Implementation Barriers to Using Virtual Reality to Administer Mindfulness Therapy: Lessons from the Field.

Abstract

<h3>Introduction</h3> Virtual Reality (VR)-based meditation has shown to help increase relaxation and decrease anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults (Navarro-Haro et al, 2017). Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful adoption and outcomes. The availability of affordable hardware and rapidly growing content that can be freely accessed in the public domain raises the possibility of VR being used in a very broad range of clinical and in-home settings. The goal of this study is to describe and highlight some key considerations and challenges when implementing VR mindfulness interventions in older adults. <h3>Methods</h3> We set up VR mindfulness interventions in two different settings (outpatient and inpatient) and used two different headsets. Each setting was a site for an IRB-approved pilot trial of VR-based mindfulness. In setting 1, we set up a twice weekly VR guided meditation outpatient program using Oculus Quest 2 VR Headsets for older adults over a 4-week period. In setting 2, we set-up VR, a guided mindfulness inpatient group intervention, using Destek V5 headset for older adults over the course of 3 consecutive days. While the studies themselves have not formally commenced at the time of submission, researchers encountered and had to negotiate several challenges and barriers to implementing VR. Based on consensus and review over 6 months of study pre-launch, the research teams documented a broad set of practical challenges that impact scalability of VR in research and care. <h3>Results</h3> We identified multiple barriers that needed to be considered and overcome to design and pragmatic and scalable VR interventions. Primary challenges are enumerated below: (1) A major challenge is the scarcity of mindfulness-compatible virtual reality videos (360 videos) available for Oculus Quest 2 VR and DESTEK V5 VR Headset on platforms like YouTube. (2) It is also challenging to standardize the quality and content of the video (e.g. embedding a standardized narration to guide the mindfulness practice in public-domain video content given the limited options to create and alter content. Additionally, using headphones to separately play a narration adds complexity and takes away from the immersive nature of VR). (3) While nature videos and apps were an intuitive fit, we found that majority of the available content is meant for recreational virtual reality and are not suitable for mindfulness. (4) There are commercial interruptions on several platforms, which are disruptive for a mindfulness intervention. A potential solution is selecting nature scenes on Google Earth. Although the images are static and thus less dynamic, we circumvent many of the obstacles encountered on YouTube. Finally, when using the DESTEK V5 VR we were required to use a smartphone, and there were privacy issues that we had to consider. If the participant uses their personal phone, they would agree to the privacy terms and conditions of the apps being used to do VR, for example, Google Earth and YouTube. <h3>Conclusions</h3> Mindfulness intervention using virtual reality might be an effective way to address stress in older adults. However, there are many details that must be accounted for before applying these interventions. This study is a first step to establishing best practices and standardizing VR mindfulness interventions in older adults. <h3>This research was funded by</h3> This project was supported in part by an FRQS grant awared to Dr. Soham Rej and an unrestricted philanthropic gift to the McLean Technology and Aging Lab by Eric Warren Goldman.