Immersive Virtual Reality Therapy as a Support for Cardiac Rehabilitation: A Pilot Randomized-Controlled Trial

Joanna Szczepańska-Gieracha, Sandra Jóźwik, Błażej Cieślik, Justyna Mazurek, Robert Gajda, Joanna Szczepańska-Gieracha, Sandra Jóźwik, Błażej Cieślik, Justyna Mazurek, Robert Gajda

Abstract

Depression and anxiety can significantly reduce the effectiveness of cardiac rehabilitation (CR). Several studies have assessed the effectiveness of virtual reality (VR)-based interventions for symptoms of anxiety and depression; however, they do not relate to patients with heart disease. The aim of this study was to assess the effects of VR therapy on the mental state of patients with coronary artery disease (CAD). Thirty-four CAD patients with elevated anxiety or depression symptoms were recruited. After randomization, 17 participants were assigned to the intervention group, and 17 to the control group. Both groups underwent standard CR for outpatients. In the intervention group, eight VR therapy sessions were applied. In the control group, eight sessions of Schultz' Autogenic Training were applied. To assess patient mental states, Hospital Anxiety and Depression Scale (HADS) and Perception of Stress Questionnaire (PSQ) were used, before and after 4 weeks of CR. In the intervention group, a significant decrease in HADS score was observed (19.46 pretreatment vs. 15.73 post-treatment, p = 0.003), HADS-Anxiety subscale decreased by 16.0 percent (p = 0.01) and HADS-Depression by 23.0 percent (p = 0.003). Similarly, a significant decrease in PSQ was recorded at 12.8 percent (64.73 vs. 56.47, p = 0.03). In the control group, HADS and PSQ data did not change. VR therapy significantly reduced the severity of depressive symptoms, anxiety, and stress levels in CAD patients undergoing CR. Immersive VR therapy effectively supports the CR of individuals with anxiety-depressive symptoms. ClinicalTrials.gov (NCT04045977).

Keywords: anxiety; cardiac rehabilitation; depression; stress; virtual reality.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Study flow diagram.

References

    1. World Health Organization. Cardiovascular diseases (CVDs). ) (accessed Nov. 26, 2019)
    1. Gan Y, Gong Y, Tong X, et al. . Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry 2014; 14:371.
    1. Paine NJ, Watkins LL, Blumenthal JA, et al. . Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. Psychosomatic Medicine 2015; 77:136–144
    1. Huffman JC, Celano CM, Beach SR, et al. . Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovascular Psychiatry and Neurology 2013; 2013:695925.
    1. Hare DL, Toukhsati SR, Johansson P, et al. . Depression and cardiovascular disease: a clinical review. European Heart Journal 2014; 35:1365–1372
    1. Emdin CA, Odutayo A, Wong CX, et al. . Meta-analysis of anxiety as a risk factor for cardiovascular disease. The American Journal of Cardiology 2016; 118:511–519
    1. Batelaan NM, Seldenrijk A, Bot M, et al. . Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. The British Journal of Psychiatry: The Journal of Mental Science 2016; 208:223–231
    1. Chalmers JA, Quintana DS, Abbott MJ-A, et al. . Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Frontiers in Psychiatry 2014; 5:80.
    1. Supervia M, Turk-Adawi K, Lopez-Jimenez F, et al. . Nature of cardiac rehabilitation around the globe. EClinicalMedicine 2019; 13:46–56
    1. Szczepańska-Gieracha J, Morka J, Kowalska J, et al. . The role of depressive and anxiety symptoms in the evaluation of cardiac rehabilitation efficacy after coronary artery bypass grafting surgery. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery 2012; 42:e108–e114
    1. Kustrzycki W, Rymaszewska J, Malcher K, et al. . Risk factors of depressive and anxiety symptoms 8 years after coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery 2012; 41:302–306
    1. Fodor LA, Coteț CD, Cuijpers P, et al. The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis. Scientific Reports 2018; 8:10323.
    1. Cieślik B, Mazurek J, Rutkowski S, et al. . Virtual reality in psychiatric disorders: a systematic review of reviews. Complementary Therapies in Medicine 2020; 52:102480.
    1. Szczepańska-Gieracha J, Cieślik B, Rutkowski S, et al. . What can virtual reality offer to stroke patients? A narrative review of the literature. NeuroRehabilitation 2020; 47:109–120
    1. Whitehead AL, Julious SA, Cooper CL, et al. . Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research 2016; 25:1057–1073
    1. Birckhead B, Khalil C, Liu X, et al. . Recommendations for methodology of virtual reality clinical trials in health care by an International Working Group: iterative Study. JMIR Mental Health 2019; 6:e11973.
    1. Schwickert M, Langhorst J, Paul A, et al. . [Stress management in the treatment of essential arterial hypertension]. MMW Fortschritte der Medizin 2006; 148:40–42; quiz 43.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67:361–370
    1. Bjelland I, Dahl AA, Haug TT, et al. . The validity of the hospital anxiety and depression scale. An updated literature review. Journal of Psychosomatic Research 2002; 52:69–77
    1. Plopa M, Makarowski R. (2010) Kwestionariusz poczucia stersu [The Perception of Stress Questionnaire]. Warsaw: VIZJA Press&IT
    1. Mazurek J, Kiper P, Cieślik B, et al. . Virtual reality in medicine: a brief overview and future directions. Human Movement 2019; 20:16–22
    1. Matthews WJ. Ericksonian approaches to hypnosis and therapy: where are we now? The International Journal of Clinical and Experimental Hypnosis 2000; 48:418–426; discussion 433–437.
    1. Carney RM. The course of emotional distress and late mortality following myocardial infarction: implications for depression screening and treatment. European Journal of Preventive Cardiology 2019; 26:1507–1509
    1. Kim J-M, Bae K-Y, Stewart R, et al. . Escitalopram treatment for depressive disorder following acute coronary syndrome: a 24-week double-blind, placebo-controlled trial. The Journal of Clinical Psychiatry 2015; 76:62–68
    1. Carney RM, Freedland KE. Treatment-resistant depression and mortality after acute coronary syndrome. The American Journal of Psychiatry 2009; 166:410–417
    1. Richards SH, Anderson L, Jenkinson CE, et al. . Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. European Journal of Preventive Cardiology 2018; 25:247–259
    1. Silva JPLN, Novaes LFM, Santos LCR dos, et al. . Effects of conventional and virtual reality cardiovascular rehabilitation in body composition and functional capacity of patients with heart diseases: randomized clinical trial. International Journal of Cardiovascular Sciences 2018; 31:619–629
    1. Penn I-W, Chuang E, Chuang T-Y, et al. . Effects of Virtual-reality-augmented cardiopulmonary rehabilitation programs for patients with cardiovascular diseases: a systemic review. Neuropsychiatry (London) 2018; 8:1630–1636
    1. Shah LBI, Torres S, Kannusamy P, et al. . Efficacy of the virtual reality-based stress management program on stress-related variables in people with mood disorders: the feasibility study. Archives of Psychiatric Nursing 2015; 29:6–13
    1. Navarro-Haro MV, Modrego-Alarcón M, Hoffman HG, et al. . Evaluation of a mindfulness-based intervention with and without Virtual Reality Dialectical Behavior Therapy® mindfulness skills training for the treatment of generalized anxiety disorder in primary care: a pilot study. Frontiers in Psychology 2019; 10:55.
    1. Schultz JH. [Autogenic training in general practice]. Medizinische Klinik 1950; 45:945–949; contd.
    1. Schultz JH. [Psychotherapy and autogenic training]. Arztliche Forschung 1960; 14:I./325–326.
    1. Schultz JH. [The genesis of autogenic training]. Medizinische Klinik 1966; 61:29–31
    1. Schultz JH. [Remark on the report “autogenic training, psychosomatic correlations”]. Der Nervenarzt 1967; 38:317–318
    1. Rager RG. [Treatment of post-myocardial infarct anxiety neuroses by Schultz's autogenic training under sophronisation]. Agressologie: Revue Internationale De Physio-Biologie Et De Pharmacologie Appliquees Aux Effets De L'agression 1970; 11:471–474
    1. Corbellini P, Biasutti B, Maisano G. [The Schultz method of autogenic training in psychological rehabilitation of myocardial infarct patients]. Minerva Cardioangiologica 1979; 27:285–290
    1. De Angelis G, Di Tommaso R. [Autogenic training and ECG. Apropos of a clinical case]. Minerva Medica 1981; 72:1201–1205

Source: PubMed

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