Personalized, Naturalistic Virtual Reality Scenarios Coupled With Web-Based Progressive Muscle Relaxation Training for the General Population: Protocol for a Proof-of-Principle Randomized Controlled Trial

Abstract

Background: Virtual reality (VR) is an innovative tool that can facilitate exposure to either stressful or relaxing stimuli and enables individuals who have difficulties visualizing scenes to be involved in a more realistic sensorimotor experience. It also facilitates multisensory stimulation, a sense of presence, and achievement of relaxation. VR scenarios representing visual and auditory elements of natural relaxing environments can facilitate the learning of relaxation techniques such as the progressive muscle relaxation technique (PMRT). A complementary standardized technique deployed to reduce anxiety symptoms is the integration of PMRT and guided imagery (GI). Exposure to a pleasant imaginary environment helps the establishment of an association between a relaxing scenario and the relaxation technique, consequently promoting relaxation. Empirical evidence has shown that VR scenarios can increase the effects of relaxation techniques by enabling people to experience emotional conditions in more vivid settings.

Objective: The main aim of this pilot study protocol is to investigate the impact on state anxiety of PMRT, associated with a personalized relaxing scenario in VR, and the role of VR scenarios in facilitating the recall of relaxing images and a sense of presence. A secondary aim is to understand if relaxing sessions administered via Zoom are more effective for managing anxiety and stress than a procedural setting based on audio-track guidance.

Methods: Based on a longitudinal, between-subject design, 108 university students will be randomly exposed to one of three experimental conditions: (1) PMRT via Zoom and GI exposure, (2) PMRT via Zoom and personalized VR exposure, and (3) PMRT based on audio-track guidance and personalized VR exposure. Individuals are assessed before and after 7 training sessions based on self-report questionnaires investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data are also detected by an Mi Band 2 sensor.

Results: The experimental procedure is ongoing. In this paper, preliminary data from a sample of 40 participants will be illustrated. The experimental phase is expected to conclude in May 2023, and the final results of the research will be presented in June 2023.

Conclusions: The results of this study will help shape the experimental design to apply it on a subsequent randomized controlled trial, also considering clinical samples. This work is expected to measure whether VR is a more engaging and helpful technique in promoting relaxation and decreasing anxiety levels than GI, by making the visualization process easier and by helping people to face more realistic sensory experiences. Assessing the efficacy of the PMRT in alternative delivery modes may extend its applications, especially in situations where the standard procedure is more challenging to be administered. To our knowledge, no equivalent study has been published so far on this matter.

Trial registration: ClinicalTrials.gov NCT05478941; https://clinicaltrials.gov/ct2/show/NCT05478941.

International registered report identifier (irrid): DERR1-10.2196/44183.

Keywords: anxiety; coping; depression; digital health; e-Health; e-therapy; mental well-being; progressive muscular relaxation technique; quality of life; relaxation; symptoms; tool; virtual reality; virtual reality therapy.

Figure 1

Consolidated Standards Of Reporting Trials 2010 flowchart. GI: guided imagery; PMRT: progressive muscle relaxation technique; VR: virtual reality.

Figure 2

Graphic description of the activities carried out during the Active Comparator condition: progressive muscle relaxation technique (PMRT) training via Zoom and guided imagery (GI) exposure.

Figure 3

Graphic description of the activities carried out during the Intervention A: PMRT training administered via Zoom integrated with a personalized virtual reality exposure deployed by a head-mounted display (Oculus Quest 2). GI: guided imagery; PMRT: progressive muscle relaxation technique.

Figure 4

Graphic description of the activities carried out during the Intervention B: PMRT training administered based on the Moodle platform via an audio-track integrated with a personalized virtual reality exposure deployed by a head-mounted display (Oculus Quest 2). GI: guided imagery; PMRT: progressive muscle relaxation technique.