Virtual Reality relaxation for self-management of stress in patients with psychiatric symptoms - a randomized cross-over pilot study

Patients with psychiatric disorders often have an increased level of stress,
which makes it more difficult to recover from their symptoms. Relaxation
exercises, involving imaginary visualization of pleasant environments, can have
a positive effect on the level of tension and arousal, but are often difficult
to perform for people with psychiatric symptoms. Virtual Reality (VR) may help
to relax. We previously conducted a feasibility pilot study with a first VR
relaxation prototype. This second pilot study examines whether VR 360o films
(VRelax) can help patients with current psychiatric symptoms to reduce level of
subjective stress.

To develop a second VRelax prototype for reducing impact of stress and test it
in patients with depressive, bipolar, anxiety and psychotic disorders. User
experiences and immediate effects on subjective stress and arousal will be
investigated and compared to standard relaxation exercises.

This pilot study is a randomized cross-over trial with two relaxation tools: 1)
the VRelax relaxation app and 2) standard relaxation exercises. Participants
will use both tools consecutively for 10 days at home. Participants will be
randomly assigned to order of the interventions.

- VRelax: the tool is used with a smartphone that is connected to a head
mounted display. When activated, the participant is on a beach, from which
he/she can choose where to go. The 360o videos of relaxing environments include
a variety of nature landscapes. Interactive elements and relaxation exercises
are embedded in the environments. Participants navigate through the
environments by looking at hotspots.

- Standard relaxation exercises: 2D nature videos and audio tracks with guided
meditation / progressive muscle relaxation.
Participants can use the interventions as much as they like, but minimally once
daily for at least 10 minutes. Before and after each session, momentary
subjective stress is measured with Visual Analogue Scales.

Pre and post-intervention assessments include questionnaires and a qualitative
interview about user experiences, with an average total duration of 3x120
minutes. Interventions take minimally 200 minutes at home. We expect patients
to benefit from the intervention by primary reduced level of stress and
secondary less psychiatric symptoms. Some patients may experience mild cyber
sickness during the VR video, i.e. transient nausea or dizziness. No major
adverse events are expected or have been documented.