The Virtual Reality Therapy as a Pulmonary Rehabilitation Supporting Method
Condition: Pulmonary Disease; COPD; Anxiety State; Stress; Depressive Symptoms; Mood Disorders
MeSH terms: Depression; Mood Disorders
Study type: Interventional

Summary: 
      This study evaluates the effectiveness of virtual reality (VR) therapy in the treatment of
      depression and anxiety symptoms in patients undergoing the pulmonary rehabilitation. The
      first study group will receive VR therapy (VR group) as an addition to the traditional
      pulmonary rehabilitation. The second group (active control group) will receive Schultz
      Autogenic Training as a standard supplement to the pulmonary treatment. The third group
      (control group) will undergo only the traditional pulmonary rehabilitation.
    

Detailed description: 
      Pulmonary rehabilitation leads to the improvement to the physical capacity and overall
      fitness of the patients with COPD allowing restoration of independence in daily functioning.

      Psychological support is required in order to reduce the negative psychological symptoms
      related to both the pulmonary disease itself and the comorbidities. In this study the
      investigators want to assess the effectiveness of the virtual reality (VR) therapy compared
      to standard psychological support (Schultz Autogenic Training).

      Thanks to using head mounted display (VR goggles 2018) and the phenomenon of total immersion
      VR therapy allows to completely separate the patient from the hospital environment, provides
      an intense visual, auditory and kinesthetic stimulation. Depending on the stage of therapy it
      can have a calming and mood-improving effect or, in another part of the therapy, it can
      motivate the patient to the rehabilitation process. The additional aim of the VR therapy is
      to help the patients regain their emotional balance, let them recognize their psychological
      resources and trigger the natural recovery mechanisms.

      The goals of the project:

        1. The evaluation of the influence of VR therapy on the depressive symptoms, the anxiety
           level and the stress level of the patients undergoing the pulmonary rehabilitation.

        2. The comparison of the influence of the VR therapy and Schultz Autogenic Training on the
           pulmonary rehabilitation process.

        3. The evaluation of the pulmonary therapy improvements in patients with and without
           depressive, anxiety or stress symptoms.
    

Intervention name(s): Pulmonary rehabilitation; Virtual therapeutic support
Intervention type(s): Behavioral; Device
Intervention description(s): Three weeks of pulmonary rehabilitation conducted in an outpatient care facility:
5- time a week for 30 minutes a specific respiratory exercises- relaxation exercises for breathing muscles, exercises to increase breathing, prolonged exhalation exercise, chest percussion
5- time a week for 20-30 min training on a cycle ergometer - until the Heart Rate reaches 60% of the HRmax
5- time a week for 30 minutes a fitness and respiratory exercises - coordination and balance exercises, stretching exercises
relaxation by Schultz Autogenic Training. The technique involves the daily practice of sessions that last around 15 minutes. During each session, the practitioner repeats a set of visualisations that induce a state of relaxation.; 8 sessions of VR therapy (each of them 20 minutes long). As a virtual reality source, VR Tier One device (Stolgraf®) were used. Thanks to using head mounted display and the phenomenon of total immersion VR therapy provides an intense visual, auditory and kinesthetic stimulation. It can have a calming and mood-improving effect or help the patients recognize their psychological resources and motivate to the rehabilitation process. In the virtual therapeutic garden there are a rich set of symbols and metaphors based on Ericksonian Psychotherapy approach. The most important is the Garden of Revival which symbolizes the patient's health. It used to be full of life and energy, now it is neglected, requires work to be revived. In the therapeutic process day by day, the therapist tells the patient a symbolic story about his/her situation.
By performing tasks in the virtual garden, the patient becomes an active participant of the therapeutic process and sees the effects his/her work.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: virtual reality; pulmonary rehabilitation; psychotherapy; depression; anxiety; stress; COPD