Project Brave Heart: Studying the impact of virtual reality preparation and relaxation therapy

Doctors at Lucile Packard Children's Hospital Stanford are conducting a pilot study to see if pediatric cardiology patients who participate in a pre-procedure virtual reality (VR) experience, called Project Brave Heart, have less anxiety and stress than patients who don’t participate.

The study, which is being conducted by Anne Dubin, MD, professor of pediatrics, and Lauren Schneider, PsyD, assistant professor of child and adolescent psychiatry, includes sending a VR headset home with patients who have a scheduled cardiac catheterization procedure so they can learn about the procedure and practice relaxation techniques at home. Although these catheterizations are outpatient procedures, catheterization patients must undergo general anesthesia. Doctors find the experience can cause stress and anxiety for patients, especially if they’re young.

The study begins in March 2017 and will include 40 patients. Half of the patients will use the VR programs, and the other half will be part of a control group that won’t use the program. Although VR technology is expanding into medical settings, research into its health care benefits is in the early stages, and it’s believed that no one has studied its impact on children with congenital heart diseases.

“We are looking for whether using VR will help patients be more prepared, calmer and less anxious about their procedure,” said Dr. Schneider.

The Project Brave Heart experience begins at the entrance of the hospital, where patients are met by a virtual peer who leads them on a tour of the hospital. The tour guides the user along the exact path that will be taken on the day of their procedure — including visits to the pre-op room where they will receive anesthesia, the Cath Lab where they fall asleep and the recovery room where they will wake up after the procedure. Throughout the tour, patients can access relaxation programs that spirit them away to enchanting natural settings where they are given mindfulness techniques to soothe themselves during moments of stress or anxiety.

Patients participating in the study, ages 8-25, are asked to watch the program several times during the week before their procedure. They also are encouraged to use the mindfulness techniques, if they need them, on the day of their procedure. As part of the study, patient’s heart rates, blood pressure and cortisol (a stress hormone) levels are measured before and after the catheterization and comprehensive questionnaires are administered to document the child’s reported levels of stress and anxiety. The study will examine whether patients who have used the VR program have less anxiety and stress than those who don’t.

“A lot of anxiety can occur for anybody who is having a procedure done, and more anxiety probably occurs for those who are having a cardiac procedure,” said Dr. Dubin. “We want to determine if patients who use VR will have less anxiety because they will have been exposed to a very realistic experience of what will happen when at the hospital on procedure day.”

Doctors Dubin and Schneider received guidance from Walter Greenleaf, PhD, visiting scholar at the Virtual Human Interaction Lab at Stanford University. The relaxation programming includes content from three companies that specialize in VR programming: Life VR, Zen Zone and Dolphin Swim Club. Virtual Ventures filmed and produced the VR program for the study in partnership with Rebecca Mandel Ben-Artzy, Founder of AlphaPresence. VR equipment for the study was donated by Oculus. Doctors Dubin and Schneider have no financial relationships with these companies.