CAN THE USE OF VR TECHNOLOGY 1

Can the Use of VR Technology Improve the Relaxation Response After

Experience of a Stressor?

Kevin A. Burns

Department of Psychology, Mansfield University

CAN THE USE OF VR TECHNOLOGY 2

Abstract

Stress has been shown to have a positive effect on one’s psychological and physical

health in the short-term, but exposure to stress over a long period of time can have detrimental

health consequences, including increased rates of anxiety and depression and decreased cognitive

abilities and heart rate variability. To that end, meditation has been used for thousands of years to

destress. Newly emerging technology, such as virtual reality, has been shown to have capabilities

to both induce and reduce stress, so it is hypothesized that combining virtual reality with an

established meditation process may be more effective at reducing physical and psychological

stress than either component individually. What follows is a literature review for those

hypotheses and a study design for testing those hypotheses.

Keywords: stress, stress management, virtual reality, meditation, mindfulness

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Can the Use of VR Technology Improve the Relaxation Response After

Experience of a Stressor?

Stress is a physiological and psychological response to a perceived threat that boasts

short- and long-term effects. Mohan, Sharma, & Bijlani (2011) found that short-term memory

scores could be improved as a result of stress. Mohan et al.’s study used 32 young adults who

had never meditated before and had them meditate either before or after inducing stress by way

of a difficult video game. They found that memory scores increased as a result of the

introduction of the stressor and that that benefit was not lost after meditation.

Stress was also found to increase levels of cortisol in saliva and increase activation in

parts of the brain associated with different stressful tasks (Dedovic, Renwick, Mahani, Engert,

Lupien, & Pruessner, 2005). Groups were given difficult math tasks to complete on the computer

while researchers took levels of their cortisol and used PET and fMRI imaging to see that

specific parts of the brain (namely, the angular gyrus) and the motor and visual association

cortices were activated (Dedovic et al., 2005).

A study of perceived stress and relationship satisfaction by Lewandowski, Mattingly, &

Pedreiro (2014) found that high levels of perceived stress can lead to lower relationship

satisfaction and higher desire for “alternatives” to current romantic partners. Using a group of

high- and low-stressed individuals, researchers had them write a list of compliments for their

partners and pick as many individuals from a page of 10 photographs, as people they would

potentially want to meet romantically and found that those with the highest stress wrote the

fewest compliments and picked the greatest number of alternatives (Lewandowski et al., 2014).
CAN THE USE OF VR TECHNOLOGY 4

Long-term stress has been shown to affect subjective memory scores. A study of middle-

aged adults found that those with the strongest depressive symptoms often reported the strongest

levels of stress (Rönnlund, Sundström, Sörman, & Nilsson, 2013). Those with the highest levels

of stress also reported having the lowest memory scores; however, when participants were tested

on their memory, it was found that these self-reports were not accurate, and that long-term stress

did not have a negative impact on memory (Rönnlund et al., 2013).

While stress has proven to have both positive and negative impacts on daily life,

meditation has been shown to decrease both physiological and perceived levels of stress. A study

using medical students, an already high-stress population, found that those who implemented a

mindfulness meditation program known as Headspace at least once increased their mindfulness

and decreased stress scores over time (Yang, Schamber, Meyer, & Gold, 2018).

Hintz, Frazier, & Meredith (2015) did a similar experiment with college students where

they had them take part in a meditation program online, where they would either get information

about college stress (control), a relaxation intervention (experimental), or a relaxation

intervention that gave them feedback on how they were doing (experimental). Scores showed

that the two relaxation interventions had lower scores for factors such as stress, anxiety, and

depression than the information-only group (the difference in scores between relaxation

interventions was about .05-.1, while the difference between these groups and information only

showed a difference of .5-.6). This suggests that even when people are aware of their stress and

its effects, it isn’t enough to reduce stress (Hintz et al., 2015).

Meditation has also been shown to be effective in reducing anxiety in children with

ADHD (Huguet, Miguel-Ruiz, Haro, & Alda, 2017). A group of children aged 7-12 received a

75 minute, once weekly group-based mindfulness training for 8 weeks. Results showed
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significant decreases in anxiety scores, ADHD symptoms, and cognitive inhibition, along with

an increase in processing speed. This implies that meditation is useful for stress reduction, as

well as general anxiety and focus (Huguet et al., 2017).

Meditation, much like stress, also has physiological benefits. For example, a 2015 study

by Taren, Gianaros, Greco, Lindsay, Fairgrieve, Brown, Rosen, Ferris, Julson, Marsland,

Bursley, Ramsburg, & Creswell found that mindfulness meditation can have a lasting effect on

the amygdala’s stress response. What they found was that, for those whose amygdalas were

highly active, a 3-day intensive mindfulness meditation training helped to reverse that and bring

it back to a normal state as well as having some proactive benefits that would prevent the

amygdala from working as hard to create a physiological response the next time they

experienced stress (Taren et al., 2015).

Meditation has also been shown to reduce physiological stress in high-stress populations,

such as college students. A study conducted in 2016 found that a 4-hour mindfulness meditation

training done over the course of 4 weeks could decrease stress levels in college students better

than a no treatment or control group, where participants played with a dog to relax (Shearer,

Hunt, Chowdhury, & Nicol, 2016). Afterwards, every group was given a cognitive stressor

challenge where an electrocardiogram showed greater heart rate variability (HRV), a measure of

the body’s ability to handle physiological stress, in the group that had undergone the mindfulness

meditation. The control group HRV was similar to that of the no treatment group (Shearer et al.,

2016).

While meditation is useful for reducing stress, virtual reality (VR), a relatively new

technology that immerses the user in a virtual world via headset, has been shown to have the

ability to both induce and reduce stress. One of the uses of VR is in teaching balance to clients
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who have experienced a fall in a safer, more controlled environment. One study found that the

best way to do this was with a virtual balance beam, where individuals would walk on a beam

raised only a few inches off the ground but would have a beam in the virtual reality that looked

as if it were on top of a high building. By inducing stress in this way, the individuals were able to

learn better balance in a safe environment. It was found that the virtual beam increased reported

stress levels, electrodermal activity, and heart rate (Peterson, Furuichi, & Ferris, 2018).

Interestingly, a study of body ownership illusion (BOI), where a user subjectively

identifies with the virtual body even though it isn’t theirs, found that having an avatar which is in

an uncomfortable, or unnatural, position could actually lead to lower HRV, greater heart rate,

and more mistakes when completing a cognitive task, but BOI was not affected (Bergström,

Kilteni, and Slater, 2016). This increase in stress levels suggests that part of what makes VR

effective in inducing stress is its level of immersion and how the participant identifies with what

they are seeing.

In a pilot study of VR’s effectiveness in reducing stress, Pizzoli, Mazzocco, Triberti,

Monzani, Alcañiz, & Pravettoni found that virtual reality was effective at reducing stress

regardless of whether it was interactive or not (2019). With interactive VR, participants are able

to move around and engage with the world around them, while noninteractive is more like a film

where participants can only go where the video goes and cannot impact the virtual setting in any

way. Pizzoli et al. (2019) also hypothesized that personalized VR, where settings could be made

to look like peaceful places from the participants’ own lives, could go a step further in enhancing

VR’s relaxation response.

In 2007, Villani & Riva found that presence, another important aspect of VR that

describes how strongly a person feels connected with and immersed in the virtual world, had a
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part to play in stress reduction. When comparing VR to audio-only and video-only groups (two

non-immersive media formats), Villani & Riva found that the users’ sense of presence, as well as

the use of VR, had a strong negative correlation with self-reported stress levels (2007).

With the use of both VR and meditation for stress reduction purposes, the use of VR

technology with guided meditation may improve the relaxation response after experience of a

stressor more than guided meditation, VR-only meditation, or normal relaxation. In a follow-up

study, Villani, Riva, & Riva (2012) compared VR with audio guided meditation to video with

audio guided meditation and audio guided meditation only groups and found that VR decreased

heart rate more than audio or video (by 7 BPM compared to 4 and 2, respectively).

In a study which looked at the effects of biofeedback and display type on a relaxation

module in VR and in video on a computer screen, it was found that VR led to greater score

increases in restorativeness of the program and presence over the computer screen video and the

use of electrodermal biofeedback helped to enhance both effects within the VR group, but not the

video group (Rockstroh, Blum, & Göritz, 2020).

Navarro-Haro, López-Del-Hoyo, Campos, Linehan, Hoffman, García-Palacios, Modrego-

Alarcón, Borao, & García-Campayo (2017) found that participants who tried out a VR program

that taught Dialectical Behavioral Therapy (DBT) mindfulness skills reported increases in the

mindfulness states and reductions in negative emotional states (such as sadness, anger, and

anxiety). Further post-test questions showed that participants also rated the training as having

moderate to high levels of presence.

Shah, Torres, Kannusamy, Chng, He, & Klainin-Yobas (2015) found that a program

which included 3 1-hour daily sessions of psychoeducation and a VR relaxation practice led to
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lowered subjective stress (t = 6.91), depression (t = 5.62), and anxiety (t = 5.54). The findings

also showed an increase of skin temperature, perceived relaxation, and knowledge of stress and

relaxation. Participant reactions to this program were positive (Shah et al., 2015).

After reviewing the literature, the following hypotheses have been proposed:

1. Use of VR technology with guided meditation will decrease blood pressure after

experience of a stressor more than audio-only meditation, VR-only meditation, or

normal relaxation.

2. Use of VR technology with guided meditation will heart rate after experience of a

stressor more than audio-only meditation, VR-only meditation, or normal

relaxation.

3. Use of VR technology with guided meditation will decrease Positive and

Negative Affect Schedule (PANAS) scores after experience of a stressor more

than audio-only meditation, VR-only meditation, or normal relaxation.

Methods

Participants

For this experiment, 40 participants will be drawn from classes in the Psychology and

Social Work departments. All participants will be prescreened for a fear of heights, prior use of

virtual reality, experience with meditation, and cyber-sickness or vertigo as part of a

demographic inventory. Participants will also be advised to wear a t-shirt, close-toed shoes, and

pants/shorts (no skirts or dresses for fear they might trip during the plank experience). A random

number generator will be used to divide participants into one of four-groups: a “relax-as-normal"
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(control) group, a VR-only group, a guided meditation audio-only group, and a VR with guided

meditation audio group (all experimental groups). In addition to the demographic inventory,

participants will be required to read and sign an informed consent form. All information, which

will be collected following APA ethical guidelines for human subject research, will be kept

confidential.

Materials

Each participant will be asked to fill out a numbered demographic inventory during the

recruitment, along with their informed consent form and the Perceived Stress Scale (PSS).

Before and after exposure to the VR, participants will fill out the Positive and Negative Affects

Schedule (PANAS). A description of these forms follows.

Demographic information. Information will be collected on gender, age, class standing,

GPA, student status, commuter status, residency status, race, parental marital status, parental

education level, height, weight, employment status, fear of heights, prior use of VR, prior use of

meditation, cyber-sickness, and vertigo (see Appendix A).

Positive and Negative Affects Schedule (PANAS). The PANAS is a 20-item scale with

10 positive affects listed, such as interested, strong, and proud, and 10 negative affects, such as

guilty, nervous, and afraid (see Appendix B). Individuals are asked to rate the strength of each

affect that they are feeling at that exact moment, ranging from 1 (very slightly or not at all) to 5

(extremely). The positive affect scale had a Cronbach α coefficient of 0.88 and the negative

affect scale had a coefficient of 0.85. Test-retest correlations over an 8-week time period showed

a coefficient of 0.58 for the positive affect scale and a 0.55 for the negative affect scale.
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Perceived Stress Scale (PSS). The PSS measures an individual’s feelings of control over

their stress over the course of the last month. It is a 10-item scale in which individuals can score

0-4 on each question, for a total score of 0-40 (see Appendix C). Pearson correlation coefficients

show a score of -.30 between the positively and negatively worded questions, showing that the

items are related but distinctly different, while a Cronbach’s α reliability estimate was at .79 for

the scale with a .82 for the negatively worded questions and a .70 for the positively worded

questions (Lee & Jeong, 2019).

Other experiment material. Blood pressure and heart rate will also be taken before

experience of the VR, during experience of the VR, and after the experience of the VR (during

the relaxation technique for the given group) for every group using the Dinamap 845XT Blood

Pressure Monitor.

Richie’s Plank Experience is a Virtual Reality simulation in which a participant goes to

the top of a skyscraper via elevator and tries to walk to the end of a wooden plank sticking out of

the building and suspended over nothing but the ground below. For the purposes of this

experiment, a real wooden plank propped up at a ~5° angle will be calibrated with the simulation

so that it will exist in the same location as the virtual plank.

Additional material for the guided meditation groups. Every individual in an

experimental group which used self-guided meditation audio will listen to the same guided

meditation, an audio clip approximately 5 minutes in length, from the company Headspace.

Additional material for the VR groups. A 360° VR Youtube video of a river was

selected for use in the VR relaxation groups, approximately 5 minutes in length.

Procedure
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Once participants arrive for the study, they will be taken to a separate room across from

the VR lab for intake so as not to be exposed to the experiment. During this time, the experiment

will be described to them and they will fill out their resting PSS inventory. Follow-up questions

can also be asked for any who answered “Yes” to any of the pre-screening questions to

determine eligibility.

From here, participants will be escorted into the VR lab where the blood pressure monitor

will be set up. The cuff will be attached and we will take a 5 minute reading (one reading each

minute, not counting the first two as they acclimate, with an average of the three final scores

being used as resting blood pressure and heart rate measurements). We will then put the headset

on the participant and give them a minute to explore the VR world before starting the Richie’s

Plank Experience. The participant will be sent to the top of the skyscraper using the computer

outside the lab.

From there, the participant will be asked to go to the end of the plank as their

physiological measures are being recorded. If a participant cannot make it to the end, they will be

encouraged to keep moving forward until at least three blood pressure and heart rate recordings

have been done. However, they can stay still if they feel that they can’t move forward. In the

case that a participant needs to get out immediately, there is a “Return to Ground” button on the

computer outside the lab that will automatically move the game back to the elevator’s starting

position on the ground.

For the relax-as-normal (control) group, the headset will be removed, and they will be

asked to sit in the chair in the VR lab for 5 minutes while we get blood pressure and heart rate

readings. They will be informed they can do anything they want to relax, so long as they remain
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in the chair. We will then remove the blood pressure cuff and they will be asked to complete the

PANAS again.

For the guided meditation audio-only group, the headset will be removed, and they will

be asked to sit in the chair in the VR lab for 5 minutes to listen to the guided meditation. They

will be asked to follow the instructions in the audio while we get heart rate and blood pressure

readings. After the audio has ended, we will remove the blood pressure cuff, and the participant

will complete the PANAS again.

For the VR-only group, participants will be asked to sit in the provided chair and try to

relax for five minutes while they look around the VR river video and we continue to monitor

heart rate and blood pressure. After the video has ended, we will remove the headset and blood

pressure cuff, and the participant will complete the PANAS again.

For the VR with guided meditation audio group, participants will be asked to sit in the

provided chair and to relax for five minutes whil looking at the VR river video and listening to

the guided meditation audio. They will be encouraged to follow all directions in the audio except

to close their eyes as they need to be able to see the VR. After the video and audio have ended,

we will remove the headset and blood pressure cuff, and the participant will complete the

PANAS again.

After each participant completes the PANAS again, we will answer any questions they

might have, ensure they signed the extra credit sheet if they are getting extra credit for the

experiment, and begin the intake process with the next participant while the headset and cuff are

wiped down and the VR experiences and guided meditation audio are reset.

Analysis
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To analyze the data, a 3x4, one-way ANOVA looking at heart rate, blood pressure, and

PANAS score changes will be used to determine the efficacy of the VR and self-guided

meditation group as compared to the audio-only, VR-only, and relax-as-normal group in creating

a relaxation response. To establish that findings are significant, a value of p<0.05 will be used.
CAN THE USE OF VR TECHNOLOGY 14

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Huguet A, Miguel-Ruiz D, Haro JM, & Alda JA (2017). Efficacy of a Mindfulness Program for

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CAN THE USE OF VR TECHNOLOGY 15

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Appendix A
Demographic Information

I am: Male Female

Age: ______ years (at last birthday)

Class Standing: Freshmen Sophomore Junior Senior

Grade Point Average _______

Student Status (circle one)

Full Time Traditional Part Time Traditional Full-Time Non-Traditional Part Time Non-Traditional

I commute to school: Yes No

I currently live at: Home Off-Campus House/Apt. Dorms Fraternity House

What is your racial/ethnic background (circle one)

African American Asian Caucasian Hispanic Other_________

My parents are (circle one): Married Divorced Separated Other or N/A

Highest Education Level Completed by Parent(s) or Primary Guardian (please circle)

Mom: Graduate Degree B.A./B.S. A.A. HS Diploma Grade School Unsure
Dad: Graduate Degree B.A./B.S. A.A. HS Diploma Grade School Unsure
Guardian: Graduate Degree B.A./B.S. A.A. HS Diploma Grade School Unsure

Height (in inches): __________

Weight (in pounds): _________
Current Employment (circle one): Full-Time Part-Time None

Do you have a fear of heights?: Yes No

Do you suffer from vertigo or cyber sickness?: Yes No
Do you have prior experience with Virtual Reality?: Yes No
Do you have prior experience with meditation?: Yes No
CAN THE USE OF VR TECHNOLOGY
Indicate to what extent you feel this way right now, that is, at the present moment.
1 2
Very Slightly or A Little
Not at All
_________________ 1. Interested
_________________ 2. Distressed
_________________ 3. Excited
_________________ 4. Upset
_________________ 5. Strong
_________________ 6. Guilty
_________________ 7. Scared
_________________ 8. Hostile
_________________ 9. Enthusiastic
_________________ 10. Proud
19
Appendix B
PANAS
3 4 5
Moderately Quite a Bit Extremely
_________________ 11. Irritable
_________________ 12. Alert
_________________ 13. Ashamed
_________________ 14. Inspired
_________________ 15. Nervous
_________________ 16. Determined
_________________ 17. Attentive
_________________ 18. Jittery
_________________ 19. Active
_________________ 20. Afraid
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Appendix C

PSS

For each question, choose from the following scores:

0 - Never 1 – Almost 2 - Sometimes 3 – Fairly Often 4 – Very Often

Never

________ 1. In the last month, how often have you been upset because of something that
happened unexpectedly?
________ 2. In the last month, how often have you felt you were unable to control the
important things in your life?
________ 3. In the last month, how often have you felt nervous and stressed?

________ 4. In the last month, how often have you felt confident about your ability to handle
your personal problems?
________ 5. In the last month, how often have you felt that things were going your way?

________ 6. In the last month, how often have you found that you could not cope with all the
things that you had to do?
________ 7. In the last month, how often have you been able to control irritations in your life?

________ 8. In the last month, how often have you felt that you were on top of things?

________ 9. In the last month, how often have you been angered by things that have happened
that were outside of your control?
________ 10. In the last month, how often have you felt that difficulties were piling up so high
that you could not overcome them?