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The effectiveness and user experience of a biofeedback intervention program for stress management supported by virtual reality and mobile technology: a randomized controlled study


Kerr, Jasmine I; Weibel, Raphael P; Naegelin, Mara; Ferrario, Andrea; Schinazi, Victor R; La Marca, Roberto; Hoelscher, Christoph; Nater, Urs M; von Wangenheim, Florian (2023). The effectiveness and user experience of a biofeedback intervention program for stress management supported by virtual reality and mobile technology: a randomized controlled study. BMC Digital Health, 1:42.

Abstract

Background: Heart rate variability biofeedback (HRV-BF) can be used for stress management. Recent feasibility studies suggest that delivering HRV-BF in virtual reality (VR) is associated with better user experience (UX) and might yield more beneficial changes in HRV than two-dimensional screens. The effectiveness of a VR-supported HRV-BF intervention program has, however, not been investigated yet.

Methods: In this study, 87 healthy women and men were assigned to a VR-supported HRV-BF intervention (INT; $n=44$) or a wait-list control (WLC; $n=43$) group. The INT came to the lab for four weekly HRV-BF sessions in VR using a head-mounted display. Between lab sessions, participants were asked to perform breathing exercises without biofeedback supported by a mobile application. Stress-related psychological and psychophysiological outcomes were assessed pre- and post-intervention and at a follow-up four weeks after the intervention in both groups. A psychosocial stress test was conducted post-intervention to investigate changes in stress reactivity. UX was assessed after each HRV-BF session in the INT.

Results: Analysis revealed that LF increased significantly from pre- to post-, whereas pNN50 increased and chronic stress decreased significantly from pre-intervention to follow-up in the INT compared to the WLC. Anxiety and mental fatigue decreased significantly, while mindfulness and health-related quality of life increased significantly from pre- to post- and from pre-intervention to follow-up in the INT compared to the WLC (all small effects). The two groups did not differ in their stress reactivity post-intervention. As for UX in the INT, the degree of feeling autonomous concerning technology adoption significantly decreased over time. Competence, involvement, and immersion, however, increased significantly from the first to the last HRV-BF session, while hedonic motivation significantly peaked in the second session and then gradually returned to first-session levels.

Conclusions: This HRV-BF intervention program, supported by VR and mobile technology, was able to significantly improve stress indicators and stress-related symptoms and achieved good to very good UX. Future studies should control for potential placebo effects and emphasize higher degrees of personalization and adaptability to increase autonomy and, thereby, long-term health and well-being. These findings may serve as a first step towards future HRV-BF applications of cutting-edge, increasingly accessible technologies, such as wearables, VR, and smartphones, in the service of mental health and healthcare.

Abstract

Background: Heart rate variability biofeedback (HRV-BF) can be used for stress management. Recent feasibility studies suggest that delivering HRV-BF in virtual reality (VR) is associated with better user experience (UX) and might yield more beneficial changes in HRV than two-dimensional screens. The effectiveness of a VR-supported HRV-BF intervention program has, however, not been investigated yet.

Methods: In this study, 87 healthy women and men were assigned to a VR-supported HRV-BF intervention (INT; $n=44$) or a wait-list control (WLC; $n=43$) group. The INT came to the lab for four weekly HRV-BF sessions in VR using a head-mounted display. Between lab sessions, participants were asked to perform breathing exercises without biofeedback supported by a mobile application. Stress-related psychological and psychophysiological outcomes were assessed pre- and post-intervention and at a follow-up four weeks after the intervention in both groups. A psychosocial stress test was conducted post-intervention to investigate changes in stress reactivity. UX was assessed after each HRV-BF session in the INT.

Results: Analysis revealed that LF increased significantly from pre- to post-, whereas pNN50 increased and chronic stress decreased significantly from pre-intervention to follow-up in the INT compared to the WLC. Anxiety and mental fatigue decreased significantly, while mindfulness and health-related quality of life increased significantly from pre- to post- and from pre-intervention to follow-up in the INT compared to the WLC (all small effects). The two groups did not differ in their stress reactivity post-intervention. As for UX in the INT, the degree of feeling autonomous concerning technology adoption significantly decreased over time. Competence, involvement, and immersion, however, increased significantly from the first to the last HRV-BF session, while hedonic motivation significantly peaked in the second session and then gradually returned to first-session levels.

Conclusions: This HRV-BF intervention program, supported by VR and mobile technology, was able to significantly improve stress indicators and stress-related symptoms and achieved good to very good UX. Future studies should control for potential placebo effects and emphasize higher degrees of personalization and adaptability to increase autonomy and, thereby, long-term health and well-being. These findings may serve as a first step towards future HRV-BF applications of cutting-edge, increasingly accessible technologies, such as wearables, VR, and smartphones, in the service of mental health and healthcare.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:13 October 2023
Deposited On:24 Jan 2024 08:28
Last Modified:25 Jan 2024 05:58
Publisher:BioMed Central
ISSN:2731-684X
Additional Information:Trial registration: The study was registered retrospectively as a clinical trial on ISRCTN registry (ISRCTN11331226, 26 May 2023).
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s44247-023-00042-z
Project Information:
  • : FunderSwiss Federal Institute of Technology Zurich
  • : Grant ID
  • : Project Title
  • Content: Published Version
  • Language: English
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)