New technologies, such as virtual reality (VR) and augmented reality (AR), can be used as an add-on to exposure therapy for common anxiety disorders. Although the benefits of VR for exposure therapy have already been demonstrated extensively in research, AR applications are only just becoming widely available. Evidence for the added value and effectiveness of AR exposure therapy (ARET) is still scarce. The current study aimed to explore whether a first markerless AR iOS app for specific phobia could induce fear for multiple animal species in a general population sample. In two experiments, participants made use of the PHOBOS AR app in a behavioral approach task (BAT), using animals for which they were anxious, but not phobic. Self-report data and physiological measures were recorded. In Experiment 1, 108 participants chose one of the seven available animal species and were allocated to either a smartphone or tablet condition. Results showed increasing levels of self-reported anxiety with increasing levels of BAT difficulty. However, this increase was smaller in individuals reporting low levels of perceived realism. No effects on heart rate (HR) could be established. In Experiment 2, 52 participants were exposed to virtual spiders. For both self-reported anxiety and the interaction with perceived realism, results were similar to those of Experiment 1. Skin conductance did increase significantly from baseline to the highest level of difficulty of the BAT, and the severity of fear of spiders also appeared to be related to the fear response in the BAT. In conclusion, the study shows that animals presented in AR through a mobile device can evoke anxiety, which is a prerequisite for the implementation of ARET. However, further research should establish the effects of ARET in a clinical sample of people with specific phobias.

Over the past years, mobile health (mHealth) applications and specifically wearables have become able and available to collect data of increasing quality of relevance for mental health. Despite the large potential of wearable technology, mental healthcare professionals are currently lacking tools and knowledge to properly implement and make use of this technology in practice. The Carewear project is aimed at developing and evaluating an online platform, allowing healthcare professionals to use data from wearables in their clinical practice. Carewear implements data collection through self-tracking, which is aimed at helping people in their behavioral change process, as a component of a broader intervention or therapy guided by a mental healthcare professional. The Empatica E4 wearables are used to collect accelerometer data, electrodermal activity (EDA), and blood volume pulse (BVP) in real life. This data is uploaded to the Carewear platform where algorithms calculate moments of acute stress, average resting heart rate (HR), HR variability (HRV), step count, active periods, and total active minutes. The detected moments of acute stress can be annotated to indicate whether they are associated with a negative feeling of stress. Also, the mood of the day can be elaborated on. The online platform presents this information in a structured way to both the client and their mental healthcare professional. The goal of the current study was a first assessment of the accuracy of the algorithms in real life through comparisons with comprehensive annotated data in a small sample of five healthy participants without known stress-related complaints. Additionally, we assessed the usability of the application through user reports concerning their experiences with the wearable and online platform. While the current study shows that a substantial amount of false positives are detected in a healthy sample and that usability could be improved, the concept of a user-friendly platform to combine physiological data with self-report to inform on stress and mental health is viewed positively in our pilots.

Accumulating evidence supports the use of virtual reality (VR) as an effective pain and anxiety management tool for pediatric patients during specific medical procedures in dedicated patient groups. However, VR is still not widely adopted in everyday clinical practice. Feasibility and acceptability measures of clinicians' experiences are often missing in studies, thereby omitting an important stakeholder in VR use in a clinical setting. Therefore, the aim of this mixed-methods study was to investigate the feasibility, acceptability, tolerability (primary outcomes), and preliminary effectiveness (secondary outcome) of Relaxation-VR in both pediatric patients aged 4–16 years and clinicians. Relaxation-VR is a VR application prototype aimed to provide distraction and relaxation for a variety of patient populations and procedures and is used to reduce anxiety, stress (tension) and pain for children in hospital. Multiple measures of acceptability, feasibility and tolerability, and pre-to-post changes in measures of pain, anxiety, stress and happiness were assessed in pediatric patients. At the end of the study, acceptability and feasibility of VR use was assessed in clinicians. Results indicate that VR use (in particular, the Relaxation-VR prototype) for both distraction and relaxation is acceptable, feasible and tolerable for a variety of pediatric patients aged 4–16 years, as assessed in both patients and clinicians, and can reduce anxiety, pain and tension (stress), and increase happiness in a hospital setting.