Relaxation, Distraction, and Fun: Improving Well-being in Situations of Acute Emotional Distress with Virtual Reality


Stefan Liszio

Processing Period:

04.10.2014 - 04.08.2021


This thesis investigates the stress-reducing and emotion-enhancing effects of virtual environments and digital games in situations of acute stress and emotional strain. Virtual reality (VR) technology allows users to immerse themselves in alternative worlds and escape reality for a moment by shielding them from stressful stimuli and distracting them from negative thoughts. First, three successive laboratory studies, forming the basic research foundation, will illuminate how the VR experience affects human sensation. Then, taking the example of magnetic resonance imaging (MRI) examinations of children, the real-world application of the findings is established.

The first study considered the role of immersion in particular. The results show that viewing an underwater simulation with a head-mounted display (HMD) leads to a more pronounced relaxation effect than viewing the same scenario on a conventional screen. The second study builds on this finding and demonstrates that active gaming in a natural virtual environment, which was developed specifically for this study, leads to an increased mood-enhancement due to the added distraction and interactivity. Furthermore, the study reveals that the experience of presence in the virtual environment promotes positive affect both during VR exposure and in a subsequent stressful situation, resulting in increased stress tolerance. The third study examined whether spending time in virtual nature or playing an action-packed VR game bears a greater recovery effect. It was found that both approaches can equally produce a significant improvement of the emotional experience. Again, the sense of presence simulated positive emotions, leading to a significant mood-enhancement in a subsequent stressful situation.

The laboratory studies required a reliable method for generating acute mental stress under controlled conditions. For this purpose, the ECG VR-TSST, a VR-based, flexible instrument that builds on a proven psychological stress induction procedure (Trier Social Stress Test), was developed within this thesis. Additionally, two studies were conducted which validate the effectiveness of the ECG VR-TSST.

MRI examinations of children constitute an example of an acute stress situation. Children often react to the MRI examination with high levels of anxiety and stress and often need to be sedated for a proper diagnosis. To this end, two content-related game-based VR applications (apps) were developed to reduce anxiety in children before and during the examination in an accompanying interdisciplinary research project. The “Pengunaut Trainer” is a VR app for smartphones to prepare for the examination based on play therapy and exposure therapy principles. In a virtual MRI scanner, children learn to lie motionless and can get used to the examination. Various playful elements and physical materials are used to promote long-term motivation for regular training of the examination. In a one-year, multicenter study, the effectiveness of the Pengunaut Trainer was demonstrated. Children who were prepared with the app were less afraid of the examination and more cooperative.

For distraction and entertainment during the MRI scan, the VR game “Pengunauts: Star Journey” was created. It continues the story of the Pengunaut Trainer and sends the patients on a journey through space using an MRI-safe HMD, which is currently under development. The thesis presents solutions for the multifaceted challenges the MRI examination poses for the game design and technical implementation of such a VR game. For instance, the game should be both distracting and calming, must not provoke movement, and be entertaining even when the patients are unable or unwilling to interact. The concept for this app was developed in a participatory development process together with children. The findings from the design process are formulated as guidelines for the design of VR games for similar use cases.

This work demonstrates that VR technology can improve many people's lives in situations of anxiety, stress, and emotional distress in a variety of ways.

You can find the thesis here: https://doi.org/10.17185/duepublico/74774