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Background Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment. Objective The main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder. Methods A total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated. Results In within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups. Conclusions The self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach. Trial Registration ClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019

A sense of gratitude is a powerful and positive experience that can promote a happier life, whereas resentment is associated with life dissatisfaction. To explore the effects of gratitude and resentment on mental well-being, we acquired functional magnetic resonance imaging and heart rate (HR) data before, during, and after the gratitude and resentment interventions. Functional connectivity (FC) analysis was conducted to identify the modulatory effects of gratitude on the default mode, emotion, and reward-motivation networks. The average HR was significantly lower during the gratitude intervention than during the resentment intervention. Temporostriatal FC showed a positive correlation with HR during the gratitude intervention, but not during the resentment intervention. Temporostriatal resting-state FC was significantly decreased after the gratitude intervention compared to the resentment intervention. After the gratitude intervention, resting-state FC of the amygdala with the right dorsomedial prefrontal cortex and left dorsal anterior cingulate cortex were positively correlated with anxiety scale and depression scale, respectively. Taken together, our findings shed light on the effect of gratitude meditation on an individual’s mental well-being, and indicate that it may be a means of improving both emotion regulation and self-motivation by modulating resting-state FC in emotion and motivation-related brain regions.

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.

A mobile virtual reality system, equipped with built-in variables such as heart rate (HR), gaze-down data, and subjective fear rating, can allow individuals with a fear of heights to overcome it by self-training. This study aimed to verify the efficacy and safety of the training program. Forty-eight volunteers completed the four-session self-training program over 2 weeks. They were allocated into either low- or high-fear group by the Acrophobia Questionnaire (AQ)-anxiety scores, and then the changes of the built-in variables and AQ-anxiety scores were analyzed between the groups. The safety was assessed using the Simulator Sickness Questionnaire (SSQ). The AQ-anxiety scores were significantly decreased after self-training in both groups, and the degree of decrease was significantly greater in the high-fear group than in the low-fear group. Gaze-down percentage and subjective fear rating showed a significant group difference, but HR did not. The SSQ scores were within the acceptable level. These results suggest that the training effect was greater in the high-fear group than in the low-fear group. This mobile program may be safely applicable to self-training for individuals with high scores on the fear of heights by repeated exposure to virtual environments with the embedded feedback system.