Why VR

Virtual Reality

Virtual reality (VR) is a computer-generated, three-dimensional simulation that allows an individual to interact using a head-mounted display (HMD) and various controllers or hand-tracking algorithms. Head-tracking and hand-tracking systems allow for one-to-one user movement within a generated virtual environment, creating an illusion of presence (Li et al.,2011). This experience is strengthened by multimodal stimuli including visual, spatial, auditory, and haptic feedback (Honzel et al., 2019). In recent years, VR technology has improved to utilize more precise tracking, higher per-eye resolution, and better rendering through dedicated PCVR systems.

 

The VR medium continues to expand beyond the use of pure entertainment. VR programs have been developed for the military, manufacturing, and surgical training. Video games, and more recently VR, have been used to provide alternative modes of education in schools. The malleable nature of virtual development offers extraordinary possibilities in its use
and purpose.

 

Though originally created for entertainment purposes, VR has increasingly been used as a nonpharmacological alternative treatment to clinically affect perception of pain, anxiety, depression, and mood (Ioannou et al., 2020. The ability to transport users into virtual environments through precise movement recognition and multiple stimuli has provided
researchers and clinicians a unique opportunity to use VR technology for pain management and the treatment of psychiatric disorders.

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Pain Management

The use of VR for pain management is one of the most widely researched uses of VR therapy. In the past 20 years, studies have shown the efficacy of VR therapy during burn care, cancer treatments, and medical procedural support. Burn care, a procedure that involves a high amount of pain and anxiety, was an early focus for researchers. In 2001, Hoffman et al.
presented a case study involving two adolescents (16 and 17 years old) that compared the use of virtual reality and a 2D video game during burn care. VR was proven to decrease levels of pain, anxiety, and time spent thinking about pain.

VR has also been used to study pain management during medical procedures. Furman et al. (2009) investigated the use of VR versus watching movies during painful dental procedures. Reported pain scores were significantly lower in the VR group compared to the movie groups and controls. Maani et al. (2011) utilized VR for pain control during wound
debridement for soldiers wounded by explosive devices in Iraq and Afghanistan. Patients reported lower scores for pain, pain unpleasantness, and time spent thinking about pain while using VR. More recently, Spiegel et al. (2019) completed a randomized comparative effectiveness trial of the use of virtual reality for pain management in hospitalized patients. The
VR group reported larger pain score reductions than the television programming group and for a
longer period after the initial intervention. The more severe pain subgroup also reported a more
pronounced change in reported pain.

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Psychiatric Disorders

VR has been used as a tool to help those experiencing anxiety and depression, particularly through exposure therapy, psychoeducation, and relaxation therapy (Ioannou et al., 2020). Lee et al. (2015) presented a random control trial for patients with Parkinson’s disease using virtual reality dance exercises to reduce depression. The VR group demonstrated
significantly improved depressive disorder status, while the control group showed no significant improvement. In 2015, Shah et al. examined the use of a VR DE-STRESS Program, consisting of three daily one-hour sessions incorporating VR-based relaxation interventions for adult inpatients diagnosed with major depressive disorder and bipolar disorder. After a 3-day program intervention, participants showed significantly lower subjective stress, depression, and anxiety. Recently in 2018, Tarrant et al demonstrated the effects of a mindfulness VR experience on anxiety. In addition to significantly reduced reports of anxiety, VR also affected EEG recorded Beta frequencies in ways consistent with a physiological reduction in anxiety.

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Virtual Reality as Therapy Augmentation

In addition to being an individual tool, VR has also been used to augment other therapies such as physical rehabilitation, hypnosis, guided imagery, biofeedback, and music/music therapy. For example, Hoffman et al. (2000) studied the use of VR in addition to analgesia during physical therapy versus analgesia alone. The VR group reported increased range of motion and lower ratings of pain. In 2001, Hoffman et al. completed another study comparing the use of VR to no distraction during physical therapy. Patients using VR reported increased range of motion and decreased pain and the effect remained consistent over multiple sessions.

 

Virtual reality was first used to augment hypnosis by Patterson & colleagues (2006). Patterson and team utilized an interactive VR environment, SnowWorld©, where burn care patients moved through a 3D icy world while throwing snowballs at virtual snowmen, penguins, and robots. Patients reported lower levels of anxiety and pain. In a case study involving a 36-year old female with a history of retractable chronic neuropathic pain, the use of virtual reality hypnosis (VRH) decreased the patient’s reported pain and unpleasantness during a 6-month trial (Oneal et al., 2008). Investigators found that the VRH treatment was more effective than hypnosis alone, reducing pain and prolonging the effects of treatment.

 

Virtual reality has also been used in conjunction with biofeedback. Rockstroh et al. (2019) documented the effectiveness of VR in performing heart rate variability biofeedback. This aided in motivating users and allowed them to maintain higher attention focus. In a later study, Rockstroh et al. (2021) demonstrated the feasibility of a mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing. Preliminary results showed that VR increased perceived breath awareness, increased relaxation, decreased stress, and reduced symptoms of burnout.

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Music Therapy and Virtual Reality

As the use of VR as a clinical tool has increased, so has its integration with music. The creative possibilities found through VR can provide novel approaches for musical engagement that can increase client motivation and self-expression (Hobbs & Worthington-Eyre, 2008; Johnston et al., 2018; Partesotti et al., 2018). Recently, research has been conducted examining the effects of combining virtual reality with music or music therapy for the treatment of individuals with Alzheimer’s Disease (AD) (Byrns et al., 2020a; Byrns et al., 2020b; Optale et al., 2001), pain management, rehabilitation (Correa et al., 2009), relaxation (Kanehira et al,. 2018), anxiety (Chirico et al, 2019), autism (Johnston et al, 2018; Shahab et al,. 2017), and
education (Hobbs & Worthington-Eyre, 2008).

 

In two studies, Byrns at al. (2020a; 2020b) combined virtual reality and passive music listening to reduce negative emotions, increase positive emotions, and increase memory performance in individuals diagnosed with AD. Utilizing a virtual performance stage and participant-preferred music, participants showed a decrease in frustration, an increase in
valence and relaxation, and improved memory performance. Optale et al. (2001) documented the use of VR and music with a 65-year old woman diagnosed with an early form of AD. After a twelve-week treatment period involving virtual reality experiences combined with passive music listening, the clinical condition of the patient improved and was maintained during a twelve-week booster period.

 

Brungardt et al. (2020) piloted a virtual reality-music therapy (VR-MT) intervention for inpatients in palliative care. Patients created a personal soundtrack with a music therapist which was played during a VR experience. Patients viewed the experience favorably and described positive emotional and physical responses. However, no live music therapy interventions were used in this study. Tamplin et al. (2020) utilized VR to create a therapeutic singing group for
people with quadriplegia due to spinal cord injury. The group met virtually in an online environment with VR headsets, singing songs around a virtual campfire. Participants reported that the use of VR was immersive and transportive, reduced inhibitions about singing in front of others, and was a positive experience. This study, though, did not involve a music therapist.

 

Virtual reality and music have also been combined for other rehabilitation and treatment purposes. Correa et al. (2009) presented a case study of an augmented reality musical system for children with cerebral palsy. With the help of a music therapist, a virtual program was designed to motivate client interaction with the system and observe motor effort. Kanehira et al. (2018) demonstrated the use of VR in conjunction with music stimuli on a group of students. Participants reported an improvement of their mental state and increased relaxation. In exploring the effects of VR and music separately on breast cancer patients during chemotherapy, Chirico et al, (2019) found both interventions to be effective at relieving anxiety, depression, and fatigue. However, no music therapist was used in this study.

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Summary

Virtual reality has shown to be effective at managing pain and positively affecting anxiety and depression in adults. Additionally, the integration of VR with other therapies has shown to increase these targeted effects. These positive results demonstrate that VR can be used as a nonpharmacological tool to help those experiencing pain and anxiety. The ability for VR to augment other therapies in a positive way provides an opportunity for music therapy researchers and clinicians to potentially expand practice in new, important ways. The targeted customization possible through virtual environment development in VR offers unlimited potential in the creation of unique experiences for patients. VR may provide a unique avenue to reach clients through a multimodal sensory approach, and it can offer both clinicians and clients the ability to interact and manipulate a virtual environment through multiple senses. This highly interactive experience could potentially increase client motivation, self-expression, and participation, while allowing for the client and music therapist to interact musically in more creative and inclusive ways.

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References