Virtual Reality and Savoring to Promote Well-being of Patients With Chronic Respiratory Diseases: a Randomized Controlled Trial

INTERVENTION: Together with the 3‐week traditional pulmonary rehabilitation in the hospital, the experimental group took part in the VR‐based enhanced with savoring intervention. It lasted two weeks and included four 25‐minute sessions, with two sessions per week. In each session, the experimental group experienced a 10‐minute relaxing virtual scenario using the Oculus Quest 2 headset integrated with a narrative voice. The content of the narrative voiceover was not created specifically for this intervention. Moreover, participants completed a savoring exercise proposed through pre‐recorded 5‐minute audio after each virtual scenario to consolidate and amplify the positive emotions generated by the VR experience. Sessions usually took place on Mondays and Thursdays, starting in the second week of traditional pulmonary rehabilitation. They were administered by the researchers and occurred one‐on‐one. Direct observation was used to assess adherence to the intervention. The baseline assessment was done in a separate session earlier to avoid overloading the patients and occurred in the same week as starting the traditional pulmonary rehabilitation. In each session, participants were asked to sit down in a chair and experience the VR scenario and the following savoring exercise. In the first session, patients explored "the secret garden," guided by a relaxing narrative through a peaceful Japanese garden, including crossing a peaceful pond and passing cherry blossom trees. Following this, participants engaged in a savoring exercise, recalling positive emotions from the VR experience and savoring a positive memory where they felt similar emotions. The second session involved watching "the waterfall in the prairie," where patients enjoyed the sights and sounds of nature, including colo CONDITION: Chronic respiratory diseases;emotional well‐being;psychological well‐being; ; Chronic respiratory diseases ; emotional well‐being ; psychological well‐being Mental Health ‐ Studies of normal psychology, cognitive function and behaviour Respiratory ‐ Other respiratory disorders / diseases PRIMARY OUTCOME: Emotional well‐being and psychological well‐being[Mental Health Continuum Short Form Baseline (T0), immediately after the completion of all four sessions (T1, primary timepoint), and in the one‐month follow‐up (T2) for both groups] Positive affect and negative affect[Scale of Positive and Negative Experiences Baseline (T0), immediately after the completion of all four sessions (T1, primary timepoint), and in the one‐month follow‐up (T2) for both groups] Relaxation[10‐point Visual Analogue Scale Baseline (T0), immediately after the completion of all four sessions (T1, primary timepoint), and in the one‐month follow‐up (T2) for both groups] SECONDARY OUTCOME: Peripheral oxygen saturation (SpO2)[NONIN Palm Saturimeter Immediately before and after each of the four sessions] Relaxation[10‐point Visual Analogue Scale Immediately before and after each of the four sessions] Sense of presence in the virtual environment[Slater Usoh Steed Presence Questionnaire Immediately after the completion of all four sessions (T1)] VR acceptance[Ad hoc questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model designed specifically for this study Immediately after the completion of all four sessions (T1)] INCLUSION CRITERIA: ‐ Age 18 years and over ‐ A diagnosis of chronic respiratory disease according to European Respiratory Society (ERS)/American Thoracic Society (ATS) criteria ‐ Written informed consent