Editorial: Assessing the Therapeutic Uses and Effectiveness of Virtual Reality, Augmented Reality and Video Games for Emotion Regulation and Stress Management

Biofeedback-Based Videogames: Fostering Emotion Regulation at a Diverse Community Summer Camp

Implementing nonstigmatized mental health interventions and tools within community programs serving diverse populations may reduce inequities in access to mental health care and preventative emotional learning. One potentially impactful tool is Mightier, a heart rate biofeedback-based videogame that aims to foster emotion regulation skills and practice through game play. In a randomized controlled trial, the present study evaluated the efficacy of Mightier when utilized in a community setting. Seventy-two children (ages 7-12) from a low-cost community summer camp were randomly assigned to play Mightier for 6 weeks or continue camp activities as usual. All campers participated in biweekly social and emotional learning groups. Participants exhibited significantly greater levels of adaptive emotion regulation and lower levels of emotional dysregulation, internalizing symptoms, and externalizing behaviors after the intervention. Caregivers of participants in the intervention group also reported significantly less parenting-related stress after the intervention. When incorporated into community programs, biofeedback-based videogames can foster emotional intelligence competencies in children without access to traditional mental health services.

A Virtual Reality-Assisted Cognitive Behavioral Therapy for and With Inuit in Québec: Protocol for a Proof-of-Concept Randomized Controlled Trial

BACKGROUND

Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback.

OBJECTIVE

We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment.

METHODS

Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre- and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms).

RESULTS

As this is the prospective registration of an RCT protocol, we do not yet report any results from the trial. Funding was confirmed in January 2020, and recruitment is expected to start in March 2023 and is set to finish in August 2025. The expected results are to be published in spring 2026.

CONCLUSIONS

The proposed study responds to the community's desire for accessible and appropriate resources for psychological well-being, as it was developed in active collaboration with the Inuit community in Québec. We will test feasibility and acceptance by comparing a culturally adapted, on-site psychotherapy with a commercial self-management program while incorporating novel technology and measurement in the area of Indigenous health. We also aim to fulfill the needs for RCT evidence of culturally adapted psychotherapies that are lacking in Canada.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN) 21831510; https://www.isrctn.com/ISRCTN21831510.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40236.

Coping with COVID- 19 pandemic stressors: Comparisons between non-players and players, and levels of Game Transfer Phenomena

During the COVID-19 pandemic, video game playing increased exponentially. The question if playing could offer benefits to cope with the pandemic stressors emerged. This study compares how non-players and players who may or may not re-experience (e.g., seeing, hearing) game content after playing [i.e., Game Transfer Phenomena (GTP)] cope with the pandemic stressors, emotion regulation and resilience. It also examines the impact of GTP on the perception of self and the world. A total of 567 completed a survey (59.6% male, MeanAge = 28.55). The measures include emotional regulation (ERC), resilience to stress (BRCS) and fear of contamination (PI). No differences between players and non-players on ERC, BRCS and PI were found. Players with moderate GTP levels were more likely to report contamination fears and show preventive COVID coping behaviours. The positive impact of GTP was associated with high resilience and cognitive reappraisal as an emotion regulation strategy. The results suggest that attention should be paid to players who experience GTP more frequently and with a negative impact. Maladaptive coping styles can exacerbate distress from GTP and situational stressors. Identifying methods of protecting vulnerable individuals from these psychological burdens can guide interventions and mitigate consequences in similar situations.

The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.