Managing anxiety with virtual reality. A research study with older patients kicks off
The goal is to test whether new technology-based therapies (virtual reality using an optical visor) can provide a more precise and personalized response to the problem of managing anxiety in seniors with impaired cognitive functions.
The feasibility study, among the first of its kind in Italy, plans to involve the facility’s residents in the coming months to test the technology and is part of the collaboration established between Fondazione Bruno Kessler/TrentinoSalute4.0 and the “Margherita Grazioli” public personal services agency in Povo (TN).
Starting next week, a group of users, selected on the basis of special requirements and in agreement with the healthcare staff of the APSP Grazioli nursing home, will be able to enjoy a pleasant and relaxing experience, and explore firsthand a 3D virtual space created and adapted to personal preferences. Thanks to the high degree of involvement that a visor (“Oculus”) worn in front of one’s eyes provides, the user will be able to experience immersion in a 360 multisensory environment (reconstructed with a computer) in a relaxing setting (the sea, the mountains, the countryside, etc.). In fact, the virtual reality into which the seniors will dive makes use of videos, music, and sound effects chosen by the user (such as birds chirping, wind, sea waves, and other environmental sounds), and offers the possibility of seeing the places full of memories that can no longer be physically visited, increasing the desire to share one’s experience.
If the results of the trial are positive, the study, which will take place over the next two months, will bring benefits for both users and the host facility.
For the elderly, the possible benefits relate to the fact that the solution – in the intentions – allows them to reduce state anxiety without the use of drugs and, thanks to involvement in an immersive activity that brings back pleasant and relaxing moments, increases general well-being. For APSP Grazioli, digital therapy offers an opportunity to provide increasingly better and modern services to its users and allows health care providers to collaborate in researching innovative care methods for improving citizens’ quality of life.
The investigation into the effects of using virtual reality on the elderly was approved by the APSS Ethics Committee and is the subject of the doctoral thesis of Susanna Pardini, Ph.D., a psychologist and cognitive-behavioral psychotherapist at the Department of General Psychology-University of Padua and Fondazione Bruno Kessler. “Several national and international studies in this area” – she explains-“have shown that experiences with Virtual Reality (VR) and Augmented Reality (AR) constitute an important tool for the management of various behavioral and cognitive symptoms related to cognitive impairment, and have demonstrated their effectiveness in increasing well-being, improving patients’ quality of life.” “Some of these technologies,” Pardini adds, “have already demonstrated their effectiveness in the literature, and substantial reductions in loneliness, depression, and motor problems have also been found.”
Susanna Pardini’s research is part of the actions planned by TrentinoSalute4.0, a center of competence for the development of digital health, established by PAT with APSS and FBK (through its center dedicated to Digital health and wellbeing), which aim at the development of a Health Care 4.0 by involving professionals in the field, people and the community in a “joint laboratory” where to test the opportunities offered by research and new digital technologies.
- [YouTube VIDEO here] How we developed the virtual reality project (3’:27’’)
The use of immersive virtual scenarios has recently been investigated (Tak et al., 2015) to implement interventions to improve the quality of life of people in elderly care facilities showing a positive impact on anxiety, depression, and apathy as well as enabling the overcoming of some of the barriers that can sometimes hinder participation in recreational activities or accessing pleasant and relaxing settings. Exposure to immersive virtual environments has shown to be a promising avenue focused on reducing isolation and increasing engagement in activities that promote well-being (McMaster University, 2019).
Virtual reality devices include technologies that expose the user to multisensory stimulation and are able to promote different levels of “immersion” within the context.
Recent studies have investigated the feasibility of using relaxing virtual environments in promoting positive emotions, engagement, and a general state of well-being, as well as managing negative emotions such as boredom, apathy, anxiety, and a sense of isolation (e.g., Tribemix, 2016; Appel et al., 2020). From a quality standpoint, positive feedback associated with the experience was received in addition to the perception of an increased state of relaxation. In addition, there was evidence of an increase in the intensity and frequency of positive emotions experienced and a reduction in the levels of some negative emotions. The authors’ conclusion is that the exposure of people with cognitive and physical impairment to virtual reality-based realistic and natural immersive scenarios via visor is safe and feasible, also suggesting the conduct of future studies that include among the objectives the investigation of the role of personalization of the content presented in the virtual context.
To involve a sample of seniors from the A.P.S.P. Margherita Grazioli in Povo, who present impairment in cognitive functions and to investigate, at a proof-of-concept and feasibility level, whether the intervention can be implemented by assessing the impact related to the use of the visor, the degree of involvement, the pleasure related to the use experience so as to understand whether the experimental procedure may merit subsequent more rigorous investigations, in terms of assessment of clinical and statistical effectiveness, with the implementation of randomized controlled trials. In addition, the intent is to preliminarily investigate whether exposure to customizable relaxing virtual environments may have a positive impact on state anxiety (Czajkowski et al., 2015).
The study will take place at the APSP “Margherita Grazioli” in Povo (Trento, Italy).
Study period: January-February 2023
The collaboration between the Azienda Pubblica di Servizi alla Persona “Margherita Grazioli” in Povo and FBK was signed in July 2022, has a duration of three years, and aims at activating the collaboration in the field of research and development aimed at identifying, processing and activating specific projects in the following areas:
- – initiation of pilot studies for the design and testing of solutions based on Virtual Reality in the field of prevention and promotion of mental well-being (e.g., anxiety, depression) of APSP Margherita Grazioli residents
- – design, implementation and validation of digital solutions for the provision of online services to users of APSP Margherita Grazioli.
For FBK: Stefano Forti (Director of the Digital Health and Wellbeing Center)
For APSP “Margherita Grazioli”: Patty Rigatti (director)
Susanna Pardini (doctoral student at Department of General Psychology-University of Padua and Fondazione Bruno Kessler, psychologist, cognitive-behavioral psychotherapist), Marco Dianti (technologist at Digital Health Lab/FBK who developed the 3D models with 3D view), Patty Rigatti (director, general A.P.S.P. Margherita Grazioli, Povo, TN), Lucia Leonardelli (coordinator, Social Area and Nucleo Demenze A.P.S.P. Margherita Grazioli, Povo, TN)
Ethics Committee: clinical protocol approved by the Ethics Committee of the Azienda provinciale per i Servizi Sanitari (APSS)
Participants: Convenience sample composed of a minimum of 15 and a maximum of 60 participants with different levels of cognitive functioning impairment (mild, moderate, advanced) (Folstein et al., 1975), recruited from within the Azienda Pubblica di Servizi alla Persona “Margherita Grazioli,” Povo (Trento, Italy).
Virtual reality: through the Oculus Quest 2 visor, participants will be exposed to a series of auditory and visual stimuli typical of customized realistic natural contexts (3D models with 3D views). Once the context has been chosen, participants will try the experience within the virtual environment for about 8 minutes.
Expected results: evidence of a significant reduction based on quantitative data analysis considering cut-off scores of anxiety associated with using customized virtual reality environments that replicate natural contexts in addition to the detection of a state of pleasantness, engagement, and agility from using the viewer and from being exposed to the virtual environments under study.
Ethical aspects: all data, parameters and management methods considered in the study and the planned processes were identified by a technical-scientific committee, composed of health professionals/contact people from the centers involved in the study.