An attempt to identify factors influencing the effectiveness of physical exercise in virtual reality conditions in the treatment of anxiety and depressive disorders – study design
DOI:
https://doi.org/10.12923/2353-8627/2024-0024Keywords:
virtual reality, physical exercise, depression, anxiety disorder, HADSAbstract
Introduction: Virtual reality (VR) has been shown to have beneficial effects in the treatment of depressive disorders, anxiety disorders, eating disorders, and addictions. This method is relatively safe and noninvasive, but its effectiveness is variable, and predictors of effectiveness have been investigated in a limited manner. We hypothesized that personality traits could impact VR effectiveness, and that cognitive impairments might relate to its therapeutic success.
Material and methods: The study involves a randomized sample of 40 patients diagnosed with anxiety and mood disorders (ICD-10 F3x and F4x) from a psychiatric rehabilitation daily unit. Over 12 weeks, they will participate in a therapeutic program that includes exercise sessions enhanced with virtual reality (VR) interventions lasting 10 to 12 minutes each. A control group of 40 patients will follow a standard therapeutic program without VR. During the screening phase, we will assess anxiety and depression severity using the HADS and STAI. We will also evaluate patients' physical fitness by using the 6MWT, personality traits by using the HEXACO-60 Personality Inventory, and cognitive functioning by the ACE III, MoCA, FAB and RAVL tests.
Results: The procedure's effectiveness will be measured using HADS and STAI assessments for anxiety and depression at weeks 6, 12, and 4 weeks after the program.
Conclusions: Defining the subpopulation of patients sensitive to the proposed therapeutic interventions and analyzing the factors influencing their treatment will allow offering therapy in virtual reality to those who will benefit the most from it.
References
1. Bracq MS, Michinov E, Jannin P. Virtual reality simulation in nontechnical skills training for healthcare professionals: a systematic review. Simul Healthc 2019 Jun;14(3):188-194.
2. Lie SS, Helle N, Sletteland NV, Vikman MD, Bonsaksen T. Implementation of Virtual Reality in Health Professions Education: Scoping Review. JMIR Med Educ 2023;9:e41589.
3. Wu Q, Wang Y, Lu L, Chen Y, Long H and Wang J (2022) Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice. Front. Med. 9:855403.
4. Fahl, J.T., Duvivier, R., Reinke, L. et al. Towards best practice in developing motor skills: a systematic review on spacing in VR simulator-based psychomotor training for surgical novices. BMC Med Educ 23, 154 (2023).
5. Behmadi, S., Asadi, F., Okhovati, M., & Ershad Sarabi, R. (2022). Virtual reality-based medical education versus lecture-based method in teaching start triage lessons in emergency medical students: Virtual reality in medical education. Journal of advances in medical education & professionalism, 10(1), 48-53.
6. Javvaji CK, Reddy H, Vagha JD, Taksande A, Kommareddy A, Reddy NS. Immersive Innovations: Exploring the Diverse Applications of Virtual Reality (VR) in Healthcare. Cureus. 2024 Mar 14;16(3):e56137. doi: 10.7759/cureus.56137. PMID: 38618363; PMCID: PMC11016331.
7. Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev. 2022 Dec;98:102213. doi: 10.1016/j. cpr.2022.102213. Epub 2022 Oct 30. PMID: 36356351.
8. Tortora C, Di Crosta A, La Malva P, Prete G, Ceccato I, Mammarella N, Di Domenico A, Palumbo R. Virtual reality and cognitive rehabilitation for older adults with mild cognitive impairment: A systematic review. Ageing Res Rev. 2024 Jan;93:102146. doi: 10.1016/j.arr.2023.102146. Epub 2023 Nov 28. PMID: 38036103.
9. Chen X, Liu F, Lin S, Yu L, Lin R. Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2022 Jul;103(7):1422-1435. doi: 10.1016/j.apmr.2022.03.012. Epub 2022 Apr 10. PMID: 35417757.
10. Ioannou A, Papastavrou E, Avraamides MN, Charalambous A. Virtual Reality and Symptoms Management of Anxiety, Depression, Fatigue, and Pain: A Systematic Review. SAGE Open Nurs. 2020 Aug 27;6:2377960820936163. doi: 10.1177/2377960820936163. PMID: 33415290; PMCID: PMC7774450.
11. Kiper P, Przysiężna E, Cieślik B, Broniec-Siekaniec K, Kucińska A, Szczygieł J, Turek K, Gajda R, Szczepańska-Gieracha J. Effects of Immersive Virtual Therapy as a Method Supporting Recovery of Depressive Symptoms in Post-Stroke Rehabilitation: Randomized Controlled Trial. Clin Interv Aging. 2022 Nov 23;17:1673-1685. doi: 10.2147/CIA.S375754. PMID: 36447623; PMCID: PMC9701456.
12. Holopainen R, Tiihonen J, Lähteenvuo M. Efficacy of immersive extended reality (XR) interventions on different symptom domains of schizophrenia spectrum disorders. A systematic review. Front Psychiatry. 2023 Aug 4;14:1208287. doi: 10.3389/ fpsyt.2023.1208287. PMID: 37599868; PMCID: PMC10436301.
13. Lundin RM, Yeap Y, Menkes DB. Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review. JMIR Ment Health. 2023 May 5;10:e43240. doi: 10.2196/43240. PMID: 37145841; PMCID: PMC10199391.
14. Bell, I. H., Nicholas, J., Alvarez-Jimenez, M., Thompson, A., & Valmaggia, L. (2020). Virtual reality as a clinical tool in mental health research and practice . Dialogues in clinical neuroscience, 22(2), 169-177.
15. Chung OS, Dowling NL, Brown C, Robinson T, Johnson AM, Ng CH, Yücel M, Segrave RA. Using the Theoretical Domains Framework to Inform the Implementation of Therapeutic Virtual Reality into Mental Healthcare. Adm Policy Ment Health. 2023 Mar;50(2):237-268.
16. Kouijzer MMTE, Kip H, Bouman YHA, Kelders SM. Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings. Implement Sci Commun. 2023 Jun 16;4(1):67. doi: 10.1186/s43058-023-00442-2. PMID: 37328858; PMCID: PMC10276472.
17. Di Liegro CM, Schiera G, Proia P, Di Liegro I. Physical Activity and Brain Health. Genes. 2019; 10(9):720. https://doi.org/10.3390/genes10090720.
18. Mahindru A, Patil P, Agrawal V. Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus. 2023 Jan 7;15(1):e33475. doi: 10.7759/cureus.33475. PMID: 36756008; PMCID: PMC9902068.
19. Ai, X., Yang, J., Lin, Z., & Wan, X. (2021). Mental health and the role of physical activity during the COVID-19 pandemic. Frontiers in psychology, 12, 759987.
20. Yao, L., Fang, H., Leng, W., Li, J., & Chang, J. (2021). Effect of aerobic exercise on mental health in older adults: A meta-analysis of randomized controlled trials. Frontiers in psychiatry, 12, 748257.
21. Giakoni-Ramírez F, Godoy-Cumillaf A, Espoz-Lazo S, Duclos-Bastias D, Del Val Martín P. Physical Activity in Immersive Virtual Reality: A Scoping Review. Healthcare (Basel). 2023 May 25;11(11):1553. doi: 10.3390/healthcare11111553. PMID: 37297694; PMCID: PMC10253075.
22. T Mulder R. The influence of personality on the treatment outcome of psychopathology. World Psychiatry. 2011 Jun;10(2):115-6. PMID: 21633687; PMCID: PMC3104887.
23. Mulder RT. Personality pathology and treat-ment outcome in major depression: a review. Am J Psychiatry. 2002;159:359-371. doi: 10.1176/appi.ajp.159.3.359.
24. Newton-Howes G, Tyrer P, Johnson T, Mulder R, Kool S, Dekker J, Schoevers R. Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. J Pers Disord. 2014 Aug;28(4):577-93. doi: 10.1521/ pedi_2013_27_070. Epub 2013 Nov 20. PMID: 24256103.
25. Fumagalli G, Margola D. Is personality the key in cognitive¬behavioural therapy for eating disorders? A review. Clin Psychol Psychother. 2022 Jan;29(1):164-177. doi: 10.1002/cpp.2627. Epub 2021 Jun 17. PMID: 34110647.
26. Heyn J, Uenze B, Christoph R, Baumann N, Kiesewetter I, Mihatsch L, Luchting B. Personality disorders and outcome after multidisciplinary pain therapy. Chronic Illn. 2023 Sep;19(3):635-645. doi: 10.1177/17423953221110150. Epub 2022 Jul 5. PMID: 35787196.
27. Kandola A, Ashdown-Franks G, Hendrikse J, Sabiston CM, Stubbs B. Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity. Neurosci Biobehav Rev. 2019;107:525-539. doi: 10.1016/j. neubiorev.2019.09.040.
28. Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, Kelly P, Khan S, Utukuri M, Laird Y, Mok A, Smith A, Tainio M, Brage S, Woodcock J. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022 Jun 1;79(6):550-559. doi: 10.1001/jamapsychiatry.2022.0609. PMID: 35416941; PMCID: PMC9008579.
29. Murri MB, Ekkekakis P, Menchetti M, Neviani F, Trevisani F, Tedeschi S, et al. Physical exercise for late-life depression: Effects on symptom dimensions and time course. Journal of Affective Disorders. 2018; 230: 65-70.
30. Depression in adults: treatment and management. London: National Institute for Health and Care Excellence (NICE); 2022 Jun 29. (NICE Guideline, No. 222.)
31. Chen C, Beaunoyer E, Guitton MJ, Wang J. Physical Activity as a Clinical Tool against Depression: Opportunities and Challenges. J Integr Neurosci. 2022 Jul 22;21(5):132. doi: 10.31083/j. jin2105132. PMID: 36137954.
32. Smith PJ, Merwin RM. The Role of Exercise in Management of Mental Health Disorders: An Integrative Review. Annu Rev Med. 2021 Jan 27;72:45-62. doi: 10.1146/annurev¬med-060619-022943. Epub 2020 Nov 30. PMID: 33256493; PMCID: PMC8020774.
33. Veling W, Lestestuiver B, Jongma M, Hoenders HJR, van Driel C. Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial. J Med Internet Res. 2021 Jan 15;23(1):e17233. doi: 10.2196/17233. PMID: 33448933; PMCID: PMC7846446.
34. Riches S, Jeyarajaguru P, Taylor L, Fialho C, Little J, Ahmed L, O'Brien A, van Driel C, Veling W, Valmaggia L. Virtual reality relaxation for people with mental health conditions: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2023 Jul;58(7):989-1007. doi: 10.1007/s00127-022-02417-5. Epub 2023 Jan 20. PMID: 36658261; PMCID: PMC9852806.
35. Zhai K, Dilawar A, Yousef MS, Holroyd S, El-Hammali H, Abdelmonem M. Virtual Reality Therapy for Depression and Mood in Long-Term Care Facilities. Geriatrics (Basel). 2021 Jun 4;6(2):58. doi: 10.3390/geriatrics6020058. PMID: 34199801; PMCID: PMC8293126.
36. Yen HY, Chiu HL. Virtual Reality Exergames for Improving Older Adults' Cognition and Depression: A Systematic Review and Meta-Analysis of Randomized Control Trials. J Am Med Dir Assoc. 2021 May;22(5):995-1002. doi: 10.1016/j. jamda.2021.03.009. Epub 2021 Apr 2. PMID: 33812843.
37. Baniasadi T., Ayyoubzadeh S.M., Mohammadzadeh N. Challenges and Practical Considerations in Applying Virtual Reality in Medical Education and Treatment. Oman Med. J. 2020;35:e125. doi: 10.5001/omj.2020.43.
38. Widyanti, A., & Hafizhah, H. N. (2022). The influence of personality, sound, and content difficulty on virtual reality sickness. Virtual Reality, 26(2), 631-637.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
