A mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing
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ORIGINAL ARTICLE
A mobile VR‑based respiratory biofeedback game to foster diaphragmatic breathing Christoph Rockstroh1 · Johannes Blum1 · Anja S. Göritz1 Received: 5 May 2020 / Accepted: 16 September 2020 © The Author(s) 2020
Abstract Virtual reality (VR) has become popular in mental health research. Several studies have explored the use of VR in the context of biofeedback protocols. In the present paper, we report on the development and evaluation of a VR-based respiratory biofeedback game to foster diaphragmatic breathing. The game integrates respiratory biofeedback, restorative VR and gamification. The game is designed to run on a mobile, all-in-one VR headset. Notably, an integrated VR hand controller is utilized as a sensor to detect respiration-induced movements of the diaphragm. In a longitudinal within-subjects study, we explored the feasibility of the game and tested the effectiveness of six training sessions. Participants reported a pleasant user experience. Moreover, the results show that the brief VR-based breathing training increased perceived breath awareness, improved diaphragmatic breathing, increased relaxation, decreased perceived stress, reduced symptoms of burnout and boosted relaxation-related self-efficacy. Future studies need to address the generalizability and long-term stability of the results, compare the approach with existing treatments and fine-tune the training components. Keywords Virtual reality · Respiratory biofeedback · Diaphragmatic breathing · Serious game · Stress reduction · Selfefficacy
1 Introduction 1.1 Virtual reality in mental health research Virtual reality (VR) is a powerful tool for mental health interventions. Contemporary head-mounted VR headsets with six-degrees-of-freedom head and hand tracking provide a deep level of immersion. Thus, customizable virtual worlds can mimic real environments and benefit from comparable effects. Researchers and practitioners Christoph Rockstroh and Johannes Blum contributed equally and share first authorship. * Christoph Rockstroh [email protected]‑freiburg.de Johannes Blum [email protected]‑freiburg.de Anja S. Göritz [email protected]‑freiburg.de 1
Department of Occupational and Consumer Psychology, Albert-Ludwigs-Universität Freiburg, Engelbergerstr. 41, 79106 Freiburg, Germany
alike can create tailored restorative virtual experiences to tackle stress-related mental health problems. While VR has technically been around for decades, the recent technological improvements such as reduced latency, higher tracking accuracy, better displays, increased ease of use and decreased cost have sparked researchers’ interest. A substantial body of research has investigated the feasibility and effectiveness of VR in several mental health contexts. For instance, VR was used to create immersive experiences for exposure therapy (Carl et al. 2019), pain management (Mallari et al. 2019; Scapin et al. 2018), mental wellness (Roche et al. 2019) or mindfulness and meditation training (Chandrasiri et al. 2020; N
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