Virtual relaxation therapy reduces distress in end-of-life care

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Palliative care is needed to ensure comfort and improved quality of life at the end of one’s life when enduring a chronic or terminal illness. As the population grays in many developed countries, the importance of this segment of healthcare is increasing rapidly.

Study: Flourishing-Life-of-Wish Virtual Reality Relaxation Therapy (Flow-VRT-Relaxation) Superior to Traditional Relaxation Therapy in Palliative Care: Results of a Randomized Controlled Trial.  Image credit: Chinnapong/
Study: Flourishing-Life-of-Wish Virtual Reality Relaxation Therapy (Flow-VRT-Relaxation) Superior to Traditional Relaxation Therapy in Palliative Care: Results of a Randomized Controlled Trial. Image Credit: Chinnapong/

A new study published in this context Frontiers in Virtual Reality Flourishing-Life-of-Wish explored the effectiveness of a psychological technique called Virtual Reality Therapy (Flow-VRT)® to help people cope with their symptoms and achieve relaxation at the end of life.


As reported in previous studies comparing the use of virtual reality (VR) in palliative therapy, none of the randomized controlled trials (RCTs) driving the current experimental study have been conducted.

It is known from previous research that palliative care unsatisfies multiple areas of need, including pain relief, emotional distress due to loss of autonomy, and limited opportunities for social interaction. It affects quality of life and promotes disease progression.

Both pharmacological and non-pharmacological interventions are used in palliative care. Psychotherapy and other psychological tools are widely used because they are unlikely to have the adverse effects of drugs. Furthermore, they are inexpensive and practical, especially when focused on helping the patient relax.

Most research on relaxation in the field of palliative medicine looks only at traditional techniques, largely ignoring the potential of VR to reduce pain and facilitate relaxation. However, VR creates an immersive experience that makes patients feel like they are present in another environment.

VR thus inhibits the consciousness of the present, ephemeral environment while promoting the feeling of being in a controlled virtual environment. This leads to distraction, a known cognitive-behavioral tool for pain relief. Moreover, it is enhanced by the opportunity to choose the environment of the patient’s choice, even using this platform to fulfill deeply cherished desires.

This ability to virtually fulfill their desire to travel to a relaxing destination or environment can bring happiness and relieve the discomfort and sadness of a terminal condition.

Based on previous feasibility and pilot studies, the present study sought to document the effects of VR on patient symptoms in palliative care by simulating meaningful activities for the patient. Researchers developed a structured psychological program for palliative care patients.

Called Flow-VRT relaxation, it is built on various psychological theories, including flow theory (“being completely absorbed in activities without reflective self-consciousness but with a deep sense of control”), self-control theory (a sense of autonomy and control), coping with stress theory, and attention recovery theory that attribute new cognitive abilities and greater well-being to exposure to natural environments. It is a form of comprehensive flow-VRT intervention, modified for relaxation, allowing patients to choose their relaxation experience.

What does the study show?

The study included 128 patients recruited from a palliative care unit over a ten-month period. About 93% completed the study, mean age was 67 years and 70% were female. Participants were administered the Chinese version of the Edmonton Symptom Assessment System (CESAS), which includes a questionnaire covering nine symptoms commonly encountered in cancer patients. This was done first at baseline, followed by randomization and post-test assessment.

At baseline, total, physical, and mental subscale scores on the CESAS were comparable for the experimental and control groups. After the Flow-VRT relaxation intervention, total, physical and mental scores changed in both groups, those exposed to Flow-VRT-relaxation therapy and those exposed to traditional relaxation therapy.

However, the reduction in all three subscale scores was significantly greater with Flow-VRT relaxation, indicating that this intervention produced greater symptom improvement than traditional measures. This may be due to the individual’s freedom to choose meaningful content for the VR experience, promoting self-determination by supporting the individual’s autonomy rather than forcing the individual to accept an experience chosen by someone else.

The use of immersive VR technology may be another factor in improved symptom control, as it induces flow, which is associated with physical and mental well-being. Additionally, it may allow patients to explore and learn to use stress management strategies when experiencing stressful physical and emotional symptoms. This type of emotion-focused coping is more easily managed for many patients who suffer end-of-life trauma after a terminal illness and are unable to practice problem-focused coping strategies.

What are the effects?

Our results showed that after a flow-VRT-relaxation session, the symptoms of distress experienced by patients in palliative care were significantly reduced.“Both physically and psychologically, patients reported that they did not experience the same level of distress. These promising results may indicate the possibility of expanding this approach to elderly patients in long-term care homes and rehabilitation centers.

This highlights the scope for the use of this intervention in this area, considering its relatively low cost, scalability, and potential for personalization. The use of this method is particularly appropriate for those suffering from terminal illness who are often confined to bed or hospital wards, unable to relieve pain, or suffering from adverse effects of necessary medical therapy. Furthermore, they are emotionally vulnerable because they have an unfulfilled desire to travel or escape their pain.

Further studies are needed to follow the effects of FLOW-VRT relaxation over time. However, this is not an essential feature in palliative care, where patient survival is generally expected to be short. Indeed, against the backdrop of unfulfilled desires and short life expectancy, Flow-VRT relaxation provides a meaningful impact on the patient’s well-being as it can practically satisfy some of these desires and provide a sense of control.

At the same time, research has highlighted some of the potential risks of such technology, which may create a greater sense of loss of past abilities or skills as opposed to the patient’s current situation. Further research should look at how VR content can be further personalized to have meaning for each individual and design training protocols to ensure that the intervention is delivered as intended.

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