Virtual Reality Therapy for Reducing Anxiety in Patients with Drug-Resistant Tuberculosis
DOI:
https://doi.org/10.58418/ijni.v4i1.129Keywords:
Virtual Reality Therapy, Drug-Resistant Tuberculosis, Anxiety, Digital Mental HealthAbstract
Drug-resistant tuberculosis (DR-TB) presents both a biological challenge and a substantial psychological burden, particularly anxiety, which often disrupts treatment adherence and diminishes patients' quality of life. This study aimed to evaluate the effectiveness of Virtual Reality (VR) therapy as a non-pharmacological intervention for reducing anxiety levels among DR-TB patients. A quasi-experimental design with a pretest-posttest control group approach was employed. A total of 384 participants were recruited from Indonesia and Philippines. Anxiety levels were assessed using the validated Hamilton Anxiety Rating Scale. Data were analyzed using paired t-tests to assess within-group changes, and Analysis of Covariance (ANCOVA) was conducted to control for potential confounding variables and determine between-group differences. The results revealed a statistically significant reduction in anxiety scores in the VR group compared to the control group (p < 0.001), with participants reporting improved emotional regulation and reduced psychological distress. These findings suggested that VR therapy was an effective non-pharmacological strategy for managing anxiety in DR-TB patients. The study contributed to the digital mental health literature by offering culturally relevant evidence on the application of immersive therapy in two high-burden TB countries. Integrating VR therapy into TB care protocols may enhance holistic patient management, particularly in resource-constrained healthcare systems.
References
Abou Hashish, E. A. (2025). Compassion through technology: Digital empathy concept analysis and implications in nursing. DIGITAL HEALTH, 11. https://doi.org/10.1177/20552076251326221
Adejumo, O. A., Jinabhai, C., Daniel, O., & Haffejee, F. (2025). The effects of stigma and social support on the health-related quality of life of people with drug resistance tuberculosis in Lagos, Nigeria. Quality of Life Research, 34(5), 1305–1316. https://doi.org/10.1007/s11136-025-03902-5
Appel, L., Appel, E., Kisonas, E., Lewis, S., & Sheng, L. Q. (2022). Virtual Reality for Veteran Relaxation: Can VR Therapy Help Veterans Living With Dementia Who Exhibit Responsive Behaviors? Frontiers in Virtual Reality, 2. https://doi.org/10.3389/frvir.2021.724020
Bachelard, L., Michel, A., & Blanc, N. (2024). Virtual Reality to Improve the Psychological and Physical Well-Being in Cancer Patients: An Umbrella Review. Cancers, 16(23), 3943. https://doi.org/10.3390/cancers16233943
Bell, I. H., Pot-Kolder, R., Rizzo, A., Rus-Calafell, M., Cardi, V., Cella, M., Ward, T., Riches, S., Reinoso, M., Thompson, A., Alvarez-Jimenez, M., & Valmaggia, L. (2024). Advances in the use of virtual reality to treat mental health conditions. Nature Reviews Psychology, 3(8), 552–567. https://doi.org/10.1038/s44159-024-00334-9
Cawley, A., & Tejeiro, R. (2024). Brief Virtual Reality Mindfulness is More Effective than Audio Mindfulness and Colouring in Reducing Stress in University Students. Mindfulness, 15(2), 272–281. https://doi.org/10.1007/s12671-024-02306-9
Cerritelli, F., Chiera, M., Abbro, M., Megale, V., Esteves, J., Gallace, A., & Manzotti, A. (2021). The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.700211
Colombo, D., Díaz‐García, A., Fernandez‐Álvarez, J., & Botella, C. (2021). Virtual reality for the enhancement of emotion regulation. Clinical Psychology & Psychotherapy, 28(3), 519–537. https://doi.org/10.1002/cpp.2618
Cushnan, J., McCafferty, P., & Best, P. (2024). Clinicians’ perspectives of immersive tools in clinical mental health settings: a systematic scoping review. BMC Health Services Research, 24(1), 1091. https://doi.org/10.1186/s12913-024-11481-3
Drigas, A., & Sideraki, A. (2024). Brain Neuroplasticity Leveraging Virtual Reality and Brain–Computer Interface Technologies. Sensors, 24(17), 5725. https://doi.org/10.3390/s24175725
Failla, C., Marino, F., Bernardelli, L., Gaggioli, A., Doria, G., Chilà, P., Minutoli, R., Mangano, R., Torrisi, R., Tartarisco, G., Bruschetta, R., Arcuri, F., Cerasa, A., & Pioggia, G. (2022). Mediating Mindfulness-Based Interventions with Virtual Reality in Non-Clinical Populations: The State-of-the-Art. Healthcare, 10(7), 1220. https://doi.org/10.3390/healthcare10071220
Gao, Y., Wang, N., & Liu, N. (2023). Effectiveness of virtual reality in reducing preoperative anxiety in adults: A systematic review and meta‐analysis. Journal of Advanced Nursing, 79(10), 3678–3690. https://doi.org/10.1111/jan.15743
Goudman, L., Jansen, J., Billot, M., Vets, N., De Smedt, A., Roulaud, M., Rigoard, P., & Moens, M. (2022). Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis. JMIR Serious Games, 10(2), e34402. https://doi.org/10.2196/34402
Haeyen, S. (2024). A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1382007
Hosseini, T., Hooshmandja, M., Noaparast, M., Mojtahedzadeh, R., & Mohammadi, A. (2024). Virtual reality exposure therapy to decrease anxiety before surgical invasive procedures in hemodialysis patients: an interventional study. BMC Nephrology, 25(1), 30. https://doi.org/10.1186/s12882-024-03461-w
Jallad, S. T., & Işık, B. (2022). The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review. Irish Journal of Medical Science (1971 -), 191(3), 1407–1426. https://doi.org/10.1007/s11845-021-02695-z
Jemal, A. (2024). Critical Clinical Social Work Practice: Pathways to Healing from the Molecular to the Macro. Clinical Social Work Journal, 52(3), 229–244. https://doi.org/10.1007/s10615-022-00843-1
Kukharuk, O., Tkalich, K., Kamash, N., & Georgiou, O. (2025). Effectiveness of immersive VR therapy in reducing stress-associated symptoms in Ukraine. European Journal of Psychotraumatology, 16(1). https://doi.org/10.1080/20008066.2025.2488097
Kumar Panda, U., Ra, D., Swaroop Sahoo, S., Kakkar, R., & Singh, J. (2024). Interplay between tuberculosis, mental illness, and treatment compliance: An integrative literature review. Indian Journal of Tuberculosis, 71(3), 353–357. https://doi.org/10.1016/j.ijtb.2023.10.004
Lee, S., Rajaguru, V., Baek, J. S., Shin, J., & Park, Y. (2023). Digital Health Interventions to Enhance Tuberculosis Treatment Adherence: Scoping Review. JMIR MHealth and UHealth, 11, e49741–e49741. https://doi.org/10.2196/49741
Liboon Aranas, L., Alam, K., Gyawali, P., & Alam, R. M. (2023). Drug-Resistant Tuberculosis Stigma Among HealthCare Workers Toward the Development of a Stigma-Reduction Strategy: A Scoping Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60, 1–10. https://doi.org/10.1177/00469580231180754
Liu, Z., Ren, L., Xiao, C., Zhang, K., & Demian, P. (2022). Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis. International Journal of Environmental Research and Public Health, 19(3), 1525. https://doi.org/10.3390/ijerph19031525
Lv, G., Jing, R., Gai, W., Luan, H., Li, P., & Yang, C. (2025). Enhancing emotion expression (3E): A novel virtual reality tool for improving alexithymia and its psychological outcomes from a multi-dimensional perspective. Journal of Affective Disorders, 373, 253–264. https://doi.org/10.1016/j.jad.2024.12.087
Ma, J., Zhao, D., Xu, N., & Yang, J. (2023). The effectiveness of immersive virtual reality (VR) based mindfulness training on improvement mental-health in adults: A narrative systematic review. EXPLORE, 19(3), 310–318. https://doi.org/10.1016/j.explore.2022.08.001
Marougkas, A., Troussas, C., Krouska, A., & Sgouropoulou, C. (2023). How personalized and effective is immersive virtual reality in education? A systematic literature review for the last decade. Multimedia Tools and Applications, 83(6), 18185–18233. https://doi.org/10.1007/s11042-023-15986-7
Mphothulo, N., Hlangu, S., Furin, J., Moshabela, M., & Loveday, M. (2025). Navigating DR-TB Treatment care: a qualitative exploration of barriers and facilitators to retention in care among people with history of early disengagement from drug-resistant tuberculosis treatment in Johannesburg, South Africa. BMC Health Services Research, 25(1), 122. https://doi.org/10.1186/s12913-025-12265-z
Myburgh, H., Baloyi, D., Loveday, M., Meehan, S.-A., Osman, M., Wademan, D., Hesseling, A., & Hoddinott, G. (2023). A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities. PLOS Global Public Health, 3(2), e0001357. https://doi.org/10.1371/journal.pgph.0001357
Naderbagi, A., Loblay, V., Zahed, I. U. M., Ekambareshwar, M., Poulsen, A., Song, Y. J. C., Ospina-Pinillos, L., Krausz, M., Mamdouh Kamel, M., Hickie, I. B., & LaMonica, H. M. (2024). Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review. Journal of Medical Internet Research, 26, e55130. https://doi.org/10.2196/55130
Nagarajan, K., Kumarsamy, K., Begum, R., Panibatla, V., Reddy, R., Adepu, R., Munjattu, J. F., Sellapan, S., Arangba, S., Goswami, A., Swamickan, R., & Muniyandi, M. (2022). A Dual Perspective of Psycho-Social Barriers and Challenges Experienced by Drug-Resistant TB Patients and Their Caregivers through the Course of Diagnosis and Treatment: Findings from a Qualitative Study in Bengaluru and Hyderabad Districts of South India. Antibiotics, 11(11), 1586. https://doi.org/10.3390/antibiotics11111586
Nurfikri, A., Kesa, D. D., Wu, M., Roselina, E., & Hidayat, A. (2024). Public awareness, attitudes, behavior and norms building green hospitals’ power. Heliyon, 10(20), e39336. https://doi.org/10.1016/j.heliyon.2024.e39336
Papava, I., Daescu, A.-M. C., Dehelean, L., Bredicean, A.-C., Ilie, A. C., Ursoniu, S., Bondrescu, M., Radu, I., Daescu, A., Gaitoane, A.-I., & Oancea, C. (2025). The Impact of Maladaptive Coping Styles on Psychological Outcomes in Tuberculosis Patients. Healthcare, 13(9), 1042. https://doi.org/10.3390/healthcare13091042
Parveen, T., Reetu Sharma, & Pawankumar Godatwar. (2025). A Survey on Anxiety Disorder: Using Assessment Tool Ham-A Scale. Journal of Ayurveda and Integrated Medical Sciences, 10(1), 69–77. https://doi.org/10.21760/jaims.10.1.9
Pasha, A., Siddiqui, H., Ali, S., Brooks, M. B., Maqbool, N. R., & Khan, A. J. (2021). Impact of integrating mental health services within existing tuberculosis treatment facilities. Medicine Access @ Point of Care, 5, 1–8. https://doi.org/10.1177/23992026211011314
Riches, S., Jeyarajaguru, P., Taylor, L., Fialho, C., Little, J., Ahmed, L., O’Brien, A., van Driel, C., Veling, W., & Valmaggia, L. (2023). Virtual reality relaxation for people with mental health conditions: a systematic review. Social Psychiatry and Psychiatric Epidemiology, 58(7), 989–1007. https://doi.org/10.1007/s00127-022-02417-5
Ridho, A., Alfian, S. D., van Boven, J. F. M., Levita, J., Yalcin, E. A., Le, L., Alffenaar, J.-W., Hak, E., Abdulah, R., & Pradipta, I. S. (2022). Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. Journal of Medical Internet Research, 24(2), e33062. https://doi.org/10.2196/33062
Roxas, E. A., Fadrilan-Camacho, V. F. F., Lota, M. M. M., Hernandez, P. M. R., Agravante, A. P. M., Loterio, L. M. M., Arevalo, M. J., Maglalang, R. L. F., Lumangaya, C. R., & Belizario, V. Y. (2023). A Qualitative Study on the Implementation of the Workplace TB Program in the Philippines: Challenges and Way Forward. Tropical Medicine and Infectious Disease, 8(2), 93. https://doi.org/10.3390/tropicalmed8020093
Saktiawati, A. M. I., Vasiliu, A., Saluzzo, F., & Akkerman, O. W. (2024). Strategies to Enhance Diagnostic Capabilities for the New Drug-Resistant Tuberculosis (DR-TB) Drugs. Pathogens, 13(12), 1045. https://doi.org/10.3390/pathogens13121045
Shahid, S., Kelson, J., & Saliba, A. (2024). Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review. JMIR Mental Health, 11, e48916. https://doi.org/10.2196/48916
Storvig, E., Harstad, I., Ehrnström, B., & Iversen, V. C. (2024). Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients’ experiences before, during and after treatment. BMC Public Health, 24(1), 1801. https://doi.org/10.1186/s12889-024-19342-8
Tan, W., Lu, Y., Chen, R., An, Q., & Yu, Z. (2023). Prevention and Prognosis of Drug-Resistant Tuberculosis. In P.-X. Lu, H. Lu, & Y. Yi (Eds.), Diagnostic Imaging of Drug Resistant Pulmonary Tuberculosis (pp. 257–267). Springer Nature Singapore. https://doi.org/10.1007/978-981-99-8339-1_17
Tarrant, J., Viczko, J., & Cope, H. (2018). Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.01280
Trusculescu, L.-M., Pitic, D. E., Sălcudean, A., Popovici, R. A., Forna, N., Badoiu, S. C., Enache, A., Enasoni, S., Kiș, A., Cosoroabă, R. M., Talpos-Niculescu, C. I., Zeicu, C. C., Cozma, M.-M., & Todor, L. (2025). Virtual Reality as a Non-Pharmacological Aid for Reducing Anxiety in Pediatric Dental Procedures. Children, 12(7), 930. https://doi.org/10.3390/children12070930
van Loenen, I., Scholten, W., Muntingh, A., Smit, J., & Batelaan, N. (2022). The Effectiveness of Virtual Reality Exposure–Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis. Journal of Medical Internet Research, 24(2), e26736. https://doi.org/10.2196/26736
Wang, H., Gu, J., Zhang, L., & Song, Y. (2024). Assessing the quality of life in patients with drug-resistant tuberculosis: a cross-sectional study. BMC Pulmonary Medicine, 24(1), 303. https://doi.org/10.1186/s12890-024-03119-1
Wankhede, N. L., Koppula, S., Ballal, S., Doshi, H., Kumawat, R., Raju, Ss., Arora, I., Sammeta, S. S., Khalid, M., Zafar, A., Taksande, B. G., Upaganlawar, A. B., Gulati, M., Umekar, M. J., Kopalli, S. R., & Kale, M. B. (2025). Virtual reality modulating dynamics of neuroplasticity: Innovations in neuro-motor rehabilitation. Neuroscience, 566, 97–111. https://doi.org/10.1016/j.neuroscience.2024.12.040
Wieczorek, A., Schrank, F., Renner, K.-H., & Wagner, M. (2024). Psychological and physiological health outcomes of virtual reality-based mindfulness interventions: A systematic review and evidence mapping of empirical studies. DIGITAL HEALTH, 10. https://doi.org/10.1177/20552076241272604
Wilson, D., Sheikh, A., Görgens, M., & Ward, K. (2021). Technology and Universal Health Coverage: Examining the role of digital health. Journal of Global Health, 11, 16006. https://doi.org/10.7189/jogh.11.16006
Wray, T. B., Kemp, J. J., & Larsen, M. A. (2023). Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions. Cognitive Behaviour Therapy, 52(6), 603–624. https://doi.org/10.1080/16506073.2023.2229017
Yani, D. I., Juniarti, N., & Lukman, M. (2022). Factors Related to Complying with Anti-TB Medications Among Drug-Resistant Tuberculosis Patients in Indonesia. Patient Preference and Adherence, 16, 3319–3327. https://doi.org/10.2147/PPA.S388989
Ye, J. (2021). Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms. JMIR Formative Research, 5(6), e22075. https://doi.org/10.2196/22075
Zeng, W., Xu, J., Yu, J., & Chu, X. (2025). Effectiveness of virtual reality therapy in the treatment of anxiety disorders in adolescents and adults: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1553290
Zhai, K., Dilawar, A., Yousef, M. S., Holroyd, S., El-Hammali, H., & Abdelmonem, M. (2021). Virtual Reality Therapy for Depression and Mood in Long-Term Care Facilities. Geriatrics, 6(2), 58. https://doi.org/10.3390/geriatrics6020058
Zhang, Y., Zhang, L., Hua, H., Jin, J., Zhu, L., Shu, L., Xu, X., Kuang, F., & Liu, Y. (2021). Relaxation Degree Analysis Using Frontal Electroencephalogram Under Virtual Reality Relaxation Scenes. Frontiers in Neuroscience, 15. https://doi.org/10.3389/fnins.2021.719869
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 International Journal of Nursing Information
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
