Full length articlePsychological and physiological responses to stressful situations in immersive virtual reality: Differences between users who practice mindfulness meditation and controls
Introduction
Rooted in Eastern contemplative traditions, mindfulness meditation (MM) is usually conceptualized as nonjudgmental attention to present moment somatosensory and mental experience (Brown and Ryan, 2003, Crescentini and Capurso, 2015, Kabat-Zinn, 1990, Kabat-Zinn, 2003, Lutz et al., 2008). Initially formalized for patients with chronic pain (e.g., Kabat-Zinn, 1982; see Baer, 2003, Baer, 2010, Didonna, 2009 for discussions of different forms of MM therapies), MM interventions have been shown to be effective for the treatment of different types of physical and psychological problems observed in individuals of various age ranges and in different clinical and non-clinical contexts (for reviews see Brown et al., 2007, Chiesa and Serretti, 2010, Didonna, 2009, Goyal et al., 2014).
For example, a number of studies based on self-report measures documented positive effects of MM therapies on anxiety, stress reactivity, depressive symptoms, ruminative thoughts, mood, and ability to regulate disturbing emotions in patients with anxiety and depressive disorders as well as in healthy individuals (Chiesa and Serretti, 2010, Desrosiers et al., 2013, Evans et al., 2008, Garland et al., 2011, Hofmann et al., 2010, Hoge et al., 2013, Jain et al., 2007, Kabat-Zinn et al., 1992). In these classes of patients as well as in non-clinical samples, such MM-related positive outcomes on mental health also seem to impact physiological parameters associated with stress and anxiety. For example, it has recently been shown in non-clinical populations that a brief training in mindfulness meditation (3–10 days of Vipassana meditation) leads to reduced heart rate (Zeidan, Johnson, Gordon, & Goolkasian, 2010) and increased heart rate variability (which is related to well-being and positive affect; Krygier et al., 2013) immediately after or during meditation tasks. Such findings have been considered to reflect feelings of relaxation (which decreases physiological arousal) or states of effortful, positive immersion in an activity promoted by MM.
Similarly, other longitudinal, within-subject studies or cross-sectional designs in which experienced meditators were compared to naïve meditators or meditation conditions to control conditions (e.g., relaxation or wait-list control conditions), have reported physiological changes during MM. Such changes include reduction of heart and respiratory rates and reduction in skin conductance level, in both clinical (e.g., individuals with fibromyalgia, a chronic pain syndrome; Lush et al., 2009) and non-clinical populations (Cahn and Polich, 2006, Delmonte, 1984, Delmonte, 1985, Ditto et al., 2006, Rubia, 2009). Moreover, a recent study on a sample of depressed patients (Rohde, Adolph, Dietrich, & Michalak, 2014) was able to link negative emotional reactions, experienced when attention drifted during a MM exercise in which subjects had to focus nonjudgmentally on breathing, to electromyographic response of the corrugator supercilii muscle. The activation of this muscle has been shown to be generally associated with negative affect, and the study by Rodhe et al. (2014) observed increased corrugator activity in depressed vs. healthy individuals after drifting from breathing, a finding that can suggest a deficit of depressed patients in the non-judgmental experience component of mindfulness.
Globally, these psychophysiological findings have been interpreted in terms of a wakeful hypometabolic state promoted by MM. This state would be characterized by increased parasympathetic nervous activity (indicative of physiological relaxation and stress relief) and decreased sympathetic activity (e.g., Rubia, 2009). However, one should note that previous studies focused on the health effects of MM therapies have generally monitored physiological parameters immediately after or during MM exercises. This does not shed light about if and how such positive effects of MM translate and generalize to wider, real-world scenarios. Virtual reality (VR) may represent a more holistic and ecological research instrument, providing users with unique, realistic and immersive experiences that are under full experimenter's control and could open up new possibilities to investigate behavioral and physiological responses of meditators to stressful real-world situations.
In the last years, it has been shown that VR exposure can be so effective in terms of experimental realism as to elicit and modulate psychophysiological symptoms of anxiety and fear reactions (e.g., in terms of electrodermal activity), in both patients with anxiety disorders and healthy individuals (Diemer, Mühlberger, Pauli, & Zwanzger, 2014). More specifically, immersive virtual reality systems, as the one we use in this study, exploit realistic 3D graphics, stereoscopic viewing, and head tracking to create interactive, first-person experiences that can be more ecologically valid than traditional, non-interactive experimental stimuli (written text as well as audio-visual materials; e.g., see Parsons, 2011) and produce users' physiological responses that are consistent with real-world experiences (Chittaro, 2014, Chittaro and Buttussi, 2015, Insko, 2003, Meehan et al., 2005, Parsons et al., 2009, Patil et al., 2014, Slater et al., 2009, Slater et al., 1994, Zanon et al., 2014). For example, immersive simulations of emergency situations - such as fires, accidents and other life-threatening events – can provide participants with visual and auditory stimuli that are able to induce negative emotions such as anxiety (Chittaro, 2014) and fear (Chittaro & Buttussi, 2015) as a real emergency would do. Moreover, behavioral responses to virtual emergencies are also consistent with real-world ones, even when particular behaviors such as prosocial behavior (Zanon et al., 2014) or ethnic discrimination (Gamberini, Chittaro, Spagnolli, & Carlesso, 2015) are considered.
To date, the potential of VR in MM studies has been scarcely explored. A few studies have recently tried to use VR and immersive systems to foster the adoption of meditative states (Vidyarthi & Riecke, 2014) or self-compassion (an important construct related to MM, see Crescentini & Capurso, 2015) (Falconer et al., 2014). In line with these recent attempts to combine VR and meditation, earlier research explored the use of VR in combination with mindfulness and relaxation in the treatment of patients with physical and psychological problems such as chronic pain (e.g., fibromyalgia) and posttraumatic stress disorder (Botella et al., 2013, Gromala et al., 2011, Spira et al., 2006; see also Tong, Gromala, Choo, Amin, & Shaw, 2015). However, to the best of our knowledge, no study has employed VR as an instrument to study how meditators respond to stressful situations that simulate, through interactive immersive experiences in controlled conditions, emergencies that occur in real life.
The aim of the current longitudinal research was to investigate the direct impact of a mindfulness-oriented meditation (MOM) intervention on the psychological and physiological responses evoked by four immersive virtual environments (IVEs) that were designed to elicit different levels of stress (low and high, see section on Immersive Virtual Environments) and that simulated real-life scenarios and activities. We studied two groups of healthy adults, one group participating in an 8-week MOM training and the second serving as matched control group whose members were not involved in any meditation intervention. In addition to self-report measures of dispositional mindfulness and trait and state anxiety, we recorded a set of physiological parameters (cardiac, electrodermal, electromyographic, and respiratory activity) while subjects were immersed and acted in the IVEs. This was done in both groups in two different sessions (i.e., before and after the 8-week period during which one of the groups was involved in MOM training). We expected to find evidence of reduced perceived stress and anxiety as well as physiological signs of emotional deactivation and reduced arousal in the MOM subjects when they faced demanding IVEs after vs. before the meditation training.
Section snippets
Participants
A total of 41 Italian participants were recruited for the study. Twenty-one participants took part in the MOM training (mean age = 43.33, SD = 10.23; mean years of education: 15.38, SD = 3.52). They were recruited through advertisements and by word of mouth from employees (administrative personnel, nurses and physicians) of the hospital “Santa Maria della Misericordia” in Udine, Italy. To control for possible influence of occupation, age, education level and gender on the measured psychological
Low-stress and high-stress IVEs: analyses of STAI-S and stress VAS
We assessed state anxiety and stress levels after Low-stress and High-stress IVEs by using the STAI-S and the stress VAS. The 2 (Session: Session1, Session2) × 2 (IVE: Low-stress, High-stress) × 2 (Group: MOM, control) ANOVA carried out for the STAI-S showed a main effect of IVE (F (1, 34) = 30.09, p < .01; ηp2 = .47; observed power = .99) indicating higher scores (i.e., higher state anxiety) after High-stress rather than Low-stress IVEs (see Fig. 4A). All other main effects and interactions
Discussion
The goal of the current study was to investigate how meditators respond to stressful situations that simulate in controlled conditions emergencies that may occur in real-world circumstances. To this end, VR was used as an ecological research instrument to study the psychological and physiological responses evoked by a series of IVEs (either reproducing a train station or a school building and differing in the levels of perceived anxiety and stress; i.e., low-stress and high-stress IVEs). Two
Disclosure statement
The authors report no conflicts of interest.
Acknowledgments
The first author was supported by a Post-Doctoral research fellowship funded by the University of Udine. The third author was supported by a Doctoral research fellowship funded by the University of Rome. The fourth author was supported by a Doctoral research fellowship funded by the University of Udine.
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2021, European Management JournalCitation Excerpt :Reassuringly, observations in scenario-based experiments hold up in real life (Murphy et al., 1986). Consistent with prior stress studies that use experimental designs (e.g., Crescentini et al., 2016; Salzmann et al., 2018), we measure perceived stress about the project deadline with one item, adapted from Howland et al. (2017): “Please indicate how you would feel regarding your project deadline” (1 = not stressed; 9 = very stressed). The level of self-distancing also uses a single-item measure, from(Ayduk & Kross, 2010): “Indicate the extent to which you saw the previous situation (described in the scenario) through your own eyes versus watched the situation unfold as an external observer” (1 = I saw the situation through my own eyes; 9 = I saw the situation as an external observer).
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2021, Consciousness and CognitionCitation Excerpt :Differently than the MBSR program, the MOM training does not include yoga practices, it does not include movement practices and the mindfulness meditation practice is the same throughout the course: following the Satipatthana discourse attributed to Siddharta Gautama (Thera, 2014), participants are taught how to practice mindfulness of breathing, bodily sensations and mental phenomena in sitting position with eye closed (Fabbro & Crescentini, 2016). The positive effects of the MOM training course have been repeatedly studied in the last decade in the general population (Campanella, Crescentini, Urgesi, & Fabbro, 2014, Crescentini, Urgesi, Campanella, Eleopra, & Fabbro, 2014, Crescentini, Chittaro, Capurso, Sioni, & Fabbro, 2016, Matiz et al., 2018, 2020), as well as in clinical settings (Crescentini et al., 2015, 2018), also employing neuroimaging techniques (Tomasino & Fabbro, 2016; Tomasino, Campanella, & Fabbro, 2016). From the group of the former MOM trainees willing to participate in the current study, 16 couples were formed according to the availability of the persons in the days when the EEG recording sessions were possible at the Udine University Hospital.
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2020, Computers in Human BehaviorCitation Excerpt :In the railway context, VR has been used to simulate a London subway, to test travelers experiencing paranoid thoughts after terrorist attacks in London, to help them overcome this fear (Freeman, Pugh, Antley & Slater, 2008). In a more recent study, VR has successfully been used to investigate physiological and psychological responses in non-optimal stressful conditions during meditation and mindfulness practice session (Crescentini, Chittaro, Capurso & Sioni, 2016). The efficacy of VR has also been shown in navigation and wayfinding in spatial cognition field (e.g Chen & Stanney, 1999; Darken & Peterson, 2014; Darken & Sibert, 1996; Lee & Wong, 2014; Steinicke, Visell, Campos & Lécuyer, 2013; Viaud-Delmon, Ivanenko, Berthoz, & Jouvent, 1998), expertise level (e.g Usman, Haworth, Berseth, Kapadia, & Faloutsos, 2017) and cognitive load (e.g (Andersen, Konge, & Sørensen, 2018; Armougum, Orriols, Gaston-Bellegarde, Marle, & Piolino, 2019)).