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Effect of virtual reality on time perception in patients receiving chemotherapy
Open accessAbstract
Purpose Virtual reality (VR) during chemotherapy has resulted in an elapsed time compression effect, validating the attention diversion capabilities of VR. Using the framework of the pacemaker-accumulator cognitive model of time perception, this study explored the influence of age, gender, state anxiety, fatigue, and cancer diagnosis in predicting the difference between actual time elapsed during receipt of intravenous chemotherapy while immersed in a VR environment versus patient's retrospective estimates of time elapsed during this treatment. Materials and methods This secondary analysis from three studies yielded a pooled sample of N = 137 participants with breast, lung, or colon cancer. Each study employed a crossover design requiring two matched intravenous chemotherapy treatments, with participants randomly assigned to receive VR during one treatment. Regressions modeled the effect of demographic variables, diagnosis, and Piper Fatigue Scale and State Anxiety Inventory scores on the difference between actual and estimated time elapsed during chemotherapy with VR. Results In a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (F=5.06, p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly. Conclusions VR is a noninvasive intervention that can make chemotherapy treatments more tolerable. Women with breast cancer are more likely and lung cancer patients less likely to experience altered time perception during VR (a possible indicator of effectiveness for this distraction intervention). Understanding factors that predict responses to interventions can help clinicians tailor coping strategies to meet each patient's needs.
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“Other research in people having chemotherapy20 argues that VR may not be effective for all as those with greater symptom distress had more accurate perception of time, suggesting they were not able to block out negative external cues.”
From SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting? (2022) · cites this paper as [20]
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“The majority of studies used tools to capture symptom change15 20 67 with only one74 using open-ended questions in their methodology.”
From SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting? (2022) · cites this paper as [20]
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“Aversive stimuli distort time perception by promoting negative physiological arousal, which accelerates the rate of pulse generation in the pacemaker; they also focus patients’ attention on the passage of time during chemotherapy, which keeps the switch between pacemaker and accumulator in the “on” position [5, 12, 43…”
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“None of the identified studies touted a robust research design and sample size (Table 1), and studies with larger sample sizes failed to utilize controls (i.e., Schneider et al., 2011).”
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“…depression (Falconer et al., 2016), paranoid delusions (Freeman et al., 2016), discomfort reduction in cancer patients undergoing chemotherapy (Schneider, Kisby, & Flint, 2010), acute pain reduction during wound care and physical therapy with burn patients (Hoffman et al., 2011), other…”
BackgroundChirico, A., Maiorano, P., Indovina, P., Milanese, C., Giordano, G. G., Alivernini, F., Iodice, G., Gallo, L., Pietro, G. D., Lucidi, F., et al. (2020) · Journal of Cellular Physiology · doi:10.1002/jcp.29422 · Cited by 260
“Different distraction interventions have shown some success in patients receiving chemotherapy (Schneider & Hood, 2007; Schneider et al., 2011).”
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“– Time perception is determined by asking the participants to calculate approximately the duration of VR immersion with therapy [40] and the ratio of subjective and objective duration will be evaluated.”
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BackgroundTime Compression in Virtual Reality
Mullen, G., & Davidenko, N. (2021) · Timing & Time Perception · doi:10.1163/22134468-bja10034 · Cited by 64
“At least one previous experiment (Schneider et al., 2011) successfully used VR to produce a similar effect, but the present study is the first to observe time compression as a significant difference between VR and non-VR experiences with otherwise identical content.”
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“It was also shown that the perception of time in VR can be in fl uenced passively via the medium as a distraction (Schneider and Hood, 2007; Schneider et al., 2011) or actively by means of time in fl uencers, or so-called zeitgebers (e.g., velocity of the course of the Sun) (Schatzschneider et al.,…”
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“Other studies have investigated the effect of VR on time perception during chemotherapy infusion, but without any distraction therapy control group [34].”
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“VR technology is well studied in medical settings as a means to attenuate pain perception, anxiety, and general distress during painful medical procedures, including wound care [9], chemotherapy [10], dental procedures [11], burn pain [12], and routine medical procedures [13].”
BackgroundLeggiero, N., Armstrong, T. S., Gilbert, M. R., & King, A. L. (2020) · Neuro-Oncology Practice · doi:10.1093/nop/npaa012 · Cited by 22
Wong, C. L., Li, C. K., Choi, K. C., So, W. K. W., Kwok, J. Y. Y., Cheung, Y. T., & Chan, C. W. H. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258514 · Cited by 26
“IVR also helped patients to alter their perception of time, thus making the chemotherapy treatment seem short [17, 18].”
BackgroundMethodPhelan, I., Furness, P. J., Matsangidou, M., Carrion-Plaza, A., Dunn, H. D., Dimitri, P., & Lindley, S. A. (2021) · Virtual Reality · doi:10.1007/s10055-021-00522-5 · Cited by 21
Application of virtual reality for supportive care in cancer patients: a systematic review
Fereidoni, M., Toni, E., Toni, E., & Ayatollahi, H. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08763-1 · Cited by 22
“…display and field of view 101º) [37, 47–50], Sony PC Glasstron PLM-S700 (a stand-alone HMD with 800 × 600 resolution display and field of view 30º) [60, 63–65], Pico Goblin (a stand-alone HMD with 2560 × 1440 resolution display and field of view 92º) [39, 44], HTC VIVE (a stand-alone HMD with 2160…”
InfluentialBonnin, C., Pejoan, D., Ranvial, E., Marchat, M., Andrieux, N., Fourcade, L., & Perrochon, A. (2023) · Journal of Visual Communication in Medicine · doi:10.1080/17453054.2023.2216243 · Cited by 21
“Most students in VR felt that time had elapsed more quickly, as shown by Schneider and al. in their study (Schneider et al., 2011).”
BackgroundVirtual Reality for Postoperative Pain Management: A Review of Current Evidence
Malik, A., Elshazly, T. B., Pokuri, K., Apai, C., Rothkrug, A., Hasoon, J. J., Chung, M., Ye, Z., Bhayani, S., Kaye, A. D., et al. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01308-5 · Cited by 23
Augmented Reality Neuronavigation for En Bloc Resection of Spinal Column Lesions
Tigchelaar, S., Medress, Z. A., Quon, J. L., Dang, P. N., Barbery, D., Bobrow, A., Kin, C., Louis, R. G., & Desai, A. M. (2022) · World Neurosurgery · doi:10.1016/j.wneu.2022.08.143 · Cited by 19
Ota, T., Nakamura, T., & Kuzuoka, H. (2023) · IEEE Access · doi:10.1109/access.2023.3279269 · Cited by 18
“Finally, VR technology offers patients a time-compression effect that allows patients to complete tedious or painful treatments in a shorter perceived time [17], [18].”
BackgroundLind, A. Y., Ahsan, M., Totzeck, M., Al‐Rashid, F., Haddad, A., Dubler, S., Brenner, T., Skarabis, A., Gabry, M. E., Rassaf, T., et al. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131130 · Cited by 18
Applied Tension and Coping with Blood Donation: A Randomized Trial
Holly, C. D., Torbit, L. A., & Ditto, B. (2011) · Annals of Behavioral Medicine · doi:10.1007/s12160-011-9315-8 · Cited by 18
“dentistry [27], injections, and chemotherapy [28, 29].”
Behrens, S. C., Streuber, S., Keizer, A., & Giel, K. E. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1011620 · Cited by 20
“VR relaxation has been shown to support acute relaxation and wellbeing in various acute medical settings, including chemotherapy for cancer (42), cardiac surgery (43), labor, and care for veterans with dementia (44) and it also showed high efficacy in reducing acute stress also in psychiatric patients, with a tendency…”
BackgroundFrom Combat to COVID-19 – Managing the Impact of Trauma Using Virtual Reality
Rizzo, A., Hartholt, A., & Mozgai, S. (2021) · Journal of Technology in Human Services · doi:10.1080/15228835.2021.1915931 · Cited by 19
“…patients (Hoffman, Patterson, Carrougher, & Sharar, 2001, Hoffman et al., 2019), discomfort reduction in cancer patients undergoing chemotherapy (Schneider, Kisby, & Flint, 2010; Chirico et al., 2020), and in other pain management contexts (Dumoulin et al., 2019; Ahmadpour et al., 2019; Gold,…”
BackgroundJourney through a virtual tunnel: Simulated motion and its effects on the experience of time
Landeck, M., Igarzábal, F. A., Unruh, F., Habenicht, H., Khoshnoud, S., Wittmann, M., Lugrin, J.-L., & Latoschik, M. E. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.1059971 · Cited by 16
“Time perception in VR can be passively affected by the medium itself as a distraction (Schneider and Hood, 2007; Schneider et al., 2011) or actively by time influencers, so-called ‘zeitgebers’ (e.”
BackgroundClinical virtual reality in mental health and rehabilitation: a brief review of the future!
Rizzo, A. (2019) · doi:10.1117/12.2524302 · Cited by 17
“A short list of the areas where Clinical VR has been usefully applied includes fear reduction in persons with specific phobias [22,27-29], treatment for posttraumatic stress disorder (PTSD) [23,30,35-37], depression, and paranoid delusions [16,23,30-37], discomfort reduction in cancer patients undergoing chemotherapy…”
BackgroundBoylan, P., Kirwan, G. H., & Rooney, B. (2017) · Virtual Reality · doi:10.1007/s10055-017-0329-9 · Cited by 15
“Some studies have reported on the phenomena that users immersed in a VE can experience their perception of time being altered and accelerated (Schneider et al. 2011; Widerhold 2005).”
BackgroundLi, M., Yu, Z., Li, H., Cao, L., Yu, H., Deng, N., & Liu, Y. (2024) · JMIR Serious Games · doi:10.2196/53825 · Cited by 14
“VR allows patients to be completely engaged in an immersive environment, which may help distract them from noxious stimuli, thereby relieving psychological stress [19,28].”
BackgroundAhmad, M. M., Mohammad, E. B., Tayyem, E. A. I., Al‐Gamal, E., & Atout, M. M. W. (2023) · Health Care For Women International · doi:10.1080/07399332.2023.2257627 · Cited by 16
“These characteristics are consistent with the breast cancer patient samples used in earlier investigations (Kashyap et al., 2022; Schneider et al., 2011; Schneider & Hood, 2007), as well as with the statistics on breast cancer from Jordan Cancer Society, which reported that breast cancer is the…”
ResultWhen virtual reality supports patients’ emotional management in chemotherapy
Buche, H., Michel, A., & Blanc, N. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1294482 · Cited by 16
Time perception in naturalistic and urban immersive virtual reality environments
Mioni, G., & Pazzaglia, F. (2023) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2023.102105 · Cited by 13
Metachron: A framework for time perception research in VR
Landeck, M., Unruh, F., Lugrin, J.-L., & Latoschik, M. E. (2020) · ACM Symposium on Virtual Reality Software and Technology (VRST) · doi:10.1145/3385956.3422111 · Cited by 13
“For instance, this effect was reported by Schneider et al. [13].”
BackgroundRead, T., Sanchez, C. A., & Amicis, R. D. (2022) · Virtual Reality · doi:10.1007/s10055-022-00723-6 · Cited by 13
“For example, time is often perceived as passing more quickly when an activity or event is more engaging or has a strong affective component (Kitajima et al. 2020; Rutrecht et al. 2021; Sander and Cairns 2010; Schneider et al. 2011; Sucala et al. 2010).”
BackgroundOlasz, O., Erdős, S., & Horváth, K. (2024) · Mindfulness · doi:10.1007/s12671-024-02438-y · Cited by 12
“Regarding time perception, our findings suggest that VR positively influences time perception in young healthy volunteers, building on the impact previously observed in chemotherapy patients (Schneider et al., 2011).”
Yeşilot, S. B., Çiftçi, H., & Özçelik, Z. (2021) · International Journal of Nursing Practice · doi:10.1111/ijn.12906 · Cited by 14
The Effect of Task Complexity on Time Estimation in the Virtual Reality Environment: An EEG Study
Li, J., & Kim, J.-E. (2021) · Applied Sciences · doi:10.3390/app11209779 · Cited by 12
“One stream of research showed that during chemotherapy, most individuals estimated the time duration in the VRE to be shorter than the actual time elapsed [1,18].”
BackgroundChirico, A., D’Aiuto, M., Pinto, M., Milanese, C., Napoli, A., Avino, F., Iodice, G., Russo, G. M., Laurentiis, M. D., Ciliberto, G., et al. (2016) · Smart innovation, systems and technologies · doi:10.1007/978-3-319-39345-2_65 · Cited by 12
İnce, M., & Özlü, Z. K. (2024) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2024.07.012 · Cited by 11
Lu, M., Song, Y., Niu, Y., Ting, L. I. U., Song, G., Sun, Y., Wang, X., Luo, Y., Kuinan, L. I., & Yang, X. (2024) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000623 · Cited by 12
Mitello, L., Marti, F., Mauro, L., Siano, L., Pucci, A., Tarantino, C., Rocco, G., Stievano, A., Iacorossi, L., Anastasi, G., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13154374 · Cited by 10
Brain Signatures of Time Perception in Virtual Reality
Niknam, S., Duraisamy, S., Botev, J., & Leiva, L. A. (2025) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2025.3549570 · Cited by 13
“This involves both investigating classical time perception modulators in VR and exploring VR itself as a time perception modulator, as time compression has often been reported during the use of VR technologies [49,54,58].”
Lewandowski, K., Kaniewska, M. A., Rosołowski, M., Kucha, P., & Rydzewska, G. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10122709 · Cited by 11
Yeşilot, S. B., Çiftçi, H., & Yener, K. (2022) · AORN Journal · doi:10.1002/aorn.13665 · Cited by 13
Edwards, A. M., Menting, S. G. P., Elferink-Gemser, M. T., & Hettinga, F. J. (2024) · Brain and Behavior · doi:10.1002/brb3.3471 · Cited by 10
“This appears to give patients the impression of time running faster than usual, resulting in an overestimation of time due to distraction and a more enjoy-able experience (Gable & Poole, 2012; Schneider et al., 2011).”
BackgroundVirtual Reality During Chemotherapy Infusion
Burrai, F., Marinis, M. G. D., & Piredda, M. (2023) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000616 · Cited by 10
“10 The increase in the speed of the passing of time could be due to the distraction produced by VR, and in terms of the simulation-accumulation cognitive model, 11 by moving the focus of attention from negative stimuli toward virtual scenes, VR has also diverted attention from the processing of…”
Bal, S., & Kulakaç, Ö. (2023) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20230798 · Cited by 9
“An increasing body of evidence points to the positive effect of VRG use in acute pain management 14 , during various medical procedures such as chemotherapy 27,28 , and in wound care 29,30 .”
BackgroundThe effects of emotion on retrospective duration memory using virtual reality
Safi, O. K., Shi, Y., Madan, C. R., Lin, T., & Palombo, D. J. (2023) · Psychological Research · doi:10.1007/s00426-023-01909-6 · Cited by 9
“For instance, Schneider et al. (2011) and Chirico et al. (2016) both report observing time compression when VR was used during chemotherapy.”
Metadata
- Authors
- Schneider, S. M., Kisby, C. K., & Flint, E. P.
- Affiliations
- Duke University (US)
- Corresponding author
- Schneider, Susan M.
- Venue
- Supportive Care in Cancer
- Published
- 2010-03-26
- Volume
- 19
- Issue
- 4
- Pages
- 555-564
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- PMC
- PMC3673561
- OpenAlex
- W2006568735
- Cited by
- 187
- References
- 44
- Citations by year
- 2026: 2 · 2025: 14 · 2024: 25 · 2023: 25 · 2022: 22 · 2021: 28 · 2020: 17 · 2019: 11 · 2018: 10 · 2017: 9 · 2016: 6 · 2015: 2 · 2014: 2 · 2013: 5 · 2012: 4
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Supportive Care in Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (1 P20 NR07795-01, P20NR007795)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- virtual reality, time perception, chemotherapy, pacemaker-accumulator model, distraction therapy, cancer pain management, breast cancer, lung cancer, colon cancer, state anxiety, fatigue, gender differences, cancer diagnosis
- MeSH terms
- Adult, Aged, Antineoplastic Agents, Anxiety, Breast Neoplasms, Colonic Neoplasms, Female, Humans, Infusions, Intravenous, Lung Neoplasms, Male, Middle Aged, Models, Psychological, Regression Analysis, Sex Factors, Time Perception, User-Computer Interface, Cross-Over Studies
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