{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:58:03Z","timestamp":1772521083377,"version":"3.50.1"},"reference-count":72,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Tampere University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Virtual Reality"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The fear of needles is a common cause of stress and negative patient experiences in pediatrics. This article reports the effects and user experience of using a mindfulness-based guided relaxation exercise in a virtual natural environment to address patient stress during an intravenous cannulation procedure of 20 children with a mean age (SD) of 10.6 (\u00b1\u20091.26) years. This was an extension study to prior research, which found positive results with deep breathing exercises in a virtual natural environment in this use context. The key findings of this preliminary study include significantly reduced stress levels during the virtual reality intervention according to the heart rate variability measurements (SDNN,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006; Stress Index,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.037) and lower level of pain experienced during the cannulation than the children expected (VAS-A Pain,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.037). The user experience was positive among patients and pediatricians and no adverse effects were found. Comparison to the deep breathing exercise suggests improved pain reduction and higher patient satisfaction with this mindfulness-based method but also implies a less reliable stress-reducing effect for patients with strong fear of needles. These results illustrate the feasibility of this method for addressing periprocedural pain and anxiety in pediatrics, particularly regarding minor to medium cases.\n                  <\/jats:p>","DOI":"10.1007\/s10055-026-01317-2","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T02:24:37Z","timestamp":1771035877000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mindfulness-based guided relaxation exercises in a virtual natural environment to reduce periprocedural pain and anxiety in pediatrics"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8615-2878","authenticated-orcid":false,"given":"Ilmari","family":"Jysk\u00e4","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7395-0769","authenticated-orcid":false,"given":"Markku","family":"Turunen","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6707-7975","authenticated-orcid":false,"given":"Kaija","family":"Puura","sequence":"additional","affiliation":[]},{"given":"Arash","family":"Chaychi Maleki","sequence":"additional","affiliation":[]},{"given":"Elina","family":"Karppa","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3270-7660","authenticated-orcid":false,"given":"Sauli","family":"Palmu","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6081-6819","authenticated-orcid":false,"given":"Jari","family":"Viik","sequence":"additional","affiliation":[]},{"given":"John","family":"M\u00e4kel\u00e4","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"1317_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11216516","volume":"11","author":"C-I Babo\u0219","year":"2022","unstructured":"Babo\u0219 C-I, Leucu\u021ba D-C, Dumitra\u0219cu DL (2022) Meditation and irritable bowel syndrome, a systematic review and meta-analysis. J Clin Med 11:6516. https:\/\/doi.org\/10.3390\/jcm11216516","journal-title":"J Clin Med"},{"key":"1317_CR2","doi-asserted-by":"publisher","unstructured":"Baevsky R, Chernikova A (2017) Heart rate variability analysis: physiological foundations and main methods.\u00a0Cardiometry 66\u201376.\u00a0https:\/\/doi.org\/10.12710\/cardiometry.2017.10.6676.\u00a0","DOI":"10.12710\/cardiometry.2017.10.6676"},{"key":"1317_CR3","doi-asserted-by":"publisher","unstructured":"Baldini A, Patron E, Gentili C et al (2024) Novel VR-based biofeedback systems: a comparison between heart rate variability- and electrodermal activity-driven approaches. IEEE Trans Affect Comput 1\u201311. https:\/\/doi.org\/10.1109\/TAFFC.2024.3352424","DOI":"10.1109\/TAFFC.2024.3352424"},{"key":"1317_CR4","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.ijpsycho.2015.08.004","volume":"98","author":"TP Beauchaine","year":"2015","unstructured":"Beauchaine TP, Thayer JF (2015) Heart rate variability as a transdiagnostic biomarker of psychopathology. Int J Psychophysiol 98:338\u2013350. https:\/\/doi.org\/10.1016\/j.ijpsycho.2015.08.004","journal-title":"Int J Psychophysiol"},{"key":"1317_CR5","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1334221","volume":"12","author":"B Benchimol-Elkaim","year":"2024","unstructured":"Benchimol-Elkaim B, Khoury B, Tsimicalis A (2024) Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review. Front Pediatr 12:1334221. https:\/\/doi.org\/10.3389\/fped.2024.1334221","journal-title":"Front Pediatr"},{"key":"1317_CR6","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.866119","author":"S Bernaerts","year":"2022","unstructured":"Bernaerts S, Bonroy B, Daems J et al (2022) Virtual reality for distraction and relaxation in a pediatric hospital setting: an interventional study with a mixed-methods design. Front Digit Health. https:\/\/doi.org\/10.3389\/fdgth.2022.866119","journal-title":"Front Digit Health"},{"key":"1317_CR7","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1097\/00004583-199910000-00011","volume":"38","author":"B Birmaher","year":"1999","unstructured":"Birmaher B, Brent DA, Chiappetta L et al (1999) Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38:1230\u20131236. https:\/\/doi.org\/10.1097\/00004583-199910000-00011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"1317_CR8","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.02172","author":"J Blum","year":"2019","unstructured":"Blum J, Rockstroh C, G\u00f6ritz AS (2019) Heart rate variability biofeedback based on slow-paced breathing with immersive virtual reality nature scenery. Front Psychol. https:\/\/doi.org\/10.3389\/fpsyg.2019.02172","journal-title":"Front Psychol"},{"key":"1317_CR9","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/acem.14412","volume":"29","author":"M Butt","year":"2022","unstructured":"Butt M, Kabariti S, Likourezos A et al (2022) Take-pause: efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. Acad Emerg Med 29:270\u2013277. https:\/\/doi.org\/10.1111\/acem.14412","journal-title":"Acad Emerg Med"},{"key":"1317_CR10","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000293","volume":"5","author":"TJ Caruso","year":"2020","unstructured":"Caruso TJ, O\u2019Connell C, Qian JJ et al (2020) Retrospective review of the safety and efficacy of virtual reality in a pediatric hospital. Pediatr Qual Saf 5:e293. https:\/\/doi.org\/10.1097\/pq9.0000000000000293","journal-title":"Pediatr Qual Saf"},{"key":"1317_CR11","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1177\/0894318419845391","volume":"32","author":"\u015e \u00c7elikol","year":"2019","unstructured":"\u00c7elikol \u015e, Tural B\u00fcy\u00fck E, Y\u0131ld\u0131zlar O (2019) Children\u2019s pain, fear, and anxiety during invasive procedures. Nurs Sci Q 32:226\u2013232. https:\/\/doi.org\/10.1177\/0894318419845391","journal-title":"Nurs Sci Q"},{"key":"1317_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12671-024-02507-2","volume":"16","author":"R Chems-Maarif","year":"2025","unstructured":"Chems-Maarif R, Cavanagh K, Baer R et al (2025) Defining mindfulness: a review of existing definitions and suggested refinements. Mindfulness 16:1\u201320. https:\/\/doi.org\/10.1007\/s12671-024-02507-2","journal-title":"Mindfulness"},{"key":"1317_CR13","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1089\/cyber.2018.0393","volume":"22","author":"A Chirico","year":"2019","unstructured":"Chirico A, Gaggioli A (2019) When virtual feels real: comparing emotional responses and presence in virtual and natural environments. Cyberpsychol Behav Soc Netw 22:220\u2013226. https:\/\/doi.org\/10.1089\/cyber.2018.0393","journal-title":"Cyberpsychol Behav Soc Netw"},{"key":"1317_CR14","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153248","volume":"10","author":"O Czech","year":"2021","unstructured":"Czech O, Wrzeciono A, Rutkowska A et al (2021) Virtual reality interventions for needle-related procedural pain, fear and anxiety\u2014a systematic review and meta-analysis. J Clin Med 10:3248. https:\/\/doi.org\/10.3390\/jcm10153248","journal-title":"J Clin Med"},{"key":"1317_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253048","volume":"16","author":"E Duncanson","year":"2021","unstructured":"Duncanson E, Le Leu RK, Shanahan L et al (2021) The prevalence and evidence-based management of needle fear in adults with chronic disease: a scoping review. PLoS One 16:e0253048. https:\/\/doi.org\/10.1371\/journal.pone.0253048","journal-title":"PLoS One"},{"key":"1317_CR16","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1213\/ANE.0000000000004165","volume":"129","author":"R Eijlers","year":"2019","unstructured":"Eijlers R, Utens EMWJ, Staals LM et al (2019) Systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety. Anesth Analg 129:1344. https:\/\/doi.org\/10.1213\/ANE.0000000000004165","journal-title":"Anesth Analg"},{"key":"1317_CR17","first-page":"1389","volume":"79","author":"E Facco","year":"2013","unstructured":"Facco E, Stellini E, Bacci C et al (2013) Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiol 79:1389\u20131395","journal-title":"Minerva Anestesiol"},{"key":"1317_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2024.100772","volume":"38","author":"L Fan","year":"2024","unstructured":"Fan L, Baharum MR (2024) The effects of digital nature and actual nature on stress reduction: a meta-analysis and systematic review. Internet Interv 38:100772. https:\/\/doi.org\/10.1016\/j.invent.2024.100772","journal-title":"Internet Interv"},{"key":"1317_CR19","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1177\/20494637221109108","volume":"16","author":"F Fatoye","year":"2022","unstructured":"Fatoye F, Gebrye T, Mbada CE et al (2022) Cost effectiveness of virtual reality game compared to clinic based McKenzie extension therapy for chronic non-specific low back pain. Br J Pain 16:601\u2013609. https:\/\/doi.org\/10.1177\/20494637221109108","journal-title":"Br J Pain"},{"key":"1317_CR20","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1097\/CIN.0000000000000586","volume":"38","author":"JM Flujas-Contreras","year":"2020","unstructured":"Flujas-Contreras JM, Ruiz-Casta\u00f1eda D, G\u00f3mez I (2020) Promoting emotional well-being in hospitalized children and adolescents with virtual reality: usability and acceptability of a randomized controlled trial. CIN Comput Inform Nurs 38:99. https:\/\/doi.org\/10.1097\/CIN.0000000000000586","journal-title":"CIN Comput Inform Nurs"},{"key":"1317_CR21","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1111\/jan.15473","volume":"79","author":"Y Gao","year":"2023","unstructured":"Gao Y, Xu Y, Liu N, Fan L (2023) Effectiveness of virtual reality intervention on reducing the pain, anxiety and fear of needle-related procedures in paediatric patients: a systematic review and meta-analysis. J Adv Nurs 79:15\u201330. https:\/\/doi.org\/10.1111\/jan.15473","journal-title":"J Adv Nurs"},{"key":"1317_CR22","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.copsyc.2021.02.004","volume":"41","author":"CNW Geraets","year":"2021","unstructured":"Geraets CNW, van der Stouwe ECD, Pot-Kolder R, Veling W (2021) Advances in immersive virtual reality interventions for mental disorders: a new reality? Curr Opin Psychol 41:40\u201345. https:\/\/doi.org\/10.1016\/j.copsyc.2021.02.004","journal-title":"Curr Opin Psychol"},{"key":"1317_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/13607863.2023.2270442","volume":"0","author":"V Girishan Prabhu","year":"2023","unstructured":"Girishan Prabhu V, Stanley L, Morgan R, Shirley B (2023) Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients. Aging Ment Health 0:1\u201316. https:\/\/doi.org\/10.1080\/13607863.2023.2270442","journal-title":"Aging Ment Health"},{"key":"1317_CR24","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.ijpsycho.2023.08.001","volume":"192","author":"N Gullett","year":"2023","unstructured":"Gullett N, Zajkowska Z, Walsh A et al (2023) Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: a critical review of the literature. Int J Psychophysiol 192:35\u201342. https:\/\/doi.org\/10.1016\/j.ijpsycho.2023.08.001","journal-title":"Int J Psychophysiol"},{"key":"1317_CR25","unstructured":"Haas JK (2014) A history of the unity game engine"},{"key":"1317_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2020.102356","author":"KR Haisley","year":"2020","unstructured":"Haisley KR, Straw OJ, M\u00fcller DT et al (2020) Feasibility of implementing a virtual reality program as an adjuvant tool for peri-operative pain control; results of a randomized controlled trial in minimally invasive foregut surgery. Complement Ther Med. https:\/\/doi.org\/10.1016\/j.ctim.2020.102356","journal-title":"Complement Ther Med"},{"key":"1317_CR27","doi-asserted-by":"publisher","DOI":"10.3389\/frvir.2022.837616","author":"A Halbig","year":"2022","unstructured":"Halbig A, Babu SK, Gatter S et al (2022) Opportunities and challenges of virtual reality in healthcare \u2013 a domain experts inquiry. Front Virtual Real. https:\/\/doi.org\/10.3389\/frvir.2022.837616","journal-title":"Front Virtual Real"},{"key":"1317_CR28","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1093\/jpepsy\/jsad003","volume":"48","author":"O Hughes","year":"2023","unstructured":"Hughes O, Shelton KH, Penny H, Thompson AR (2023) Living with physical health conditions: a systematic review of Mindfulness-Based interventions for children, adolescents, and their parents. J Pediatr Psychol 48:396\u2013413. https:\/\/doi.org\/10.1093\/jpepsy\/jsad003","journal-title":"J Pediatr Psychol"},{"key":"1317_CR29","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/pan.13547","volume":"29","author":"JF Hunter","year":"2019","unstructured":"Hunter JF, Kain ZN, Fortier MA (2019) Pain relief in the palm of your hand: harnessing mobile health to manage pediatric pain. Pediatr Anesth 29:120\u2013124. https:\/\/doi.org\/10.1111\/pan.13547","journal-title":"Pediatr Anesth"},{"key":"1317_CR30","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1097\/AJP.0000000000000599","volume":"34","author":"P Indovina","year":"2018","unstructured":"Indovina P, Barone D, Gallo L et al (2018) Virtual reality as a distraction intervention to relieve pain and distress during medical procedures. Clin J Pain 34:858\u2013877. https:\/\/doi.org\/10.1097\/AJP.0000000000000599","journal-title":"Clin J Pain"},{"key":"1317_CR31","unstructured":"Jysk\u00e4 I (2020) Effects of virtual natural environment and meditative guidance to stress reduction in therapeutic applications. Master\u2019s Thesis, Tampere University, Tampere"},{"key":"1317_CR32","doi-asserted-by":"publisher","first-page":"9316","DOI":"10.3390\/app12189316","volume":"12","author":"I Jysk\u00e4","year":"2022","unstructured":"Jysk\u00e4 I, Puura K, Turunen M (2022) Therapeutic potential of interactive audiovisual 360-degree virtual reality environments for anxiety reduction\u2014a case study with an abstract art application. Appl Sci 12:9316. https:\/\/doi.org\/10.3390\/app12189316","journal-title":"Appl Sci"},{"key":"1317_CR33","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11243129","volume":"11","author":"I Jysk\u00e4","year":"2023","unstructured":"Jysk\u00e4 I, Turunen M, Chaychi Maleki A et al (2023a) Design and user experience of VirNE application: deep breathing exercise in a virtual natural environment to reduce treatment anxiety in pediatrics. Healthcare 11:3129. https:\/\/doi.org\/10.3390\/healthcare11243129","journal-title":"Healthcare"},{"key":"1317_CR34","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11243140","volume":"11","author":"I Jysk\u00e4","year":"2023","unstructured":"Jysk\u00e4 I, Turunen M, Chaychi Maleki A et al (2023b) Effects of using guided deep breathing exercises in a virtual natural environment to reduce stress during pediatric treatment. Healthcare 11:3140. https:\/\/doi.org\/10.3390\/healthcare11243140","journal-title":"Healthcare"},{"key":"1317_CR35","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1093\/clipsy.bpg016","volume":"10","author":"J Kabat-Zinn","year":"2003","unstructured":"Kabat-Zinn J (2003) Mindfulness-Based interventions in context: past, present, and future. Clin Psychol Sci Pract 10:144\u2013156. https:\/\/doi.org\/10.1093\/clipsy.bpg016","journal-title":"Clin Psychol Sci Pract"},{"key":"1317_CR36","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1355046","author":"E Karppa","year":"2024","unstructured":"Karppa E, Puura K, Jysk\u00e4 I et al (2024) Case report: virtual natural environment solution helped a child cope with a painful procedure. Front Pediatr. https:\/\/doi.org\/10.3389\/fped.2024.1355046","journal-title":"Front Pediatr"},{"key":"1317_CR37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2013.06.018","author":"A Kemp","year":"2013","unstructured":"Kemp A, Quintana D (2013) The relationship between mental and physical health: insights from the study of heart rate variability. Int J Psychophysiol. https:\/\/doi.org\/10.1016\/j.ijpsycho.2013.06.018","journal-title":"Int J Psychophysiol"},{"key":"1317_CR38","doi-asserted-by":"crossref","unstructured":"Kolasinski EM (1995) Simulator sickness in virtual environments. U.S. Army Research Institute for the Behavioral and Social Sciences","DOI":"10.21236\/ADA295861"},{"key":"1317_CR39","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s11469-020-00363-4","volume":"20","author":"Y Kotera","year":"2022","unstructured":"Kotera Y, Richardson M, Sheffield D (2022) Effects of Shinrin-Yoku (forest bathing) and nature therapy on mental health: a systematic review and meta-analysis. Int J Ment Health Addict 20:337\u2013361. https:\/\/doi.org\/10.1007\/s11469-020-00363-4","journal-title":"Int J Ment Health Addict"},{"key":"1317_CR40","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s00508-021-01991-z","volume":"134","author":"OD Kothgassner","year":"2022","unstructured":"Kothgassner OD, Goreis A, Bauda I et al (2022) Virtual reality biofeedback interventions for treating anxiety. Wien Klin Wochenschr 134:49\u201359. https:\/\/doi.org\/10.1007\/s00508-021-01991-z","journal-title":"Wien Klin Wochenschr"},{"key":"1317_CR41","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1002\/nop2.330","volume":"6","author":"F Labaste","year":"2019","unstructured":"Labaste F, Ferr\u00e9 F, Combelles H et al (2019) Validation of a visual analogue scale for the evaluation of the postoperative anxiety: a prospective observational study. Nurs Open 6:1323\u20131330. https:\/\/doi.org\/10.1002\/nop2.330","journal-title":"Nurs Open"},{"key":"1317_CR42","doi-asserted-by":"publisher","DOI":"10.3390\/f13101625","volume":"13","author":"M Lee","year":"2022","unstructured":"Lee M, Kim E, Choe J et al (2022) Psychological effects of green experiences in a virtual environment: a systematic review. Forests 13:1625. https:\/\/doi.org\/10.3390\/f13101625","journal-title":"Forests"},{"key":"1317_CR43","unstructured":"Lehrer PM, Woolfolk RL, Sime WE (2007) Mindfulness Meditation. Principles and Practice of Stress Management, Third Edition. Guilford Press, pp 393\u2013427"},{"key":"1317_CR44","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/j.bja.2023.09.001","volume":"131","author":"J Li","year":"2023","unstructured":"Li J, Yang H, Xiao Y et al (2023) The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers. Br J Anaesth 131:1082\u20131092. https:\/\/doi.org\/10.1016\/j.bja.2023.09.001","journal-title":"Br J Anaesth"},{"key":"1317_CR45","doi-asserted-by":"publisher","DOI":"10.1177\/2164956120905597","volume":"9","author":"CM Luberto","year":"2020","unstructured":"Luberto CM, Hall DL, Park ER et al (2020) A perspective on the similarities and differences between mindfulness and relaxation. Glob Adv Health Med 9:2164956120905597. https:\/\/doi.org\/10.1177\/2164956120905597","journal-title":"Glob Adv Health Med"},{"key":"1317_CR46","doi-asserted-by":"publisher","first-page":"389","DOI":"10.2217\/pmt-2018-0079","volume":"9","author":"MM Makhlouf","year":"2019","unstructured":"Makhlouf MM, Garibay ER, Jenkins BN et al (2019) Postoperative pain: factors and tools to improve pain management in children. Pain Manag 9:389\u2013397. https:\/\/doi.org\/10.2217\/pmt-2018-0079","journal-title":"Pain Manag"},{"key":"1317_CR47","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.2147\/JPR.S200498","volume":"12","author":"B Mallari","year":"2019","unstructured":"Mallari B, Spaeth EK, Goh H, Boyd BS (2019) Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res 12:2053\u20132085. https:\/\/doi.org\/10.2147\/JPR.S200498","journal-title":"J Pain Res"},{"key":"1317_CR48","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00926","volume":"11","author":"E Mantovani","year":"2020","unstructured":"Mantovani E, Zucchella C, Bottiroli S et al (2020) Telemedicine and virtual reality for cognitive rehabilitation: a roadmap for the COVID-19 pandemic. Front Neurol 11:926. https:\/\/doi.org\/10.3389\/fneur.2020.00926","journal-title":"Front Neurol"},{"key":"1317_CR49","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9121729","volume":"9","author":"E Mazgelyt\u0117","year":"2021","unstructured":"Mazgelyt\u0117 E, Rekien\u0117 V, Dere\u0161kevi\u010di\u016bt\u0117 E et al (2021) Effects of virtual reality-based relaxation techniques on psychological, physiological, and biochemical stress indicators. Healthcare 9:1729. https:\/\/doi.org\/10.3390\/healthcare9121729","journal-title":"Healthcare"},{"key":"1317_CR50","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/jan.13818","volume":"75","author":"J McLenon","year":"2019","unstructured":"McLenon J, Rogers MAM (2019) The fear of needles: a systematic review and meta-analysis. J Adv Nurs 75:30\u201342. https:\/\/doi.org\/10.1111\/jan.13818","journal-title":"J Adv Nurs"},{"key":"1317_CR51","doi-asserted-by":"publisher","DOI":"10.3390\/children9121869","volume":"9","author":"RL Moline","year":"2022","unstructured":"Moline RL, Constantin K, Chambers CT et al (2022) A brief mindfulness intervention for parents and children before pediatric venipuncture: a randomized controlled trial. Children 9:1869. https:\/\/doi.org\/10.3390\/children9121869","journal-title":"Children"},{"key":"1317_CR52","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(19)39619-2","volume":"156","author":"LAB Nguyen","year":"2019","unstructured":"Nguyen LAB, Adler EP, Rodriguez S et al (2019) Tu1614 \u2013 Virtual Reality Mindfulness Therapy Reduces Pain and Anxiety in Patients with Chronic Abdominal Pain. Gastroenterology 156:S-1062. https:\/\/doi.org\/10.1016\/S0016-5085(19)39619-2","journal-title":"Gastroenterology"},{"key":"1317_CR53","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2021.107008","volume":"126","author":"T Nukarinen","year":"2022","unstructured":"Nukarinen T, Rantala J, Korpela K et al (2022) Measures and modalities in restorative virtual natural environments: an integrative narrative review. Comput Human Behav 126:107008. https:\/\/doi.org\/10.1016\/j.chb.2021.107008","journal-title":"Comput Human Behav"},{"key":"1317_CR54","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.pmn.2022.03.013","volume":"23","author":"S O\u2019Connor","year":"2022","unstructured":"O\u2019Connor S, Mayne A, Hood B (2022) Virtual reality-based mindfulness for chronic pain management: a scoping review. Pain Manag Nurs 23:359\u2013369. https:\/\/doi.org\/10.1016\/j.pmn.2022.03.013","journal-title":"Pain Manag Nurs"},{"key":"1317_CR55","doi-asserted-by":"publisher","first-page":"237796081875944","DOI":"10.1177\/2377960818759442","volume":"4","author":"T Orenius","year":"2018","unstructured":"Orenius T, LicPsych, S\u00e4il\u00e4 H et al (2018) Fear of injections and needle phobia among children and adolescents: an overview of Psychological, Behavioral, and contextual factors. SAGE Open Nurs 4:237796081875944. https:\/\/doi.org\/10.1177\/2377960818759442","journal-title":"SAGE Open Nurs"},{"key":"1317_CR56","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1097\/AJP.0000000000001173","volume":"40","author":"M Paschali","year":"2024","unstructured":"Paschali M, Lazaridou A, Sadora J et al (2024) Mindfulness-based interventions for chronic low back pain: a systematic review and meta-analysis. Clin J Pain 40:105. https:\/\/doi.org\/10.1097\/AJP.0000000000001173","journal-title":"Clin J Pain"},{"key":"1317_CR57","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.burns.2022.02.002","volume":"49","author":"DR Patterson","year":"2023","unstructured":"Patterson DR, Drever S, Soltani M et al (2023) A comparison of interactive immersive virtual reality and still nature pictures as distraction-based analgesia in burn wound care. Burns 49:182\u2013192. https:\/\/doi.org\/10.1016\/j.burns.2022.02.002","journal-title":"Burns"},{"key":"1317_CR58","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/s10055-020-00471-5","volume":"25","author":"C Rockstroh","year":"2021","unstructured":"Rockstroh C, Blum J, G\u00f6ritz AS (2021) A mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing. Virtual Reality 25:539\u2013552. https:\/\/doi.org\/10.1007\/s10055-020-00471-5","journal-title":"Virtual Reality"},{"key":"1317_CR59","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1097\/ACO.0000000000001255","volume":"36","author":"K R\u00f6her","year":"2023","unstructured":"R\u00f6her K, Becke-Jakob K, Eich C (2023) Safety and quality in paediatric procedural sedation: what really matters? Curr Opin Anesthesiol 36:340. https:\/\/doi.org\/10.1097\/ACO.0000000000001255","journal-title":"Curr Opin Anesthesiol"},{"key":"1317_CR60","unstructured":"Schrepp M, Thomaschewski J (2019) Handbook for the modular extension of the user experience questionnaire"},{"key":"1317_CR61","doi-asserted-by":"publisher","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","volume":"5","author":"F Shaffer","year":"2017","unstructured":"Shaffer F, Ginsberg JP (2017) An overview of heart rate variability metrics and norms. Front Public Health 5:258. https:\/\/doi.org\/10.3389\/fpubh.2017.00258","journal-title":"Front Public Health"},{"key":"1317_CR62","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002997","volume":"165","author":"L Sharpe","year":"2024","unstructured":"Sharpe L, Richmond B, Menzies RE et al (2024) A synthesis of meta-analyses of mindfulness-based interventions in pain. Pain 165:18. https:\/\/doi.org\/10.1097\/j.pain.0000000000002997","journal-title":"Pain"},{"key":"1317_CR63","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.chc.2014.03.002","volume":"23","author":"DR Simkin","year":"2014","unstructured":"Simkin DR, Black NB (2014) Meditation and mindfulness in clinical practice. Child Adolesc Psychiatr Clin North Am 23:487\u2013534. https:\/\/doi.org\/10.1016\/j.chc.2014.03.002","journal-title":"Child Adolesc Psychiatr Clin North Am"},{"key":"1317_CR64","doi-asserted-by":"publisher","unstructured":"Sim\u00f3n-Vicente L, Rodr\u00edguez-Cano S, Delgado-Benito V et al (2022) Cybersickness. A systematic literature review of adverse effects related to virtual reality.\u00a0Neurolog\u00eda.\u00a0https:\/\/doi.org\/10.1016\/j.nrl.2022.04.009","DOI":"10.1016\/j.nrl.2022.04.009"},{"key":"1317_CR65","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.104115","volume":"125","author":"V Simonetti","year":"2022","unstructured":"Simonetti V, Tomietto M, Comparcini D et al (2022) Effectiveness of virtual reality in the management of paediatric anxiety during the peri\u2011operative period: a systematic review and meta-analysis. Int J Nurs Stud 125:104115. https:\/\/doi.org\/10.1016\/j.ijnurstu.2021.104115","journal-title":"Int J Nurs Stud"},{"key":"1317_CR66","volume-title":"A History of Mindfulness","author":"B Sujato","year":"2011","unstructured":"Sujato B (2011) A History of Mindfulness. Bhikkhu Sujato"},{"key":"1317_CR67","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1080\/10447318.2020.1848161","volume":"37","author":"L Tabbaa","year":"2021","unstructured":"Tabbaa L, Ang CS, Siriaraya P et al (2021) A reflection on virtual reality design for psychological, cognitive and behavioral interventions: design needs, opportunities and challenges. Int J Hum Comput Interact 37:851\u2013866. https:\/\/doi.org\/10.1080\/10447318.2020.1848161","journal-title":"Int J Hum Comput Interact"},{"key":"1317_CR68","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1111\/pan.14546","volume":"32","author":"FQ Tas","year":"2022","unstructured":"Tas FQ, van Eijk CAM, Staals LM et al (2022) Virtual reality in pediatrics, effects on pain and anxiety: a systematic review and meta-analysis update. Paediatr Anaesth 32:1292\u20131304. https:\/\/doi.org\/10.1111\/pan.14546","journal-title":"Paediatr Anaesth"},{"key":"1317_CR69","doi-asserted-by":"crossref","unstructured":"Turunen M, Hakulinen J, Melto A et al (2009) SUXES - user experience evaluation method for spoken and multimodal interaction. Interspeech","DOI":"10.21437\/Interspeech.2009-676"},{"key":"1317_CR70","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00360","author":"W von Rosenberg","year":"2017","unstructured":"von Rosenberg W, Chanwimalueang T, Adjei T et al (2017) Resolving ambiguities in the LF\/HF ratio: LF-HF scatter plots for the categorization of mental and physical stress from HRV. Front Physiol. https:\/\/doi.org\/10.3389\/fphys.2017.00360","journal-title":"Front Physiol"},{"key":"1317_CR71","doi-asserted-by":"publisher","first-page":"3263","DOI":"10.3390\/ijerph16183263","volume":"16","author":"X Wang","year":"2019","unstructured":"Wang X, Shi Y, Zhang B, Chiang Y (2019) The influence of forest resting environments on stress using virtual reality. Int J Environ Res Public Health 16:3263. https:\/\/doi.org\/10.3390\/ijerph16183263","journal-title":"Int J Environ Res Public Health"},{"key":"1317_CR72","doi-asserted-by":"publisher","DOI":"10.3390\/children8050368","volume":"8","author":"AA Wren","year":"2021","unstructured":"Wren AA, Neiman N, Caruso TJ et al (2021) Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: a pilot feasibility and acceptability study. Children 8:368. https:\/\/doi.org\/10.3390\/children8050368","journal-title":"Children"}],"container-title":["Virtual Reality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10055-026-01317-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10055-026-01317-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10055-026-01317-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:14:53Z","timestamp":1772518493000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10055-026-01317-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":72,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["1317"],"URL":"https:\/\/doi.org\/10.1007\/s10055-026-01317-2","relation":{},"ISSN":["1434-9957"],"issn-type":[{"value":"1434-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]},"assertion":[{"value":"29 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and approved by the Authority Ethics Committee of Pirkanmaa Wellfare Area (R21068L, 21 June 2021) and Finnish Medicines Agency (2021\/007366, 16 March 2022).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional review board statement"}},{"value":"was obtained from all subjects involved in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"71"}}