Novel VR-Based Biofeedback Systems: A Comparison Between Heart Rate Variability- and Electrodermal Activity-Driven Approaches

Anxiety symptoms are important contributors to the global health-related burden. Low-intensity interventions have been proposed to reduce anxiety symptoms in the population. Among these, biofeedback (BF) offers an effective approach to reducing anxiety. In the present study, BF was integrated into a novel virtual reality (VR) architecture to enhance BF's effectiveness to i) evaluate the feasibility of a VR-based single-session BF in teaching participants to self-regulate; ii) compare the BF aiming at reducing sympathetic (measured though the tonic level of skin conductance, SCL) versus increasing cardiac vagal (i.e., normalized high frequency of heart rate variability, HFnu-HRV) activation, and iii) evaluate which of the two VR-BF single-sessions was most effective in reducing perceived state anxiety. 20 healthy participants underwent both SCL- and HFnu-based in a single session VR-BF. Results showed the feasibility of a short single-session VR-BF and the effectiveness of both VR-BF sessions in reducing perceived state anxiety. Moreover, SCL-based VR-BF determined a significant reduction in sympathetic activation and in sympathovagal balance as well as a greater reduction in perceived state anxiety compared to HFnu-based VR-BF. SCL-based VR-BF represents a safe and effective intervention in reducing anxiety while enhancing adaptive psychophysiological activation.