J. Med. Internet Res. - Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.


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CKGROUND: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress.OBJECTIVE: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).METHODS: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation.RESULTS: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs. CG=0.5%) in chronic "trait" anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill.CONCLUSIONS: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).

Resumo Limpo

ckground recent converg technolog medicin offer innov method tool behavior health care among emerg approach use virtual realiti vr within exposurebas protocol anxieti disord particular posttraumat stress disord howev systemat test vr protocol avail manag psycholog stressobject goal evalu efficaci new technolog paradigm interr manag prevent psycholog stress main featur interr twofold link virtual real world achiev experienti virtual scenario fulli control therapist use learn cope skill improv selfefficaci realtim monitor support identifi critic situat assess clinic chang use advanc technolog virtual world wearabl biosensor smartphonesmethod studi design block random control trial involv particip recruit two differ worker populationsteach nursesthat high expos psycholog stress particip sampl teacher recruit milan block n sampl nurs recruit messina itali block n particip within block random assign experiment group eg n b b receiv week treatment base interr paradigm control group cg n b b receiv week tradit stress manag train base cognit behavior therapi cbt waitlist group wl n b b reassess compar two group week initi evaluationresult although treatment abl signific reduc perceiv stress better wl eg particip report signific reduct eg vs cg chronic trait anxieti similar pattern found cope skill treatment abl signific increas cope skill eg particip report signific increas eg vs cg emot support skillconclus find provid initi evid interr protocol yield better outcom tradit accept gold standard psycholog stress treatment cbt consequ find constitut sound foundat rational import continu futur research technologyenhanc protocol psycholog stress managementtri registr clinicaltrialsgov nct httpclinicaltrialsgovshownct archiv webcit httpwwwwebcitationorgqnzihvh

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