VIRTUAL REALITY IN THE PRACTICE OF MINDFULNESS IN PSYCHOTHERAPY: A NARRATIVE REVIEW

Paula, Dirce Maria Bengel de; Moretti, Luciana

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ARTICLE • Psicol. Estud. 26 • 2021 • https://doi.org/10.4025/psicolestud.v26i0.46410 copy

VIRTUAL REALITY IN THE PRACTICE OF MINDFULNESS IN PSYCHOTHERAPY: A NARRATIVE REVIEW

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ABSTRACT

The association between mindfulness (MF) and Virtual Reality (VR) is recent. MF has been used in psychotherapy due to the therapeutic effects reported. However, not all patients are able to obtain the benefits of this resource, and VR becomes a way to work with MF as it facilitates the sense of presence. This paper presents a narrative review of the literature about therapeutic uses of VR in the practice of MF. A total of 23 complete papers were analyzed, being the main research focuses: the improvement of immersive ecosystems and therapeutic resources in the context of MF in relation to the user experience; the development of economic technological resources; easy to handle material to facilitate the user experience. We concluded that VR can be a facilitator as a tool in the treatment of patients who could benefit from MF-informed therapy, although controlled studies are needed to understand the specificities of VR and the variables with therapeutic value.

Keywords:
Mindfulness; virtual reality; narrative review

Ref.	Type, population, sample	Comments
Amores & Maes (2017Amores, J; & Maes, P. (2017). Essence: olfactory interfaces for unconscious influence of mood and cognitive performance. In Proceedings of the 17 Conference on Human Factors in Computing Systems (p. 28-34). Denver, CO: Association for Computing Machinery. doi: 10.1145/3025453.3026004 https://doi.org/10.1145/3025453.3026004... )	pilot comparative study; non-clinical; n = 12	Viability of VR+NFB and olfactory necklace for MF. Physiological response measured with EEG compatible to subjective perception of relaxation.
Baños et al, (2011Baños, R. M; Guillen, V; Quero, S; García-Palacios, A; Alcaniz, M; & Botella, C. (2011). A virtual reality system for the treatment of stress-related disorders: a preliminary analysis of efficacy compared to a standard cognitive behavioral program. International Journal of Human-Computer Studies, 69(9), 602-613. doi: 10.1016/j.ijhcs.2011.06.002 https://doi.org/10.1016/j.ijhcs.2011.06.... )	RCT; clinical; n = 39	Significant differences (depression, relaxation and social interferences). Greater efficiency of the VR condition.
Botella et al, (2013Botella, C; García-Palacios, A; Vizcaíno, Y; Herrero, R; Baños, R. M; & Belmonte, M. A. (2013). Virtual reality in the treatment of fibromyalgia: a pilot study. Cyberpsychol Behavior and Social Networking, 16(3), 215-223. doi: 10.1089/cyber.2012.1572 https://doi.org/10.1089/cyber.2012.1572... )	pre-post pilot study, 6-month monitoring; clinical; n = 6	Efficiency of adaptive virtual environment with TCC in fibromyalgia in group MF. Long-term benefits with significant decrease of pain and depression.
Bruggeman & Wurster (2018Bruggeman, K. J; & Wurster, S. W. (2018). The hiatus system: virtual healing spaces: low dose mindfulness based stress reduction virtual reality application. In Proceedings of the 18th Special Interest Group on Computer Graphics and Interactive Techniques Conference (p. 1-2). Vancouver, CA: Association for Computing Machinery. doi: 10.1145/3213779.3213785 https://doi.org/10.1145/3213779.3213785... )	prototype	Describe a prototype of MBSR with VR and Biofeedback (breath).
Chen et al, (2018Chen, X. J; Wang, D. M; Zhou, L. D; Winkler, M; Pauli, P; Sui, N; & Li, Y. H. (2018). Mindfulness-based relapse prevention combined with virtual reality cue exposure for methamphetamine use disorder: study protocol for a randomized controlled trial. Contemporary Clinical Trials, 70(1), 99-105.)	RCT; clinical; n = 180	Effects of mindfulness-based relapse prevention (MBRP) + VRET. Ongoing during this review.
Cikajlo, Čižman-Štaba, Vrhovac, Larkin, & Roddy (2016Cikajlo, I; Čižman-Štaba, U; Vrhovac, S; Larkin, F, & Roddy, M. (2016). ReCoVR: realising collaborative virtual reality for wellbeing and self-healing. In Proceedings of the 3rd IASTED International Conference (p. 11-17). Zurich, CH: The International Association of Science and Technology for Development. doi: 10.2316/P.2016.846-008 https://doi.org/10.2316/P.2016.846-008... )	controlled; clinical and non-clinical; n = 8	The results in MF were obtained in less time than the traditional MBSR.
Cikajlo, Čižman-Štaba, Vrhovac, Larkin, & Roddy (2017Cikajlo, I; Čižman-Štaba, U; Vrhovac, S. Larkin, F; & Roddy, M. (2017). A Cloud-based virtual reality app for a novel telemindfulness service: rationale, design and feasibility evaluation. JMIR Research Protocols, 6(6), e108. doi: 10.2196/resprot.6849 https://doi.org/10.2196/resprot.6849... )	controlled; clinical and non-clinical; n = 8	Viability of remote VRMF in brain injury. They reported vital satisfaction, better MAAS scores and movements decrease during VRMF.
Falconer et al, (2014Falconer, C. J; Slater, M; Rovira, A; King, J. A; Gilbert, P; Antley, A; & Brewin, C. R. (2014). Embodying compassion: a virtual reality paradigm for overcoming excessive self-criticism. PloS One, 9(11), e111933. doi: 10.1371/journal.pone.0111933 https://doi.org/10.1371/journal.pone.011... )	pilot comparative study on conditions; clinical; n = 43	VR as an embodiment technique as in the recipient position increases self-compassion in people high in self-criticism.
Falconer et al, (2016Falconer, C. J; Slater, M; Rovira, A; King, J. A; Gilbert, P; Antley, A; … Brewin, C. R. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. BJPsych Open, 2(1), 74-80. doi: 10.1192/bjpo.bp.115.002147 https://doi.org/10.1192/bjpo.bp.115.0021... )	comparative; clinical; n=15	Significant decreases on the severity of depression and self-criticism, increase on self-pity in 4 weeks.
Gomez et al, (2017Gomez, J; Hoffman, H. G.; Bistricky, S. L; Gonzalez, M; Rosenberg, L; Sampaio, M; ... Linehan, M. M. (2017). The use of virtual reality facilitates dialectical behavior therapy® “Observing sounds and visuals” mindfulness skills training exercises for a latino patient with severe burns: a case study. Frontiers in Psychology, 8(1), 1-8.)	single case; clinical; n = 1	VRMF in DBT for emotional regulation in patient with severe burns. Decrease of negative emotions and increase of positive ones, good acceptance.
Kosunen et al, (2016Kosunen, I; Salminen, M; Järvelä, S; Ruonala, A; Ravaja, N; & Jacucci, G. (2016). Relaworld: neuroadaptive and immersive virtual reality meditation System. InProceedings of the 21st International Conference on Intelligent User Interfaces(p. 208-217). ACM, Association for Computing Machinery.)	Comparative; non-clinical; n = 43	Neuroadaptive system combined with neurofeedback and VRMF. It is concluded that Relaword can provide deeper levels of meditation, relaxation and presence in VR+NFB condition.
Modrego-Alarcón et al, (2016)	Review; n = 10	Analyses 10 articles on VR to enhance mindfulness. Pilot projects with small samples.
Navarro-Haro et al, (2017Navarro-Haro, M. V ; López-Del-Hoyo, Y; Campos, D; Linehan, M. M ; Hoffman, H. G ; García-Palacios, A; … García-Campayo, J. (2017). Meditation experts try virtual reality mindfulness: a pilot study evaluation of the feasibility and acceptability of virtual reality to facilitate mindfulness practice in people attending a mindfulness conference. PLoS ONE, 12(11): e0187777. doi.org/10.1371/journal.pone.0187777 https://doi.org/10.1371/journal.pone.018... )	pilot; uncontrolled; non-clinical; n = 44	Acceptability by experienced mediators and perception of benefits from VRMF to DBT. Satisfaction, improvement in MF condition and emotional condition.
Serra-Pla et al (2017Serra-Pla, J. F; Pozuelo, M; Richarte, V; Corrales, M; Ibanez, P; Bellina, M; ... Ramos-Quiroga, J. A. (2017). Tratamiento del trastorno por deficit de atención/hiperactividad en la edad adulta a traves de la realidad virtual mediante un programa de mindfulness. Revista de Neurología, 64(s01), S117-S122. doi: https://doi.org/10.33588/ rn.64s01.2017022 https://doi.org/10.33588/ rn.64s01.20170...	comparative; clinical; n = 25	Intervention to TDAH in adults based on VRMF seeking for treatment adherence and cost reduction. Ongoing during review.
Navarro-Haro et al (2016Navarro-Haro, M. V; Hoffman, H. G; Garcia-Palacios, A; Sampaio, M ; Alhalabi, W; Hall, K; & Linehan, M. (2016). The use of virtual reality to facilitate mindfulness skills training in dialectical behavioral therapy for borderline personality disorder: a case study. Frontiers in Psychology, 7(1), 1-9. doi: 10.3389/fpsyg.2016.01573 https://doi.org/10.3389/fpsyg.2016.01573... )	single case; clinical; n = 1	Clinical potential of VRMF in Borderline Personality Disorder. VR can facilitate MF skills in DBT. Studies required on results durability and efficiency to TPL.
Prpa, Cochrane, & Riecke (2015Prpa, M; Cochrane, K; & Riecke, B. E. (2015). Hacking alternatives in 21st century: Designing bio-responsive virtual environment for stress reduction. In Proceedings 5th International Conference (p. 34-39). Milan, IT: MindCare.)	prototype	Prototype of VRMF with biofeedback (SOLAR) considering non-identification, abstract visual elements, reward system and immersion.
Schroeder el tal. (2013Schroeder, D; Korsakov, F; Jolton, J; Keefe, F. J; Haley, A; & Keefe, D. F. (2013). Toward a next generation of widely accessible spatial interfaces: mobile vr environments for patients with persistent pain. IEEE Computer Graphics and Applications, 33(3), 82-89. doi: 10.1109/MCG.2013.38 https://doi.org/10.1109/MCG.2013.38... )	protutype	Multimodal prototype of VR with haptic devices for chronic pain with sensorial feedback. It is viable to develop experiences by using low-cost VR.
Shaw, Gromala, & Song (2012Shaw, C; Gromala, D; & Song, M. (2012). The meditation chamber: towards self-modulation. In G. Mura, Metaplasticity in virtual worlds: aesthetics and semantic concepts (p. 121-133). doi: 10.4018/978-1-60960-077-8.ch007 https://doi.org/10.4018/978-1-60960-077-... )	discussion and prototype; non-clinical; n = 411	VRMF+biofeedback system for chronic pain. It combines Jacobson relaxation and biofeedback. VR optimizes relaxation learning when physiological measures are observed.
Tarrant, Viczko, & Cope (2018aTarrant, J; Viczko, J; & Cope, H. (2018a). Virtual reality for anxiety reduction demonstrated by quantitative EEG: a pilot study. Frontiers in Psychology, 9(1), 1-15. doi:10.3389/fpsyg.2018.01280 https://doi.org/10.3389/fpsyg.2018.01280... )	controlled pilot; non-clinical; n = 14	Verify VRMF short session effect on moderate or severe generalized anxiety. The group with VR presented specific electrophysiological markers of anxiety reduction.
Tarrant & Cope, (2018bTarrant, J; & Cope, H. (2018b). Combining frontal gamma asymmetry neurofeedback with virtual reality: A proof of concept case study. NeuroRegulation, 5(2), 57-67.)	pre-post controlled pilot;non-clinical; n = 4	Verify if low-cost wearable can be used with VRMF for NFB of frontal gamma asymmetry to generate positive states of mind. Results show possible VR specific effects on brain activity observed with QEEG and sLORETA.
Tong, Gromala, Choo, Amin, & Shaw (2015Tong, X; Gromala, D; Choo, A; Amin, A; & Shaw, C. (2015). The virtual meditative walk: an immersive virtual environment for pain self-modulation through mindfulness-based stress reduction meditation. In Proceedings of the 7th International Conference (388-397). Los Angeles, CA. Recuperado de https://link.springer.com/chapter/10.1007/978-3-319-21067-4_40 https://link.springer.com/chapter/10.100... )	RCT; clinical; n = 13	Verify efficiency of immersive system with biofeedback based on MF for chronic pain. In VRMF condition with biofeedback for MBSR it was observed a significant decrease in pain perception.
Wood et al, (2007Wood, D. P; Murphy, J; Center, K; McLay, R; Reeves, D; Pyne, J; … Wiederhold, B. K.(2007). Combat-related post-traumatic stress disorder: a case report using virtual reality exposure therapy with physiological monitoring. CyberPsychology & Behavior, 10(2), 309-315. doi: 10.1089/cpb.2006.9951. PMID: 17474853 https://doi.org/10.1089/cpb.2006.9951... )	single case; clinical; n = 1	Virtual-Reality Exposure Therapy with Arousal Control (VRET-AC) for EPT in warriors. Significant decrease on EPT symptoms, depression and anxiety.
Wood, Wiederhold, & Spira (2010Wood, D. P; Wiederhold, B. K; & Spira, J. (2010). Lessons learned from 350 virtual-reality sessions with warriors diagnosed with combat-related posttraumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 13(1), 3-11. doi: doi.org/10.1089/cyber.2009.0396 https://doi.org/10.1089/cyber.2009.0396... )	case study; clinical; n = 30	Controlled Virtual-Reality Exposure Therapy with Arousal Control (VRET-AC). VR is an effective treatment when associated with combat situations.

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