Paper presented at the 3rd Immersive Learning Research Network Conference on June 26-29 2017, Coimbra, Portugal. Abstract. This paper describes a mobile learning app aimed to be used for relaxation training, primarily for adolescents suffering from tension-type headaches. Combining expertise from neuromedicine, psychology, and technology-enhanced learning, we have developed a concept and a working prototype for low-cost biofeedback training applications. The system uses virtual reality technology for delivering visual experience on both low-cost and advanced virtual reality glasses. A wirelessly connected wristband is used to measure user’s pulse and adjust the training scenario and the virtual environment based on the heart rate data. The app simulates an immersive environment of a tropical beach with several interactive visual and audio elements. The main goal of the simulation is to make the weather as calm as possible by reducing own heart rate. The progression through the scenario is guided by a therapist’s voice with some degree of self-exploration. Repeating the exercise would make the user able to go through the scenario without using the app, learn how to relax, and ultimately combat tension-type head-ache. The prototype is currently being evaluated in a feasibility study with a small group of participants that answer a questionnaire and interview questions after trying the app. The first evaluation results are presented in the pa-per. The results are discussed with a focus on wearability – suitable for wearing – of virtual reality glasses and of the wristband.

1. Mikhail Fominykh
Independent researcher, Norway
Ekaterina Prasolova-Førland
Norwegian University of Science and Technology, Norway
28/06/2017 13RD IMMERSIVE LEARNING RESEARCH NETWORK CONFERENCE – ILRN 2017
Relaxation Training with
Biofeedback in Virtual Reality
Discussion of Wearability

2. 28/06/2017 2RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY
Team
Mikhail Fominykh
Independent developer / Molde University College, Norway
mihail.fominyh@gmail.com / mikhail.fominykh@himolde.no
Ekaterina Prasolova-Førland
Department of Education and Lifelong Learning, NTNU, Norway
ekaterip@ntnu.no
Tore C. Stiles
Department of Psychology, NTNU, Norway
tore.stiles@ntnu.no
Petter Chr. Borchgrevink
Department of circulation and medical imaging, NTNU, Norway
petter.borchgrevink@ntnu.no
Anne Berit Krogh
Department of Public Health and Nursing, NTNU, Norway
anne-berit.krogh@ntnu.no
Mattias Linde
Department of Neuromedicine and Movement Science, NTNU, Norway
mattias.linde@ntnu.no

3. About Mikhail
328/06/2017
Researcher and project
coordinator in
workplace experience
capturing for job
seekers in welfare
Project manager in
workplace training with
Augmented Reality
and Wearables
Associate professor
and researcher in
Emergency
Management training
Software developer in
psychological
treatment training
Adjunct Professor
and teacher in
Virtual Reality
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

4. More results

5. Pre-conference

6. About Ekaterina
628/06/2017 RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

7. Relaxation Training

8. Virtual Reality and Biofeedback

9. Background

10. Background: Learning to Control Body Reactions –
Psychological Treatment with Biofeedback
28/06/2017 10
Psychological treatments are designed to alter processes
underlying or contributing to pain, distress, and/or
disability (Eccleston et al. 2014).
Biofeedback improves psychological treatments, allowing
patients to learn how to voluntarily modify their bodily
reactions through the feedback from their own
physiological processes (Schwartz and Andrasik 2017).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

11. Background: Perception and Sensing –
Virtual Reality and Wearable Technologies
28/06/2017 11
VR simulates spaces, objects, humans, and activities that
can reproduce a precise image of the reality and simulate
required settings (Steuer 1992).
VR glasses is a type of WT devices that is worn on the
head and has a display in front of the user’s eyes
(Cakmakci and Rolland 2006; van Krevelen and Poelman
2010).
Wireless body sensors perceive the user’s physical state.
Capturing human’s psycho-physiological states using bio-
signals and physiological phenomena is at the core of
perceptual technologies (Stiefelhagen 2009).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

12. Building a Conceptual
Framework

13. Pain coping mechanisms and therapeutic
procedures for VR
28/06/2017 13
Distraction: drawing attention from the patient’s mental
pain processing with immersive and interactive VR
experiences, for example, SnowWorld for burn victims
(Hoffman et al. 2011).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY
See photos and screenshots at
https://www.hitl.washington.edu/projects/vrpain/

14. Pain coping mechanisms and therapeutic
procedures for VR
28/06/2017 14
Relaxation: immersing users in relaxing simulated virtual
situations and places, suitable for meditation and
mindfulness, for example, Guided Meditation VR
(https://guidedmeditationvr.com/).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

15. Pain coping mechanisms and therapeutic
procedures for VR
28/06/2017 15
Illusion: manipulating sensory brain input (visual, haptic
etc.) in order to manipulate experience of pain, for
example, providing false visual feedback of head
movements to people with neck pain alters onset of
movement-evoked pain (Harvie et al. 2015).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

16. Pain coping mechanisms and therapeutic
procedures for VR
28/06/2017 16
Visualization: controlling pain by manipulating a visual
representation of pain experience (in 3D/VR), often with
bio- or neurofeedback, for example: manipulating
stereoscopic geometric shapes (with mouse), each of
them corresponding to a certain type and intensity of
pain.
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

17. Pain coping mechanisms and therapeutic
procedures for VR
28/06/2017 17
Physiotherapy: enhancing traditional training in a variety
of physiotherapeutic situations with VR, for example, VR
training for patients with neck injuries (Sarig Bahat et al.).
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

18. VR features for pain coping and relief
therapy
28/06/2017 18
User / Patient
Embodiment
Sense of presence and immersion
Identity
Virtual place
Visual appearance
Place structure and navigation
Multisensory: sound, touch, movement
Therapy artefacts
Objects and interactions with objects
Bio- and neurofeedback associated with objects
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

19. Scenario features for pain coping and relief
therapy
28/06/2017 19
Linear narrative
Branching and levels
Role playing
Progression through tasks
Inter-platform transitions
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

20. Therapy
goal/sub-
goal (CBT)
Pain coping
mechanisms/
therapy
procedures in VR
VR elements Scenario elements Software/
hardware
elements
Guided
imagery
with
biofeedback
Relaxation Virtual place: visual
appearance (such as
beach, sunset, visual
borders), multisensory
(voice, music, sound
of waves), interactive
artifacts with
biofeedback (waves),
simple embodiment
of the user (optional)
Following simple
narrative (the
therapist’s voice),
exploring
environment
(within one scene
only in the pilot),
progression
depending on
biofeedback
values, transiting
between platforms
(PC-smartphone)
PC, Android
smartphone, VR
glasses (Oculus
Rift, Google
Cardboard),
biofeedback
sensors (MioLink)
2028/06/2017 RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

21. Design

22. User interfaces and technology platforms for
pain coping and relief therapy
28/06/2017 22
Output
Visualization devices (HMD, PC, smart phone) Sound
devices (stereo, 3d sound)
Input
Biosensors (heart rate, EEG, skin conductivity) Body
tracking (head movement, gestures, motion capture)
Controls, haptic, treadmill
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

23. 28/06/2017

24. 28/06/2017

25. Low heart rate

26. Increased heart rate

27. Evaluation
results

28. Results: design and functionality
28/06/2017 28
Suggestion focus: VR features
Visual appearance
Bio- and neurofeedback associated with objects
Suggestion focus: Scenario features
Linear narrative
Branching and levels
Progression through tasks
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

29. RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

30. Results: relaxation and biofeedback
28/06/2017 30
Achieved
Provides relaxation experience
Suggestion focus
VR feature Bio- and neurofeedback associated with
objects is functioning, but not effective enough (e.g., it
was difficult to spot the changes of the waves).
Voice instructions functioned well if the changes in the
heart rate were significant.
Scenario features Linear narrative and Branching need to
be better connected to the Progression through tasks.
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

32. Results: Wearability
28/06/2017 32
Highlights
Wearability or comfort of use are important (for some – most
important)
Issues in VR
Wearing 3D glasses (esp. cardboard) is uncomfortable
Adjusting 3D glasses takes time
Wearing 3D glasses for a long time (10 min) is uncomfortable
Peripheral vision cut off affects relaxation negatively
Bending head lightly down during relaxation led to missing elements
Issues in Real Reality
Comfortable physical environment is as important for relaxation as VR
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

33. Results: Wearability codes
28/06/2017 33RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

34. Results: suggestion for future work
28/06/2017 34
Achieved
Positive attitude towards the concept of therapeutic
training with VR and biofeedback
Suggestion focus
Systematization of therapeutic training mechanisms
Modular approach
Other areas of therapeutic training (in addition to pain
coping and relief)
RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

35. 28/06/2017 35RELAXATION TRAINING WITH BIOFEEDBACK IN VIRTUAL REALITY

36. 36
Q & A
28/06/2017 3RD IMMERSIVE LEARNING RESEARCH NETWORK CONFERENCE – ILRN 2017

37. 3728/06/2017 3RD IMMERSIVE LEARNING RESEARCH NETWORK CONFERENCE – ILRN 2017