Anxiety and lack of focus are significant problems now: Globally, close to 1/5 of the world’s population is currently suffering from post-traumatic stress disorder (1) and according to the World Health Organization, there is an increase in anxiety of 25% worldwide (2). Ordinarily, one would think that people would be able to use their cognitive resources to regulate their anxiety, but a large percentage of the population is also having short-term memory deficits and experiencing difficulty with self-control3. Given these challenges, Mayo Clinic, the #1 hospital in the nation (4), conducted a pilot study to see if video and virtual reality (VR) might offer a panacea to those suffering from stress, anxiety, and lack of focus (5). Their findings are striking and worth noting.
The Reulay-Mayo Clinic Video and VR Study: The study was conducted by Mayo Clinic with participants who were first responders during the COVID-19 pandemic. In the study, the investigators administered an intervention consisting of two of seven brain-based 10-minute video and virtual reality scenes that have been designed by Reulay, Inc, a virtual therapeutic platform (6). Each of the experiences took a personalized approach by targeting different parts of the anxiety circuitry in the brain.
The first was designed to generally reduce anxiety, with a hypothesized effect on a key brain structure (called the amygdala) that activates when anxious (7). It involved walking through the woods while a narrator guided the user on the journey. In the second experience, the scene involved going up a mountain and encountering and focusing on scene elements such as glowing embers and fireflies. This scene was designed to improve focus, and was hypothesized to correlate with activation of the “focus” network in the brain (8). Twenty-four participants experienced these scenes as 4K Video or using an Oculus VR headset.
All participants were randomly given the video or VR and their anxiety and focus levels were measured using standardized questionnaires. At the end of the study almost all participants (96%) said that they would participate in the study again and recommend it to others. Twenty-three of the 24 participants also felt relaxed after seeing the imagery. All four sessions had a statistically significant decrease in score after the session compared to before the session. There were improvements in anxiety, emotional distress, and focus.
Anxiety and lack of focus go hand-in-hand: In the brain, the “anxiety” and “focus” circuits are connected (9). If you’re anxious, you may have trouble focusing, and if you have trouble focusing, it may make you anxious. The fact that video and VR both helped people feel less anxious and more focused was a promising signal in this pilot study.
Why the Reulay study was different: While prior studies have demonstrated that exposure to nature using virtual reality can help to reduce anxiety (10,11) and one study even found that computer-generated VR imagery is better than 360 degree video or imagery on a TV screen (12), no prior studies have shown such strong improvements in anxiety with both video and VR. Furthermore, in the Reulay study, the VR experiences were designed with specific regions of the brain in mind. This is the first specific brain-based design of its kind.
Also, anxiety is not the same for every person (13) , and it does not impact the brain in the same way either. For some people, disrupted attention is a big deal, whereas for others it is not (14). This was the first study of its kind to study both anxiety and attention using video and VR.
How might video and VR work? And why does VR seem to have a slight advantage? Nature exposure can benefit mental health (15.) The calming walk through a beautiful environment can have a positive effect on one’s brain health by putting the brain into a relaxed state (16.) But VR offers more than eye-candy. You don’t just see calming scenes; you feel it in your body because you’re immersed in an environment. Called embodiment, this is an effect of VR that can intensify the visual experience too (17.)
Other potential applications: Video and VR for Pain: Being immersed in VR has been shown to have a large role to play in pain relief as well (18.) In the brain, the circuits for pain and anxiety overlap and interact (19.) When people feel anxious, they may experience their pain as being greater since they pay more attention to the pain and their muscles tense up as well, sometimes making the pain worse. Some researchers believe that chronic stress and chronic pain are two sides of the same coin (20.) So, if Reulay video and VR can help anxiety, it is reasonable to assume it may be able to help pain as well. Future studies will need to test this.
The Reulay Promise: Only about 5–9% of the population meditates (21,22.) The higher-end estimate of meditators globally is around 14%. That leaves 86% of people without a solution like meditation, and guided experiences through nature in VR and video could be wonderful alternative.
Of course, further studies will be necessary to prove this out. And since Reulay is built on a machine-learning platform, we will eventually understand how to personalize recommendations. In the meanwhile, corporations, sports teams, and law enforcement agencies are benefitting from Reulay’s platform. And as the studies advance, we are bound to learn more.
[References]
(1) Yunitri, N.; Chu, H.; Kang, X. L.; Jen, H.-J.; Pien, L.-C.; Tsai, H.-T.; Kamil, A. R.; Chou, K.-R. Global Prevalence and Associated Risk Factors of Posttraumatic Stress Disorder during COVID-19 Pandemic: A Meta-Analysis. Int. J. Nurs. Stud. 2022, 126, 104136. https://doi.org/10.1016/j.ijnurstu.2021.104136.
(2) COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide (accessed 2022-05-08).
(3) Callan, C.; Ladds, E.; Husain, L.; Pattinson, K.; Greenhalgh, T. ‘I Can’t Cope with Multiple Inputs’: A Qualitative Study of the Lived Experience of ‘Brain Fog’ after COVID-19. BMJ Open 2022, 12 (2), e056366. https://doi.org/10.1136/bmjopen-2021-056366.
(4) The #1 hospital in the nation – About Us – Mayo Clinic. https://www.mayoclinic.org/about-mayo-clinic/quality/top-ranked (accessed 2022-05-08).
(5) Croghan, I. T.; Hurt, R. T.; Aakre, C. A.; Fokken, S. C.; Fischer, K. M.; Lindeen, S. A.; Schroeder, D. R.; Ganesh, R.; Ghosh, K.; Bauer, B. A. Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program. J. Prim. Care Community Health 2022, 13, 21501319221086716. https://doi.org/10.1177/21501319221086716.
(6) REULAY. REULAY. https://www.reulay.com (accessed 2020-03-19).
(7) Ressler, K. J. Amygdala Activity, Fear, and Anxiety: Modulation by Stress. Biol. Psychiatry 2010, 67 (12), 1117–1119. https://doi.org/10.1016/j.biopsych.2010.04.027.
(8) Gold, A. L.; Shechner, T.; Farber, M. J.; Spiro, C. N.; Leibenluft, E.; Pine, D. S.; Britton, J. C. Amygdala-Cortical Connectivity: Associations with Anxiety, Development, and Threat. Depress. Anxiety 2016, 33 (10), 917–926. https://doi.org/10.1002/da.22470.
(9) van der Meer, D.; Hoekstra, P. J.; van Rooij, D.; Winkler, A. M.; van Ewijk, H.; Heslenfeld, D. J.; Oosterlaan, J.; Faraone, S. V.; Franke, B.; Buitelaar, J. K.; Hartman, C. A. Anxiety Modulates the Relation between Attention-Deficit/Hyperactivity Disorder Severity and Working Memory-Related Brain Activity. World J. Biol. Psychiatry Off. J. World Fed. Soc. Biol. Psychiatry 2018, 19 (6), 450–460. https://doi.org/10.1080/15622975.2017.1287952.
(10) Browning, M. H. E. M.; Mimnaugh, K. J.; van Riper, C. J.; Laurent, H. K.; LaValle, S. M. Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors. Front. Psychol. 2020, 10. https://doi.org/10.3389/fpsyg.2019.02667.
(11) White, M. P.; Yeo, N. L.; Vassiljev, P.; Lundstedt, R.; Wallergård, M.; Albin, M.; Lõhmus, M. A Prescription for “Nature” – the Potential of Using Virtual Nature in Therapeutics. Neuropsychiatr. Dis. Treat. 2018, 14, 3001–3013. https://doi.org/10.2147/NDT.S179038.
(12) Yeo, N. L.; White, M. P.; Alcock, I.; Garside, R.; Dean, S. G.; Smalley, A. J.; Gatersleben, B. What Is the Best Way of Delivering Virtual Nature for Improving Mood? An Experimental Comparison of High Definition TV, 360° Video, and Computer Generated Virtual Reality. J. Environ. Psychol. 2020, 72, 101500. https://doi.org/10.1016/j.jenvp.2020.101500.
(13) Shackman, A. J.; Fox, A. S.; Oler, J. A.; Shelton, S. E.; Davidson, R. J.; Kalin, N. H. Neural Mechanisms Underlying Heterogeneity in the Presentation of Anxious Temperament. Proc. Natl. Acad. Sci. U. S. A. 2013, 110 (15), 6145–6150. https://doi.org/10.1073/pnas.1214364110.
(14) Price, R. B.; Beltz, A. M.; Woody, M. L.; Cummings, L.; Gilchrist, D.; Siegle, G. J. Neural Connectivity Subtypes Predict Discrete Attentional Bias Profiles Among Heterogeneous Anxiety Patients. Clin. Psychol. Sci. J. Assoc. Psychol. Sci. 2020, 8 (3), 491–505. https://doi.org/10.1177/2167702620906149.
(15) Bratman, G. N.; Hamilton, J. P.; Hahn, K. S.; Daily, G. C.; Gross, J. J. Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation. Proc. Natl. Acad. Sci. U. S. A. 2015, 112 (28), 8567–8572. https://doi.org/10.1073/pnas.1510459112.
(16) Tarrant, J.; Viczko, J.; Cope, H. Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study. Front. Psychol. 2018, 9. https://doi.org/10.3389/fpsyg.2018.01280.
(17) Gall, D.; Roth, D.; Stauffert, J.-P.; Zarges, J.; Latoschik, M. E. Embodiment in Virtual Reality Intensifies Emotional Responses to Virtual Stimuli. Front. Psychol. 2021, 12, 674179. https://doi.org/10.3389/fpsyg.2021.674179.
(18) Matamala-Gomez, M.; Donegan, T.; Bottiroli, S.; Sandrini, G.; Sanchez-Vives, M. V.; Tassorelli, C. Immersive Virtual Reality and Virtual Embodiment for Pain Relief. Front. Hum. Neurosci. 2019, 13, 279. https://doi.org/10.3389/fnhum.2019.00279.
(19) Crofford, L. J. Chronic Pain: Where the Body Meets the Brain. Trans. Am. Clin. Climatol. Assoc. 2015, 126, 167–183.
(20) Abdallah, C. G.; Geha, P. Chronic Pain and Chronic Stress: Two Sides of the Same Coin? Chronic Stress 2017, 1, 2470547017704763. https://doi.org/10.1177/2470547017704763.
(21) Cramer, H.; Hall, H.; Leach, M.; Frawley, J.; Zhang, Y.; Leung, B.; Adams, J.; Lauche, R. Prevalence, Patterns, and Predictors of Meditation Use among US Adults: A Nationally Representative Survey. Sci. Rep. 2016, 6, 36760. https://doi.org/10.1038/srep36760.
(22) Kachan, D. Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey. Prev. Chronic. Dis. 2017, 14. https://doi.org/10.5888/pcd14.160034.