Virtual reality therapy for depression and anxiety treatment in China: an integrated assessment based on media richness theory and social cognitive theory

Purpose To summarize the research on the effectiveness of virtual reality (VR) therapy for the management of phantom limb pain (PLP). Methods Three databases (SCOPUS, Ovid Embase, and Ovid MEDLINE) were searched for studies investigating the use of VR therapy for the treatment of PLP. Original research articles fulfilling the following criteria were included: (i) patients 18 years and older; (ii) all etiologies of amputation; (iii) any level of amputation; (iv) use of immersive VR as a treatment modality for PLP; (v) self-reported objective measures of PLP before and after at least one VR session; (vi) written in English. Results A total of 15 studies were included for analysis. Fourteen studies reported decreases in objective pain scores following a single VR session or a VR intervention consisting of multiple sessions. Moreover, combining VR with tactile stimulation had a larger beneficial effect on PLP compared with VR alone. Conclusions Based on the current literature, VR therapy has the potential to be an effective treatment modality for the management of PLP. However, the low quality of studies, heterogeneity in subject population and intervention type, and lack of data on long-term relief make it difficult to draw definitive conclusions. IMPLICATION FOR REHABILITATION Virtual reality (VR) therapy has emerged as a new potential treatment option for phantom limb pain (PLP) that circumvents some limitations of mirror therapy. VR therapy was shown to decrease PLP following a single VR session as well as after an intervention consisting of multiple sessions. The addition of vibrotactile stimuli to VR therapy may lead to larger decreases in PLP scores compared with VR therapy alone.

Functional rehabilitation is important when managing Parkinson disease (PD). Virtual reality (VR) therapy is a noninvasive, potential alternative or adjunct to conventional therapies used during rehabilitation. The authors searched for articles in Google Scholar, PubMed, Physiotherapy Evidence Database Score (PEDro), and Cochrane after setting specific requirements starting in July 2019. Methodologic quality was assessed by PEDro for randomized controlled trials. Among 89 studies identified, 28 included in this review evaluated VR therapy for use during rehabilitation for PD: 7 used immersive VR and 21 used nonimmersive VR. Among the immersive VR studies, 6 showed improvement in primary outcomes after adding VR therapy. Among the nonimmersive VR studies, 5 showed improvement with VR therapy when compared with conventional therapy, 9 showed improvement with VR and conventional therapy with no between group difference, and the remaining 7 showed improvement in primary outcomes after adding VR intervention. The quality and diversity of studies was a major limitation. VR therapy is a promising rehabilitation modality for PD but more studies are needed. Additional investigations of VR therapy and PD should include direct comparisons between immersive and nonimmersive VR therapies.

BackgroundAutomated virtual reality therapies are being developed to increase access to psychological interventions. We assessed the experience with one such therapy of patients diagnosed with psychosis, including satisfaction, side effects, and positive experiences of access to the technology. We tested whether side effects affected therapy.MethodsIn a clinical trial 122 patients diagnosed with psychosis completed baseline measures of psychiatric symptoms, received gameChange VR therapy, and then completed a satisfaction questionnaire, the Oxford-VR Side Effects Checklist, and outcome measures.Results79 (65.8%) patients were very satisfied with VR therapy, 37 (30.8%) were mostly satisfied, 3 (2.5%) were indifferent/mildly dissatisfied, and 1 (0.8%) person was quite dissatisfied. The most common side effects were: difficulties concentrating because of thinking about what might be happening in the room (n = 17, 14.2%); lasting headache (n = 10, 8.3%); and the headset causing feelings of panic (n = 9, 7.4%). Side effects formed three factors: difficulties concentrating when wearing a headset, feelings of panic using VR, and worries following VR. The occurrence of side effects was not associated with number of VR sessions, therapy outcomes, or psychiatric symptoms. Difficulties concentrating in VR were associated with slightly lower satisfaction. VR therapy provision and engagement made patients feel: proud (n = 99, 81.8%); valued (n = 97, 80.2%); and optimistic (n = 96, 79.3%).ConclusionsPatients with psychosis were generally very positive towards the VR therapy, valued having the opportunity to try the technology, and experienced few adverse effects. Side effects did not significantly impact VR therapy. Patient experience of VR is likely to facilitate widespread adoption.

During ultrasound-guided regional anesthesia and surgery, patients receive sensory input, which combined with stress and anxiety, can exacerbate or cause pain. Virtual reality therapy could provide digital sedation. Our aim is to assess the effect of virtual reality therapy on pain levels during the placement of regional anesthesia and surgery. This prospective randomized controlled superiority trial enrolled 120 patients undergoing elective hand surgery to investigate the effect of perioperative virtual reality therapy, consisting of a visual and audible three-dimensional, passive program. Patients were randomized to virtual reality therapy (n=60) or no virtual reality therapy (n=60) during regional anesthesia block placement and surgical procedure. Mean pain score (11-point numerical rating scale) during ultrasound-guided regional anesthesia placement was the primary outcome. Secondary outcomes were the mean pain score during surgery, heart rate variation during ultrasound-guided regional anesthesia placement and surgery, perioperative opioid use, anxiety (11-point numerical rating scale where 0=no anxiety at all and 10=extremely anxious), virtual reality immersion and presence (Igroup Presence Questionnaire), adverse events and patient satisfaction (11-point numerical rating scale where 0=not satisfied at all and 10=extremely satisfied). Mean pain scores during ultrasound-guided regional anesthesia placement were 3.9±2.4 in the control group and 3.6±2.4 in the virtual reality group, with a mean difference of -0.3 (95% CI -1.2 to 0.5; p=0.22). Heart rate variation during ultrasound-guided regional anesthesia placement and surgery was non-significantly different. Anxiety during ultrasound-guided regional anesthesia placement showed no significant difference; however, it was significantly different during surgery (control: 1.5 (0.0, 4.0) vs virtual reality: 0.0 (0.0, 2.0), p<0.01). Virtual reality immersion showed a total mean score of 4.2±0.9. Seven patients (11.9%) suffered from adverse virtual reality effects. Patient satisfaction during surgery and perioperative opioid use showed no significant difference. Satisfaction with virtual reality was high: 9.0 (8.0, 10.0). Our results show that the use of virtual reality therapy during ultrasound-guided regional anesthesia placement and hand surgery does not result in lower pain scores. A perioperative significant positive effect on anxiety was measured, combined with a clinically significant effect on perioperative anxiety. The clinical influence of different virtual reality therapy systems on pain and anxiety should be further investigated in (other) elective procedures. NCT05183412.

Introduction. Balance impairments and mobility limitations are prevalent challenges among elderly individuals, often contributing to an increased risk of falls and a diminished quality of life. Traditional physiotherapy interventions have effectively addressed these issues, but novel approaches, such as virtual reality (VR) therapy, have emerged as potential enhancements to rehabilitation protocols. Through its immersive environments, VR therapy may engage and challenge patients, potentially leading to improved outcomes. Objective. To investigate whether VR therapy enhances balance and mobility outcomes in elderly patients compared with a traditional physiotherapy protocol. Methods. Sixty elderly individuals, aged 65 and above, referred for outpatient physiotherapy due to balance and mobility issues, were recruited for this randomized controlled trial (RCT) with two parallel arms. They were randomly allocated to the intervention group, treated with VR therapy sessions, while the control group received traditional physiotherapy sessions focused on balance exercises and mobility. The treatment duration was twice a week for over 8 weeks. Baseline assessments were conducted before the intervention, and follow-up assessments were performed immediately after the 8-week intervention period. Outcome Measures. Primary Outcome: Balance was assessed using the Berg Balance Scale (BBS) as the primary outcome, while mobility was assessed using the Timed Up and Go (TUG) test, and quality of life was evaluated using the EQ-5D Questionnaire as the secondary outcome. Results. The VR therapy group demonstrated a more significant improvement in balance (BBS score increase of 12.4 points) than the control group (BBS score increase of 7.6 points). Regarding mobility, the VR group reduced TUG time by 3.8 seconds, compared to 2.8 seconds in the control group, indicating faster completion times and improved functional mobility. The VR group reported a more significant increase in quality of life (0.17 EQ-5D improvement) compared to the control group (0.12 improvement), suggesting that immersive therapy positively impacted overall well-being. Conclusion. It was anticipated that the VR therapy group would demonstrate more significant improvements in balance, mobility, and quality of life than those in the traditional physiotherapy group.

BackgroundAutomated virtual reality (VR) therapy could allow a greater number of patients to receive evidence-based psychological therapy. The aim of the gameChange VR therapy is to help patients overcome anxious avoidance of everyday social situations. gameChange has been evaluated with outpatients, but it may also help inpatients prepare for discharge from psychiatric hospital.ObjectiveThe aim of this study is to explore the views of patients and staff on the provision of VR therapy on psychiatric wards.MethodsFocus groups or individual interviews were conducted with patients (n=19) and National Health Service staff (n=22) in acute psychiatric wards. Questions were derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability framework. Expectations of VR therapy were discussed, and participants were then given the opportunity to try out the gameChange VR therapy before they were asked questions that focused on opinions about the therapy and feasibility of adoption.ResultsThere was great enthusiasm for the use of gameChange VR therapy on psychiatric wards. It was considered that gameChange could help build confidence, reduce anxiety, and “bridge that gap” between the differences of being in hospital and being discharged to the community. However, it was reflected that the VR therapy may not suit everyone, especially if they are acutely unwell. VR on hospital wards for entertainment and relaxation was also viewed positively. Participants were particularly impressed by the immersive quality of gameChange and the virtual coach. It was considered that a range of staff groups could support VR therapy delivery. The staff thought that implementation would be facilitated by having a lead staff member, having ongoing training accessible, and involving the multidisciplinary team in decision-making for VR therapy use. The most significant barrier to implementation identified by patients and staff was a practical one: access to sufficient, private space to provide the therapy.ConclusionsPatients and staff were keen for VR to be used on psychiatric wards. In general, patients and staff viewed automated VR therapy as possible to implement within current care provision, with few significant barriers other than constraints of space. Patients and staff thought of many further uses of VR on psychiatric wards. The value of VR therapy on psychiatric wards now requires systematic evaluation.International Registered Report Identifier (IRRID)RR2-10.2196/20300

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

Stress is widely experienced. Relaxation practices, including mindfulness, meditation, yoga, and breathing exercises, are often used to combat stress, but can be difficult to maintain in everyday life. Virtual reality (VR) therapies appear to address stress in various contexts, and can be used to support relaxation techniques, including meditation, as they are immersive and can transport individuals to calming natural environments while limiting distractions. Many relaxation techniques invite individuals to focus their attention on their bodily sensations. This may be a challenge when using VR therapies as users are often disembodied in the VR. This article argues that inviting users to focus on bodily sensations in VR therapies may reduce their sense of presence or immersion in the virtual environment and create a conflict between focusing on the virtual world and the real world. An alternative strategy for relaxation and meditation in VR may be for users to have an outward and overtly audio-visual focus of attention on the features of the virtual environment, rather than bodily sensations. This could maintain sense of presence, immersion, and the unity of the experience, and make better use of VR technologies.

Virtual Reality (VR) therapy has emerged as a promising intervention for alleviatinganxiety levels in children diagnosed with Autism Spectrum Disorder (ASD). This studyaims to explore the effectiveness of VR therapy in reducing anxiety and improvingoverall well-being among children with ASD. The research employed a mixed-methodsapproach, combining quantitative assessments of anxiety levels and qualitative insightsinto the subjective experiences of participants. The quantitative aspect involved a randomized controlled trial with a sample of 100children aged 6 to 12 years diagnosed with ASD. Participants were randomly assignedtoeither the experimental group, which received VR therapy sessions, or the control group, which received standard therapy. Anxiety levels were measured using standardizedscales at baseline, post-intervention, and follow-up assessments conducted one monthafter the intervention. Additionally, demographic information and baseline anxiety levelswere collected to ensure comparability between the two groups. Preliminary findings indicate a significant reduction in anxiety levels among childrenwhounderwent VR therapy compared to those receiving standard therapy. The experimentalgroup demonstrated statistically significant improvements in anxiety scores frombaseline to post-intervention and maintained these improvements at the one-monthfollow-up. Conversely, the control group exhibited marginal changes in anxiety levelsover the same period. Qualitative data obtained through semi-structured interviews with participants andtheircaregivers provided valuable insights into the subjective experiences of childrenundergoing VR therapy. Themes that emerged from the qualitative analysis includedenhanced engagement, reduced fear of social interaction, and increased feelings ofempowerment and control. Participants reported a sense of immersion and enjoymentduring VR sessions, describing them as engaging and interactive. The study also examined potential moderators and mediators of treatment outcomes,including age, gender, ASD severity, and presence of comorbid conditions. Subgroupanalyses revealed differential treatment effects based on these variables, with youngerchildren and those with milder forms of ASD experiencing greater benefits fromVRtherapy. Overall, the findings suggest that VR therapy holds promise as an effective interventionfor reducing anxiety levels in children with ASD. Its immersive and interactive natureappears to engage participants and create a sense of presence, leading to significantimprovements in anxiety symptoms. Future research should further explore the long- term effects of VR therapy and investigate its mechanisms of action to optimizetreatment protocols and enhance outcomes for children with ASD.

Background Researchers have long been interested in the physiological and psychological aspects of wellbeing. Studies have found that Virtual Reality (VR) therapy, using computer generated environments and avatars, can have positive effects in relieving pain in some patient populations and can be used to alleviate symptoms of depression, anxiety, and Post Traumatic Stress Disorder. To date, there is little published research about the physical and psychological impact of VR therapy using real life environments/settings and the potential for VR to be used effectively in palliative care has not been fully investigated. Method Participants are given a single VR therapy experience lasting no more than 4 min, once a week, for 4 weeks. Quantitative data is obtained through the comparative analysis of pre- and post-session Edmonton Symptom Assessment System: Revised (ESAS-R) scores and qualitative data is gathered through set interviews completed after each VR therapy. Results Preliminary data evidences a 53% mean reduction in pain symptoms, 66% mean reduction in fatigue, 60% mean reduction in drowsiness, 50% mean reduction of SOB, 52% mean reduction in depression, and 62% mean reduction in anxiety with an overall 49% mean increase in overall wellbeing. Qualitatively, participants spoke about feeling more relaxed and generally ‘happier’ as a result of VR. Additionally participants spoke about VR connecting them to positive memories as well giving them a sense of freedom both from their illness, their symptoms, and life as a patient. Conclusion Preliminary findings positively demonstrate a reduction of common physiological and psychological palliative care symptoms. Additional participants and VR therapy sessions are planned. Additional positive results will provide robust evidence for VR Therapy to be adopted and used alongside current symptom control measures used in palliative care.

Background: Fibromyalgia syndrome (FMS) affects a significant portion of the global population, predominantly women, with profound impacts on quality of life due to widespread pain and associated symptoms. Traditional treatments, while beneficial, may not fully address all aspects of the condition. Virtual Reality (VR) therapy offers a novel approach, leveraging immersive environments to distract from pain and improve patient engagement. Methodology: This randomized controlled trial evaluated the efficacy of non-immersive VR therapy in managing FMS symptoms. Participants (n=52) were recruited from a tertiary care hospital and assigned to either VR therapy or standard care groups. Outcome measures included pain intensity, physical function (FIQ), and quality of life (SF-36), assessed at baseline, post-intervention (4 weeks), and follow-up (12 weeks). Results: VR therapy significantly reduced pain intensity compared to standard care (mean difference -2.5, p&lt;0.001). While improvements in physical function and quality of life were observed in the VR group, they were not statistically significant. Importantly, VR therapy effectively reduced kinesiophobia, demonstrating its potential to enhance patient participation in physical activities crucial for managing FMS. Conclusion: VR therapy shows promise as a standalone treatment for reducing pain intensity and addressing kinesiophobia in FMS patients. Future research should focus on larger samples, longer follow-up periods, and standardized outcome measures to elucidate VR therapy's broader impacts on physical function and quality of life in fibromyalgia management. Keywords: Fibromyalgia, Virtual Reality Therapy, Pain Management, Kinesiophobia.

BackgroundMental health conditions pose a major challenge to health care providers and society at large. The World Health Organization predicts that by 2030, mental health conditions will be the leading cause of disease burden worldwide. The current need for mental health care is overwhelming. In New Zealand, 1 in 6 adults has been diagnosed with common mental disorders, such as depression and anxiety disorders, according to a national survey. Cognitive behavioral therapy (CBT) has been shown to effectively help patients overcome a wide variety of mental health conditions. Virtual reality exposure therapy (VRET) might be one of the most exciting technologies emerging in the clinical setting for the treatment of anxiety and depression.ObjectiveThis study aims to investigate the virtual reality (VR) technologies currently being used to help support the treatment of depression and anxiety. We also aim to investigate whether and how CBT is included as part of VRET and look at the VR technologies and interventions that have been used in recent studies on depression and anxiety.MethodsWe performed a scoping review. To identify significant studies, we decided to use already aggregated sources from the Google Scholar database. Overall, the goal of our search strategy was to limit the number of initial results related to VR in mental health to only a relevant minimum.ResultsUsing our defined keywords, Google Scholar identified >17,300 articles. After applying all the inclusion and exclusion criteria, we identified a total of 369 articles for further processing. After manual evaluation, 34 articles were shortlisted; of the 34 articles, 9 (26%) reported the use of CBT with VR. All of the articles were published between 2017 and 2021. Out of the 9 studies, CBT was conducted within a VR environment in 5 (56%) studies, whereas in the remaining 4 (44%) studies, CBT was used as an addition to VRET. All 9 studies reported the use of CBT either in vivo or in a virtual environment to be effective in supporting the treatment of anxiety or depression.ConclusionsMost studies demonstrated the use of VR to be effective for supporting the treatment of anxiety or depression in a range of settings and recommended its potential as a tool for use in a clinical environment. Even though standalone headsets are much easier to work with and more suitable for home use, the shift from tethered VR headsets to standalone headsets in the mental health environment was not observed. All studies that looked at the use of CBT either in vivo or in a virtual environment found it to be effective in supporting the treatment of anxiety or depression.

Introduction:Virtual reality (VR) therapy is increasingly used to mitigate pain and anxiety in inpatient settings, with varying effectiveness in postoperative settings. The costs of VR therapy also differ among suppliers. This health-economic analysis aims to inform policy- and decision-makers on the potential impact of VR therapy from a societal perspective based on pain management at discharge and the development of chronic postsurgical pain (CPSP).Methods:A Markov model was developed to simulate 1-year postoperative costs and effects. Using a threshold and headroom analysis, the Incremental Cost-effectiveness Ratio (ICER) was calculated for various VR effectiveness estimates and costs when VR therapy demonstrated cost-effectiveness or cost-savings for postoperative pain management. VR effectiveness was based on opioid use at discharge, affecting the Markov model’s initial distribution and CPSP development. The ICER was calculated from quality-adjusted life-years (QALYs) and costs associated with CPSP. A univariate sensitivity analysis was used to assess parameter uncertainty by varying each parameter by ±20% from the base-case value.Results:VR therapy needs to reduce opioid use at discharge by at least 2.8% to be cost-effective at a willingness-to-pay threshold of €20 000 per QALY and VR costs of €47.48 per patient. To be cost-saving, a reduction of at least 6.5% is needed. The sensitivity analysis indicated that the transition probability from “pain with opioid” to “pain free” in month 2 had the most impact on the ICER. Other significant variables included VR effectiveness and costs, each influencing the ICER by over €5000.Conclusion:The needed 2.8% reduction in opioid use at discharge seems plausible based on literature. However, knowledge gaps regarding the effectiveness of VR, the incidence of chronic postoperative pain, and societal costs of chronic pain need to be addressed, to better understand VR therapy’s role in optimizing postoperative pain management.

Background Researchers have long been interested in the physiological and psychological aspects of wellbeing. Various studies have found that Virtual Reality (VR) therapy, using computer generated environments and avatars, can have a positive effect in relieving pain in paediatric intravenous cannulation (Gold et al., 2006) and burn wound debridement (Hoffman et al., 2000), as well as in alleviating symptoms of depression (Falconer et al., 2016), anxiety (Repetto & Riva, 2011), and Post Traumatic Stress Disorder (Rothbaum et al., 2001). To date, there is little published research about the physical and psychological impact of VR Therapy using real life environments/settings and the potential for VR to be used effectively in palliative care has not been fully investigated. Aim Existing research on the use of still images shown to healthy subjects has concluded that personally emotive images trigger stronger positive physiological and psychological responses (Fedorovskaya et al., 2001). Our study’s principal hypothesis is: ‘Personalised virtual reality therapy has a positive impact on adult palliative care patients’ self-reported symptoms of physical and psychological well-being and pain scores thus resulting in an increase in overall quality of life/wellbeing.’ Methods Participants on our study will be given a VR Therapy experience lasting approximately four minutes, once a week, for four weeks. We will be obtaining quantitative data through the comparative analysis of pre- and post-session Edmonton Symptom Assessment System: Revised (ESAS-R) scores and qualitative data through set interviews that will be completed with each participant after each VR Therapy session and at the end of the project. Results/Conclusion Positive results from this study could provide the evidence required for VR Therapy to be adopted and to be used alongside current symptom control measures provided by hospices and palliative care teams to manage symptoms at the end of life. It is our hope that this study will also give us a better understanding how VR Therapy can be used responsibly and ethically for patients across hospices and other palliative care settings.

The development of technology to improve effective, efficient, and comprehensive mental health care services have now been carried out, one of which is the development of Virtual Reality Therapy (VR) in mental health services to achieve optimal health by creating the illusion of living in virtual reality. This article aimed to find out the application of technology-based Virtual Reality Therapy (VR) in mental health care services and modifications that might be made by reviewing the existing limitations. A scoping review was written based on identifying scientific articles in three databases, namely Science Direct, Pubmed NCBI, and Proquest, using the terms Virtual Reality Therapy, Mental Health, and Nursing. The author carried out the selection and analysis process using PRISMA based on the inclusion and exclusion criteria determined by the researcher, and a total of 15 articles were analyzed. The use of technology-based Virtual Reality Therapy in psychiatric nursing has been shown to have a positive impact on the condition of psychological health problems, including reducing anxiety, changing moods, emotions, empathy, reducing stress, loneliness. Therapy delivery system and allows for program modifications. Virtual Reality Therapy has a positive impact on improving one's mental health. It is necessary to develop modifications in VR implementation to achieve optimal physical and psychological health