Luca Bernardelli

Transformative experiences (TEs) are brief and profound experiences that can lead to significant changes in self-perception and emotional understanding. Recent literature suggests that immersive virtual reality (VR), through its properties such as sensory immersion and sense of presence, can be a powerful tool to elicit TEs. This experimental study aimed to investigate the transformative potential of a VR-TE compared to a traditional media-based TE (audio-TE) on epistemic expansion (broadening one’s understanding) and positive emotions (PEs). The role of individual differences, such as mindful attention, engagement with beauty, and gender, was also explored. Seventy-eight young adults from Italy and Spain, aged 18–30, were randomly assigned to either a VR or audio-TE condition. The VR-TE group experienced a 10-minute virtual TE (a metaphorical journey in a natural setting), whereas the audio-TE group heard the same narrative without visuals. Both groups completed questionnaires before (t0) and after the intervention (t1). Student’s t-test showed that the VR-TE group reported significantly higher epistemic expansion (p = .020) and greater increases in PEs at t1, especially in self-transcendent PEs such as awe (p < .001) and hope (p < .001) compared to the audio-TE group. These effects emerged regardless of participants’ gender, baseline mindful attention, or engagement with beauty (epistemic expansion: ANCOVA, F(1,73) = 7.99, p < .006, partial η² = 0.09; PEs: MANCOVA, F(8,65) = 4.18, p < .001, partial η² = 0.34), suggesting that VR’s capacity to induce transformative states may transcend these individual differences. This study contributes to the growing body of research on technology-mediated transformation and offers insights for designing personalized VR interventions aimed at enhancing personal growth, reflection, and psychological well-being. Future research should investigate the long-term effects of VR-based transformative experiences and explore their applicability across diverse and clinical populations.

[This corrects the article DOI: 10.2196/50326.].

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).

Background: Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist’s office or hospitals) and content (ie, virtual experiences only for relaxation). Objective: This randomized pilot trial aims to investigate the efficacy and acceptability of a brief remote VR-based training for supporting stress and anxiety management in a sample of Italian health care workers. Methods: A total of 29 doctors and nurses (n=21; 72% female; mean age 35.6, SD 10.3 years) were recruited and randomized to a VR intervention group or a control group in a passive control condition. Participants assigned to the VR intervention group received remote VR-based training consisting of 3 sessions at home delivered in 1 week using the VR psychoeducational experience “MIND-VR” and the 360° relaxing video “The Secret Garden.” The primary outcome measures were stress, anxiety, depression, and the knowledge of stress and anxiety assessed at baseline and posttreatment. We also evaluated the immediate effect of the remote VR-based training sessions on the perceived state of anxiety and negative and positive emotions. The secondary outcome measure was the usability at home of the VR system and content. Results: The VR intervention significantly reduced stress levels as assessed by the Perceived Stress Scale (6.46, 95% CI 2.77 to 10.5; P=.046) and increased the knowledge of stress and anxiety, as evaluated by the ad hoc questionnaire adopted (–2.09, 95% CI –3.86 to –0.529; P=.046). However, the home-based VR training did not yield similar reductions in stress, anxiety, and depression levels as assessed by the Depression, Anxiety, and Stress Scale-21 items or in trait anxiety as evaluated through the State-Trait Anxiety Inventory Form Y-1. After the home training sessions with VR, there was a significant decrease in anxiety, anger, and sadness and an increase in happiness levels. Analyses of the questionnaires on usability indicated that the health care workers found using the VR system at home easy and without adverse effects related to cybersickness. Of 33 participants, 29 (88%) adhered to the protocol. Conclusions: The results of this randomized pilot study suggest that a week-long home VR intervention, created with content created specifically for this purpose and available free of charge, can help individuals manage stress and anxiety, encouraging further research investigating the potential of remote VR interventions to support mental health. Trial Registration: ClinicalTrials.gov NCT04611399; https://tinyurl.com/scxunprd

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Chronic respiratory diseases (CRDs) are widespread pathologies that cause non-reversible airflow limitations as well as a variety of extrapulmonary adverse effects. For these reasons, these pathologies are related to frequent hospitalizations and, consequently, high levels of anxiety, depression, and stress. In this respect, relaxation in Virtual Reality (VR) integrated with savoring, which is the ability to generate and amplify positive emotions, can be used to increase well-being and relaxation in CRDs patients. Objective: This pilot randomized controlled trial aimed to investigate the effectiveness of a two-week VR-based relaxation intervention integrated with savoring in CRDs patients in increasing emotional and psychological well-being, positive emotions, relaxation, oxygen saturation levels (SpO2) and decreasing negative emotions. Methods: This study involved 45 hospitalized CRDs patients from the Pulmonary Rehabilitation Unit of IRCCS INRCA Casatenovo. Alongside traditional pulmonary rehabilitation, the experimental group (N = 23) took part in the four-session VR-based intervention, while the active control group (N = 22) listened to relaxing music. In each session, the experimental group experienced a relaxing virtual scenario followed by a savoring exercise. Both groups filled out the self-reported questionnaires before the intervention (T0), after (T1), and in the one-month follow-up (T2), and before and after each session. The experimental group's VR acceptance and sense of presence were also measured. Results: Regarding the primary outcomes, taking T0 and T1 into account, repeated measures ANCOVAs revealed a significant increase for the experimental group in emotional and psychological well-being, positive emotions, relaxation, and a significant decrease in negative emotions compared to the control group. The psychological changes were maintained at T2. Concerning secondary outcomes, patients reported high VR acceptance and sense of presence. Conclusions: These results suggest that relaxation VR integrated with savoring can promote well-being and reduce clinical symptoms not only in the post-intervention, but also in the long term. Indeed, savoring can amplify the positive effects of relaxing VR and help patients to focus and amplify their positive experiences, thus counteracting the negative psychological consequences of CRDs. Clinical Trial: anzctr.org, ACTRN12624000435583; https://www.anzctr.org.au/ACTRN12624000435583.aspx (retrospectively registered). This study was approved by the Ethics Committee of the IRCCS INRCA Casatenovo but for administrative issues the trial registration was no completed prospectively. The registration was therefore completed retrospectively before data analysis and paper writing.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist’s office or hospitals) and content (ie, virtual experiences only for relaxation). Objective: This randomized pilot trial aims to investigate the efficacy and acceptability of a brief remote VR-based training for supporting stress and anxiety management in a sample of Italian health care workers. Methods: A total of 29 doctors and nurses (n=21; 72% female; mean age 35.6, SD 10.3 years) were recruited and randomized to a VR intervention group or a control group in a passive control condition. Participants assigned to the VR intervention group received remote VR-based training consisting of 3 sessions at home delivered in 1 week using the VR psychoeducational experience “MIND-VR” and the 360° relaxing video “The Secret Garden.” The primary outcome measures were stress, anxiety, depression, and the knowledge of stress and anxiety assessed at baseline and posttreatment. We also evaluated the immediate effect of the remote VR-based training sessions on the perceived state of anxiety and negative and positive emotions. The secondary outcome measure was the usability at home of the VR system and content. Results: The VR intervention significantly reduced stress levels as assessed by the Perceived Stress Scale (6.46, 95% CI 2.77 to 10.5; P=.046) and increased the knowledge of stress and anxiety, as evaluated by the ad hoc questionnaire adopted (–2.09, 95% CI –3.86 to –0.529; P=.046). However, the home-based VR training did not yield similar reductions in stress, anxiety, and depression levels as assessed by the Depression, Anxiety, and Stress Scale-21 items or in trait anxiety as evaluated through the State-Trait Anxiety Inventory Form Y-1. After the home training sessions with VR, there was a significant decrease in anxiety, anger, and sadness and an increase in happiness levels. Analyses of the questionnaires on usability indicated that the health care workers found using the VR system at home easy and without adverse effects related to cybersickness. Of 33 participants, 29 (88%) adhered to the protocol. Conclusions: The results of this randomized pilot study suggest that a week-long home VR intervention, created with content created specifically for this purpose and available free of charge, can help individuals manage stress and anxiety, encouraging further research investigating the potential of remote VR interventions to support mental health. Trial Registration: ClinicalTrials.gov NCT04611399; https://tinyurl.com/scxunprd