TY  - JOUR
AU  - Gaggioli, Andrea
AU  - Pallavicini, Federica
AU  - Morganti, Luca
AU  - Serino, Silvia
AU  - Scaratti, Chiara
AU  - Briguglio, Marilena
AU  - Crifaci, Giulia
AU  - Vetrano, Noemi
AU  - Giulintano, Annunziata
AU  - Bernava, Giuseppe
AU  - Tartarisco, Gennaro
AU  - Pioggia, Giovanni
AU  - Raspelli, Simona
AU  - Cipresso, Pietro
AU  - Vigna, Cinzia
AU  - Grassi, Alessandra
AU  - Baruffi, Margherita
AU  - Wiederhold, Brenda
AU  - Riva, Giuseppe
PY  - 2014
DA  - 2014/07/08
TI  - Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e167
VL  - 16
IS  - 7
KW  - psychological stress
KW  - Interreality
KW  - virtual reality
KW  - biosensors
KW  - heart rate
KW  - heart rate variability
KW  - biofeedback training
KW  - relaxation training
KW  - physiological monitoring
KW  - smartphones
AB  - Background: 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). 
SN  - 1438-8871
UR  - http://www.jmir.org/2014/7/e167/
UR  - https://doi.org/10.2196/jmir.3235
UR  - http://www.ncbi.nlm.nih.gov/pubmed/25004803
DO  - 10.2196/jmir.3235
ID  - info:doi/10.2196/jmir.3235
ER  -