Mental health improvement after the COVID-19 pandemic in individuals with psychological distress.

The COVID-19 pandemic and associated countermeasures had an immensely disruptive impact on people's lives. Due to the lack of systematic pre-pandemic data, however, it is still unclear how individuals' psychological health has been affected across this incisive event. In this study, we analyze longitudinal data from two healthy samples (N = 307) to provide quasi-longitudinal insight into the full trajectory of psychological burden before (baseline), during the first peak, and at a relative downturn of the COVID-19 pandemic. Our data indicated a medium rise in psychological strain from baseline to the first peak of the pandemic (d = 0.40). Surprisingly, this was overcompensated by a large decrease of perceived burden until downturn (d = - 0.93), resulting in a positive overall effect of the COVID-19 pandemic on mental health (d = 0.44). Accounting for this paradoxical positive effect, our results reveal that the post-pandemic increase in mental health is driven by individuals that were already facing psychological challenges before the pandemic. These findings suggest that coping with acute challenges such as the COVID-19 pandemic can stabilize previously impaired mental health through reframing processes.

The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study.

BACKGROUND: Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. METHODS: This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. DISCUSSION: The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).

VR for Studying the Neuroscience of Emotional Responses.

Emotions are frequently considered as the driving force of behavior, and psychopathology is often characterized by aberrant emotional responding. Emotional states are reflected on a cognitive-verbal, physiological-humoral, and motor-behavioral level but to date, human research lacks an experimental protocol for a comprehensive and ecologically valid characterization of such emotional states. Virtual reality (VR) might help to overcome this situation by allowing researchers to study mental processes and behavior in highly controlled but reality-like laboratory settings. In this chapter, we first elucidate the role of presence and immersion as requirements for eliciting emotional states in a virtual environment and discuss different VR methods for emotion induction. We then consider the organization of emotional states on a valence continuum (i.e., from negative to positive) and on this basis discuss the use of VR to study threat processing and avoidance as well as reward processing and approach behavior. Although the potential of VR has not been fully realized in laboratory and clinical settings yet, this technological tool can open up new avenues to better understand the neurobiological mechanisms of emotional responding in healthy and pathological conditions.

A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study.

BACKGROUND: Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. OBJECTIVE: This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. METHODS: In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. RESULTS: More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=-0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=-0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. CONCLUSIONS: Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on.

Social cognitive factors outweigh negative emotionality in predicting COVID-19 related safety behaviors.

Emotion-motivation models propose that behaviors, including health behaviors, should be predicted by the same variables that also predict negative affect since emotional reactions should induce a motivation to avoid threatening situations. In contrast, social cognitive models propose that safety behaviors are predicted by a different set of variables that mainly reflect cognitive and socio-structural aspects. Here, we directly tested these opposing hypotheses in young adults (N = 4134) in the context of COVID-19-related safety behaviors to prevent infections. In each participant, we collected measures of negative affect as well as cognitive and socio-structural variables during the lockdown in the first infection wave in Germany. We found a negative effect of the pandemic on emotional responses. However, this was not the main predictor for young adults' willingness to comply with COVID-19-related safety measures. Instead, individual differences in compliance were mainly predicted by cognitive and socio-structural variables. These results were confirmed in an independent data set. This study shows that individuals scoring high on negative affect during the pandemic are not necessarily more likely to comply with safety regulations. Instead, political measures should focus on cognitive interventions and the societal relevance of the health issue. These findings provide important insights into the basis of health-related concerns and feelings as well as behavioral adaptations.

Embodiment in Virtual Reality Intensifies Emotional Responses to Virtual Stimuli.

Modulating emotional responses to virtual stimuli is a fundamental goal of many immersive interactive applications. In this study, we leverage the illusion of illusory embodiment and show that owning a virtual body provides means to modulate emotional responses. In a single-factor repeated-measures experiment, we manipulated the degree of illusory embodiment and assessed the emotional responses to virtual stimuli. We presented emotional stimuli in the same environment as the virtual body. Participants experienced higher arousal, dominance, and more intense valence in the high embodiment condition compared to the low embodiment condition. The illusion of embodiment thus intensifies the emotional processing of the virtual environment. This result suggests that artificial bodies can increase the effectiveness of immersive applications psychotherapy, entertainment, computer-mediated social interactions, or health applications.

Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke.

BACKGROUND: The rehabilitation of gait disorders in patients with multiple sclerosis (MS) and stroke is often based on conventional treadmill training. Virtual reality (VR)-based treadmill training can increase motivation and improve therapy outcomes. The present study evaluated an immersive virtual reality application (using a head-mounted display, HMD) for gait rehabilitation with patients to (1) demonstrate its feasibility and acceptance and to (2) compare its short-term effects to a semi-immersive presentation (using a monitor) and a conventional treadmill training without VR to assess the usability of both systems and estimate the effects on walking speed and motivation. METHODS: In a within-subjects study design, 36 healthy participants and 14 persons with MS or stroke participated in each of the three experimental conditions (VR via HMD, VR via monitor, treadmill training without VR). RESULTS: For both groups, the walking speed in the HMD condition was higher than in treadmill training without VR and in the monitor condition. Healthy participants reported a higher motivation after the HMD condition as compared with the other conditions. Importantly, no side effects in the sense of simulator sickness occurred and usability ratings were high. No increases in heart rate were observed following the VR conditions. Presence ratings were higher for the HMD condition compared with the monitor condition for both user groups. Most of the healthy study participants (89%) and patients (71%) preferred the HMD-based training among the three conditions and most patients could imagine using it more frequently. CONCLUSIONS: For the first time, the present study evaluated the usability of an immersive VR system for gait rehabilitation in a direct comparison with a semi-immersive system and a conventional training without VR with healthy participants and patients. The study demonstrated the feasibility of combining a treadmill training with immersive VR. Due to its high usability and low side effects, it might be particularly suited for patients to improve training motivation and training outcome e. g. the walking speed compared with treadmill training using no or only semi-immersive VR. Immersive VR systems still require specific technical setup procedures. This should be taken into account for specific clinical use-cases during a cost-benefit assessment.

Self-organizing knowledge management might improve the quality of person-centered dementia care: A qualitative study.

BACKGROUND: In institutional dementia care, person-centered care improves care processes and the quality of life of residents. However, communication gaps impede the implementation of person-centered care in favor of routinized care. OBJECTIVE: We evaluated whether self-organizing knowledge management reduces communication gaps and improves the quality of person-centered dementia care. METHOD: We implemented a self-organizing knowledge management system. Eight significant others of residents with severe dementia and six professional caregivers used a mobile application for six months. We conducted qualitative interviews and focus groups afterward. MAIN FINDINGS: Participants reported that the system increased the quality of person-centered care, reduced communication gaps, increased the task satisfaction of caregivers and the wellbeing of significant others. CONCLUSIONS: Based on our findings, we develop the following hypotheses: self-organizing knowledge management might provide a promising tool to improve the quality of person-centered care. It might reduce communication barriers that impede person-centered care. It might allow transferring content-maintaining tasks from caregivers to significant others. Such distribution of tasks, in turn, might be beneficial for both parties. Furthermore, shared knowledge about situational features might guide person-centered interventions.

The Impact of Avatar Personalization and Immersion on Virtual Body Ownership, Presence, and Emotional Response.

This article reports the impact of the degree of personalization and individualization of users' avatars as well as the impact of the degree of immersion on typical psychophysical factors in embodied Virtual Environments. We investigated if and how virtual body ownership (including agency), presence, and emotional response are influenced depending on the specific look of users' avatars, which varied between (1) a generic hand-modeled version, (2) a generic scanned version, and (3) an individualized scanned version. The latter two were created using a state-of-the-art photogrammetry method providing a fast 3D-scan and post-process workflow. Users encountered their avatars in a virtual mirror metaphor using two VR setups that provided a varying degree of immersion, (a) a large screen surround projection (L-shape part of a CAVE) and (b) a head-mounted display (HMD). We found several significant as well as a number of notable effects. First, personalized avatars significantly increase body ownership, presence, and dominance compared to their generic counterparts, even if the latter were generated by the same photogrammetry process and hence could be valued as equal in terms of the degree of realism and graphical quality. Second, the degree of immersion significantly increases the body ownership, agency, as well as the feeling of presence. These results substantiate the value of personalized avatars resembling users' real-world appearances as well as the value of the deployed scanning process to generate avatars for VR-setups where the effect strength might be substantial, e.g., in social Virtual Reality (VR) or in medical VR-based therapies relying on embodied interfaces. Additionally, our results also strengthen the value of fully immersive setups which, today, are accessible for a variety of applications due to the widely available consumer HMDs.