Recieved: 04/26/2023
Accepted: 10/31/2023
Published: 12/08/2023
Keywords: virtual reality; schizophrenia; relaxation training; heart rate variability
p.: 78-89
DOI: 10.11621/npj.2023.0407
Available online: 08.12.2023
Nikonova Evgenia Yu., Rupchev George E. , Morozova Margarita A., Burminskiy Denis S.. Using Virtual Reality for Relaxation in Patients with Schizophrenia. A Pilot Study. // National Psychological Journal 2023. 4. p.78-89. doi: 10.11621/npj.2023.0407
Copied to Clipboard
CopyBackground. The article discusses the possibilities and prospects of using virtual reality (VR) technology as a method of relaxation in schizophrenic patients in remission. It is known that the effectiveness of antipsychotic drugs is limited. In this regard, the development of complementary therapy with non-pharmacological methods can expand the range of positive effects without affecting the safety of treatment.
Objective. The study aims to test the hypothesis of possible positive effects of relaxation with VR-program in patients with episodic form of paranoid schizophrenia in drug remission.
Sample. The study involved 10 participants with paranoid schizophrenia (9 men, 1 woman) in stable remission, aged 29 to 47 years (mean age 37.3). Length of illness ranged from 8 to 27 years (mean length 17.2). All study participants received stable antipsychotic therapy for at least 12 months. The immersive VR experience with virtual reality glasses was the first for all participants. Each participant underwent 5 training sessions, with 50 sessions included in the analysis.
Methods. A series of 5 relaxation trainings were conducted using the Nature Treks VR application in the Samsung Gear VR virtual reality glasses. The ITC SOPI (Lessiter et al., 2001) questionnaire was used to assess the dynamics of the presence effect. Assessment of the dynamics of changes in the subjective indicators of functional state was performed using the HAM technique (health, activity, and mood) (Lavrentieva, Miroshnikov et al., 1973). Heart rate variability was measured with a one-channel cardiac recorder “Omega” NPF “Dinamika” St. Petersburg. Statistical data processing was performed using IBM SPSS Statistics 24 program and included correlation analysis using nonparametric Spearman correlation coefficient, Wilcoxon T-criterion, and multidimensional analysis of variance (ANOVA).
Results. During the training there were no statistically significant indicators of relaxation effect but participants tolerated VR-training well and noted improvement of mood and well-being. During the training they did not feel unpleasant background sensations. There was also an increase in the work of parasympathetic departments of the vegetative nervous system.
Conclusion. The results of the pilot study showed that in the subjective report, the experience of diffuse psychophysiological disorders decreased. The result depended on the features of emotional and personal perception of stimulus material.The procedures were well tolerated.
Adhyaru, J.S., & Kemp, C. (2022). Virtual reality as a tool to promote wellbeing in the workplace. Digital Health, 8,20552076221084473.
Benjamin, B.R., et al. (2021). Heart rate variability is associated with disease severity in psychosis spectrum disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 111, 110108. https://doi.org/10.1016/j.pnpbp.2020.110108
Bisso, E., Signorelli, M.S., Milazzo, M., Maglia, M., Polosa, R., Aguglia, E., & Caponnetto, P. (2020). Immersive virtual reality applications in schizophrenia spectrum therapy: a systematic review. International Journal of Environmental Research and Public Health, 17(17), 6111. https://doi.org/10.3390/ijerph17176111
Calogiuri, С., Litleskare, S., Fröhlich, F., (2021). Physical Activity and Virtual Nature: Perspectives on the Health and Behavioral Benefits of Virtual Green Exercise. Nature and Health. New York: Routledge Press, 127–146. https://doi.org/10.4324/9781003154419-10
Chan, K.C.S., et al. (2023). Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review. Brain Sciences, 13(3), 471. https://doi.org/10.3390/brainsci13030471
Cieślik, B., Mazurek, J., Rutkowski, S., Kiper, P., Turolla, A., & Szczepańska-Gieracha, J. (2020). Virtual reality in psychiatric disorders: A systematic review of reviews. Complementary Therapies in Medicine, 52, 102480.
Clamor, A., Koenig, J., Thayer, J.F., & Lincoln, T.M. (2016). A randomized-controlled trial of heart rate variability biofeedback for psychotic symptoms. Behaviour Research and Therapy, 87, 207–215. https://doi.org/10.1016/j.brat.2016.10.003
Clamor, A., Lincoln, T.M., Thayer, J.F., & Koenig, J. (2016). Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. The British Journal of Psychiatry, 208(1), 9–16. https://doi.org/10.1192/bjp.bp.114.160762
Du Sert, O.P., et al. (2018). Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: a pilot clinical trial. Schizophrenia Research, 197, 176–181. https://doi.org/10.1016/j.schres.2018.02.031.
Fornells-Ambrojo, M., et al. (2016). Hypersensitivity to contingent behavior in paranoia: a new virtual reality paradigm. The Journal of Nervous and Mental Disease, 204(2), 148–152.
Frewen, P., et al. (2020). Proof of concept of an eclectic, integrative therapeutic approach to mental health and well-being through virtual reality technology. Frontiers in Psychology, 11, 858.
Gamito, P., et al. (2010). Training presence: the importance of virtual reality experience on the “sense of being there”. Stud Health Technol Inform, 154, 128–133. https://doi.org/10.3233/978-1-60750-561-7-128
Jung, W., Jang, K.I., & Lee, S.H. (2019). Heart and brain interaction of psychiatric illness: a review focused on heart rate variability, cognitive function, and quantitative electroencephalography. Clinical Psychopharmacology and Neuroscience, 17(4), 459. https:// doi.org/10.9758/cpn.2019.17.4.459
Lee C.H., Huk J.J., & Janf S.W. (2017). Study on the Effects of Forest VR Contents on Stress Relief and Relaxation. International Journal of Signal Processing, Image Processing and Pattern Recognition, 10(8), 103–110. https://doi.org/0.14257/ijsip.2017.10.8.09
Lessiter, J., Freeman, J., Keogh, E., & Davidoff, J. (2001). A cross-media presence questionnaire: The ITC-Sense of Presence Inventory. Presence: Teleoperators and Virtual Environments, 10(3), 282–297. https://doi.org/10.1162/105474601300343612
Litleskare, S., & Calogiuri, G. (2023). Seasonal Variations in the Effectiveness of Immersive Virtual Nature. HERD: Health Environments Research & Design Journal, 16(1), 219–232. https://doi.org/10.1177/19375867221127420
Miranda, B., Moreira, P.M., Romero, L., & Rego, P.A. (2022). Therapeutic use of VR serious games in the treatment of negative schizophrenia symptoms: a systematic review. Healthcare, 10(8), 1497. MDPI. https://doi.org/10.3390/healthcare10081497
Montaquila, J.M., Trachik, B.J., & Bedwell, J.S. (2015). Heart rate variability and vagal tone in schizophrenia: a review. Journal of Psychiatric Research, 69, 57–66. https://doi.org/10.1016/j.jpsychires.2015.07.025. Pardini, S., et al. (2022). The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation. International Journal of Environmental Research and Public Health, 19(12), 7237. https://doi. org/10.3390/ ijerph19127237
Rault, O., Lamothe, H., & Pelissolo, A. (2022). Therapeutic use of virtual reality relaxation in schizophrenia: A pilot study. Psychiatry Research, 309, 114389. https://doi.org/10.1016/j.psychres.2022.114389.
Riches, S., Azevedo, L., Bird, L., Pisani, S., & Valmaggia, L. (2021). Virtual reality relaxation for the general population: a systematic review. Social Psychiatry and Psychiatric Epidemiology, 56, 1707–1727. https://doi.org/10.1007/s00127-021-02110-z
Riva, G. (2006). Being-in-the-world-with: presence meets social and cognitive neuroscience. In: G. Riva (Eds.). From Communication to Presence: Cognition, Emotions and Culture Towards the Ultimate Communicative Experience (pp. 47–80). Amsterdam: IOS Press.
Rus-Calafell, M., et al. (2018). Virtual reality in the assessment and treatment of psychosis: A systematic review of its utility, acceptability and effectiveness. Psychological Medicine, 48(3), 362–391. https://doi.org/10.1017/S0033291717001945
Sánchez-Nieto, D., Castaño-Castaño, S., Navarro-Martos, R., Obrero-Gaitán, E., Cortés-Pérez, I., & Nieto-Escamez, F. (2023). An Intervention on Anxiety Symptoms in Moderate Alzheimer’s Disease through Virtual Reality: A Feasibility Study and Lessons Learned. International Journal of Environmental Research and Public Health, 20(3), 2727. https://doi.org/10.3390/ijerph20032727
Smalley, A.J., & White, M.P. (2023). Beyond blue-sky thinking: Diurnal patterns and ephemeral meteorological phenomena impact appraisals of beauty, awe, and value in urban and natural landscapes. Journal of Environmental Psychology, 101955.
Sonney, J., Björling, E.A., Rodriguez, S., & Carr, N. (2021). Pivoting to “No Contact”: A Protocol for Conducting a Virtual Reality Relaxation Home Study for Teens Amidst the COVID-19 Pandemic. Journal of Pediatric Health Care, 35(5), 552–558.
Specht, B.J., et al. (2021). Virtual reality after surgery—a method to decrease pain after surgery in pediatric patients. The American Surgeon, 89(4), 596–602. https://doi.org/10.1177/00031348211032204
Terathongkum, S., & Pickler, R.H. (2004). Relationships among heart rate variability, hypertension, and relaxation techniques. Journal of Vascular Nursing, 22(3), 78–82. https://doi.org/10.1016/j.jvn.2004.06.003.
Verzwyvelt, A.L., McNamara, A., Xu, X., & Stubbins, R. (2021). Effects of virtual reality v. biophilic environments on pain and distress in oncology patients: a case-crossover pilot study. Scientific Reports, 11(1), 20196. https://doi.org/10.1038/s41598-021-99763-2
Weijers, J., et al. (2021). Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial. Psychological Medicine, 51(16), 2846–2855. https://doi.org/10.1017/S0033291720001506
Nikonova Evgenia Yu., Rupchev George E. , Morozova Margarita A., Burminskiy Denis S.. Using Virtual Reality for Relaxation in Patients with Schizophrenia. A Pilot Study. // National Psychological Journal 2023. 4. p.78-89. doi: 10.11621/npj.2023.0407
Copied to Clipboard
Copy