A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

Abstract

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.

Keywords: COVID-19; digital technology; psychological stress; self-help technology; virtual reality; well-being.

Figure 1

Participant flowchart.

Figure 2

‘The Secret Garden’, a 360° virtual reality scenario where participants are immersed in a naturalistic and safe digital place, far from the stressful situations experienced in routine daily contexts, in which they can learn how to relax and reflect upon their experience following a guided protocol.

Figure 3

Bonferroni-adjusted, pairwise comparisons for Depression Anxiety Stress Scale Subscale Depression (DASS_21 Depression, (A) and Subscale Stress (DASS_21 Stress, (B), Depression Anxiety Stress Scale total score General Distress (DASS_21 General Distress, (C), Beck Hopelessness Scale (BHS, (D)), Stress, Perceived Stress Scale (PSS, (E)), Fear of Coronavirus outcome (FCOR, (F)), and Social Connectedness Scale (SCS, (G)) across the different time points. (7 days before the start of the intervention—Waiting Period, before the start of the intervention, Day 0—T0; end of the intervention, Day 7—T1; 2-week follow-up, Day 21—T2). * <0.05; ** <0.01; *** <0.001.

Figure 4

Daily changes in the subjective experience (refreshed feelings, SRSI3-Rest/Refresh; energised feelings; SRSI3-Energised, relaxation SRSI3-Physical relaxation; feelings of peace, SRSI3-At ease/peace; feelings of joy, SRSI3-Joy; mental quiet, SRSI3-Mental quiet; mental awareness, SRSI3-Aware; somatic stress, SRSI3-Somatic stress; emotional stress, SRSI3- Emotional stress; cognitive stress, SRSI3-Cognitive stress; anxiety level, State–Trait Anxiety Inventory-State—STAI-S; discomfort, Subjective Units of Distress Scale SUDS). State measures collected each day during the waiting week (7 days before the start of the intervention) and during the intervention phase, after each treatment module. Mean and 95% CI are depicted in the graphs.

Figure 5

Jacobson plot depicting the 95% CI of the RCI between the blue lines and the CSC cutoff for pre- and post-test between the green lines. Blue dots represent participants who did not have a reliable change between pre and post measures. Red dots represent individuals who had a reliable deterioration between the two time points. Green dots are participants who showed a reliable improvement between the two measures. Green dots falling in the bottom-right section of the rectangle delimited by the green horizontal and vertical lines are participants with a reliable change plus a CSC. Green dots falling in the bottom-left section of the rectangle delimited by the green horizontal, and vertical lines are participants who already have high scores to show a CSC. RCI: reliable change index; CSC: clinically significant change.