Background Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements. Objective To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises. Methods A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance. Results Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t1684=−2.02, 95% CI −18.70 to −0.28; P=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t1684=−3.24, 95% CI −6.86 to −1.69), sadness (t1684=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t1684=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms. Conclusions If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments. Trial Registration Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096

Background Psychosocial stress is associated with onset and relapse of psychosis, and stress-reactivity is high in patients with psychotic disorder. Stress management is an important part of treatment, but stress-reducing interventions are challenging for people with psychotic or other psychiatric disorder. We developed a virtual reality self-management relaxation tool (VRelax; 360o nature videos with interactive elements) and investigated its immediate effects on stress level, mood states and symptoms in patients with a psychotic or other psychiatric disorder, compared to standard relaxation exercises. Methods A randomized cross-over trial was conducted in 50 patients receiving ambulatory treatment for psychotic, anxiety, depressive or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation, and used both interventions for 10 days at home. They completed Visual Analogue Scales (VAS) of stress level and mood states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel repeated-measures regression models and two-way ANOVA. Results Both VRelax and standard relaxation exercises reduced subjective stress and improved momentary mood states. Compared to standard relaxation, VRelax resulted in a significantly greater immediate improvement of anxiety (B=-4.30, 95%CI=-5.86;-2.73), sadness (B=-3.65, 95%CI =-5.39;-1.91), cheerfulness (B=3.67, 95%CI=2.15;5.18), overall positive mood (B=7.59, 95%CI=2.28;12.89), and overall negative mood (B=10.88, 95%CI=5.89;15.87). There were no significant differences between short-term effects of the two treatments on symptoms and global perceived stress. Discussion If the results of this trial are replicated and extended, VRelax may provide a much needed effective self-management stress intervention to enhance treatment of patients with psychotic and other psychiatric disorders.

BACKGROUND Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements. OBJECTIVE To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises. METHODS A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance. RESULTS Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t₁₆₈₄=−2.02, 95% CI −18.70 to −0.28; <i>P</i>=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t₁₆₈₄=−3.24, 95% CI −6.86 to −1.69), sadness (t₁₆₈₄=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t₁₆₈₄=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms. CONCLUSIONS If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments. CLINICALTRIAL Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096