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We present a novel Virtual Reality (VR) life review therapy system. Life review therapy is an intervention used by clinical psychologists, counselors, and social workers for patients under palliative care to systematically examine various life experiences to resolve conflicts and complete life tasks. The goal of the therapy is to narrativize the patient’s life before death in order to come to terms with their mortality. Our VR life review therapy system allows therapists to perform their interventions in customized virtual spaces designed to encourage the patient to reflect and reminisce about their life experiences. Our system is also developed in response to mobility restrictions and COVID-19 pandemic-related quarantine measures that have separated patients under palliative care from family and friends, resulting in emotional and psychological distress. As VR systems related to health are increasingly being used by therapists in their interventions, it is of utmost importance that the health professionals who will be the end users of these systems are involved in the design process to create ethical healthcare technologies. In response, we initiated the participatory design and evaluation of our VR life review therapy system prototype with six clinical psychologists who have practical experience delivering life review therapy to patients in palliative care in the Hong Kong hospital system. In the study, each participant experienced the VR life review therapy system and evaluated its strengths and weaknesses through semi-structured interviews. The qualitative data gathered from these interviews was coded according to nine different categories; avatars, content design, evaluation, haptic sensations, interaction, gesturing and gaze direction, movement and navigation, non-verbal communication, soundtrack. These conceptual categories were chosen based on our analysis of common themes reported by the clinical psychologists’ experience of the system. Feedback from clinical psychologists on each of these categories was incorporated into the redesign and update of the final system. Overall, participants generally evaluated the system as feasible and effective for use with patients under palliative care, while movement and interaction were the features requiring the most improvement.

Introduction: As the global population continues to age, the demand for palliative care is progressively increasing. This growing trend highlights the pressing need for groundbreaking interventions that can effectively manage palliative symptoms and improve the quality of end-of-life care. We present a brief, structured, personalized, and innovative psychological intervention named Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT)®, which capitalizes on the distinctiveness of virtual reality (VR) as an advanced technology for symptom management. FLOW-VRT is theoretically based on self-determination theory, stress coping theory, flow theory, and attention restoration theory. With a special focus on relaxation, “FLOW-VRT-Relaxation” is designed to enhance end-of-life coping through personalized VR relaxation. As most studies on the use of VR in palliative care have been feasibility or pilot studies with small sample sizes, there is a need for a randomized controlled trial with sufficient statistical power.Methods: The current study used a randomized controlled trial (n = 128) to test the efficacy of FLOW-VRT-Relaxation by comparing it to traditional relaxation practice in palliative care.Results: Our results showed that following a FLOW-VRT-Relaxation session, the symptoms of distress that patients in palliative care have to endure significantly reduced, whether physical or emotional in nature.Discussions: The current findings provide promising results regarding the therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable, and personalized VR relaxation for patients in palliative care.

Augmented Reality (AR) overlays computer-generated visual, auditory or other sensory information onto the real world. Due to recent technological advancement in the field, it can become increasingly difficult for the user to differentiate between sensory information coming from real and virtual objects, leading to interesting perceptual phenomena. For example, an AR experience in which users can experience their own hands in flames has been shown to elicit heat illusions on the affected hands. In this study, we investigate the potential that AR has for top-down modulation of pain and thermal perception. We assessed thermal pain and detection thresholds on the participant’s right hand while covering it with realistic virtual flames. We compared this experience to a baseline condition with no additional stimuli. We also report on a condition in which the hand is covered by a blue fluid not instantly associated with fire. We found that experiencing a virtual burning hand induces analgesic as well hyperalgesic effects as participants begin to feel heat related pain at lower temperatures and cold related pain at higher temperatures. The experience also impacts significantly on the lowest temperature at which participants starts perceiving warmth. The blue fluid do not affect the thresholds corresponding to the baseline condition. Our research thus confirms previous experiments showing that pain and thermal perception can be manipulated by by AR, while providing quantitative results on the magnitude of this effect.