## 4 Discussion  
This literature review aimed to explore the advances in stress management interventions utilizing VR technologies in healthy adults without psychopathological conditions. Sixteen research studies that employed VR systems for ameliorating stress were identified and considered for further analysis. While the modest number of the analyzed studies indicates a developing research area, the inclusion of more recent publications (i.e., after 2017) suggests that there is a growing interest in the field of VR applications for stress man \begin{table}
\begin{tabular}{c c c} \hline \hline
**Author (Year)** & **MINOS Score (Raw)** & **Overall MINORS (\%)** \\ \hline [PERSON] et al. [46] & 16/24 & 66.6 \\ [PERSON] et al. [31] & 18/24 & 75 \\ [PERSON] et al. [47] & 19/24 & 79.1 \\ [PERSON] et al. [48] & 20/24 & 83.3 \\ [PERSON] et al. [49] & 18/24 & 75 \\ [PERSON] et al. [50] & 14/24 & 58.3 \\ [PERSON] et al. [51] & 18/24 & 75 \\ [PERSON] et al. [52] & 19/24 & 79.1 \\ [PERSON] et al. [53] & 17/24 & 70.8 \\ [PERSON] et al. [54] & 16/24 & 66.6 \\ [PERSON] et al. [55] & 17/24 & 70.8 \\ [PERSON] and [PERSON] [35] & 16/24 & 66.6 \\ [PERSON] et al. [56] & 18/24 & 75 \\ [PERSON] et al. [57] & 18/24 & 75 \\ [PERSON] et al. [58] & 18/24 & 75 \\ [PERSON] et al. [59] & 18/24 & 75 \\ \hline Mean Scores & 17.5/24 & 75\% \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Methodological assessment of the study sample. agement. Recently, technology-enhanced healthcare approaches appear to have become more beneficial in terms of the care process, user experience, and costs [80]. In our study sample, eight studies (50%) reported a positive effect of the VR application employed on self-reported stress. Although half of the studies suggested a positive change in the primary outcome, one could say that this number highlights the heterogeneity of the methods of measurement and their produced effects. The review reveals, indeed, that the studies utilized diverse stress assessment instruments, which may render the identification of standardized or dominant experimental regimes for stress management in VR challenging. This variety may also imply that synthesizing and comparing study results (i.e., stress ratings) is very difficult. Previous research has also identified the same methodological problem regarding the different subjective questionnaires, which shows that rigorous testing protocols have not yet been established [81]. This fact can be linked to the broad definition attributed to the term \"stress\", which usually refers not only to a person's perception of a particular situation as upsetting or threatening, but also covers other factors, such as the emotional state of an individual, vulnerability, and coping resources [82]. As a result, researchers tend to measure only particular aspects of stress, such as emotional reactivity, ignoring factors that are equally important to capture the impact of VR interventions. To embrace different approaches regarding the definition of stress, future research should see stress in humans as a whole-person response [83], including psychological and physiological changes in their measurements. This notion is also supported by the review findings that suggested a positive change in the physiological indices, including cardiac or brain activity, and cortisol and electrodermal activity (11 studies; 68.75%). The assessment of particular stress biomarkers could offer many advantages in future research, as the multidimensional nature of stress underlines the need for adopting a method depending on several modalities [84]. To be specific, such measures will allow researchers to identify their main outcomes in a more accurate way and simultaneously consider individual differences in stress susceptibility and relaxation mechanisms [38]. In line with this, several inherent and individual acquired factors, such as age, health status, and personality, can influence the physiological responses to stress as well as an individual's ability to activate their own resources and deal with challenges.