Development and Feasibility Assessment of Virtual Reality-Based Relaxation Self-Training Program

Diaphragmatic breathing and progressive muscle relaxation (PMR) are an effective way for relaxation training and anxiety control, but their use is not common to the general public. Today, as the need for non-face-to-face contact increases, virtual reality (VR)-based self-training is gaining attention in public health. This study aimed to evaluate the feasibility of the newly developed VR-based relaxation training program. Both diaphragmatic breathing and PMR can be trained without an assistant using this VR application in three steps: 1) learning in a virtual clinic, 2) review in a comfortable virtual environment, and 3) practice in outdoor virtual environments. Self-training is recommended on a 3-weeks schedule with a total of 4–6 trials per day for 4 days a week. Thirty-one healthy volunteers were divided into the VR (n = 15) and worksheet (n = 16) groups, and participated in self-training under similar conditions as much as possible. Multiple evaluations were performed before, during, and after self-training. The change rates of all psychological and psychophysiological measures before and after self-training did not significantly differ between the two groups. The levels of tension after breathing practices showed no group difference, whereas those after PMR practices were significantly lower in the VR group than in the worksheet group. In the VR group, trials of outdoor practices tended to induce a decrease of the tension level, particularly after outdoor breathing trials. The VR group gave a practicable score of 70 points or more, average 43.5, and average 180.3 for usability, cybersickness, and presence of this program, respectively. These results suggest that the VR-based relaxation self-training program can be used by healthy people as a means of relaxation. In the use of this program, diaphragmatic breathing may be used more easily, but the benefit of using VR is higher in PMR. These findings provide justification for a randomized controlled study of whether this program can be used for stress relief in the general population and, furthermore, treatment of patients with anxiety disorders.

CONTRIBUIÇÕES DA TERAPIA COGNITIVO-COMPORTAMENTAL NO TRATAMENTO DA DISFUNÇÃO TEMPOROMANDIBULAR (DTM)

Resumo: A Disfunção Temporomandibular (DTM) é um distúrbio que afeta as articulações temporomandibulares e os músculos mastigatórios, entre outras estruturas da face. Os sintomas podem gerar dores nessas articulações e músculos, bem como dores na cabeça, orelha, ruídos nas articulações, zumbidos, dores no ouvido, limitação na abertura da boca, entre outros. Sua etiologia é multifatorial. Entre os fatores que podem influenciar a DTM encontram-se os psicológicos. Assim, este estudo teve como objetivo identificar as principais estratégias da terapia cognitivo-comportamental (TCC) utilizadas para o tratamento de indivíduos diagnosticados com DTM. Por método, adotou-se a revisão da literatura. Os bancos de dados utilizados foram PePSIC, SCIELO, PubMed e BVS, em inglês e português. Os descritores utilizados em todos os bancos foram: DTM e terapia cognitiva-comportamental; Disfunção temporomandibular e terapia-cognitiva comportamental, Disfunção temporomandibular e terapia-cognitiva, TMD and cognitive behavioral therapy; Temporomandibular disorder and cognitive behavioral therapy, Temporomandibular disorder and cognitive therapy. Os filtros utilizados para inclusão dos estudos foram artigos sobre intervenções em TCC, em português e/ou inglês e com datas de publicação dos últimos três anos. Seis artigos foram analisados, após a passagem dos filtros. Os resultados apontam que as principais estratégias de TCC utilizadas no tratamento da DTM são a restruturação cognitiva, a autogestão, a psicoeducação e o relaxamento. Sugerem, também, que a TCC pode trazer contribuições positivas para os casos de DTM, porém a amostra deste estudo foi pequena. Os artigos analisados apontam que o tratamento multidisciplinar deve incluir intervenções cognitivas e comportamentais. Sendo assim, fica evidenciada a necessidade de realização de mais pesquisas com o objetivo de verificar os efeitos da TCC em pacientes com DTM, principalmente, estudos com ensaios clínicos.Palavras-chave: Terapia cognitiva-comportamental. Disfunção temporomandibular. DTM. Estresse. Ansiedade. Abstract: Temporomandibular Disorder (TMD) is a disorder that affects the temporomandibular joints and masticatory muscles, among other facial structures. Symptoms can generate pain in these joints and muscles, as well as pain in the head, ear, noise in the joints, tinnitus, ear pain, limitation in opening the mouth, among others. Its etiology has multifactorial causes. Among the factors that can influence TMD are psychological. Objective: This study aimed to identify cognitive behavioral therapy (CBT) strategies used to treat individuals diagnosed with TMD. Method: Literature review. The databases used were PePSIC, SCIELO, PubMed and BVS, in English and Portuguese. The descriptors used in databases were: TMD and cognitive-behavioral therapy; Temporomandibular disorders and cognitive behavioral therapy, Temporomandibular disorders and cognitive therapy, TMD and cognitive behavioral therapy; Temporomandibular disorder and cognitive behavioral therapy, Temporomandibular disorder and cognitive therapy. The filters used to include the studies were: articles on CBT interventions, articles in Portuguese and/or English and with publication dates in the last three years. Results: Six articles were analyzed, after passing the filters. Discussion: The results show that the main CBT guidelines used in the treatment of TMD are: cognitive restructuring, self-management, psychoeducation and relaxation training. They also suggest that a CBT can bring positive contributions to TMD cases, but the sample in this study was small. The articles point out that multidisciplinary treatment must include cognitive and behavioral interventions. Thus, the need for further research to verify the effects of CBT in patients with TMD is evidenced, especially, studies with clinical trials.Keywords: Cognitive behavioral therapy. Temporomandibular disorder. TMD. Stress. Anxiety.

Pelatihan Terapi Relaksasi Hypnobirthing Untuk Tenaga Kesehatan Dalam Rangka Meningkatkan Pelayanan Kesehatan Ibu Dan

Background: labor pain is a real problem for maternity mothers, as many as 90% of women experience pain during childbirth. Mothers who are about to give birth expect to be able to give birth with a sense of comfort, but in reality many health workers, especially midwives, do not understand how to accompany mothers in labor and teach the correct relaxation techniques to reduce labor pain. The hypnobirthing relaxation technique is a natural pain reduction program by utilizing the subconscious mind to believe that childbirth is a natural, comfortable, and normal process that pregnant women can learn during their pregnancy. Methods: Method this study is used relaxation hypnobirthing intervention. The sample of this study were all midwives in the South Klaten Public Health Center area. The researcher demonstrated hypnobirthing relaxation and then the respondents practiced it in pairs. Results: the average value of the knowledge of the midwives before the training on hypnobirthing relaxation was only 50, after the training the knowledge increased by 90. Hypnobirthing relaxation training can increase knowledge and skills of midwives to in assisting pregnant women during their pregnancy and lead pregnant women to a comfortable, smooth, natural, and normal labor. Conclusion: Hypnobirthing relaxation training for midwives can increase their knowledge in assisting mothers in childbirth so that they can relax in the face of childbirth.

Evaluating the Role of Breathing Guidance on Game-Based Interventions for Relaxation Training

Working in a fast-paced environment can lead to shallow breathing, which can exacerbate stress and anxiety. To address this issue, this study aimed to develop micro-interventions that can promote deep breathing in the presence of stressors. First, we examined two types of breathing guides to help individuals learn deep breathing: providing their breathing rate as a biofeedback signal, and providing a pacing signal to which they can synchronize their breathing. Second, we examined the extent to which these two breathing guides can be integrated into a casual game, to increase enjoyment and skill transfer. We used a 2 × 2 factorial design, with breathing guide (biofeedback vs. pacing) and gaming (game vs. no game) as independent factors. This led to four experimental groups: biofeedback alone, biofeedback integrated into a game, pacing alone, and pacing integrated into a game. In a first experiment, we evaluated the four experimental treatments in a laboratory setting, where 30 healthy participants completed a stressful task before and after performing one of the four treatments (or a control condition) while wearing a chest strap that measured their breathing rate. Two-way ANOVA of breathing rates, with treatment (5 groups) and time (pre-test, post-test) as independent factors shows a significant effect for time [F(4, 50) = 18.49, p &lt; 0.001, ηtime2=0.27] and treatment [F(4, 50) = 2.54, p = 0.05, η2 = 0.17], but no interaction effects. Post-hoc t-tests between pre and post-test breathing rates shows statistical significance for the game with biofeedback group [t(5) = 5.94, p = 0.001, d = 2.68], but not for the other four groups, indicating that only game with biofeedback led to skill transfer at post-test. Further, two-way ANOVA of self-reported enjoyment scores on the four experimental treatments, with breathing guide and game as independent factors, found a main effect for game [F(1,20)=24.49,p<0.001, ηgame2=0.55], indicating that the game-based interventions were more enjoyable than the non-game interventions. In a second experiment, conducted in an ambulatory setting, 36 healthy participants practiced one of the four experimental treatments as they saw fit over the course of a day. We found that the game-based interventions were practiced more often than the non-game interventions [t (34) = 1.99, p = 0.027, d = 0.67]. However, we also found that participants in the game-based interventions could only achieve deep breathing 50% of the times, whereas participants in the non-game groups succeeded 85% of the times, which indicated that the former need adequate training time to be effective. Finally, participant feedback indicated that the non-game interventions were better at promoting in-the-moment relaxation, whereas the game-based interventions were more successful at promoting deep breathing during stressful tasks.

Relaksasi Otot Progresif Terhadap Penurunan Tingkat Stres Akademik

Pandemi covid-19 menimbulkan berbagai permasalahan di masyarakat, salah satunya adalah stres akademik yang dirasakan oleh mahasiswa. Stres akademik yang dirasakan terus menerus oleh mahasiswa akan berdampak pada hasil belajar mahasiswa. Berdasarkan permasalahan tersebut maka diadakan kegiatan pengabdian masyarakat berupa pelatihan secara daring mengenai relaksasi otot progresif untuk menurunkan stres akademik mahasiswa. Tujuan dari kegiatan pengabdian masyarakat ini adalah agar masyarakat lebih khususnya mahasiswa mampu menambah pengetahuan dan keterampilan mengenai pengaplikasian relaksasi otot progresif agar dapat menurunkan stres akademik. Hasil analisis data ditemukan bahwa nilai sig (p) = 0.000 (p<0.05) hal ini bermakna bahwa terdapat perbedaan antara skor sebelum diberikan pelatihan (pre-test) dengan sesudah diberikan pelatihan (pos-test), penjelasan tersebut terlihat dari adanya penurunan stres akademik yang dirasakan oleh peserta setelah mengikuti pelatihan relaksasi otot progresif. The Covid-19 pandemic has caused various problems in society, one of which is academic stress felt by students. Academic stress that is felt continuously by students will have an impact on student learning outcomes. Based on these problems, community service activities were held in the form of online training on progressive muscle relaxation to reduce student academic stress. The purpose of this community service activity is for the community, especially students, to be able to increase their knowledge and skills regarding the application of progressive muscle relaxation in order to reduce academic stress. The results of data analysis found that the value of sig (p) = 0.000 (p<0.05) this means that there is a difference between the scores before being given training (pre-test) and after being given training (post-test), the explanation can be seen from the decrease in stress the academic experience felt by participants after participating in progressive muscle relaxation training.

A systematic evaluation of primary headache management apps leveraging behavior change techniques

Background Mobile health apps have the potential to promote adherence to headache management through the use of evidence-based behavior change techniques (e.g., self-monitoring). While many headache management apps exist, the extent to which these apps include behavior change techniques remains unknown. Thus, the present study systematically evaluated the content and quality of commercially available headache management apps. Methods Headache apps were identified using a systematic search in the Apple App and Google Play stores. A total of 55 apps were evaluated using the taxonomy of behavior change techniques and app quality using the Mobile App Rating Scale. Results Headache management apps included 0–14 behavior change techniques (Mean [M] = 5.89) and 0–8 headache management behavior change techniques (M = 4.29). App quality ranged from 2.84–4.67 (M = 3.73) out of 5.00. Three apps, Migraine Trainer, Easeday: Headache & Migraine, and PainScale, included the highest number of overall and headache management behavior change techniques along with good quality scores. Conclusions While randomized controlled trials are necessary to determine the efficacy of individual headache apps, most existing apps include evidence-based headache management behavior change techniques. Headache apps often focus on either self-monitoring or stress management via relaxation training, suggesting that patients’ needs should be used to inform app selection.

The effect of progressive muscle relaxation training on chemotherapy-induced nausea, vomiting and anxiety in Egyptian breast cancer women: A randomized controlled trial

Background and objective: This study was conducted to examine the effect of progressive muscle relaxation training (PMRT) in combination with antiemetic drugs on chemotherapy-associated nausea, vomiting and anxiety in breast cancer women receiving chemotherapy.Methods: A randomized controlled trial design was conducted on 74 patients divided into control (n = 37) and PMRT group (n = 37). The study was conducted at Oncology Center affiliated to Mansoura University, Egypt. The intervention included daily PMRT practice for seven days two hours before chemotherapy. The patients exercised in the oncology unit with the researcher, and individually applied the exercises at home. The data was collected using Rhodes index of nausea-vomiting and retching used daily after chemotherapy for seven days and Zung self-rating anxiety scale used before chemotherapy and at the seventh and 14th days after chemotherapy.Results: A significant decrease in the frequency, severity, and duration of vomiting, nausea, retching and anxiety in PMRT group than in the control group (p < .0001). Conclusions: Progressive muscle relaxation combined with antiemetics was effective in reducing vomiting, nausea, and retching, as well as improving anxiety level induced by chemotherapy.

Efficacy of combination of biofeedback therapy and pelvic floor muscle training in dyssynergic defecation

Background: It is now known that with appropriate exercises, the functions of the muscles in the body ameliorate and increase in strength. We applied pelvic floor muscle relaxation training and exercises that strengthen the abdominal and pelvic muscles in combination with biofeedback therapy (BFT) to patients with dyssynergic defecation (DD). Methods: Patients who met the criteria for DD and had no underlying organic cause were included in this study. The electromyography (EMG) technique was used for BFT therapy. Patients had received at least six sessions of BFT. BFT was considered successful in patients when the DD pattern in anorectal manometry (ARM) disappeared and/or adequate anal relaxation was obtained following BFT and in patients who had full clinical recovery. Results: Data of 104 patients (58 females [55.8%] and 46 males [44.2%]) was evaluated. Abdominal and rectal symptoms disappeared in 71 (68.26%) patients. Of the patients who achieved symptomatic improvement, 58 (55.76%) saw a disappearance of the dyssynergic defecation pattern. When the differences between anal sphincter pressures before and after treatment were compared in patients who responded to BFT and those who did not, no significant differences were observed, but significant changes were found in anal squeezing pressures. It was found that those who had high squeezing pressures before BFT, those who increased their squeezing pressures after BFT, and those who decreased their resting pressure responded better to BFT. Conclusions: In this study, BFT was found to be more effective in those with a high squeezing pressure and those that increased squeezing pressure after BFT. These findings will influence the treatment of patients with dyssynergic defecation who do not respond to treatment. A combination of abdominal and pelvic floor muscle exercises and BFT increases patient response.

Effect of Balance Training Versus Stretching Relaxation Exercise in Memory and Spatial Cognition Enhancement on Healthy Adults

Background Physical exercise has been shown to improve cognitive functions. However, it is still unknown which type of exercise affects cognition. In the present study, we tested the hypothesis that demanding balance training program improves memory and spatial cognition. Objective To test the effect of balance training versus stretching relaxation exercise on memory and spatial cognition in cognitive enhancement. Patients and Methods Participants randomly assigned into 2 groups, 40 participants in balance training group and 40 participants in stretching relaxation training group: Participants trained in groups of 10–12 individuals. Each group trained four times a week for 6 weeks. Each session lasts for 50 minutes. Training groups instructed by the same professional trainers. Each participant took part in 24 training sessions in total. All participants advised not to change their habitual level of physical activity throughout the intervention period. Results Balance performance improved only in the balance group from pre- to post-training from 85.8±3.0 to 95.0±2.2. Only the balance group improved in memory in wechsler IQ test from 94.6±2.6 to 108.0±4.5 and spatial cognitive abilities in spatial reasoning from 17.5±5.0 to 26.2±5.2. Finally, none of the two groups displayed changes in mismatch negativity test. The findings suggest that systematic balance training is capable of enhancing some cognitive functions, such as memory and spatial cognition. Conclusion In sum, we are able to conclude that 6 weeks of balance training in healthy adults has positive effects on memory and spatial cognition, and an increase in cardiorespiratory fitness does not seem to be necessary to induce beneficial effects of physical exercise on cognition. From an applied perspective, balance training might represent a promising alternative intervention for individuals who are not able to participate in aerobic training following health restrictions.