Validating the Threat of a Virtual Reality Clinical Environment: A Mixed Methods Study

There is an increasing need for virtual reality (VR) health applications. In the field of pain, VR has been used mainly as a distraction, with minimal use of VR to answer basic clinical questions. Pain is multifactorial and inherently threatening. Our lab recently designed two VR clinical environments with varying threat values; the present study sought to validate these environments. Subjects were randomly allocated into either the threatening or non-threatening VR consultation room and both subjective (threat questionnaire) and physiological (salivary cortisol) measurements were taken. As hypothesised, subjects in the threat condition recorded a higher threat score (p < 0.001; effect size = 0.76). There was a cortisol change across time in the threat condition (χ2(2) = 13.83, p < 0.001), but there were unexpected decreases at both 20 (p = 0.001) and 26 min (p = 0.03) following VR. While the physiological findings need further clarification, this study provides some validation of the threat value of our VR clinical tools. As such, these VR environments can potentially be used in pain experiments to help better our understanding of basic pain mechanisms. It is only with such understanding that we might offer new avenues for pain management.