRelax use measured by a single-question VAS-stress scale. Statistically significant difference of the mean VAS-stress before and after use was determined using the paired t student test. A socio-demographic questionnaire, a questionnaire on perceived stress and stress resilience and VRelax user experiences were sent by email. Eighty-six (26%) nurses used VRelax at least once; 77% (N=66) of these filled out the VAS-stress scale before and after use of VRelax. Mean perceived stress lowered with 39.9% after use of VRelax (mean difference=14.0, SD=13.3, p<0.005). Mean score on the perceived stress scale-10 was 11.4 (SD=6.50), mean score on the Connor-Davidson Resilience Scale-10 was 29.0 (SD=5.51). Sixty-two percentage of the ICU nurses thought VRelax was helpful to reduce stress. Main barrier for use was a high workload. It is feasible for nurses to use VRelax in an ICU context. VRelax is an effective intervention to reduce immediate perceived stress and is of added value in stressful situations as during the COVID-19 pandemic, inducing a positive affective state and lowering perceived stress.
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Affiliation(s)
- J W H Mathijs Nijland
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands.,VRelax B.V., Groningen, Netherlands
| | - Bart P Lestestuiver
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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Jensen BS, Andersen N, Petersen J, Nyboe L. Enhanced Mental Health with Virtual Reality Mental Hygiene by a Veteran Suffering from PTSD. Case Rep Psychiatry 2021; 2021:5576233. [PMID: 34285821 PMCID: PMC8275405 DOI: 10.1155/2021/5576233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
This paper describes the application and feasibility of the use of Virtual Reality Mental Hygiene (VRMH) as a mean to reduce anxiety and stress in a Danish veteran suffering from posttraumatic stress disorder (PTSD) and enduring personality change after a catastrophic experience. The results from this case study provide preliminary evidence that VRMH can be used as a mean to reduce arousal in patients with severe PTSD.
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Affiliation(s)
| | | | | | - Lene Nyboe
- Clinic for PTSD and Anxiety, Aarhus University Hospital Skejby, Denmark
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Colombo D, Díaz-García A, Fernandez-Álvarez J, Botella C. Virtual reality for the enhancement of emotion regulation. Clin Psychol Psychother 2021; 28:519-537. [PMID: 34048621 DOI: 10.1002/cpp.2618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023]
Abstract
In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
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