What is the clinical evidence from this study?

Study design: RCT. Population: High stress (n=74). Intervention: Virtual Reality (VR) relaxation vs. Biofeedback. Primary outcome: Change in State-Trait Anxiety Inventory-X1 (STAI-X1) score from stress to relaxation phase (p=0.394).

August 10, 2021Open Access

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

Key Result

Virtual reality relaxation significantly reduced subjective stress in individuals with high stress, but the magnitude of the effect was not significantly different from conventional biofeedback (p=0.394).

Study Design

Type

RCT (n=74)

Blinding

Open-label

Randomization

Randomized crossover

Multicenter

PICO

Population

High stress (n=74)

Intervention / Comparator

Virtual Reality (VR) relaxation vs Biofeedback (10 minutes and 30 seconds session)

Primary Outcome

Change in State-Trait Anxiety Inventory-X1 (STAI-X1) score from stress to relaxation phase, p=0.394

Main Result

Absolute Event Rate: 6.42% vs 5.85%

p-value: p=0.394

Limitations

Exposed stressors in a laboratory environment may not be delivered effectively depending on the individual's intrinsic tolerance.
The 10.5-minute duration of the relaxation sessions may not be sufficient to induce the maximum level of relaxation.
The study only investigated the short-term effect of stress reduction, so long-term effects remain unknown.
The study was conducted with healthy adults (aged 19-59), making it difficult to apply the results to children, adolescents, or the elderly.
Factors assessing immersion, presence, and interactivity during the VR experience were not evaluated.

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.

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