Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial.

Dowan Kim,Hong Jin Jeon,Kyung-Ah Park,Seonwoo Kim,James D K Kim,Won Ho Chung,Dong Jun Kim,Min Ji Kim,Kiwon Kim,Hyewon Kim

doi:10.3389/fpsyt.2021.614539

Abstract

Introduction: Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback.Methods: Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the State-Trait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases.Results: A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback.Conclusion: VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.

Highlights

Attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback
There was a significant difference in electromyography, low-frequency band (LF)/high-frequency band (HF) ratio, LF total, and NN50 between VR relaxation and biofeedback
Hippocampal dysfunction can lead to inappropriate emotional responses [7], and changes of hippocampal volume have been reported in psychiatric disorders, including schizophrenia, posttraumatic stress disorder, borderline personality disorder, and depression [8,9,10,11]

Summary

Introduction

Attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback. The stress-vulnerability model proposes that, depending on the intensity of the elicited stress and the threshold for tolerating it, i.e., one’s vulnerability, a stressful crisis may be contained homeostatically or may lead to psychiatric disorders [1]. This model has been useful for identifying and managing psychiatric disorders, and many studies have examined how stress affects the brain and what traits of individuals affect vulnerability. Stress increases the level of cortisol, and persistent hypercortisolemia leads to glucocorticoid receptor tolerance [5] This change affects the hippocampus, a brain region rich in corticosteroid receptors [6]. Hippocampal dysfunction can lead to inappropriate emotional responses [7], and changes of hippocampal volume have been reported in psychiatric disorders, including schizophrenia, posttraumatic stress disorder, borderline personality disorder, and depression [8,9,10,11]

Objectives

Methods

Results

Conclusion