The Efficacy of Virtual-Reality Augmented Mindfulness in Reducing Acute Experimental Pain

INTERVENTION: All participants will attend 1 session in the laboratory and will receive the interventions face‐to‐face. They will be randomised to 1 of 4 conditions. Virtual reality (VR): Participants in the VR conditions will use ‘Oculus Quest’ VR goggles that display multiple relaxing scenes such as beaches or forests. Participants can choose which scene they prefer for the training. The VR only group will have the same VR scenes available as those in the VR‐augmented mindfulness group but will not receive mindfulness instructions. Instead, they will be instructed to focus on the relaxing scene and try to immerse themselves in it. Both conditions will be matched on time (i.e. 15 minutes). Mindfulness: The mindfulness instruction will be based on a guided mindfulness of breath and body scan instruction from mindfulness‐based stress reduction (Kabat‐Zinn, 2003), and will be pre‐recorded for participants to listen to in session. The audio will be the same for the two mindfulness groups (VR and not VR) and will take approx. 15 minutes. VR‐augmented Mindfulness: Participants will listen to the mindfulness audio whilst simultaneously viewing the relaxing scene of their choice with the VR goggles. During the final 5 minutes of the assigned intervention, participants will be asked to complete the cold pressor task, which involves placing their arm in a tank of cold water to assess for pain outcomes, such as threshold, tolerance and intensity. CONDITION: Chronic pain; ; Chronic pain Musculoskeletal ‐ Osteoarthritis Musculoskeletal ‐ Osteoporosis Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: Tolerance during thermode task. This is the maximum temperature participants can reach before stopping the thermode task (up to a maximum of 50 degrees Celsius). Participants will complete three trials and the average will form the final measurement.; ; [Tolerance with the thermode will be recorded twice, as participants complete the task twice. Initially, it will be measured immediately before the training (timepoint 2), and subsequently it will measured after the cold pressor task (timepoint 4); ; ] Tolerance measurement during the cold pressor task. This is a measurement of time before the participant withdraws their arm from the cold pressor task, to a maximum of 4 minutes. This measure will be taken whilst participants are engaged in their assigned training condition (in the final 5 minutes), using a stopwatch.; ; [During the cold pressor task (timepoint 3), which occurs in the last 5 minutes of the training session.] ; ; ] Hesitance during the cold pressor task. This is a timed measurement of how long the participant takes to fully immerse their arm (up to their elbow). It will be recorded using a stopwatch.[During the cold pressor task (timepoint 3), which occurs in the last 5 minutes of the training session.] Mindfulness. The Toronto Mindfulness Scale will be used to determine whether the mindfulness instruction has increased the targeted skill and therefore will be administered pre and post training. ; ; [Mindfulness will be measured while participants complete the baseline questionnaires at the beginning of the study (timepoint 1) and will also be measured immediately after the cold pressor task (timepoint 4) but before the second thermode task. ] Pain intensity will be measured on an 11‐point visual analogue scale for both instances of the thermode task and during the cold pressor task. ; ; ; INCLUSION CRITERIA: Participants must be pain‐free, healthy adults (please see exclusion criteria) Fluency in English SECONDARY OUTCOME: Acceptability. At the conclusion of the study, participants will be asked to rate how acceptable they found their respective training condition on an 11 point scale, and will be asked how likely it is they would recommend it to a friend with a pain condition, also on an 11 point scale. This will help to inform whether VR‐augmented mindfulness is indeed acceptable to people in the community, and therefore whether it could be used in a future clinical trial. [Acceptability will be measured immediately after the second thermode task (timepoint 5). ] Credibility. The credibility and expectancy questionnaire (Devilly & Borkovec, 2000) will be administered to measure participants’ perceptions of their training condition credibility, specifically whether they find the VR‐only condition to be credible. [Credibility will be assessed immediately after the cold pressor task (timepoint 4) but before the second thermode task. ; For the thermode, 6 different temperature points will be pre‐set and individualised to each participant (baseline ‐ 32degrees, average threshold, average tolerance, 3 x midpoint between threshold and tolerance). Participants will receive these 6 temperatures in a randomised order and will be asked to rate their pain. The average of their 3 mid‐point ratings will form the intensity outcome. ; For the cold pressor task, pain intensity ratings will be taken at threshold, 30 seconds after immersion and at tolerance.[Pain intensity will initially be recorded during the first instance of the thermode task (after threshold and tolerance ratings), which occurs before the training session (timepoint 2). It will then be recorded during the cold pressor task, which happens in the last 5 minutes of the training session. Finally, intensity will be recorded during the second and final thermode task, which occurs after the cold pressor task (timepoint 4). ] Pain‐related distress will be recorded on an 11‐point Likert scale during both instances of the thermode task and during the cold pressor task. ; For the thermode task, distress will be measured during the pain intensity ratings. For the cold pressor, distress will be measured after the participant withdraws their arm from the cold pressor task (tolerance).[Pain‐related distress will initially be recorded during the first instance of the thermode task (during intensity ratings), which occurs before the training session (timepoint 2). It will then be recorded at the very end of the cold pressor task, which happens in the last 5 minutes of the training session. Finally, pain‐related distress will be recorded during the second and final thermode task, which occurs after the cold pressor task (timepoint 4). ] Threshold. This is a measurement of time taken for the participant to first report pain. Threshold will be assessed during both instances of the thermode task, and similarly to tolerance an average of three trials will form the final outcomes. Threshold will also be measured during the cold pressor task and will be recorded using a stopwatch.[Threshold will be initially recorded during the first instance of the thermode task, which occurs before the training session (timepoint 2). It will then be recorded during the cold pressor task, which happens in the last 5 minutes of the training session. Finally, threshold will be recorded during the second and final thermode task, which occurs after the cold pressor task (timepoint 4). ]