@article{guingo_efficacy_2026,

title = {Efficacy of Virtual Reality vs. Tablet Games for Pain and Anxiety in Children Undergoing Bone Pins Removal: Randomised Clinical Trial},

author = {E. Guingo and M. H. Debeurme and R. P. Santos and S. Addab and P. Rainville and S. Bouchard and K. Chougui and A. Tsimicalis and M. -L. Nault and T. Ducruet and O. Ledjiar and M. Noel and K. St-Arneault and C. Cotes-Turpin and N. Hung and P. Ouimet and S. Parent and J. Gardner and M. Bernstein and S. Le May},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105004216228&doi=10.1111%2Fjan.16991&partnerID=40&md5=9200a82b5c9572abcc5170e9c9d6142b},

doi = {10.1111/jan.16991},

issn = {03092402 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Advanced Nursing},

volume = {82},

number = {2},

pages = {1791–1802},

abstract = {Aims: To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures. Design: Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game. Methods: Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure. Results: A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety. Conclusion: Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older. Implication for the Professional and/or Patient Care: Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal. Impact: This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older. Reporting Method: We adhered to the CONSORT checklist for reporting results. Patient or Public Contribution: A patient partner reviewed the study design, methods and final manuscript. Trial Registration: NCT03680625. © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.},

keywords = {Adolescent, analgesia, Anxiety, Bone Nails, Child, Children, clinical trial, comparative study, controlled study, female, human, Humans, intramedullary nailing, male, multicenter study, Pain Management, procedural pain, procedures, randomized controlled trial, Therapy, video game, Video Games, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{delangle_speaking_2026,

title = {Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results},

author = {M. Delangle and A. Moïse-Richard and A. -L. Leclercq and D. Labbé and S. Bouchard and S. Andrews and L. Ménard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105028302364&doi=10.1016%2Fj.jfludis.2026.106194&partnerID=40&md5=af0d246f9187ee19796f36456887400b},

doi = {10.1016/j.jfludis.2026.106194},

issn = {0094730X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Fluency Disorders},

volume = {87},

abstract = {Purpose Speaking in class is challenging for students who stutter. Cognitive-behavioral therapy (CBT) with exposure in virtual reality (VR) emerges as a promising intervention for treating speaking anxiety in pediatric populations. This pilot study tested if real-time avatar-based VR can elicit anxiety responses while remaining acceptable to youth who stutter. Method Twelve students who stutter (aged 9–18) were randomly assigned to a single training session conducted either (1) in VR with a realistic avatar controlled live by their SLP, or (2) in role-play with their SLP, before facing a real actor. We assessed system acceptability, anxiety levels and perceived self-efficacy. Results The VR system was well accepted and elicited physiological arousal comparable to real-life interactions. Although participants reported experiencing less anxiety during VR, skin conductance level showed higher arousal; suggesting a divergence between the subjective report and physiological response. Finally, one training session (either in VR or with the SLP) did not produce gains in self-efficacy or decrease in anxiety related to the final real-actor conversation. Conclusion This study demonstrates evidence that the potential use of immersive VR could represent an acceptable and viable complementary strategy for SLP treatment, that could control exposure parameters while evoking physiological responses similar to real-life contexts. The differences between subjective and physiological measures suggest that VR is inducing anxiety responses differently than it was perceived. Further research could investigate the use of VR as anxiety interventions for students who stutter and should be explored across multi-session studies to understand their therapeutic effect. © 2026 The Authors.},

keywords = {Adolescent, adult, Anxiety, Arousal, article, Avatar, avoidance behavior, Canada, Child, clinical article, cognitive behavioral therapy, complication, controlled study, distance learning, ecological validity, electrocardiogram, electrodermal response, exposure, female, Heart Rate, heart rate variability, human, Humans, Liebowitz Social Anxiety Scale, Likert scale, male, nonverbal communication, physiological stress, Pilot Projects, pilot study, procedures, psychology, questionnaire, randomized controlled trial, role playing, School-age children, Self Concept, Self Efficacy, self report, Signal processing, skin conductance, social anxiety, speech, student, Students, Stuttering, Therapy, treatment outcome, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{alessandra_preselected_2026,

title = {Preselected and preferred immersive virtual reality versus narrative alone to induce post-stress relaxation in patients with pulmonary arterial hypertension: A pilot study on perceived stress and heart rate},

author = {G. Alessandra and D. M. Beatrice and C. Sara and M. Roberta and V. Martina and K. Patrycja and B. Maurizio and B. Luca and D. V. Laura Adelaide and B. Stéphane},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105029595132&doi=10.1111%2Fbjhp.70059&partnerID=40&md5=b86f0151066a7923d8854913cbd54318},

doi = {10.1111/bjhp.70059},

issn = {1359107X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {British Journal of Health Psychology},

volume = {31},

number = {1},

abstract = {Objectives: Several studies have shown the effectiveness of immersive virtual reality (IVR)-based relaxation techniques in alleviating stress within the general population. However, few data are available on patients, or on the effectiveness of different scenarios in inducing relaxation. This pilot study aims to compare the effectiveness of three relaxation techniques—preselected IVR (IVR-PS), preferred IVR (i.e. chosen by the participant from different alternatives—IVR-PR), and narrative alone (CTR)—in reducing physiological and psychological stress in 16 pulmonary arterial hypertension (PAH) female patients (N = 16, average age: 46 ± 10.66 years; average education: 13.31 ± 3.8 years; mean duration of illness: 8.56 ± 5.24 years) following an acute stress. Methods: Patients performed a mental stress test followed by three different relaxation sessions presented in a randomized order on three separate occasions. Self-perceived stress, level of relaxation, and heart rate (HR) were monitored during the sessions. Participants' ratings of their experiences were also collected. Results: The results indicated that the three relaxation methods were equally effective in reducing perceived stress induced by acute stress and in lowering HR. However, greater cognitive activation was reported in the two IVR conditions compared with the narrative condition. Conclusions: This is the first study to show evidence of the impact of IVR on a rare population. Despite the lack of significant differences between the two IVR and narrative-alone conditions in physiological and subjective relaxation, more than half of the participants expressed a subjective preference for the virtual experience, especially for the preferred one. © 2026 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.},

keywords = {adult, controlled study, female, Heart Rate, human, Humans, hypertension, Immersive virtual reality, mental stress, Middle Aged, Narration, pathophysiology, physiology, Pilot Projects, pilot study, procedures, Psychological, psychology, Pulmonary, pulmonary arterial hypertension, pulmonary hypertension, randomized controlled trial, rehabilitation, relaxation, Relaxation Therapy, relaxation training, Stress, Therapy, verbal communication, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{guingoEfficacyVirtualReality2026,

title = {Efficacy of Virtual Reality vs. Tablet Games for Pain and Anxiety in Children Undergoing Bone Pins Removal: Randomised Clinical Trial},

author = {E. Guingo and M. H. Debeurme and R. P. Santos and S. Addab and P. Rainville and S. Bouchard and K. Chougui and A. Tsimicalis and M. -L. Nault and T. Ducruet and O. Ledjiar and M. Noel and K. St-Arneault and C. Cotes-Turpin and N. Hung and P. Ouimet and S. Parent and J. Gardner and M. Bernstein and S. Le May},

url = {https://www.scopus.com/pages/publications/105004216228?origin=resultslist},

doi = {10.1111/jan.16991},

issn = {03092402 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Advanced Nursing},

volume = {82},

number = {2},

pages = {1791–1802},

publisher = {John Wiley and Sons Inc},

abstract = {Aims: To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures. Design: Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game. Methods: Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure. Results: A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety. Conclusion: Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older. Implication for the Professional and/or Patient Care: Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal. Impact: This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older. Reporting Method: We adhered to the CONSORT checklist for reporting results. Patient or Public Contribution: A patient partner reviewed the study design, methods and final manuscript. Trial Registration: NCT03680625. © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.},

keywords = {Adolescent, analgesia, Anxiety, Bone Nails, Child, Children, clinical trial, comparative study, controlled study, female, human, Humans, intramedullary nailing, male, multicenter study, Pain Management, procedural pain, procedures, randomized controlled trial, Therapy, video game, Video Games, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{ouellet-courtoisCognitiveMechanismsChange2026,

title = {Cognitive mechanisms of change in OCD: Inferential confusion, obsessive beliefs, and mindfulness across three randomized treatments},

author = {C. Ouellet-Courtois and S. Bouchard and C. -E. Giguère and D. Koszycki and M. E. Lavoie and F. Aardema},

url = {https://www.scopus.com/pages/publications/105034701697?origin=resultslist},

doi = {10.1016/j.brat.2026.105022},

issn = {00057967 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Behaviour Research and Therapy},

volume = {201},

publisher = {Elsevier Ltd},

abstract = {Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is widely regarded as the gold-standard psychological treatment for obsessive–compulsive disorder (OCD). Inference-based cognitive behavioral therapy (I-CBT) represents a distinct cognitive approach that targets inferential confusion, defined as a reasoning process whereby imagined possibilities are treated as reflecting reality, without relying on deliberate exposure. The present study reports further mechanism-focused analyses from a previously published multicenter randomized controlled trial (Aardema et al., 2022; ClinicalTrials.gov Identifier: NCT01794156) comparing CBT with ERP, I-CBT, and mindfulness-based stress reduction (MBSR) for OCD. A total of 111 participants with a primary diagnosis of OCD were randomized to one of three treatment conditions. Across treatments, therapy was associated with significant reductions in inferential confusion and obsessive belief domains, whereas dispositional mindfulness did not show significant change. At the bivariate level, residualized changes in inferential confusion, obsessive belief domains, and mindfulness were associated with reductions in OCD symptoms. However, when examined concurrently using mixed-effects models, only reductions in inferential confusion accounted for unique symptom improvement over time. This association was consistent across modalities and remained robust after controlling for concurrent anxiety and depression. Sensitivity analyses indicated that psychotropic medication use did not account for this association; controlling for medication strengthened the independent contribution of inferential confusion (partial η2 ≈ .29). These findings indicate that inferential confusion was independently associated with symptom improvement in OCD across therapeutic approaches. © 2026 Elsevier Ltd},

keywords = {adult, antidepressant agent, Anxiety disorder, article, behavior therapy, benzodiazepine, clinical outcome, clinical trial, cognition, cognitive behavioral therapy, Cognitive mechanisms of change, confusion, confusion (uncertainty), controlled study, Depression, exposure and response prevention, female, human, Humans, Implosive Therapy, inference based cognitive behavioral therapy, Inferential confusion, major clinical study, male, Middle Aged, mindfulness, mindfulness-based stress reduction, multicenter study, obsession, obsessive compulsive disorder, Obsessive-Compulsive Disorder, procedures, psychology, randomized controlled trial, risk factor, Sensitivity analysis, Therapy, treatment outcome, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{alessandraPreselectedPreferredImmersive2026,

title = {Preselected and preferred immersive virtual reality versus narrative alone to induce post-stress relaxation in patients with pulmonary arterial hypertension: A pilot study on perceived stress and heart rate},

author = {G. Alessandra and D. M. Beatrice and C. Sara and M. Roberta and V. Martina and K. Patrycja and B. Maurizio and B. Luca and D. V. Laura Adelaide and B. Stéphane},

url = {https://www.scopus.com/pages/publications/105029595132?origin=resultslist},

doi = {10.1111/bjhp.70059},

issn = {1359107X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {British Journal of Health Psychology},

volume = {31},

number = {1},

publisher = {John Wiley and Sons Ltd},

abstract = {Objectives: Several studies have shown the effectiveness of immersive virtual reality (IVR)-based relaxation techniques in alleviating stress within the general population. However, few data are available on patients, or on the effectiveness of different scenarios in inducing relaxation. This pilot study aims to compare the effectiveness of three relaxation techniques—preselected IVR (IVR-PS), preferred IVR (i.e. chosen by the participant from different alternatives—IVR-PR), and narrative alone (CTR)—in reducing physiological and psychological stress in 16 pulmonary arterial hypertension (PAH) female patients (N = 16, average age: 46 ± 10.66 years; average education: 13.31 ± 3.8 years; mean duration of illness: 8.56 ± 5.24 years) following an acute stress. Methods: Patients performed a mental stress test followed by three different relaxation sessions presented in a randomized order on three separate occasions. Self-perceived stress, level of relaxation, and heart rate (HR) were monitored during the sessions. Participants' ratings of their experiences were also collected. Results: The results indicated that the three relaxation methods were equally effective in reducing perceived stress induced by acute stress and in lowering HR. However, greater cognitive activation was reported in the two IVR conditions compared with the narrative condition. Conclusions: This is the first study to show evidence of the impact of IVR on a rare population. Despite the lack of significant differences between the two IVR and narrative-alone conditions in physiological and subjective relaxation, more than half of the participants expressed a subjective preference for the virtual experience, especially for the preferred one. © 2026 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.},

keywords = {adult, controlled study, female, Heart Rate, human, Humans, hypertension, Immersive virtual reality, mental stress, Middle Aged, Narration, pathophysiology, physiology, Pilot Projects, pilot study, procedures, Psychological, psychology, Pulmonary, pulmonary arterial hypertension, pulmonary hypertension, randomized controlled trial, rehabilitation, relaxation, Relaxation Therapy, relaxation training, Stress, Therapy, verbal communication, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{delangleSpeakingFacetofaceVirtual2026,

title = {Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results},

author = {M. Delangle and A. Moïse-Richard and A. -L. Leclercq and D. Labbé and S. Bouchard and S. Andrews and L. Ménard},

url = {https://www.scopus.com/pages/publications/105028302364?origin=resultslist},

doi = {10.1016/j.jfludis.2026.106194},

issn = {0094730X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Fluency Disorders},

volume = {87},

publisher = {Elsevier Inc.},

abstract = {Purpose Speaking in class is challenging for students who stutter. Cognitive-behavioral therapy (CBT) with exposure in virtual reality (VR) emerges as a promising intervention for treating speaking anxiety in pediatric populations. This pilot study tested if real-time avatar-based VR can elicit anxiety responses while remaining acceptable to youth who stutter. Method Twelve students who stutter (aged 9–18) were randomly assigned to a single training session conducted either (1) in VR with a realistic avatar controlled live by their SLP, or (2) in role-play with their SLP, before facing a real actor. We assessed system acceptability, anxiety levels and perceived self-efficacy. Results The VR system was well accepted and elicited physiological arousal comparable to real-life interactions. Although participants reported experiencing less anxiety during VR, skin conductance level showed higher arousal; suggesting a divergence between the subjective report and physiological response. Finally, one training session (either in VR or with the SLP) did not produce gains in self-efficacy or decrease in anxiety related to the final real-actor conversation. Conclusion This study demonstrates evidence that the potential use of immersive VR could represent an acceptable and viable complementary strategy for SLP treatment, that could control exposure parameters while evoking physiological responses similar to real-life contexts. The differences between subjective and physiological measures suggest that VR is inducing anxiety responses differently than it was perceived. Further research could investigate the use of VR as anxiety interventions for students who stutter and should be explored across multi-session studies to understand their therapeutic effect. © 2026 The Authors.},

keywords = {Adolescent, adult, Anxiety, Arousal, article, Avatar, avoidance behavior, Canada, Child, clinical article, cognitive behavioral therapy, complication, controlled study, distance learning, ecological validity, electrocardiogram, electrodermal response, exposure, female, Heart Rate, heart rate variability, human, Humans, Liebowitz Social Anxiety Scale, Likert scale, male, nonverbal communication, physiological stress, Pilot Projects, pilot study, procedures, psychology, questionnaire, randomized controlled trial, role playing, School-age children, Self Concept, Self Efficacy, self report, Signal processing, skin conductance, social anxiety, speech, student, Students, Stuttering, Therapy, treatment outcome, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{delangleSpeakingFacetofaceVirtual2026a,

title = {Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results},

author = {M. Delangle and A. Moïse-Richard and A. -L. Leclercq and D. Labbé and S. Bouchard and S. Andrews and L. Ménard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105028302364&doi=10.1016%2Fj.jfludis.2026.106194&partnerID=40&md5=af0d246f9187ee19796f36456887400b},

doi = {10.1016/j.jfludis.2026.106194},

issn = {0094730X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Fluency Disorders},

volume = {87},

abstract = {Purpose Speaking in class is challenging for students who stutter. Cognitive-behavioral therapy (CBT) with exposure in virtual reality (VR) emerges as a promising intervention for treating speaking anxiety in pediatric populations. This pilot study tested if real-time avatar-based VR can elicit anxiety responses while remaining acceptable to youth who stutter. Method Twelve students who stutter (aged 9–18) were randomly assigned to a single training session conducted either (1) in VR with a realistic avatar controlled live by their SLP, or (2) in role-play with their SLP, before facing a real actor. We assessed system acceptability, anxiety levels and perceived self-efficacy. Results The VR system was well accepted and elicited physiological arousal comparable to real-life interactions. Although participants reported experiencing less anxiety during VR, skin conductance level showed higher arousal; suggesting a divergence between the subjective report and physiological response. Finally, one training session (either in VR or with the SLP) did not produce gains in self-efficacy or decrease in anxiety related to the final real-actor conversation. Conclusion This study demonstrates evidence that the potential use of immersive VR could represent an acceptable and viable complementary strategy for SLP treatment, that could control exposure parameters while evoking physiological responses similar to real-life contexts. The differences between subjective and physiological measures suggest that VR is inducing anxiety responses differently than it was perceived. Further research could investigate the use of VR as anxiety interventions for students who stutter and should be explored across multi-session studies to understand their therapeutic effect. © 2026 The Authors.},

keywords = {Adolescent, adult, Anxiety, Arousal, article, Avatar, avoidance behavior, Canada, Child, clinical article, cognitive behavioral therapy, complication, controlled study, distance learning, ecological validity, electrocardiogram, electrodermal response, exposure, female, Heart Rate, heart rate variability, human, Humans, Liebowitz Social Anxiety Scale, Likert scale, male, nonverbal communication, physiological stress, Pilot Projects, pilot study, procedures, psychology, questionnaire, randomized controlled trial, role playing, School-age children, Self Concept, Self Efficacy, self report, Signal processing, skin conductance, social anxiety, speech, student, Students, Stuttering, Therapy, treatment outcome, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{guingoEfficacyVirtualReality2026a,

title = {Efficacy of Virtual Reality vs. Tablet Games for Pain and Anxiety in Children Undergoing Bone Pins Removal: Randomised Clinical Trial},

author = {E. Guingo and M. H. Debeurme and R. P. Santos and S. Addab and P. Rainville and S. Bouchard and K. Chougui and A. Tsimicalis and M. -L. Nault and T. Ducruet and O. Ledjiar and M. Noel and K. St-Arneault and C. Cotes-Turpin and N. Hung and P. Ouimet and S. Parent and J. Gardner and M. Bernstein and S. Le May},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105004216228&doi=10.1111%2Fjan.16991&partnerID=40&md5=9200a82b5c9572abcc5170e9c9d6142b},

doi = {10.1111/jan.16991},

issn = {03092402 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Advanced Nursing},

volume = {82},

number = {2},

pages = {1791–1802},

abstract = {Aims: To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures. Design: Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game. Methods: Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure. Results: A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety. Conclusion: Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older. Implication for the Professional and/or Patient Care: Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal. Impact: This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older. Reporting Method: We adhered to the CONSORT checklist for reporting results. Patient or Public Contribution: A patient partner reviewed the study design, methods and final manuscript. Trial Registration: NCT03680625. © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.},

keywords = {Adolescent, analgesia, Anxiety, Bone Nails, Child, Children, clinical trial, comparative study, controlled study, female, human, Humans, intramedullary nailing, male, multicenter study, Pain Management, procedural pain, procedures, randomized controlled trial, Therapy, video game, Video Games, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{alessandraPreselectedPreferredImmersive2026a,

title = {Preselected and preferred immersive virtual reality versus narrative alone to induce post-stress relaxation in patients with pulmonary arterial hypertension: A pilot study on perceived stress and heart rate},

author = {G. Alessandra and D. M. Beatrice and C. Sara and M. Roberta and V. Martina and K. Patrycja and B. Maurizio and B. Luca and D. V. Laura Adelaide and B. Stéphane},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105029595132&doi=10.1111%2Fbjhp.70059&partnerID=40&md5=b86f0151066a7923d8854913cbd54318},

doi = {10.1111/bjhp.70059},

issn = {1359107X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {British Journal of Health Psychology},

volume = {31},

number = {1},

abstract = {Objectives: Several studies have shown the effectiveness of immersive virtual reality (IVR)-based relaxation techniques in alleviating stress within the general population. However, few data are available on patients, or on the effectiveness of different scenarios in inducing relaxation. This pilot study aims to compare the effectiveness of three relaxation techniques—preselected IVR (IVR-PS), preferred IVR (i.e. chosen by the participant from different alternatives—IVR-PR), and narrative alone (CTR)—in reducing physiological and psychological stress in 16 pulmonary arterial hypertension (PAH) female patients (N = 16, average age: 46 ± 10.66 years; average education: 13.31 ± 3.8 years; mean duration of illness: 8.56 ± 5.24 years) following an acute stress. Methods: Patients performed a mental stress test followed by three different relaxation sessions presented in a randomized order on three separate occasions. Self-perceived stress, level of relaxation, and heart rate (HR) were monitored during the sessions. Participants' ratings of their experiences were also collected. Results: The results indicated that the three relaxation methods were equally effective in reducing perceived stress induced by acute stress and in lowering HR. However, greater cognitive activation was reported in the two IVR conditions compared with the narrative condition. Conclusions: This is the first study to show evidence of the impact of IVR on a rare population. Despite the lack of significant differences between the two IVR and narrative-alone conditions in physiological and subjective relaxation, more than half of the participants expressed a subjective preference for the virtual experience, especially for the preferred one. © 2026 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.},

keywords = {adult, controlled study, female, Heart Rate, human, Humans, hypertension, Immersive virtual reality, mental stress, Middle Aged, Narration, pathophysiology, physiology, Pilot Projects, pilot study, procedures, Psychological, psychology, Pulmonary, pulmonary arterial hypertension, pulmonary hypertension, randomized controlled trial, rehabilitation, relaxation, Relaxation Therapy, relaxation training, Stress, Therapy, verbal communication, virtual reality},

pubstate = {published},

tppubtype = {article}

}