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

Published

10 months ago

February 2, 2024

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By Dr. Liji Thomas, MD Feb 1 2024 Reviewed by Danielle Ellis, B.Sc.

Palliative care is necessary to ensure comfort and an improved quality of life towards the end of one’s life when enduring chronic or fatal diseases. With the graying of the population in many developed countries, the importance of this segment of healthcare is growing rapidly. Study: Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Image Credit: Chinnapong/Shutterstock.com

In this context, a new study published in Frontiers in Virtual Reality explored the effectiveness of a psychological strategy called Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT)® in helping people cope with their symptoms and achieve relaxation at the end of life. Background

While earlier studies that compared the use of virtual reality (VR) in palliative therapy have been reported, none have been randomized controlled trials (RCTs), driving the current experimental study.

It is known from prior research that palliative care leaves multiple areas of need unsatisfied, including pain relief, psychological distress over loss of autonomy, and limited opportunity for social interactions. This impacts the quality of life and promotes the progression of the illness.

Both pharmacological and non-pharmacological interventions are used in palliative care. Psychotherapy and other psychological tools are extensively used as they do not have the potential for adverse effects that medications have. Moreover, these are inexpensive and practical, especially when focused on helping the patient relax.

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

VR thus prevents the consciousness of the present, miserable surroundings while promoting a sense of being in a virtual environment that is controlled. This leads to distraction, a known cognitive-behavioral tool for pain relief. Moreover, this is improved by the chance for the patient to choose the preferred environment, even using this platform to fulfill deeply cherished longings.

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

Building on earlier feasibilty and pilot studies, the current study seeks to document the impact of VR on patient symptoms in palliative care by simulating activities that are meaningful for the patient. The researchers built a structured psychological program for palliative care patients.

Called FLOW-VRT Relaxation, this is built upon various psychological theories, including flow theory (“completely absorbed in activity without reflective self-consciousness but with a deep sense of control”), self-determination theory (autonomy and a sense of control), stress coping theory, and the attention restoration theory that attributes renewed cognitive ability and greater wellbeing to exposures to natural environments. It is one form of the broader FLOW-VRT intervention, modified for relaxation, allowing patients to choose their relaxing experience. What did the study show?

The study included 128 patients recruited from a palliative care unit over ten months. About 93% completed the study, the mean age being 67 years, and 70% being female. The participants were administered the Chinese version of the Edmonton Symptom Assessment System (CESAS), consisting of a questionnaire exploring nine typically encountered symptoms among cancer patients. This was first done at baseline, followed by randomization and post-test assessment. Related StoriesUK Biobank research reveals significant impact of type 2 diabetes on COVID-19 outcomesNew research highlights regional variations in COPD prevalence according to diagnostic criteriaStudy shows how social media fuels unhappiness and materialism

At baseline, total, physical, and emotional subscale scores on the CESAS were comparable for test and control groups. After the Flow-VRT Relaxation intervention, total, physical, and emotional scores changed in both groups, those exposed to the FLOW-VRT –Relaxation therapy and those who underwent traditional relaxation therapy.

However, the scale of reduction in all three subscale scores was significantly greater with FLOW-VRT Relaxation, indicating that this intervention produced superior symptom improvement compared to 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 person’s autonomy rather than forcing the individual to embrace an experience chosen by someone else.

The use of immersive VR technology could be another reason for the improved symptom control, as this induces flow, which is linked to physical and mental wellbeing. In addition, it may allow patients to explore and learn to use stress management strategies when going through stressful physical and emotional symptoms. Such emotion-focused coping is more easily managed for many patients undergoing the trauma of end-of-life after a terminal illness and are unable to exercise problem-focused coping strategies. What are the implications?

“Our results showed that following a FLOW-VRT-Relaxation session, the symptoms of distress that patients in palliative care have to endure significantly reduced.” Both physically and emotionally, patients reported that they did not feel the same level of distress. These promising results could point to the extending potential of this approach for elderly patients in long-term care homes and rehabilitation centers.

This sheds light on the scope for the use of this intervention in this area, considering its relatively low cost, scalability, and personalization potential. The use of this approach is especially suitable for those with terminal illnesses who are often bedridden or confined to hospital wards, unable to find pain relief, or suffering from the adverse effects of required medical therapy. Moreover, they are emotionally vulnerable as they have unfulfilled wishes of traveling or escaping their pain.

Further studies are required to follow up on the effects of FLOW-VRT Relaxation over time. However, this is not an essential feature in palliative care, where patient survival is typically expected to be short. In fact, against a background of unfulfilled wishes and a short lifespan, FLOW-VRT Relaxation provides a meaningful impact on the patient’s wellbeing as it can virtually satisfy some of these longings and provide a sense of control.

At the same time, the study brought out some potential risks of such technology, which may engender a greater sense of loss of past abilities or skills in contrast to the patient’s current situation. Further research should look at how VR content may be made still more personalized to have meaning for each individual and design training protocols to make sure the intervention is delivered as intended. Journal reference: Woo, O. K. L. et al. (2024). Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Frontiers in Virtual Reality. doi: https://doi.org/10.3389/frvir.2023.1304155. https://www.frontiersin.org/articles/10.3389/frvir.2023.1304155/full.

World

Joe Biden allows Ukraine to begin firing US rockets deep into Russia – as politician warns it ‘risks World War Three’

Published

32 mins ago

November 18, 2024

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Joe Biden allows Ukraine to begin firing US rockets deep into Russia - as politician warns it 'risks World War Three'

Joe Biden has authorised Ukraine to begin firing US-supplied rockets deep into Russia – as Sir Keir Starmer prepares to push for “further support” for Kyiv at the G20 summit.

Mr Biden’s policy shift means Kyiv will now be able to use Army Tactical Missile Systems (ATACMS) for long-range attacks, two American officials have told Sky News’ US partner network NBC News.

Follow latest: Ukraine war live updates

Ukraine plans to conduct its first such attacks in the coming days, the sources said, without revealing details due to operational security concerns.

The US has eased restrictions on the use of ATACMS, which have a range of up to 190 miles, after Russia began deploying North Korean ground troops to supplement its own forces in the conflict.

Kremlin spokesman Dmitry Peskov said such a move would deepen America’s involvement in the war.

“It is obvious that the outgoing administration in Washington intends to… continue adding fuel to the fire and provoking further escalation of tensions around this conflict,” Peskov said.

The development was also condemned by Biden officials as a possible expansion of the war.

A Russian politician and the son of President-elect Donald Trump have both likened the move to risking a third world war.

Maria Butina told the Reuters news agency: “These guys, Biden’s administration, is trying to escalate the situation to the maximum while they still have power and are still in office.

“I have a great hope that Trump will overcome this decision if this has been made because they are seriously risking the start of World War Three which is not in anybody’s interest.”

Meanwhile, Donald Trump Jr wrote on X: “The Military Industrial Complex seems to want to make sure they get World War 3 going before my father has a chance to create peace and save lives… Imbeciles!”

The outgoing Biden administration’s move comes as there are concerns about the level of support the Trump White House may be willing to give Ukraine.

Mr Trump has previously vowed to limit US support for Ukraine and end its war with Russia.

In an evening address after Kyiv was given permission to fire deep into Russia, Ukrainian President Volodymyr Zelenskyy said: “Today, there’s a lot of talk in the media about us receiving permission for respective actions. But strikes are not carried out with words. Such things are not announced. Missiles will speak for themselves. They certainly will.”

Back in September, Russian President Vladimir Putin said if the US were to lift the ban on long-range missile use it would be seen as NATO’s “direct participation” in the war.

He added: “This, of course, will significantly change the very essence, the very nature of the conflict.”

Meanwhile, the UK prime minister has said he has “no plans” to speak with the Russian president as world leaders gather for the G20 summit in Rio de Janeiro.

Mr Putin will not be attending the two-day summit which starts on Monday after saying in October that his presence would “disrupt the normal work of this forum”. Russia’s foreign minister Sergei Lavrov will be attending instead.

It will take place days after German Chancellor Olaf Scholz spoke to Mr Putin on what was the Russian leader’s first publicly announced conversation with the sitting head of a major Western power in nearly two years.

Asked if he had any plans to make a similar call, Sir Keir said: “It’s a matter for Chancellor Scholz who he speaks to. I have no plans to speak to Putin.”

Speaking to reporters while on his way to the summit, he added: “We are coming up to the 1,000th day of this conflict on Tuesday.

“That’s 1,000 days of Russian aggression, 1,000 days of huge impact and sacrifice in relation to the Ukrainian people and recently we’ve seen the addition of North Korean troops working with Russians which does have serious implications.

“I think on one hand it shows the desperation of Russia, but it’s got serious implications for European security […] and for Indo-Pacific security and that’s why I think we need to double down on shoring up our support for Ukraine and that’s top of my agenda for the G20.

“There’s got to be full support as long as it takes and that certainly is top of my agenda, shoring up that further support for Ukraine.”

The latest developments come after Russia launched a large-scale attack on Ukraine on Sunday, with Mr Zelenskyy claiming Moscow had launched a total of 120 missiles and 90 drones.

Two major strikes, which left a total of 18 people dead, hit a residential building in the northeastern city of Sumy as well as energy infrastructure across Ukraine, prompting emergency power cuts.

Hours later, Moscow mayor Sergei Sobyanin said Russia’s air defence units had destroyed a drone heading towards the city.

World

It’s a stunning shift in US policy – but Biden’s announcement will trigger fury and fresh threats from Moscow

Published

32 mins ago

November 18, 2024

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It's a stunning shift in US policy - but Biden's announcement will trigger fury and fresh threats from Moscow

Joe Biden’s belated decision to allow Ukraine to use US-supplied, long-range missiles inside Russia will be cheered by Kyiv and will almost certainly prompt the UK to follow suit.

But the stunning shift in US policy – just weeks before Donald Trump takes over as US president – will also trigger fury and fresh threats from Moscow at a time of increasing uncertainty about the future course of its war.

President Vladimir Putin has warned the West they would be playing with fire if they allowed Ukrainian forces to launch Western-supplied cruise and ballistic missiles at Russia, saying it could even trigger a global conflict.

British and US officials, though, have repeatedly advised their respective capitals not to be intimidated by Moscow’s sabre rattling.

Ukraine war latest: Biden lifts ban on Russia strikes

Yet there has been hesitancy, particularly in Washington, over the unleashing of US Army Tactical Missile System (ATACMS) ballistic missiles beyond the borders of Ukraine.

However, it seems that a move by North Korea to send thousands of its troops to fight with Russia has changed US calculations.

The New York Times, which was among the US media organisations to break news of the Biden administration’s decision on long-range missiles, reported that the first time the American weapons will be used inside Russia will likely be against Russian and North Korean troops battling a Ukrainian incursion in the Russian region of Kursk.

While a significant step up in support for Ukraine, the ability to use American long-range missiles inside Russia is not a war-winning development.

But it does expand Kyiv’s capacity to hit important military targets deliberately positioned by Russian commanders far back from the frontline. This includes stockpiles of missiles, drones and other ammunition used to strike Ukraine.

Just as important as the military impact, though, is the political signal that the US decision sends to the Kremlin about Washington’s willingness to defy Russian warnings about dire consequences should Mr Biden dare to grant Ukraine the permission it’s so long been seeking.

The dramatic move by the US comes after months of lobbying by Ukraine’s leader, Volodymyr Zelenskyy.

A key thing to watch now will be how Mr Putin reacts the first time an American missile kills Russian soldiers on Russian soil.

Moscow does not want a direct war with the United States and NATO – nuclear-armed forces with far greater combined firepower – but the Kremlin could well ramp up an already heightened campaign of sabotage and other forms of hybrid warfare across Europe.

Another important reaction to track will be how Mr Trump responds to Mr Biden’s move and whether he continues to allow Ukraine this permission once he takes over as the US commander-in-chief.

The president-elect has vowed to end Russia’s war in Ukraine quickly but he has not said how. Yet he has voiced fierce opposition to the continued gifting of vast quantities of American weapons to the Ukrainian military.

It is a reason perhaps for Ukraine to make use of its new freedoms with US missiles as quickly as possible.

World

Vladimir Shklyarov: Russian ballet star dies aged 39 after ‘fall from building’

Published

32 mins ago

November 18, 2024

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Vladimir Shklyarov: Russian ballet star dies aged 39 after 'fall from building'

An acclaimed Russian ballet dancer has died aged 39 after reportedly falling off a balcony.

Vladimir Shklyarov, one of the world’s top male ballet stars, died on Saturday night, according to the Mariinsky Theatre, where he was a principal dancer.

The St Petersburg theatre said: “It is with profound sadness that the Mariinsky Theatre announces the untimely passing of principal dancer Vladimir Shklyarov.

“Shklyarov, a beloved artist and audience favourite, died tragically on 16 November.

“His loss is deeply felt by the entire Mariinsky family and the wider ballet world.”

The Mariinsky Theatre told Sky News Shklyarov had a back injury at the time, and was due to have “complicated spinal surgery” on Monday 18 November. He was “taking serious pain medication”.

A spokesperson for the theatre was reported in Russian media at the weekend as saying he had fallen from the fifth floor of a building.

Dancers have been paying tribute to Shklyarov, who was married to fellow company dancer Maria Shklyarov, with whom he had two children.

Former ballerina Irina Bartnovskaya said Shklyarov had been at home, on pain relief, preparing for foot surgery at the time of his death.

In a post on Telegram, she continued: “He went out onto the balcony to get some air and smoke, lost his balance (a very narrow balcony) and fell down (from the 5th floor).

“Stupid, unbearable accident.”