Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial
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BACKGROUND: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. OBJECTIVE: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). METHODS: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. RESULTS: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs. CG=0.5%) in chronic "trait" anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. CONCLUSIONS: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).
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VR and BF demonstrated effectiveness in reducing anxiety.
“Integrated VR and BF technology has been increasingly applied to self-help healthcare training (Yu et al., 2018), demonstrating effectiveness in reducing stress levels (Rockstroh et al., 2021), anxiety (Gaggioli et al., 2014), and self-reported pain (Prabhu et al., 2019).”
From Frontal Electroencephalography Asymmetry and Desynchronized Functional Connectivity Associated with Long-Term and Short-Term Breathing Training (2026) · cites this paper as Gaggioli et al., 2014
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- Authors
- Gaggioli, A., Pallavicini, F., Morganti, L., Serino, S., Scaratti, C., Briguglio, M., Crifaci, G., Vetrano, N., Giulintano, A., Bernava, G., Tartarisco, G., Pioggia, G., Raspelli, S., Cipresso, P., Vigna, C., Grassi, A., Baruffi, M., Wiederhold, B., & Riva, G.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- IRCCS Istituto Auxologico Italiano (IT)
- National Research Council (IT)
- Virtual Reality Medical Institute (BE)
- Corresponding author
- Gaggioli, Andrea
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2014-07-08
- Volume
- 16
- Issue
- 7
- Pages
- e167
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4115267
- OpenAlex
- W2127512944
- Cited by
- 164
- References
- 90
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 22 · 2023: 17 · 2022: 13 · 2021: 22 · 2020: 13 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 9 · 2015: 4 · 2014: 2
- FWCI
- 11.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, cc-by)
- BOA (University of Milano-Bicocca) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Funders
- European Commission (247685)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Keywords
- virtual reality, psychological stress management, real-time monitoring, wearable biosensors, smartphone-based monitoring, coping strategies, trait anxiety, teachers, nurses, occupational stress, cognitive behavioral therapy, stress management training, virtual worlds, emotional support, self-efficacy, post-traumatic stress disorder, anxiety disorders, exposure therapy
- MeSH terms
- Adaptation, Psychological, Adult, Analysis of Variance, Faculty, Female, Humans, Male, Nurses, Stress, Psychological, Cognitive Behavioral Therapy, Virtual Reality Exposure Therapy, Visual Analog Scale
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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