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McGhee WRG, Doherty CJ, Graham-Wisener L, Fallis R, Stone C, Axiaq A, Dempster M. Immersive virtual reality and psychological well-being in adult chronic physical illness: systematic review. BMJ Support Palliat Care 2024; 14:14-24. [PMID: 37848219 DOI: 10.1136/spcare-2023-004502] [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: 07/18/2023] [Accepted: 08/11/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Individuals with chronic physical illness are at increased risk of negative psychological sequelae. Immersive virtual reality (VR) is an emerging treatment that might reduce these negative effects and increase quality of life in individuals with chronic physical illness. OBJECTIVE To systematically review literature examining the use of immersive VR in adult populations with chronic physical illness to understand: (1) how immersive VR is used to improve psychological well-being of adults with chronic physical illness (2) what effect this immersive VR has on the psychological well-being of adults with chronic physical illness. DESIGN Systematic literature review and meta-analysis. Searches of Ovid Medline/PubMed, PsycINFO, Embase, Web of Science and Scopus between July 1993 and March 2023 inclusive. RESULTS 12 811 texts were identified; 31 met the inclusion criteria. Relaxing and engaging immersive VR interventions were shown to be acceptable and feasible among adults with cancer, dementia, cardiovascular disease, kidney disease and multiple sclerosis. Many of the studies reviewed were feasibility or pilot studies and so the evidence about effectiveness is more limited. The evidence, mostly from studies of people with cancer, suggests that immersive VR can have a positive effects on anticipatory anxiety symptoms and pain. CONCLUSIONS Environment-based and game-based relaxing immersive VR offer novel interventions, with beneficial effects among people with cancer and, potentially, beneficial effects in those with other long-term physical illness.
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Affiliation(s)
| | | | | | | | | | - Ariana Axiaq
- Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, Belfast, UK
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Pardini S, Gabrielli S, Olivetto S, Fusina F, Dianti M, Forti S, Lancini C, Novara C. Personalized Virtual Reality Compared With Guided Imagery for Enhancing the Impact of Progressive Muscle Relaxation Training: Pilot Randomized Controlled Trial. JMIR Ment Health 2024; 11:e48649. [PMID: 38289673 PMCID: PMC10871070 DOI: 10.2196/48649] [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: 05/02/2023] [Revised: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Empirical evidence has shown that virtual reality (VR) scenarios can increase the effects of relaxation techniques, reducing anxiety by enabling people to experience emotional conditions in more vivid settings. OBJECTIVE This pilot randomized controlled study aims to investigate whether the progressive muscle relaxation technique (PMRT) associated with a personalized scenario in VR promotes psychological well-being and facilitates the recall of relaxing images more than the standard complementary intervention that involves the integration of PMRT and guided imagery (GI). METHODS On the basis of a longitudinal, between-subject design, 72 university students were randomly exposed to one of two experimental conditions: (1) standard complementary procedure (PMRT and GI exposure) and (2) experimental procedure (PMRT and personalized VR exposure). Individuals were assessed by a therapist before and after 7 training sessions based on measures investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data were also collected. RESULTS Differences in changes between the 2 groups after the in vivo PMRT session conducted by the psychotherapist (T1) were statistically significant for state anxiety (F1,67=30.56; P<.001) and heart rate (F1,67=4.87; P=.01). Individuals in the VR group obtained lower scores both before (t67=-2.63; P=.01; Cohen d=0.91) and after (t67=-7.23; P<.001; Cohen d=2.45) the relaxation session when it was self-administered by participants (T2). A significant reduction in perceived state anxiety at T1 and T2 was observed for both groups (P<.001). After the VR experience, individuals reported feeling higher engagement in the experience than what was mentioned by participants in the GI group (F1,67=2.85; P=.03; ηp2=0.15), and they experienced the environment as more realistic (F1,67=4.38; P=.003; ηp2=0.21). No differences between groups regarding sense of presence were found (F1,67=1.99; P=.11; ηp2=0.11). Individuals exposed before to the VR scenario (T1) referred to perceiving the scenario recalled in-imagination at T2 as more realistic than what those in the GI group experienced (F1,67=3.21; P=.02; ηp2=0.12). The VR group had lower trait anxiety levels than the GI group after the relaxation session during session 7 (T2; t67=-2.43; P=.02). CONCLUSIONS Personalized relaxing VR scenarios can contribute to improving relaxation and decreasing anxiety when integrated with PMRT as a complementary relaxation method. TRIAL REGISTRATION ClinicalTrials.gov NCT05478941; https://classic.clinicaltrials.gov/ct2/show/NCT05478941. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/44183.
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Affiliation(s)
- Susanna Pardini
- Department of General Psychology, University of Padova, Padova, Italy
- Digital Health Research, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padova, Italy
| | - Silvia Gabrielli
- Digital Health Research, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Silvia Olivetto
- Department of General Psychology, University of Padova, Padova, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Marco Dianti
- Digital Health Research, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Stefano Forti
- Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Cristina Lancini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Caterina Novara
- Department of General Psychology, University of Padova, Padova, Italy
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Villada Castillo JF, Montoya Vega MF, Muñoz Cardona JE, Lopez D, Quiñones L, Henao Gallo OA, Lopez JF. Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study. JMIR Serious Games 2024; 12:e48900. [PMID: 38206670 PMCID: PMC10811592 DOI: 10.2196/48900] [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: 05/10/2023] [Revised: 09/28/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Since the early 2000s, there has been a growing interest in using exercise video games (exergames) and virtual reality (VR)-based interventions as innovative methods to enhance physical rehabilitation for individuals with multiple disabilities. Over the past decade, researchers and exercise professionals have focused on developing specialized immersive exercise video games for various populations, including those who have experienced a stroke, revealing tangible benefits for upper limb rehabilitation. However, it is necessary to develop highly engaging, personalized games that can facilitate the creation of experiences aligned with the preferences, motivations, and challenges communicated by people who have had an episode of stroke. OBJECTIVE This study seeks to explore the customization potential of an exergame for individuals who have undergone a stroke, concurrently evaluating its usability as a technological tool in the realm of physical therapy and rehabilitation. METHODS We introduce a playtest methodology to enhance the design of a VR exergame developed using a user-centered approach for upper limb rehabilitation in stroke survivors. Over 4 playtesting sessions, stroke survivors interacted with initial game versions using VR headsets, providing essential feedback for refining game content and mechanics. Additionally, a pilot study involving 10 stroke survivors collected data through VR-related questionnaires to assess game design aspects such as mechanics, assistance, experience, motion sickness, and immersion. RESULTS The playtest methodology was beneficial for improving the exergame to align with user needs, consistently incorporating their perspectives and achieving noteworthy results. The pilot study revealed that users had a positive response. In the first scenario, a carpenter presents a game based on the flexion-extension movement of the elbow; the second scenario includes a tejo game (a traditional Colombian throwing game) designed around game mechanics related to the flexion-extension movement of the shoulder; and in the third scenario, a farmer challenges the player to perform a movement combining elbow flexion and extension with internal and external rotation of the shoulder. These findings suggest the potential of the studied exergame as a tool for the upper limb rehabilitation of individuals who have experienced a stroke. CONCLUSIONS The inclusion of exergames in rehabilitation for stroke-induced hemiparesis has significantly benefited the recovery process by focusing on essential shoulder and elbow movements. These interactive games play a crucial role in helping users regain mobility and restore practical use of affected limbs. They also serve as valuable data sources for researchers, improving the system's responsiveness. This iterative approach enhances game design and markedly boosts user satisfaction, suggesting exergames have promising potential as adjunctive elements in traditional therapeutic approaches.
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Affiliation(s)
| | | | | | - David Lopez
- Engineering Faculty, Universidad Tecnologica de Pereira, Pereira, Colombia
| | - Leonardo Quiñones
- Engineering Faculty, Universidad Tecnologica de Pereira, Pereira, Colombia
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Pardini S, Gabrielli S, Gios L, Dianti M, Mayora-Ibarra O, Appel L, Olivetto S, Torres A, Rigatti P, Trentini E, Leonardelli L, Bernardi M, Lucianer M, Forti S, Novara C. Customized virtual reality naturalistic scenarios promoting engagement and relaxation in patients with cognitive impairment: a proof-of-concept mixed-methods study. Sci Rep 2023; 13:20516. [PMID: 37993549 PMCID: PMC10665464 DOI: 10.1038/s41598-023-47876-1] [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: 05/29/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
Being immersed in a natural context has a beneficial and pervasive impact on well-being. Virtual Reality (VR) is a technology that can help expose people to naturalistic scenarios virtually, overcoming obstacles that prevent them from visiting real natural environments. VR could also increase engagement and relaxation in older adults with and without cognitive impairment. The main aim of this study is to investigate the feasibility of a customized naturalistic VR scenario by assessing motion-sickness effects, engagement, pleasantness, and emotions felt. Twenty-three individuals with a diagnosis of cognitive impairment living in a long-term care home participated in our study. At the end of the entire VR experimental procedure with older adults, five health staff operators took part in a dedicated assessment phase focused on evaluating the VR procedure's usability from their individual perspectives. The tools administered were based on self-reported and observational tools used to obtain information from users and health care staff professionals. Feasibility and acceptance proved to be satisfactory, considering that the VR experience was well-tolerated and no adverse side effects were reported. One of the major advantages emerged was the opportunity to deploy customized environments that users are not able to experience in a real context.Trial Registration: National Institute of Health (NIH) U.S. National Library of Medicine, ClinicalTrials.gov NCT05863065 (17/05/2023).
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Affiliation(s)
- Susanna Pardini
- Department of General Psychology, University of Padova, Padua, Italy.
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy.
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy.
| | - Silvia Gabrielli
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Lorenzo Gios
- Competence Center for Digital Health, TrentinoSalute4.0, Trento, Italy
| | - Marco Dianti
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Oscar Mayora-Ibarra
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada
- Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
| | - Silvia Olivetto
- Department of General Psychology, University of Padova, Padua, Italy
| | - Alina Torres
- Faculty of Science, University of Toronto, Toronto, ON, Canada
| | - Patty Rigatti
- Azienda Pubblica di Servizi alla Persona (APSP) "Margherita Grazioli", Trento, Italy
| | - Emanuela Trentini
- Azienda Pubblica di Servizi alla Persona (APSP) "Margherita Grazioli", Trento, Italy
| | - Lucia Leonardelli
- Azienda Pubblica di Servizi alla Persona (APSP) "Margherita Grazioli", Trento, Italy
| | - Michela Bernardi
- Azienda Pubblica di Servizi alla Persona (APSP) "Margherita Grazioli", Trento, Italy
| | - Marzia Lucianer
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
- Competence Center for Digital Health, TrentinoSalute4.0, Trento, Italy
| | - Stefano Forti
- Digital Health Research Unit, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Caterina Novara
- Department of General Psychology, University of Padova, Padua, Italy
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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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Yang E. Implications of immersive technologies in healthcare sector and its built environment. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1184925. [PMID: 37799269 PMCID: PMC10548380 DOI: 10.3389/fmedt.2023.1184925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Objectives This research focuses on how built environment experts can contribute to the MXR-enabled digital innovation as part of the multidisciplinary team effort to ensure post-pandemic resilience in healthcare built environment. The goal of this research is to help healthcare providers, built environment experts, and policy makers respectively: (1) Advocate the benefits of MXR for innovating health and social care; (2) Spark debate across networks of expertise to create health-promoting environment; and (3) Understand the overriding priorities in making effective pathways to the implementation of MXR. Methods To highlight the novelty of this research, the study relies on two qualitative methodologies: exploratory literature review and semi-structured interviews. Based on the evaluation of prior works and cross-national case studies, hypotheses are formulated from three arenas: (1) Cross-sectional Initiatives for Post-pandemic Resilience; (2) Interoperability and Usability of Next-gen Medicines; and (3) Metaverse and New Forms of Value in Future Healthcare Ecosystems. To verify those hypotheses, empirical findings are derived from in-depth interviews with nine key informants. Results The main findings are summarized under the following three themes: (1) Synergism between Architecture and Technology; (2) Patient Empowerment and Staff Support; and (3) Scalable Health and Wellbeing in Non-hospital and Therapeutic Settings. Firstly, both built environment and healthcare sectors can benefit from the various capabilities of MXR through cross-sectional initiatives, evidence-based practices, and participatory approaches. Secondly, a confluence of knowledge and methods of HCI and HBI can increase the interoperability and usability of MXR for the patient-centered and value-based healthcare models. Thirdly, the MXR-enabled technological regime will largely affect the new forms of value in healthcare premises by fostering more decentralized, preventive, and therapeutic characteristics in the future healthcare ecosystems. Conclusion Whether it's virtual or physical, our healthcare systems have placed great emphasis on the rigor of evidence-based approach linking health outcome to a clinical environment. Henceforth, built environment experts should seek closer ties with the MXR ecosystems for the co-production of scalable health and wellbeing in non-hospital and therapeutic settings. Ultimately, this is to improve resource efficiency in the healthcare sector while considering the transition of health resources towards in silico status by increasing the implementation of MXR.
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Affiliation(s)
- Eunsil Yang
- Healthcare Facilities, Bartlett School of Sustainable Construction, University College London, London, United Kingdom
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Woo OKL, Lee AM. Case report: Therapeutic potential of Flourishing-Life-Of-Wish Virtual Reality Therapy on Relaxation (FLOW-VRT-Relaxation)-a novel personalized relaxation in palliative care. Front Digit Health 2023; 5:1228781. [PMID: 37674510 PMCID: PMC10477913 DOI: 10.3389/fdgth.2023.1228781] [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: 05/25/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
In view of the global aging population and growing need of palliative care, innovative intervention for effective symptom management is of urgent need. Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) is a brief, structured, manualized, and personalized psychological intervention with theoretical foundations based on stress coping theory, self-determination theory, flow theory, and attention restoration theory. With a specific focus on relaxation, FLOW-VRT-Relaxation intends to facilitate adaptive end-of-life coping through delivering personalized relaxation. This paper reports a case study of the application of FLOW-VRT-Relaxation, and discusses its therapeutic potential as a cost-effective method for reducing palliative symptoms by addressing patient's unmet needs. The case study is a 51-year-old Chinese female, diagnosed with advanced cervix cancer, and presented with unmet psychological (i.e., unfulfilled wishes) and physical needs (i.e., pain and fatigue) before FLOW-VRT-Relaxation. To address her unmet needs, FLOW-VRT-Relaxation was delivered by a registered clinical psychologist specialized in palliative care. Need assessment was first conducted, followed by a 10-min VR travel of Japan as her own choice. Relaxation was verbally coached during VR. Right after VR, consolidation with psychological components including psychoeducation, cognitive and emotional processing, and reminiscence intervention were delivered. The patient showed improvement in physical and psychological symptoms, lower sense of loneliness and engulfment, as well as enhanced peace after FLOW-VRT-Relaxation. The current findings provide encouraging initial support for the feasibility, acceptability, and therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable and personalized VR relaxation for patients under palliative care. It is hoped that with its optimal use, FLOW-VRT-Relaxation can serve as an alternative therapeutic tool that effectively improves the end-on-life care.
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Affiliation(s)
- Olive K. L. Woo
- Department of Psychology, The University of Hong Kong, Hong Kong, China
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Alanazi MO, Patano A, Bente G, Mason A, Goldstein D, Parsnejad S, Wyatt G, Lehto R. Nature-Based Virtual Reality Feasibility and Acceptability Pilot for Caregiver Respite. Curr Oncol 2023; 30:5995-6005. [PMID: 37504309 PMCID: PMC10378650 DOI: 10.3390/curroncol30070448] [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: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Home-based informal caregivers (CGs), such as the family members and friends of cancer patients, often suffer averse emotional symptoms, such as anxiety and depression, due to the burden associated with providing care. The natural environment has been valued as a healing sanctuary for easing emotional pain, promoting calmness, relaxation, and restoration. The use of virtual reality (VR) nature experiences offers an alternative option to CGs to manage emotional symptoms and improve their quality of life. The aim of this mixed-method pilot was to evaluate the feasibility and acceptability of a nature-based VR experience for home-based CGs. Nine informal CGs participated in a 10 min nature-based VR session and completed feasibility, acceptability, and VR symptom measures in the laboratory. Semi-structured interviews with five of the CGs provided qualitative data regarding their experiences with VR. The CGs (mean age 64.78 years) were mostly female (n = 7). Our analysis showed high feasibility (15.11 ± 1.76; range 0-16) and acceptability (15.44 ± 1.33; range 0-16), as well as low VR Symptoms (1.56 ± 1.33; range 0-27). Participants primarily expressed positive perceptions regarding VR feasibility and acceptability during interviews. Our findings show promise for the use of VR nature experiences. In the next phase of the study, the intervention will be tested on home-based informal CGs of patients at end of life.
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Affiliation(s)
- Mohammed Owayrif Alanazi
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
- Department of Nursing, College of Applied Medical Sciences, University of Bisha, Bisha 61922, Saudi Arabia
| | - Arienne Patano
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | - Gary Bente
- College of Communication Arts & Sciences, Michigan State University, East Lansing, MI 48824, USA
| | - Andrew Mason
- College of Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Dawn Goldstein
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | - Sina Parsnejad
- Texas Instruments, 1001 Winstead Dr #305, Cary, NC 27513, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
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Pardini S, Gabrielli S, Olivetto S, Fusina F, Dianti M, Forti S, Lancini C, Novara C. Personalized, Naturalistic Virtual Reality Scenarios Coupled With Web-Based Progressive Muscle Relaxation Training for the General Population: Protocol for a Proof-of-Principle Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44183. [PMID: 37067881 PMCID: PMC10152380 DOI: 10.2196/44183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is an innovative tool that can facilitate exposure to either stressful or relaxing stimuli and enables individuals who have difficulties visualizing scenes to be involved in a more realistic sensorimotor experience. It also facilitates multisensory stimulation, a sense of presence, and achievement of relaxation. VR scenarios representing visual and auditory elements of natural relaxing environments can facilitate the learning of relaxation techniques such as the progressive muscle relaxation technique (PMRT). A complementary standardized technique deployed to reduce anxiety symptoms is the integration of PMRT and guided imagery (GI). Exposure to a pleasant imaginary environment helps the establishment of an association between a relaxing scenario and the relaxation technique, consequently promoting relaxation. Empirical evidence has shown that VR scenarios can increase the effects of relaxation techniques by enabling people to experience emotional conditions in more vivid settings. OBJECTIVE The main aim of this pilot study protocol is to investigate the impact on state anxiety of PMRT, associated with a personalized relaxing scenario in VR, and the role of VR scenarios in facilitating the recall of relaxing images and a sense of presence. A secondary aim is to understand if relaxing sessions administered via Zoom are more effective for managing anxiety and stress than a procedural setting based on audio-track guidance. METHODS Based on a longitudinal, between-subject design, 108 university students will be randomly exposed to one of three experimental conditions: (1) PMRT via Zoom and GI exposure, (2) PMRT via Zoom and personalized VR exposure, and (3) PMRT based on audio-track guidance and personalized VR exposure. Individuals are assessed before and after 7 training sessions based on self-report questionnaires investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data are also detected by an Mi Band 2 sensor. RESULTS The experimental procedure is ongoing. In this paper, preliminary data from a sample of 40 participants will be illustrated. The experimental phase is expected to conclude in May 2023, and the final results of the research will be presented in June 2023. CONCLUSIONS The results of this study will help shape the experimental design to apply it on a subsequent randomized controlled trial, also considering clinical samples. This work is expected to measure whether VR is a more engaging and helpful technique in promoting relaxation and decreasing anxiety levels than GI, by making the visualization process easier and by helping people to face more realistic sensory experiences. Assessing the efficacy of the PMRT in alternative delivery modes may extend its applications, especially in situations where the standard procedure is more challenging to be administered. To our knowledge, no equivalent study has been published so far on this matter. TRIAL REGISTRATION ClinicalTrials.gov NCT05478941; https://clinicaltrials.gov/ct2/show/NCT05478941. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44183.
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Affiliation(s)
- Susanna Pardini
- Department of General Psychology, University of Padova, Padova, Italy
- Digital Health Lab, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
- Human Inspired Technology Research Centre, University of Padova, Padova, Italy
| | - Silvia Gabrielli
- Digital Health Lab, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Silvia Olivetto
- Department of General Psychology, University of Padova, Padova, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Marco Dianti
- Digital Health Lab, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Stefano Forti
- Digital Health Lab, Centre for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | - Cristina Lancini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Caterina Novara
- Department of General Psychology, University of Padova, Padova, Italy
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Malighetti C, Bernardelli L, Pancini E, Riva G, Villani D. Promoting Emotional and Psychological Well-Being During COVID-19 Pandemic: A Self-Help Virtual Reality Intervention for University Students. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:309-317. [PMID: 36940285 DOI: 10.1089/cyber.2022.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Mental health problems are very common among university students, and the situation worsened during the COVID-19 pandemic. The closure of universities, the restrictions imposed, and the reduction of social activities led to considerable changes in students' lives, thus posing new mental health and emotional challenges. Within this context, promoting university students' general well-being, in particular emotional and psychological well-being, becomes essential. In addition to the possibility of online interventions aimed at overcoming distance limitations and reaching people at their home, other advanced technologies such as virtual reality (VR) have demonstrated the potential to improve people's well-being, quality of life, and positive experiences. The study reported in this article is aimed at exploring the feasibility and preliminary effectiveness of a self-help VR intervention lasting 3 weeks in promoting emotional well-being in university students. Forty-two university students voluntarily participated in a six-session intervention. In each session, a different virtual scenario was presented: two relaxing experiences and four transformative experiences based on metaphors or metaphoric ones aimed at encouraging students to be aware of their emotions and positive resources. Students were randomly allocated to an experimental group and to a waiting list group that started the intervention after 3 weeks. Before and after the six sessions, participants completed an assessment by completing online questionnaires. Results showed a significant increase in both emotional well-being and psychological well-being in the experimental group compared to the waiting list group. The majority of participants said that they would recommend the experience to other students.
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Affiliation(s)
- Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Elisa Pancini
- Research Center in Communication Psychology, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano (IRCCS), Milano, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniela Villani
- Research Center in Communication Psychology, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Mazzocco K, Busacchio D, Summers PE, Marzorati C, Pricolo P, Petralia G, Pravettoni G. Is whole-body magnetic resonance imaging a source of anxiety in oncological patients? Cancer Rep (Hoboken) 2023; 6:e1737. [PMID: 36494325 PMCID: PMC10026313 DOI: 10.1002/cnr2.1737] [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: 02/16/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Magnetic resonance often produces feelings of anxiety before, or during, the examination. The aim of this study was to assess anxiety and potential causes of anxiety in cancer patients undergoing whole-body magnetic resonance imaging (WB-MRI). METHODS This monocentric study recruited 70 cancer patients who were scheduled to undergo WB-MRI for detection, staging or therapy monitoring. At baseline (prior to the WB-MRI), assessments were performed using the State-Trait Anxiety Inventory (STAI-Y 1), Illness Perception Questionnaire (IPQ-R), Big Five Inventory (BIF-10) and Revised Life Orientation Test (LOT-R), while at the end of the WB-MRI examination the patients repeated the STAI-Y 1 questionnaire and were asked to indicate their preference between WB-MRI and computed tomography. RESULTS We found a positive correlation between pre- and post-examination STAI-Y 1 scores (r = 0.536, p < .0001), with no significant difference between them. Pre-examination STAI-Y 1 scores had a negative correlation with the emotional stability in the BIF-10 questionnaire (r = -0.47, p = .001) and a positive correlation with emotional representation (r = 0.57, p = .001) in IPQ-R. The post-examination STAI-Y 1 had a negative correlation with optimistic orientation (r = -0.59, p = .001). CONCLUSIONS The anxiety associated with a WB-MRI examination was only in small part associated with the examination itself, and in fact, most patients preferred WB-MRI to computed tomography. Concern with the outcome of the examination was likely a greater source of anxiety.
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Affiliation(s)
- Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Derna Busacchio
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paul Eugene Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Precision Imaging and Research Unit - Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Tchao D, Lewis-Fung S, Gray H, Pardini S, Harris LR, Appel L. Describing epilepsy-related anxiety to inform the design of a virtual reality exposure therapy: Results from Phase 1 of the AnxEpiVR clinical trial. Epilepsy Behav Rep 2023; 21:100588. [PMID: 36794093 PMCID: PMC9922786 DOI: 10.1016/j.ebr.2023.100588] [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: 10/16/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
People with epilepsy (PwE) are at a greater risk of comorbid anxiety, which is often related to the fear of having another seizure for safety or social reasons. While virtual reality (VR) exposure therapy (ET) has been successfully used to treat several anxiety disorders, no studies to date have investigated its use in this population. This paper discusses Phase 1 of the three-phase AnxEpiVR pilot study. In Phase 1, we aimed to explore and validate scenarios that provoke epilepsy/seizure-specific (ES) interictal anxiety and provide recommendations that lay the foundation for designing VR-ET scenarios to treat this condition in PwE. An anonymous online questionnaire (including open- and closed-ended questions) that targeted PwE and those affected by it (e.g., through a family member, friend, or as a healthcare professional) was promoted by a major epilepsy foundation in Toronto, Canada. Responses from n = 18 participants were analyzed using grounded theory and the constant comparison method. Participants described anxiety-provoking scenes, which were categorized under the following themes: location, social setting, situational, activity, physiological, and previous seizure. While scenes tied to previous seizures were typically highly personalized and idiosyncratic, public settings and social situations were commonly reported fears. Factors consistently found to increase ES-interictal anxiety included the potential for danger (physical injury or inability to get help), social factors (increased number of unfamiliar people, social pressures), and specific triggers (stress, sensory, physiological, and medication-related). We make recommendations for incorporating different combinations of anxiety-related factors to achieve a customizable selection of graded exposure scenarios suitable for VR-ET. Subsequent phases of this study will include creating a set of VR-ET hierarchies (Phase 2) and rigorously evaluating their feasibility and effectiveness (Phase 3).
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Affiliation(s)
| | | | - Hannah Gray
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada,Faculty of Science, Department of Biology, York University, Toronto, ON, Canada
| | - Susanna Pardini
- OpenLab, University Health Network, Toronto, ON, Canada,Department of General Psychology, University of Padova, Padova, Italy,Digital Health Lab, Centre for Health and Wellbeing, Bruno Kessler Foundation, Trento, Italy
| | - Laurence R. Harris
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada
| | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada,Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada,Michael Garron Hospital, Toronto, ON, Canada,Corresponding author at: 242 Roselawn Ave, Toronto, Ontario, M4R 1E9, Canada.
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Andreatta M, Winkler MH, Collins P, Gromer D, Gall D, Pauli P, Gamer M. VR for Studying the Neuroscience of Emotional Responses. Curr Top Behav Neurosci 2023; 65:161-187. [PMID: 36592276 DOI: 10.1007/7854_2022_405] [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] [Indexed: 06/17/2023]
Abstract
Emotions are frequently considered as the driving force of behavior, and psychopathology is often characterized by aberrant emotional responding. Emotional states are reflected on a cognitive-verbal, physiological-humoral, and motor-behavioral level but to date, human research lacks an experimental protocol for a comprehensive and ecologically valid characterization of such emotional states. Virtual reality (VR) might help to overcome this situation by allowing researchers to study mental processes and behavior in highly controlled but reality-like laboratory settings. In this chapter, we first elucidate the role of presence and immersion as requirements for eliciting emotional states in a virtual environment and discuss different VR methods for emotion induction. We then consider the organization of emotional states on a valence continuum (i.e., from negative to positive) and on this basis discuss the use of VR to study threat processing and avoidance as well as reward processing and approach behavior. Although the potential of VR has not been fully realized in laboratory and clinical settings yet, this technological tool can open up new avenues to better understand the neurobiological mechanisms of emotional responding in healthy and pathological conditions.
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Affiliation(s)
- Marta Andreatta
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Markus H Winkler
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Peter Collins
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Daniel Gromer
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Dominik Gall
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Paul Pauli
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Matthias Gamer
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany.
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Curcio G, Placidi G, Triberti S. Editorial: Using virtual environments to understand behavior. Front Behav Neurosci 2023; 17:1156800. [PMID: 37035627 PMCID: PMC10081689 DOI: 10.3389/fnbeh.2023.1156800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- *Correspondence: Giuseppe Curcio
| | - Giuseppe Placidi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Stefano Triberti
- Faculty of Human Sciences, Università Telematica Pegaso, Naples, Italy
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Alexanian S, Foxman M, Pimentel D. Virtual reality and music's impact on psychological well-being. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:864990. [PMID: 36188907 PMCID: PMC9397989 DOI: 10.3389/fresc.2022.864990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Abstract
Quality of life is bound to psychological well-being, which in turn is affected by the frequency and magnitude of negative mood states. To regulate mood states, humans often consume media such as music and movies, with varied degrees of effectiveness. The current investigation examined the effectiveness of virtual reality (VR) vs. two-dimensional (2D) online interventions with various stimuli (audiovisual vs. visual only vs. audio only) to assess which interventions were most effective for improved well-being. Additionally, this study examined which groups displayed the highest amount of perceived presence to understand what components are essential when maximizing a person's subjective feeling of being “in” a new place and if this translated toward therapeutic results. Our data suggests that even though VR participants generally experienced more presence and had similar benefits as 2D groups for increasing positive mood, only participants in the 2D groups had a reduction in negative mood overall with 2D audiovisual participants experiencing the best results. These results contradict past studies which indicate that there could be other psychological and theoretical considerations that may play a role in determining what online experiences are more effective than just examining presence and immersive stimuli. Further research and development into using VR as a tool for improved well-being is needed to understand its efficacy in remote and in-person setting.
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Affiliation(s)
- Stephen Alexanian
- School of Journalism and Communication, University of Oregon, Eugene, ORUnited States
- Correspondence: Stephen Alexanian
| | - Maxwell Foxman
- School of Journalism and Communication, University of Oregon, Eugene, ORUnited States
| | - Danny Pimentel
- University of Oregon, Oregon Reality Labs, School of Journalism and Communication, Portland, OR, United States
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The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127237. [PMID: 35742483 PMCID: PMC9223778 DOI: 10.3390/ijerph19127237] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 12/10/2022]
Abstract
Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.
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17
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Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study. J Clin Anesth 2022; 80:110876. [PMID: 35525050 DOI: 10.1016/j.jclinane.2022.110876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain. DESIGN Randomized, controlled crossover within-subject clinical trial. SETTING This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine. PATIENTS 156 healthy volunteers were included. INTERVENTIONS Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed. MEASUREMENTS Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR. MAIN RESULTS 153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences. CONCLUSIONS Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.
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Ong T, Wilczewski H, Soni H, Nisbet Q, Paige SR, Barrera JF, Welch BM, Bunnell BE. The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review. FRONTIERS IN VIRTUAL REALITY 2022; 3:848066. [PMID: 37483657 PMCID: PMC10361704 DOI: 10.3389/frvir.2022.848066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Phobias and related anxiety are common and costly mental health disorders. Experts anticipate the prevalence of phobias will increase due to the COVID-19 pandemic. Exposure therapies have been established as effective and reliable treatments for anxiety, including recent innovations in virtual reality-based exposure therapy (VRET). With the recent advent of telemental health (TMH), VRET is poised to become mainstream. The combination of VRET and TMH has the potential to extend provider treatment options and improve patient care experiences. In this narrative review, we describe how recent events have accelerated VRET + TMH, identify barriers to VRET + TMH implementation, and discuss strategies to navigate those barriers.
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Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Quinn Nisbet
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Innovation in Mental Health Lab, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
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19
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de Zambotti M, Yuksel D, Kiss O, Barresi G, Arra N, Volpe L, King C, Baker FC. A virtual reality-based mind–body approach to downregulate psychophysiological arousal in adolescent insomnia. Digit Health 2022; 8:20552076221107887. [PMID: 35733879 PMCID: PMC9208061 DOI: 10.1177/20552076221107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022] Open
Abstract
Objective In this study, we describe the rationale, supported by preliminary data, for a novel, digital, immersive virtual reality (VR)-based mind–body approach, designed to reduce bedtime arousal in adolescents with insomnia. Methods Fifty-two high-school students (16–20 years; 32 female) with ( N = 18) and without ( N = 34) DSM-5 insomnia symptoms engaged with 20 min of immersive VR-guided meditation and paced breathing (0.1 Hz) ( intervention condition) and 20 min of quiet activity ( control condition), right before bedtime, on two separate evenings. Results The intervention resulted in acute autonomic and cortical modulation ( p < 0.05), leading to reduced physiological arousal (↓heart rate, ↓cortisol) compared with the control condition, with similar effects in adolescents with and without insomnia. No significant changes were detected for cognitive arousal levels. During the intervention, all participants were able to achieve the targeted 0.1 Hz breathing rate, and the majority experienced no discomfort associated with the VR exposure. However, 30–40% of the participants experienced some trouble slowing down their breathing. Conclusions The study provides supporting preliminary evidence for the mechanism behind a novel VR-based digital approach, designed to regulate psychophysiological arousal levels by acting on neurocognitive and autonomic pathways. Further studies (e.g. randomized clinical trials) are needed to evaluate the isolated and synergistic effects of its components (e.g. VR vs. VR + paced breathing), and its efficacy, acceptance, and feasibility in alleviating insomnia symptoms in adolescents.
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Affiliation(s)
| | - Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Giacinto Barresi
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Nicole Arra
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Laila Volpe
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Christopher King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Adhyaru JS, Kemp C. Virtual reality as a tool to promote wellbeing in the workplace. Digit Health 2022; 8:20552076221084473. [PMID: 35284084 PMCID: PMC8905197 DOI: 10.1177/20552076221084473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background NHS staff are disproportionately impacted by workplace stress, threatening not only quality of service delivery, but the sustainability, of this vital healthcare system. There is an urgent need for accessible and cost-effective interventions that promote the wellbeing of this integral workforce. Aim The aim of this study was to explore the potential propensity of a short virtual reality (VR) nature experience, delivered during the workday, to induce positive mood states NHS clinicians. Method NHS clinicians working in a fast-paced trauma service were offered the opportunity to take part in a short virtual reality (VR) relaxation session, during their working day, in which they were able to explore the “Green Meadows” experience available within the Nature Treks application. An indication of physiological arousal (heart rate) was obtained, and subjective measures of emotional state were employed to assess the effect of the intervention on participants’ mood. Further, feedback was gathered to provide an initial indication of the acceptability of the experience. Results Analysis of data from 39 clinicians revealed that, following the VR experience, participants reported significantly increased feelings of happiness (p < 0.001) and relaxation (p < 0.001), and significantly decreased feelings of sadness (p = 0.003), anger (p < 0.001) and anxiety (p < 0.001). No significant differences in reported levels of surprise (p = 0.603) or vigour (p = 0.566) were found. Further, the experience was associated with a significant reduction in heart-rate (p = 0.025), and had high acceptability ratings, despite participants’ varied experience with computers and VR technology. Conclusions The findings of this study indicate that the administration of VR for the promotion of NHS staff wellbeing in the workplace is a potentially fruitful avenue of exploration that warrants further investigation.
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Affiliation(s)
- Jai Shree Adhyaru
- Children and Young People's Trauma Service, Grenfell Health and Wellbeing Service, London, UK
| | - Charlotte Kemp
- City University, London, UK.,The Fred Company, London, UK
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Pizzoli SFM, Monzani D, Mazzocco K, Maggioni E, Pravettoni G. The Power of Odor Persuasion: The Incorporation of Olfactory Cues in Virtual Environments for Personalized Relaxation. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:652-661. [PMID: 34752166 PMCID: PMC9069654 DOI: 10.1177/17456916211014196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Olfaction is the most ancient sense and is directly connected with emotional areas in the brain. It gives rise to perception linked to emotion both in everyday life and in memory-recall activities. Despite its emotional primacy in perception and its role in sampling the real physical world, olfaction is rarely used in clinical psychological settings because it relies on stimuli that are difficult to deliver. However, recent developments in virtual-reality tools are creating novel possibilities for the engagement of the sense of smell in this field. In this article, we present the relevant features of olfaction for relaxation purposes and then discuss possible future applications of involving olfaction in virtual-reality interventions for relaxation. We also discuss clinical applications, the potential of new tools, and current obstacles and limitations.
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Affiliation(s)
- Silvia Francesca Maria Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Emanuela Maggioni
- Sussex Computer Human Interaction (SCHI) Lab, Creative Technology Research Group, School of Engineering and Informatics, University of Sussex
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
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Michalski SC, Szpak A, Ellison C, Cornish R, Loetscher T. Using virtual reality to improve classroom behaviour in people with Down syndrome: An experimental study (Preprint). JMIR Serious Games 2021; 10:e34373. [PMID: 35124567 PMCID: PMC9030893 DOI: 10.2196/34373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/28/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background People with Down syndrome face various learning challenges. Introducing new and enjoyable experiences in learning settings may improve learning outcomes. Immersive and interactive technologies such as virtual reality can be used to deliver rich visual experiences in classrooms. Objective The aim of this study was to investigate the feasibility and benefits of virtual reality exposure for people with Down syndrome in learning settings. Methods To address this aim, we used a within-subjects design to assess the effect of a brief virtual reality drawing experience and conventional drawing experience on subsequent behavior in 16 participants. Results Large positive effects were found for virtual reality drawing (t15=5.020, P<.001) and conventional drawing (t15=3.720, P=.002) in improving subsequent behavior in a learning setting. Irrespective of the intervention, the participant’s mood, attention, and overall behavior significantly improved. No significant differences were found between the interventions (t15=–0.648; P=.53). Conclusions This study’s results are encouraging for researchers and educators interested in using virtual reality for people with Down syndrome, as virtual reality was found to be highly feasible. Recommendations are made for researchers and educators interested in providing virtual reality experiences for people with Down syndrome.
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Affiliation(s)
| | - Ancret Szpak
- UniSA Justice and Society, University of South Australia, Adelaide, Australia
| | - Caroline Ellison
- UniSA Justice and Society, University of South Australia, Adelaide, Australia
| | | | - Tobias Loetscher
- UniSA Justice and Society, University of South Australia, Adelaide, Australia
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From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning. CURRENT PSYCHOLOGY 2021; 42:8697-8704. [PMID: 34429574 PMCID: PMC8376294 DOI: 10.1007/s12144-021-02158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary ‘I met you’ from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.
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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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25
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Kluge MG, Maltby S, Walker N, Bennett N, Aidman E, Nalivaiko E, Walker FR. Development of a modular stress management platform (Performance Edge VR) and a pilot efficacy trial of a bio-feedback enhanced training module for controlled breathing. PLoS One 2021; 16:e0245068. [PMID: 33529187 PMCID: PMC7853514 DOI: 10.1371/journal.pone.0245068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
This paper describes the conceptual design of a virtual reality-based stress management training tool and evaluation of the initial prototype in a pilot efficacy study. Performance Edge virtual-reality (VR) was co-developed with the Australian Defence Force (ADF) to address the need for practical stress management training for ADF personnel. The VR application is biofeedback-enabled and contains key stress management techniques derived from acceptance and commitment and cognitive behavioural therapy in a modular framework. End-user-provided feedback on usability, design, and user experience was positive, and particularly complimentary of the respiratory biofeedback functionality. Training of controlled breathing delivered across 3 sessions increased participants' self-reported use of breath control in everyday life and progressively improved controlled breathing skills (objectively assessed as a reduction in breathing rate and variability). Thus the data show that a biofeedback-enabled controlled breathing protocol delivered through Performance Edge VR can produce both behaviour change and objective improvement in breathing metrics. These results confirm the validity of Performance Edge VR platform, and its Controlled Breathing module, as a novel approach to tailoring VR-based applications to train stress management skills in a workplace setting.
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Affiliation(s)
- Murielle G. Kluge
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicole Walker
- Army School of Health, Latchford Barracks, Bonegilla, VIC, Australia
| | | | - Eugene Aidman
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Land Division, Defence Science & Technology Group, Edinburgh, SA, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
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26
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Veling W, Lestestuiver B, Jongma M, Hoenders HJR, van Driel C. Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial. J Med Internet Res 2021; 23:e17233. [PMID: 33448933 PMCID: PMC7846446 DOI: 10.2196/17233] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023] Open
Abstract
Background Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements. Objective To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises. Methods A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance. Results Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t1684=−2.02, 95% CI −18.70 to −0.28; P=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t1684=−3.24, 95% CI −6.86 to −1.69), sadness (t1684=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t1684=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms. Conclusions If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments. Trial Registration Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096
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Affiliation(s)
- Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,VRelax BV, Groningen, Netherlands
| | - Bart Lestestuiver
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Catheleine van Driel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Virtual Reality as a Tool to Study the Influence of the Eating Environment on Eating Behavior: A Feasibility Study. Foods 2021; 10:foods10010089. [PMID: 33466255 PMCID: PMC7824759 DOI: 10.3390/foods10010089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 12/17/2022] Open
Abstract
In this manuscript, we describe a new approach to study the effect of the eating environment on food intake and eating behavior using virtual reality technology. Fifteen adults consumed pizza rolls in two virtual reality (VR) environments: a restaurant and a table in an empty room. The participants' food intake, eating parameters (e.g., masticatory parameters and eating rate), and their sensory evaluation of the test food was measured. The participants' sense of presence (the feeling of being in the virtual environment) and markers of arousal were also measured. There was no statistical significant difference in food intake or the sensory evaluation of the test food. In the restaurant condition, participants used fewer masticatory cycles before swallowing but there was no effect on eating rate or maximum bite force. Participants experienced a greater sense of presence when they were in the pizza restaurant scene. Moreover, their heart rate and skin temperature were higher in the restaurant condition. This study suggests that VR could be developed as a new tool to study the effect of the eating environment on food intake and eating behavior.
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Kaplan-Rakowski R, Johnson KR, Wojdynski T. The impact of virtual reality meditation on college students’ exam performance. SMART LEARNING ENVIRONMENTS 2021; 8:21. [PMCID: PMC8520331 DOI: 10.1186/s40561-021-00166-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Advocates of meditation claim that it can improve various aspects of life, including health, attention, thinking, and learning. The purpose of this empirical, quantitative, between-subject study was twofold. First, it compared the effectiveness of meditation delivered through virtual reality versus video, as measured by students’ test scores. Second, the study provided insights on the use of meditation, whether via virtual reality or video, as a way to positively affect well-being. T-test analysis showed virtual reality meditation to be significantly more beneficial than video meditation. Students reported that meditation techniques delivered using either medium to be helpful in decreasing their pre-exam anxiety. This study has practical implications and offers evidence on the beneficial impact of VR meditation on students’ exam performance and anxiety levels.
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Affiliation(s)
- Regina Kaplan-Rakowski
- Department of Learning Technologies, College of Information, University of North Texas, 3940 N. Elm Street, G159, Denton, TX 76207 USA
| | - Karen R. Johnson
- Department of Learning Technologies, College of Information, University of North Texas, 3940 N. Elm Street, G150, Denton, TX 76207 USA
| | - Tomasz Wojdynski
- School of Banking and Management in Cracow, Aleja Kijowska 14, 30-079 Kraków, Poland
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29
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Busacchio D, Mazzocco K, Gandini S, Pricolo P, Masiero M, Summers PE, Pravettoni G, Petralia G. Preliminary observations regarding the expectations, acceptability and satisfaction of whole-body MRI in self-referring asymptomatic subjects. Br J Radiol 2020; 94:20191031. [PMID: 33237810 DOI: 10.1259/bjr.20191031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the satisfaction of asymptomatic subjects who self-referring Whole-Body Magnetic Resonance Imaging (WB-MRI) for early cancer diagnosis. METHODS Subjects completed a pre-examination questionnaire, while waiting for their WB-MRI examination, recording demographics, expected discomfort, perceived knowledge and usefulness of the procedure and health risk perceptions, as well as a post-examination questionnaire, measuring discomfort experienced, acceptability and satisfaction with WB-MRI. We examined which factors influenced discomfort and satisfaction associated with WB-MRI. RESULTS 65 asymptomatic subjects (median age 51; 29 females) completed the questionnaire. Before WB-MRI, 29% of subjects expected discomfort of some form with claustrophobia (27.7%) and exam duration (24.6%) being the most common concerns. Experienced discomfort due to shortness of breath was significantly lower than expected. This difference was significantly associated with the personal risk perception to get a disease (p = 0.01) and educational level (p = 0.002). More specifically, higher level of perceived personal risk of getting a disease and lower level of education were associated with higher expected than experienced discomfort. Similarly, experiencing less claustrophobia than expected was significantly associated with gender (p = 0.005) and more pronounced among females. A majority (83%) of subjects expressed high levels of satisfaction with WB-MRI for early cancer diagnosis and judged it more acceptable than other diagnostic exams. CONCLUSIONS Asymptomatic subjects self-referring to WB-MRI for early cancer diagnosis showed high levels of satisfaction and acceptability with the examination. Nevertheless, a relevant proportion of participants reported some form of discomfort. Interestingly, participants with higher perceived personal risk to get a disease, lower education and females showed to expect higher discomfort than experienced. ADVANCES IN KNOWLEDGE Scope exists for measures to assess expected feelings and develop personalized interventions to reduce the stress anticipated by individuals deciding to undergo WB-MRI for early cancer diagnosis.
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Affiliation(s)
- Derna Busacchio
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Paul Eugene Summers
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Grabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Precision Imaging and Research Unit - Department of Medical Imaging and Radiation Sciences, IEO, European Institute of Oncology IRCCS, Milan, Italy
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30
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Imperatori C, Dakanalis A, Farina B, Pallavicini F, Colmegna F, Mantovani F, Clerici M. Global Storm of Stress-Related Psychopathological Symptoms: A Brief Overview on the Usefulness of Virtual Reality in Facing the Mental Health Impact of COVID-19. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:782-788. [DOI: 10.1089/cyber.2020.0339] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Benedetto Farina
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Federica Pallavicini
- Department of Human Sciences for Education “Riccardo Massa,” University of Milano Bicocca, Milan, Italy
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Fabrizia Mantovani
- Department of Human Sciences for Education “Riccardo Massa,” University of Milano Bicocca, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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31
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A Personalised Emotion-Based Model for Relaxation in Virtual Reality. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10176124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the most frequent health problems is stress. It has been linked to negative effects on employee well-being in many occupations, and it is considered responsible for many physical and psychological problems. Traditional in-person relaxation therapy has proven to be effective in reducing stress. However, it has some drawbacks such as high cost, required infrastructure and the need for qualified trainers. Relaxation therapy in Virtual Reality (VR) tries to solve these problems. However, one aspect has received little attention, that is personalised therapy. Indeed, while many studies show the need for patient-tailored relaxation exercises, little existing work focuses on personalised VR content. One reason for this is the complexity of recognising emotions, which is required for emotion-based adaptive VR. In this work, a method for adapting VR content to the emotional state of the user is presented. This model has been applied in a VR relaxation therapy application, which adapts to the user’s emotional state utilising a heuristic optimiser. Simulations have proven the performance and usability of the emotion model. Additionally, this paper explores the impact of the order in which adaptations are performed on the effectiveness of the relaxation experience.
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32
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Sainz-Fuertes R, Gelabert Mir JM, Valderas JM, Bullock K, Giersch A, Vogeley K, García AT, Huguet MA, Russell T, Hollingdale J, Lopez-Moriñigo JD, Delgado IN, Selsick H, Gurr H, Fitzpatrick T, Maddox T. COVID-19 and mental health: A review and the role of telehealth and virtual reality. DIGITAL MEDICINE 2020; 6:53-66. [PMID: 35663234 PMCID: PMC9148628 DOI: 10.4103/digm.digm_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/21/2020] [Accepted: 11/26/2020] [Indexed: 01/10/2023]
Abstract
On March 12, 2020, with more than 20,000 confirmed cases and almost 1000 deaths in the European Region, the World Health Organization classified the COVID-19 outbreak as a pandemic. As of August 15, 2020, there are 21.5 million confirmed cases of COVID-19 and over 766,000 deaths from the virus, worldwide. Most governments have imposed quarantine measures of varied degrees of strictness on their populations in attempts to stall the spread of the infection in their communities. However, the isolation may have inflicted long-term psychological injury to the general population and, in particular, to at-risk groups such as the elderly, the mentally ill, children, and frontline healthcare staff. In this article, we offer the most up-to-date review of the effects of COVID-19 confinement on all the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders. We make data-driven predictions of the impact of COVID-19 confinement on mental health outcomes and discuss the potential role of telemedicine and virtual reality in mental health screening, diagnosis, treatment, and monitoring, thus improving the above outcomes in such a difficult time
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Affiliation(s)
| | | | | | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, USA
| | - Anne Giersch
- University of Strasbourg, INSERM, University Hospital of Strasbourg, France
| | - Kai Vogeley
- Department of Psychiatry, University Hospital Cologne, Germany
| | | | | | - Tamara Russell
- Mindfulness Centre of Excellence, The Maudsley Hospital, London, UK
| | | | | | | | - Hugh Selsick
- Royal London Hospital for Integrated Medicine, London, UK
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33
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Javaid M, Haleem A. Virtual reality applications toward medical field. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.12.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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34
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Lee CC, Hsiao KL, Chen CC. Exploring the Benefit and Sacrifice Factors of Virtual Reality Gameplay. Front Psychol 2020; 11:251. [PMID: 32210870 PMCID: PMC7076171 DOI: 10.3389/fpsyg.2020.00251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
Although Virtual reality (VR) entertainment is now relatively popular, the adoption of VR devices is still low. In this study, a framework based benefit and sacrifice factors was developed to understand players' intention to use VR devices to play games. Online questionnaire items were developed and published to collect the responses from university students in Taiwan. The feedback of 152 inexperienced players and 150 experienced players were collected. The eleven hypotheses were tested by using SmartPLS, a structural equation modeling (SEM) tool. The analysis results show that the influences of the benefit factors (flow, spatial presence, and relaxation) on the adoption intention in two groups are consistent. All of the positive influences are supported. Moreover, visual fatigue had the strongest negative effects on flow and intention. Players who are opener to new technology are more possible to adopt VR devices. The findings can provide insights to VR device developers to design their VR devices/contents and marketing strategies.
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Affiliation(s)
- Chun-Chia Lee
- School of Business, Minnan Normal University, Zhangzhou, China
| | - Kuo-Lun Hsiao
- Department of Information Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chia-Chen Chen
- Department of Management Information Systems, National Chung Hsing University, Taichung, Taiwan
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35
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Caruso TJ, George A, Menendez M, De Souza E, Khoury M, Kist MN, Rodriguez ST. Virtual reality during pediatric vascular access: A pragmatic, prospective randomized, controlled trial. Paediatr Anaesth 2020; 30:116-123. [PMID: 31785015 DOI: 10.1111/pan.13778] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vascular access is a minor procedure that is associated with reported pain and fear in pediatric patients, often resulting in procedural incompliance. Virtual reality has been shown to be effective in adult populations for reducing pain and anxiety in various medical settings, although large studies are lacking in pediatrics. AIMS The primary aim was to determine whether pain would be reduced in pediatric patients using virtual reality undergoing vascular access. The four secondary aims measured patient fear, procedural compliance, satisfaction, and adverse events. METHODS A prospective, randomized, controlled trial was completed at a pediatric hospital, enrolling children 7-18 years old undergoing vascular access in a variety of clinical settings, randomized to virtual reality or standard of care. Pain scores were measured using a numeric pain faces scale. The secondary outcomes of patient fear, procedural compliance, satisfaction, and adverse events were measured with the Child Fear Scale, modified Induction Compliance Checklist, and satisfaction surveys, respectively. Chi-squared, t tests, and regression models were used to analyze the results. RESULTS The analysis included 106 patients in the virtual reality group and 114 in the control. There were no significant differences in postprocedure pain (VR group estimated 0.11 points lower, 95% confidence interval: 0.50 points lower to 0.28 points greater, P = .59), postprocedure fear (VR group estimated 0.05 points lower, 95% confidence interval: 0.23 points lower to 0.13 points greater), or compliance (adjusted odds ratio 2.31, 95% confidence interval: 0.96-5.56). Children in the virtual reality group were satisfied with the intervention. There were no adverse events. CONCLUSION This study demonstrates no reduction in pain while using Virtual reality (VR) across a heterogeneous pediatric inpatient population undergoing vascular access.
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Affiliation(s)
- Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandria George
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth De Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Khoury
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Madison N Kist
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
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36
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Mazzocco K, Masiero M, Carriero MC, Pravettoni G. The role of emotions in cancer patients' decision-making. Ecancermedicalscience 2019; 13:914. [PMID: 31123497 PMCID: PMC6467455 DOI: 10.3332/ecancer.2019.914] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Despite the attempt to make decisions based on evidence, doctors still have to consider patients' choices which often involve other factors. In particular, emotions seem to influence the way that options and the surrounding information are interpreted and used. OBJECTIVE The objective of the present review is to provide a brief overview of research on decision making and cancer with a specific focus on the role of emotions. METHOD Thirty-nine studies were identified and analysed. Most of the studies investigated anxiety and fear. Worry was the other psychological factor that, together with anxiety, played a crucial role in cancer-related decision-making. RESULTS The roles of fear, anxiety and worry were described for detection behaviour, diagnosis, choice about prevention and curative treatments and help-seeking behaviour. Results were inconsistent among the studies. Results stressed that cognitive appraisal and emotional arousal (emotion's intensity level) interact in shaping the decision. Moderate levels of anxiety and worry improved decision-making, while low and high levels tended to have no effect or a hindering effect on decision making. Moderating factors played an under-investigated role. CONCLUSIONS Decision making is a complex non-linear process that is affected by several factors, such as, for example, personal knowledge, past experiences, individual differences and certainly emotions. Research studies should investigate further potential moderators of the effect of emotions on cancer-related choice. Big data and machine learning could be a good opportunity to test the interaction between a large amount of factors that is not feasible in traditional research. New technologies such as eHealth and virtual reality can offer support for the regulation of emotions and decision making.
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Affiliation(s)
- Ketti Mazzocco
- Department of Oncology and Hemato-oncology, University of Milan, 20122 Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy
| | - Maria Chiara Carriero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, 20122 Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
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