The potential of virtual reality as anxiety management tool: a randomized controlled study in a sample of patients affected by generalized anxiety disorder

Abstract

Background: Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by a constant and unspecific anxiety that interferes with daily-life activities. Its high prevalence in general population and the severe limitations it causes, point out the necessity to find new efficient strategies to treat it. Together with the cognitive-behavioural treatments, relaxation represents a useful approach for the treatment of GAD, but it has the limitation that it is hard to be learned. To overcome this limitation we propose the use of virtual reality (VR) to facilitate the relaxation process by visually presenting key relaxing images to the subjects. The visual presentation of a virtual calm scenario can facilitate patients' practice and mastery of relaxation, making the experience more vivid and real than the one that most subjects can create using their own imagination and memory, and triggering a broad empowerment process within the experience induced by a high sense of presence. According to these premises, the aim of the present study is to investigate the advantages of using a VR-based relaxation protocol in reducing anxiety in patients affected by GAD.

Methods/design: The trial is based on a randomized controlled study, including three groups of 25 patients each (for a total of 75 patients): (1) the VR group, (2) the non-VR group and (3) the waiting list (WL) group. Patients in the VR group will be taught to relax using a VR relaxing environment and audio-visual mobile narratives; patients in the non-VR group will be taught to relax using the same relaxing narratives proposed to the VR group, but without the VR support, and patients in the WL group will not receive any kind of relaxation training. Psychometric and psychophysiological outcomes will serve as quantitative dependent variables, while subjective reports of participants will be used as qualitative dependent variables.

Conclusion: We argue that the use of VR for relaxation represents a promising approach in the treatment of GAD since it enhances the quality of the relaxing experience through the elicitation of the sense of presence. This controlled trial will be able to evaluate the effects of the use of VR in relaxation while preserving the benefits of randomization to reduce bias.

Trial registration: NCT00602212 (ClinicalTrials.gov).

Figures

Figure 1

The Procomp Infiniti System. a) the Procomp Infiniti control box; b) the Skin Conductance Response sensors; c) the Electromyography sensor; d) the Blood Volume Pulse sensor; e) the Respiration sensor.

Figure 2

The virtual reality equipment. a) the Head Mounted Display, Sony Glasstron PLM S-700; b) the position tracker, Intersense Intertrax2 256 Hz.

Figure 3

A screenshot from NeuroVR (V. 1.5). The Green Valley is the virtual environment used to facilitate relaxation in the VR group.

Figure 4

A screenshot from NeuroVR (V. 1.5). The figure illustrates a virtual kitchen, one of the stressful environments showed to the patients during the last week of treatment.

Figure 5

Form of self-observation of early anxiety signals (adapted from Ost, 1987).

Figure 6

Form for registration of homework relaxation training (adapted from Ost, 1987).