The Advances of Immersive Virtual Reality Interventions for the Enhancement of Stress Management and Relaxation among Healthy Adults: A Systematic Review

Finding Peace in Pixels: Exploring the Therapeutic Mechanisms of Virtual Nature for Young Adults' Mental Well-Being

Background: This investigation examines the phenomenological dimensions of young adults' engagement with virtual natural environments for psychological stress amelioration through rigorous thematic analysis. Contemporary epidemiological data reveal a concerning prevalence of stress among young adults aged 18 to 29 years, with approximately 30% reporting moderate to severe manifestations. Despite virtual reality (VR)'s emergence as a promising modality for mental well-being interventions, a significant lacuna exists regarding the qualitative understanding of these immersive experiences. Methods: Through semi-structured interviews with 35 young adults following a four-week VR nature intervention, we constructed a conceptual framework comprising five interconnected strata: intervention, experience, process, context, and outcome. Results: Our analysis illuminated intricate bidirectional relationships among sensory elements, emotional responses, immersion depth, interactive affordances, post-session effects, psychological development, implementation challenges, individual variability, and comparative efficacy. The findings demonstrate congruence with both Attention Restoration Theory and Stress Recovery Theory while necessitating consideration of technology-specific mediators. Notably, the identified "stress barrier" phenomenon temporarily inhibited intrusive cognitions, suggesting promising therapeutic mechanisms. Pronounced heterogeneity in environmental preferences and psychophysiological responsiveness underscores the imperative for personalized implementation strategies. Conclusions: These insights provide substantive guidance for VR nature applications across therapeutic, occupational, and educational domains, potentially augmenting our repertoire for addressing stress-related sequelae in contemporary society.

Designing a Smartphone-Based Virtual Reality App for Relaxation: Qualitative Crossover Study

BACKGROUND

Accumulating evidence supports the use of virtual reality (VR) in mental health care, with one potential application being its use to assist individuals with relaxation exercises. Despite studies finding support for the potential of VR to effectively aid in relaxation, its implementation remains limited outside of specialized clinics. Known barriers are insufficient knowledge regarding VR operation, lack of availability of VR relaxation apps tailored to local health care systems, and cost concerns. Unfortunately, many VR relaxation apps are designed exclusively for stand-alone headsets, limiting accessibility for a broad audience.

OBJECTIVE

We aimed to design an accessible, smartphone-based VR relaxation app based on user preferences. This paper describes the assessment of 2 stand-alone VR relaxation apps and the resulting smartphone-based VR relaxation app design.

METHODS

Overall, 30 participants (n=23, 77% women; n=7, 23% men) took part in 2 separate VR sessions, assessing 1 of the 2 VR relaxation apps (Flowborne and Calm Place) in each session. After each session, participants were presented with open-ended questions to assess their experiences via a web-based survey tool. These questions explored positive and negative features, shortcomings, and suggestions for improvements while also allowing space for additional remarks concerning the 2 VR relaxation apps. Three of the authors analyzed the responses using inductive thematic analysis, a process comprising 6 phases.

RESULTS

Across both the apps, 5 recurring themes and 13 recurring subthemes were identified in the participants' answers: audio (music and sounds, guidance), visuals (content, realism, variation and dynamics in the environment), features (language, options, feedback and instructions, duration, exercise), implementation (technical aspects, cybersickness, acceptability and usability), and experience. We analyzed the participants' findings and conducted a literature review, which served as the basis for developing the app. The resulting app is a Dutch-language, smartphone-based VR relaxation app, with customization options including 3 types of relaxation exercises, 2 guiding voices, and 3 different environments. Efforts have been made to ensure maximum variation and dynamism in the environments. Calming music and nature sounds accompany the exercises. The efficacy and effectiveness of the resulting app design were not assessed.

CONCLUSIONS

This study provides insights into key features of VR relaxation apps, which were subsequently used for the development of a novel smartphone-based VR relaxation app. Further research concerning the effectiveness of this app, along with a broader evaluation of the efficacy and user feedback for smartphone-based VR relaxation apps, is needed. More generally, there is a clear need for more research on the impact of interactivity, biofeedback, and type of environment in VR relaxation.

The effects of digital nature and actual nature on stress reduction: A meta-analysis and systematic review

Objectives

The study aims to conduct a systematic literature review and meta-analysis to assess the effects of digital nature and actual nature on stress reduction.

Methods

In August 2023, Web of Science, Scopus, ProQuest, PubMed, and EBSCOhost databases were used, and ten articles were in the analysis, with a total sample size of 886 participants. Studies within- or between-subjects design conducted in either a randomized controlled trial or a quasi-experimental design were included. No restriction was put on the year of publication or geographical region. Conference papers and dissertations were also included whereas, book chapters were excluded. Participants included those who were exposed to at least one form of digital nature exposure, such as static images, videos, 360° pictures, and 360° videos. The risk of bias determined through Review Manager 5.4 was used to assess the quality of the studies. STATA software package version 16 was used for visual analysis of funnel plots. For the assessment of potential publication bias, Egger's test was implemented.

Results

Digital natural environments had the same level of stress recovery compared to actual environmental exposures with the same intervention content (SMD = -0.01; 95% CI: -0.15, 0.12). Subgroup analyses and meta-regression indicated that subjective or physiological stress measures, level of immersion, and data extraction method were not associated with pooled effect stress recovery. All subgroups showed comparable stress levels in both conditions. In addition, all included studies had different levels of risk of bias (low, moderate, and high).

Conclusions

The present study concludes that previous research has generally shown that stress levels are reduced in both digital and actual natural environments. The results of the meta-analysis support this conclusion with no significant differences between the two modes of stress recovery through nature viewing.

A comprehensive study on unraveling the advances of immersive technologies (VR/AR/MR/XR) in the healthcare sector during the COVID-19: Challenges and solutions

The current COVID-19 pandemic has affected almost every aspect of life but its impact on the healthcare landscape is conspicuously adverse. However, digital technologies played a significant contribution in coping with the challenges spawned by this pandemic. In this list of applied digital technologies, the role of immersive technologies in battling COVID-19 is notice-worthy. Immersive technologies consisting of virtual reality (VR), augmented reality (AR), mixed reality (MR), extended reality (XR), metaverse, gamification, etc. have shown enormous market growth within the healthcare system, particularly with the emergence of pandemics. These technologies supplemented interactivity, immersive experience, 3D modeling, touching sensory elements, simulation, and feedback mechanisms to tackle the COVID-19 disease in healthcare systems. Keeping in view the applicability and significance of immersive technological advancement, the major aim of this study is to identify and highlight the role of immersive technologies concerning handling COVID-19 in the healthcare setup. The contribution of immersive technologies in the healthcare domain for the different purposes such as medical education, medical training, proctoring, online surgeries, stress management, social distancing, physical fitness, drug manufacturing and designing, and cognitive rehabilitation is highlighted. A comprehensive and in-depth analysis of the collected studies has been performed to understand the current research work and future research directions. A state-of-the-artwork is presented to identify and discuss the various issues involving the adoption of immersive technologies in the healthcare area. Furthermore, the solutions to these emerging challenges and issues have been provided based on an extensive literature study. The results of this study show that immersive technologies have the considerable potential to provide massive support to stakeholders in the healthcare system during current COVID-19 situation and future pandemics.

Indicated Stress Prevention Addressing Adolescents with High Stress Levels Based on Principles of Acceptance and Commitment Therapy: A Randomized Controlled Trial

INTRODUCTION

Stress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms.

METHODS

We conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778).

RESULTS

Results showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress.

CONCLUSION

Indicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.

Virtual Reality Breathing Interventions for Mental Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Breathing exercises have been shown to reduce mental health problems among clinical and non-clinical populations. Although virtual reality (VR) breathing interventions are assumed to have potential benefits, it remains unclear whether VR breathing interventions are more effective at improving mental health than non-VR breathing interventions. We conducted a systematic literature search in six electronic databases (Web of Science, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Scopus, and PubMed) from inception to 30th September, 2022. We included randomized controlled trials in adults evaluating effects of VR compared to non-VR breathing interventions on primary outcomes of mental health (stress, anxiety and mood), and secondary outcomes of physiological stress measures (e.g., heart rate (HR), heart rate variability (HRV)). Within these selected studies, we explored differences in likeability and future use between VR and non-VR breathing interventions. 2.848 records were identified of which 65 full-text articles were assessed. Six RCTs were included, of which five were suitable for meta-analyses. Comparing VR to non-VR breathing interventions, there were no significant differences in overall mental health, stress, anxiety or mood, nor in HR or HRV. There was no evidence that participants liked VR breathing interventions more than non-VR, nor would use them more in the future. These results suggest that there is no evidence that VR breathing interventions are more effective than non-VR in improving mental health outcomes, HR, HRV. Further research is required to determine whether there may be advantages to longer-term VR-implementation and practice, and explore possible mechanisms.

Toward immersive communications in 6G

The sixth generation (6G) networks are expected to enable immersive communications and bridge the physical and the virtual worlds. Integrating extended reality, holography, and haptics, immersive communications will revolutionize how people work, entertain, and communicate by enabling lifelike interactions. However, the unprecedented demand for data transmission rate and the stringent requirements on latency and reliability create challenges for 6G networks to support immersive communications. In this survey article, we present the prospect of immersive communications and investigate emerging solutions to the corresponding challenges for 6G. First, we introduce use cases of immersive communications, in the fields of entertainment, education, and healthcare. Second, we present the concepts of immersive communications, including extended reality, haptic communication, and holographic communication, their basic implementation procedures, and their requirements on networks in terms of transmission rate, latency, and reliability. Third, we summarize the potential solutions to addressing the challenges from the aspects of communication, computing, and networking. Finally, we discuss future research directions and conclude this study.