VR intervention
Research staff demonstrated use of the VR headsets with the patients in a telehealth meeting prior to the initial intervention. Once all baseline assessments were collected, patients completed a brief, self-selected 5-min VR intervention under remote supervision by study staff. Staff remained in the telehealth meeting with the patients during the VR intervention so they could monitor for any technology issues or device-related AEs.The VR headset used in this trial is the Pico G2 4K device, which is an immersive, lightweight, stand-alone headset that comes with an orientation-tracked controller and does not require a smartphone or a PC to function. This headset can be used via “gaze mode” or “controller mode” where the user can make selections on the screen by either directing their gaze at a particular item or by pointing at it using the remote controller. Additionally, there is a breath shield attachment on the front of the headset that can detect breathing patterns of the user and will change the virtual environment experienced if a breath-based scenario is chosen. The VR software loaded on the headset was designed by AppliedVR™ for use within clinical populations and aims to target unpleasant symptoms and promote relaxation. There are a total of 41 scenarios on the VR headset that fall within 3 main categories: (1) Dynamic Breathing, (2) Guided Relaxation, and (3) Instant Escape, shown in Fig. AppliedVR™ virtual scenarios on Pico G2 4K headset. The dynamic breathing scenarios, which make use of a breath shield attachment, guide the participant to take slow, deep breaths in order to slow the heart rate and induce relaxation as the environment seen changes based on the breathing pattern. Guided relaxation scenarios are meditative in nature and promote mindfulness and bringing attention to unhelpful thoughts and emotions that participants might be experiencing. Instant escape scenarios allow distraction through exploration of immersive environments, including ocean-based experiences, travel to various locations around the world, and interactive gamesFollowing the initial VR intervention, patients had self-directed VR use for the 1 month period they were on study and could choose any scenario available on the headset. Study staff conducted weekly check-ins to help troubleshoot any technological questions, to ask about device-related AEs, and to ask how often they used VR during the previous week. Other members of the household, including caregivers, were permitted to use the VR headset and patients were asked to inform us if this occurred, though no data was collected from those individuals.