Mechanisms of a Virtual Reality Respiratory Biofeedback Intervention: a Proof-of-Concept Randomized Controlled Trial
Researchers: Elke Vlemincx & Gabriela Cortez Vazquez, Health Science VU
Application development and support: Marco Otte, Network Institute VU
Research on the effectiveness of VR-based breathing exercises has yielded mixed results. Some studies suggest that brief VR breath control interventions do not provide significant advantages over traditional implementations in terms of mental health outcomes or user experience (Cortez-Vazquez et al., 2024). However, other studies have found that VR-based heart rate variability biofeedback can reduce distractions, enhance focus, and promote relaxation (Rockstroh et al., 2019).
Despite the conflicting nature of these findings, there is growing interest in the potential of VR for respiratory biofeedback exercises, used to enhance breath awareness, reduce respiration rate, and provide a positive user experience (Blum et al., 2020).
We hypothesize that the immersive nature of VR enhances motivation and engagement, making breath control exercises more effective through gamification. In addition, VR may improve bodily awareness and reduce distractions by fostering a sense of presence, offering a distinct advantage over 2D biofeedback implementations.
To conduct this research, the Network Institute Tech Labs designed a custom virtual environment, set in a tranquil, low-poly natural landscape next to a lake. Participants are placed in one of three random locations and have the chance to wonder around, exploring their surroundings.
A BioSignalsPlux Piezo Respiratory sensor is attached to the participant’s chest to monitor their breathing, with data transmitted via Bluetooth to the computer running the virtual environment. The system processes the breathing data into breaths-per-minute (BPM) using smooth filters within a moving data window. The participant’s BPM directly controls the number of flowers that appear in front of them—lower BPM, relative to their baseline, reveals more flowers. Once the BPM reaches the target level, the runes on the rocks light up, signaling success.
Throughout the trials, all data is logged for post-experiment analysis, allowing to thoroughly evaluate participant performance. Data collection took place in one of the Tech Labs’ facilities at the VU campus’s NU building.