Efficacy of Virtual Reality Therapy on anxiety in adolescence
- Gifted Gabber
- Jun 9
- 7 min read
VR therapy is a type of mental health treatment that uses virtual scenarios for therapeutic results. It often utilizes a headset, which allows individuals to interact and be immersed in the virtual environment. The nature of the intervention can vary based on the patient and situation. Exposure therapy uses virtual reality to allow patients to gain exposure to their fears in a safe and controlled environment, eventually leading to patients overcoming their anxiety. Second, distraction techniques are often used during medical procedures to alleviate pain felt by patients. This is done by using VR to immerse patients a calming and relaxing setting, which helps reduce their pain and anxiety. Third, immersion therapy involves immersing an individual in a controlled environment that is safe for them to confront their fears. It replicates real world scenarios that may seem daunting for the patients. Immersion therapy shares similar traits with exposure therapy. Pre-operative anxiety involves feelings of fear or stress that patients feel before undergoing a procedure. It is often caused by fear of the unknown, fear of pain, or potential complications. In order to reduce this anxiety, patients need to be properly educated and informed on the procedure. They need emotional support from both doctors and loved ones to cope with their anxiety. The use of non-pharmological interventions to reduce pre-operative anxiety is a common practice. VR therapy is an example of one of these interventions. Adolescents experience pre-operative anxiety much differently than adults. Adolescents are still in the formative years of their lives, and often have heightened emotions. It is also likely that they won’t fully understand the situation they are in, which can lead to additional anxiety. In the past, interventions of many forms have shown to help reduce pre-operative anxiety such as music therapy, games and videos, educational tours and videos, and many more. In this paper, I will explore anxiety in pre-operative adolescent patients, and how VR therapy is a promising solution to reduce this anxiety.
The paper will begin with an introduction to give context to readers of what VR therapy is, as well as defining pre-operative anxiety. Then, the methods section will outline precisely how I found the sources I analyzed and the process I used to select the most credible papers. The results section will present the general themes and findings of the papers. The discussion will explore why this topic is relevant in today’s medical field, and the potential of VR therapy. Finally, the conclusion will close out the paper by discussing the key points and overall impact of VR therapy on preoperative anxiety.
Method
Search Strategy
The search was conducted on August 3rd, 2024, using the database PubMed. The search strategy entered was: “(virtual reality) OR (VR) AND (adolescent) AND (anxiety)”. When the word “preoperative” was included as a keyword, papers that explored preoperative patients but did not use that exact term as a keyword were left out. Hence, although the search strategy did not contain “preoperative,” this was still the target population of our search.
Figure 1 depicts screening decisions, modified from a PRISMA) flow diagram.
The search strategy resulted in 280 records. After filtering by papers published in the past 5 years, there were 172 results. The results were limited to papers that were: Adaptive Clinical Trial, Books and Documents, Clinical Study, Clinical Trial, Clinical Trial Protocol, Clinical Trial, Phase I, Clinical Trial, Phase II, Clinical Trial, Phase III, Clinical Trial, Phase IV, Comparative Study, Controlled Clinical Trial, Pragmatic Clinical Trial, Randomized Controlled Trial. This limited the number of results to 53, and excluded other literature reviews.
The 53 resulting reports were assessed for eligibility to select those that fit the research question. Papers were accessed through PubMed; abstracts were all open access. The platform had full text versions of the papers that did not require any further subscription/payment. Articles that did not focus primarily on adolescents were removed. Articles were also excluded if they focused on depression or other mental health disorders, rather than anxiety. Finally, articles were not included if they did not focus on patients in the preoperative stage. Articles focused on anxiety in the perioperative or post-operative stage were excluded.
After assessing articles for eligibility, 5 articles remained that fit the research question.
Figure 1. PRISMA flow diagram depicting identification and screening of articles.
Results
Throughout all six papers, there were a total of 653 participants. More detail about each study, the participants, the intervention(s) used, and the outcomes are displayed in Table 1. Overall, findings showed that VR interventions had a significant effect of reducing anxiety in preoperative adolescent patients (Table 1).
Table 1. Summary of articles analyzed.
Article Identification | Sample | VR Intervention / Time administered | Pre-operative Anxiety Outcome Measure | Main Finding |
(Eijlers et al., 2019) | N = 200 Children aged 4-12 in a children’s hospital in the Netherlands Located in the Netherlands | Children were exposed to a realistic child-friendly virtual version of the operating theater | mYPAS, self reported anxiety | In children undergoing elective day care surgery, VR intervention did not have a significant effect on the observed measures. |
(Esposito et al., 2022) | N = 40 Patients aged 12-17 (median age 14.5 years) scheduled for elective surgery Located in Naples, Italy | Patients watched a 5 minute long video using a head-mounted display | Patient heart rate (before anesthesia), self evaluation using FAS, anesthesiologist evaluation using FAS, subjective stress scoring using a 5 item Likert-type scale | The VR intervention led to overall decreased preoperative anxiety in comparison to the control group. |
(Carbó et al., 2024) | N = 241 Children aged 3-12 years old, ASA I-II, scheduled for elective low-complexity surgery Located in Barcelona, Spain | Patients viewed a VR based educational video on the surgical process 7-10 days prior to surgery | PA using the mYPAS | The VR based intervention reduce preoperative anxiety in children undergoing elective, low complexity surgery. |
(Dehgan et al., 2019) | N = 40 Children undergoing abdominal surgery Located in Iran | Patients had a 5 minute exposure to the operating room using virtual reality technology | Yale Preoperative Anxiety Scale - based questionnaire | The use of virtual reality technology reduced preoperative anxiety in children |
(Chamberland et al., 2024) | N = 101 Patients aged 5-7 years old scheduled for elective day surgery under general anesthesia Located in Quebec | Patients were accompanied by two virtual characters who taught them relaxation techniques and provided informational/ emotional support. | Short version of the mYPAS | Anxiety scores were significantly lower in the augmented reality group compared to the control at the time of admission. Most patients in the augmented reality group had a positive experience and said they would want to wear the glasses again. |
Participant Characteristics
The patients who responded were children/adolescents aged 4-17. The studies took place in various countries such as Italy, Iran, Spain, the Netherlands, and Quebec (Table 1). There were generally equal numbers of male and female participants recruited. The patients were all undergoing elective surgery, which allowed for preoperative intervention. Elective surgeries included dental surgery, ENT surgery, abdominal surgery, and surgeries in the fields of ophthalmology, dentistry, urology, otorhinolaryngology, orthopedics, and general surgery. The patients' health problems were mild, and they were categorized as either ASA-I or ASA-II. These categories refer to the classification system created by the American Society of Anesthesiologists. The patients included in these studies all had mild systemic disease without functional limitation.
Measures of Preoperative Anxiety
Out of the various measures used to document anxiety, some used a doctor’s observation, and others relied on self-report. Occasionally, the use of a biometric measurement (e.g., heart rate) was used to supplement patient self-report.
One measure used to document the outcome was the modified Yale Preoperative Anxiety Scale (mYPAS), which was used in multiple papers (Cite, or reference Table 1 if you include the measures there). Some studies used the Yale Preoperative Anxiety Scale (YPAS), rather than the modified version. The YPAS and mYPAS are both reports that require a doctor to observe a patient's behavior and record the results accordingly. The YPAS identifies 21 items that indicate anxiety in five categories: activity, emotional expressivity, state of arousal, vocalization, and use of adults. The mYPAS identifies 22 items and 5 categories. It is administered at four different times.
Another measure that was used was the state-trait anxiety inventory scale (STAI). The State-Trait anxiety inventory scale is a self assessment.
Another measure used is the facial affective scale, which was used in addition to the measurement of a patient's heartbeat. The facial affective scale is a self assessment that uses pictures for patients to indicate any discomfort, pain, or anxiety.
The papers did not point out the specific demographic of patients that did not respond to VR intervention. There were no outstanding differences in sex/age that were linked to an altered response.
Reduction In Pre-operative Anxiety
Discussion
The review of all five papers reveals a general trend of VR therapy being effective in reducing pre-operative anxiety in pediatric and adolescent patients, with some studies also showing reductions in associated outcomes such as heart rate, pain perception, and the need for rescue analgesia. These findings display the potential of VR therapy in reducing anxiety in preoperative adolescent patients undergoing elective surgery, making it an extremely useful tool in the medical field. The importance of the benefits of VR therapy is shown in many aspects of the recovery process. The benefits of reduced anxiety in the preoperative stage can lead to improved surgical outcomes, shortened recovery times, and overall more positive patient experiences.
It is important to note the factors that lead to adolescents being perceptive to VR therapy. One hypothesis that can be drawn is the fact that the The younger generation has greater familiarity with technology, making them more comfortable with this method.
Second, children and adolescents may be more likely to allow themselves to be distracted by and immersed in the VR experience, in comparison to adults. The future research done on this topic should explore the optimal duration and characteristic of the VR therapy (distraction, immersion, etc.) that produces the best outcome. The effect of VR therapy on preoperative anxiety in children and adolescents should be explored through diverse populations and different types of surgeries, such as more emergent procedures. A strength of this review is the diverse procedures involved as well as the various forms of intervention . It provides a well rounded and informative perspective. A weakness of this review is the limited research available on the specific topic of VR therapy’s effectiveness in preoperative anxiety in adolescents. However, the available research was credible and synthesized into a strong review.
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