{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:59:42Z","timestamp":1763621982354,"version":"3.45.0"},"reference-count":97,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Psychotherapists face substantial occupational stress and emotional demands placing them at risk of burnout, yet interventions aimed at enhancing their well-being remain understudied. This case series explored the effectiveness of a brief relaxation intervention comparing the traditional safe place imagination exercise with a virtual reality (VR) adaptation. The VR adaptation comprised a personalized visualization of the safe place by artificial intelligence (AI). The exploratory research questions investigated how both interventions would influence relaxation, burnout and stress over the course of the study and whether VR would yield different effects than imagination. Further, the roles of imagery ability and presence were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five psychotherapists from an outpatient setting participated in a six-week, within-subject study that used an alternating treatments design (ABCABC) which was created via a participatory approach where participants actively engaged in the planning of the study. Imagination- (B) and VR-based (C) relaxation interventions alternated weekly with baseline weeks (A) in between. The VR environments were tailored to participants' preferences through generative AI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Relaxation consistently increased in both conditions based on self-report and physiological (skin conductance levels) measures. Burnout and stress did not significantly decrease over time and VR did not yield significantly greater effects on all outcomes. Imagery ability was not associated with greater relaxation, whereas presence showed a positive correlation in one VR session.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that brief imagination and VR interventions can enhance relaxation in psychotherapists. The lack of significant differences between conditions suggests that VR does not inherently outperform traditional methods, especially with participants already familiar with imagination exercises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2025.1665457","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:20:50Z","timestamp":1763619650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring AI-personalized visualization of the safe place in virtual reality versus imagination of the safe place for stress, burnout, and relaxation in psychotherapists: a case series"],"prefix":"10.3389","volume":"7","author":[{"given":"Viktoria","family":"Wollweber","sequence":"first","affiliation":[]},{"given":"Franziska","family":"Pfannerstill","sequence":"additional","affiliation":[]},{"given":"Thomas","family":"Probst","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.5271\/sjweh.615","article-title":"Burnout and engagement at work as a function of demands and control","volume":"27","author":"Demerouti","year":"2001","journal-title":"Scand J Work Environ Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/j.1540-4560.1974.tb00706.x","article-title":"Staff burn-out","volume":"30","author":"Freudenberger","year":"1974","journal-title":"J Soc Issues"},{"key":"B3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.5860\/choice.26-1580","article-title":"Career burnout: causes and cures","volume":"26","author":"Pines","year":"1988","journal-title":"Choice Rev Online"},{"key":"B4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/oso\/9780198522799.003.0004","article-title":"A multidimensional theory of burnout","volume-title":"Theories of Organizational Stress","author":"Maslach","year":"1998"},{"key":"B5","volume-title":"Maslach Burnout Inventory","author":"Maslach","year":"1997"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.3390\/ijerph19031780","article-title":"Burnout: a review of theory and measurement","volume":"19","author":"Ed\u00fa-Valsania","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1002\/da.22766","article-title":"Associations between therapists\u2019 occupational burnout and their patients\u2019 depression and anxiety treatment outcomes","volume":"35","author":"Delgadillo","year":"2018","journal-title":"Depress Anxiety"},{"key":"B8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/capr.12483","article-title":"\u201cAt what cost am I doing this?\u201d An interpretative phenomenological analysis of the experience of burnout among private practitioner psychotherapists","volume":"22","author":"Finan","year":"2021","journal-title":"Couns Psychother Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s10488-011-0352-1","article-title":"Burnout in mental health services: a review of the problem and its remediation","volume":"39","author":"Morse","year":"2011","journal-title":"Adm Policy Mental Health Mental Health Serv Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.eurpsy.2018.06.003","article-title":"Burnout in mental health professionals: a systematic review and meta-analysis of prevalence and determinants","volume":"53","author":"O\u2019Connor","year":"2018","journal-title":"Eur Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1002\/jclp.22615","article-title":"Personal risk factors associated with burnout among psychotherapists: a systematic review of the literature","volume":"74","author":"Simionato","year":"2018","journal-title":"J Clin Psychol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1002\/capr.12532","article-title":"Self-perceived clinical competence, gender and workplace setting predict burnout among psychotherapists","volume":"23","author":"Sp\u00e4nnarg\u00e5rd","year":"2022","journal-title":"Couns Psychother Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1080\/02678370500297720","article-title":"The Copenhagen burnout inventory: a new tool for the assessment of burnout","volume":"19","author":"Kristensen","year":"2005","journal-title":"Work Stress"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/cpp.2909","article-title":"The emotionally exhausted treating the mentally unwell? A systematic review of burnout and stress interventions for psychologists","volume":"31","author":"Bell","year":"2023","journal-title":"Clin Psychol Psychother"},{"key":"B15","doi-asserted-by":"publisher","first-page":"345","DOI":"10.2147\/prbm.s437277","article-title":"Efficacy of progressive muscle relaxation in adults for stress, anxiety, and depression: a systematic review","volume":"17","author":"Khir","year":"2024","journal-title":"Psychol Res Behav Manag"},{"key":"B16","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1080\/21679169.2018.1452980","article-title":"The effect of mindfulness meditation on therapists\u2019 body-awareness and burnout in different forms of practice","volume":"20","author":"Mohammed","year":"2018","journal-title":"Eur J Physiother"},{"key":"B17","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1089\/eco.2024.0031","article-title":"Nature-Based guided imagery and meditation significantly enhance mental well-being and reduce depressive symptoms: a randomized experiment","volume":"17","author":"Owens","year":"2025","journal-title":"Ecopsychology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.jpsychores.2019.03.003","article-title":"Mindfulness training for healthcare professionals and trainees: a meta-analysis of randomized controlled trials","volume":"120","author":"Spinelli","year":"2019","journal-title":"J Psychosom Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"28","DOI":"10.5298\/1081-5937-42.1.07","article-title":"Effect of a brief guided imagery on stress","volume":"42","author":"Bigham","year":"2014","journal-title":"Biofeedback"},{"key":"B20","doi-asserted-by":"publisher","first-page":"538","DOI":"10.3109\/10253890.2015.1053454","article-title":"The effect of progressive muscle relaxation on daily cortisol secretion","volume":"18","author":"Chellew","year":"2015","journal-title":"Stress"},{"key":"B21","doi-asserted-by":"publisher","first-page":"105314","DOI":"10.1016\/j.bspc.2023.105314","article-title":"Effects of mindfulness-based stress reduction meditation on the emotional reaction to affective pictures assessed by electrodermal activity","volume":"86","author":"Correia","year":"2023","journal-title":"Biomed Signal Process Control"},{"key":"B22","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s10055-021-00595-2","article-title":"Exposure to virtual nature: the impact of different immersion levels on skin conductance level, heart rate, and perceived relaxation","volume":"26","author":"Knaust","year":"2021","journal-title":"Virtual Real"},{"key":"B23","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.ijpsycho.2015.04.017","article-title":"Is meditation always relaxing? Investigating heart rate, heart rate variability, experienced effort and likeability during training of three types of meditation","volume":"97","author":"Lumma","year":"2015","journal-title":"Int J Psychophysiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.jcbs.2017.10.001","article-title":"Mindfulness and acceptance-based trainings for fostering self-care and reducing stress in mental health professionals: a systematic review","volume":"6","author":"Rudaz","year":"2017","journal-title":"J Contextual Behav Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"561","DOI":"10.4414\/smf.2016.02698","article-title":"Burnout-behandlung teil 2: praktische empfehlungen","volume":"16","author":"Hochstrasser","year":"2016","journal-title":"Swiss Med Forum Schw Med Forum"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1160714","DOI":"10.3389\/fpsyg.2023.1160714","article-title":"Comparison of two brief mindfulness interventions for anxiety, stress and burnout in mental health professionals: a randomised crossover trial","volume":"14","author":"Ruiz-\u00cd\u00f1iguez","year":"2023","journal-title":"Front Psychol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1219.e1","DOI":"10.1016\/j.amjmed.2017.05.041","article-title":"Brief mindfulness practices for healthcare providers\u2014a systematic literature review","volume":"130","author":"Gilmartin","year":"2017","journal-title":"Am J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/0091217415592369","article-title":"Designing and implementing a resiliency program for family medicine residents","volume":"50","author":"Brennan","year":"2015","journal-title":"Int J Psychiatry Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.pedn.2014.10.005","article-title":"An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot","volume":"30","author":"Gauthier","year":"2015","journal-title":"J Pediatr Nurs"},{"key":"B30","volume-title":"Imagination als Heilsame Kraft: Zur Behandlung von Traumafolgen mit Ressourcenorientierten Verfahren","author":"Reddemann","year":"2007"},{"key":"B31","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1177\/02762366231159848","article-title":"Imagining a safe place: emotion regulation with detachment intervention","volume":"43","author":"Drujan","year":"2023","journal-title":"Imagin Cogn Personal"},{"key":"B32","doi-asserted-by":"publisher","first-page":"28","DOI":"10.7748\/mhp.2017.e1142","article-title":"The effectiveness of self-soothing techniques for people with PTSD in secure units","volume":"20","author":"Jubb","year":"2017","journal-title":"Mental Health Pract"},{"key":"B33","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/00207144.2018.1421356","article-title":"Revisiting the safe place: method and regulatory aspects in psychotherapy when easing allostatic overload in traumatized patients","volume":"66","author":"Gerge","year":"2018","journal-title":"Int J Clin Exp Hypn"},{"key":"B34","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.jbtep.2013.07.003","article-title":"Is it dangerous to fantasize revenge in imagery exercises? An experimental study","volume":"45","author":"Seebauer","year":"2014","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"B35","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/16506073.2015.1108360","article-title":"Imagery rescripting of revenge, avoidance, and forgiveness for past bullying experiences in young adults","volume":"45","author":"Watson","year":"2015","journal-title":"Cogn Behav Ther"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1495036","DOI":"10.1080\/23311908.2018.1495036","article-title":"Short-term autonomic nervous system and experiential responses during a labyrinth walk","volume":"5","author":"Behman","year":"2018","journal-title":"Cogent Psychol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.cnur.2020.06.013","article-title":"The multiple uses of guided imagery","volume":"55","author":"Krau","year":"2020","journal-title":"Nurs Clin North Am"},{"key":"B38","first-page":"211","article-title":"Imaginal processes","volume-title":"Springer EBooksPsychotherapy Process","author":"Anderson","year":"1980"},{"key":"B39","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1002\/(sici)1098-240x(199806)21:3","article-title":"Imaging ability and effective use of guided imagery","volume":"21","author":"Kwekkeboom","year":"1998","journal-title":"Res Nurs Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1472-6882-5-21","article-title":"Effects among healthy subjects of the duration of regularly practicing a guided imagery program","volume":"5","author":"Watanabe","year":"2005","journal-title":"BMC Complement Altern Med"},{"key":"B41","first-page":"60","article-title":"Differences in relaxation by means of guided imagery in a healthy community sample","volume":"12","author":"Watanabe","year":"2006","journal-title":"Altern Ther Health Med"},{"key":"B42","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/978-981-10-8034-0_18","article-title":"Imaging capability, absorption, anxiety, positive and negative affect: a guided imagery intervention","volume-title":"Springer EBooks. Applied Psychology Readings","author":"Vemu","year":"2018"},{"key":"B43","doi-asserted-by":"publisher","first-page":"858","DOI":"10.3389\/fpsyg.2020.00858","article-title":"Proof of concept of an eclectic, integrative therapeutic approach to mental health and well-being through virtual reality technology","volume":"11","author":"Frewen","year":"2020","journal-title":"Front Psychol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1007\/s00127-021-02110-z","article-title":"Virtual reality relaxation for the general population: a systematic review","volume":"56","author":"Riches","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s00127-022-02417-5","article-title":"Virtual reality relaxation for people with mental health conditions: a systematic review","volume":"58","author":"Riches","year":"2023","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"205520762210844","DOI":"10.1177\/20552076221084473","article-title":"Virtual reality as a tool to promote wellbeing in the workplace","volume":"8","author":"Adhyaru","year":"2022","journal-title":"Digit Health"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.3390\/healthcare9121729","article-title":"Effects of virtual reality-based relaxation techniques on psychological, physiological, and biochemical stress indicators","volume":"9","author":"Mazgelyt\u0117","year":"2021","journal-title":"Healthcare"},{"key":"B48","doi-asserted-by":"publisher","first-page":"e48649","DOI":"10.2196\/48649","article-title":"Can personalized virtual reality be better than guided imagery in enhancing the impact of progressive muscle relaxation training?: a pilot randomized controlled study on an Italian university sample","volume":"11","author":"Pardini","year":"2024","journal-title":"JMIR Ment Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/09638237.2023.2182428","article-title":"Virtual reality and immersive technologies to promote workplace wellbeing: a systematic review","volume":"33","author":"Riches","year":"2023","journal-title":"J Mental Health"},{"key":"B50","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1007\/s40806-016-0065-5","article-title":"Joy and calm: how an evolutionary functional model of affect regulation informs positive emotions in nature","volume":"2","author":"Richardson","year":"2016","journal-title":"Evol Psychol Sci"},{"key":"B51","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1111\/j.1083-6101.1997.tb00072.x","article-title":"At the heart of it all: the concept of presence","volume":"3","author":"Lombard","year":"1997","journal-title":"J Comput Mediat Commun"},{"key":"B52","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1089\/109493101300117884","article-title":"Research on presence in virtual reality: a survey","volume":"4","author":"Schuemie","year":"2001","journal-title":"Cyberpsychol Behav"},{"key":"B53","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1007\/978-3-319-08234-9_162-1","article-title":"Presence and immersion in virtual reality","volume-title":"Encyclopedia of Computer Graphics and Games","author":"Berkman","year":"2019"},{"key":"B54","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3389\/fpsyg.2015.00026","article-title":"The impact of perception and presence on emotional reactions: a review of research in virtual reality","volume":"6","author":"Diemer","year":"2015","journal-title":"Front Psychol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.jenvp.2006.09.001","article-title":"What\u2019s wrong with virtual trees? Restoring from stress in a mediated environment","volume":"26","author":"De Kort","year":"2006","journal-title":"J Environ Psychol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e0187777","DOI":"10.1371\/journal.pone.0187777","article-title":"Meditation experts try virtual reality mindfulness: a pilot study evaluation of the feasibility and acceptability of virtual reality to facilitate mindfulness practice in people attending a mindfulness conference","volume":"12","author":"Navarro-Haro","year":"2017","journal-title":"PLoS One"},{"key":"B57","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1089\/cpb.2006.9993","article-title":"Affective interactions using virtual reality: the link between presence and emotions","volume":"10","author":"Riva","year":"2007","journal-title":"Cyberpsychol Behav"},{"key":"B58","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1037\/1072-5245.14.3.260","article-title":"New technologies for relaxation: the role of presence","volume":"14","author":"Villani","year":"2007","journal-title":"Int J Stress Manag"},{"key":"B59","first-page":"1460","article-title":"Safe place VR: a guided imagery-based virtual reality trauma stabilization technique","author":"Dai","year":"2025"},{"key":"B60","doi-asserted-by":"publisher","first-page":"7237","DOI":"10.3390\/ijerph19127237","article-title":"The role of personalization in the user experience, preferences and engagement with virtual reality environments for relaxation","volume":"19","author":"Pardini","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B61","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3389\/fpsyg.2019.00479","article-title":"User-centered virtual reality for promoting relaxation: an innovative approach","volume":"10","author":"Pizzoli","year":"2019","journal-title":"Front Psychol"},{"key":"B62","doi-asserted-by":"publisher","first-page":"200318","DOI":"10.1016\/j.mhp.2023.200318","article-title":"Virtual reality relaxation for mental health staff in complex care services: a feasibility and acceptability study","volume":"33","author":"Williams","year":"2024","journal-title":"Ment Health Prev"},{"key":"B63","doi-asserted-by":"publisher","first-page":"200408","DOI":"10.1016\/j.mhp.2025.200408","article-title":"Multi-session virtual reality relaxation for mental health staff: a feasibility and acceptability study","volume":"37","author":"Martland","year":"2025","journal-title":"Ment Health Prev"},{"key":"B64","doi-asserted-by":"publisher","first-page":"24","DOI":"10.29245\/2578-2959\/2023\/2.1281","article-title":"Increasing diversity and inclusion in research on virtual reality relaxation: commentary on \u2018virtual reality relaxation for people with mental health conditions: a systematic review.\u2019","volume":"7","author":"Riches","year":"2023","journal-title":"J Mental Health Clin Psychol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/s1121189(00001858","article-title":"Growing recognition of the importance of service user involvement in mental health service planning and evaluation","volume":"14","author":"Thornicroft","year":"2005","journal-title":"Epidemiol Psichiatr Soc"},{"key":"B66","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12961-020-0528-9","article-title":"Research co-design in health: a rapid overview of reviews","volume":"18","author":"Slattery","year":"2020","journal-title":"Health Res Policy Syst"},{"key":"B67","volume-title":"Co-design as Collaborative Research","author":"Zamenopoulos","year":"2018"},{"key":"B68","doi-asserted-by":"publisher","first-page":"S111","DOI":"10.1016\/j.apmr.2011.12.017","article-title":"Small sample research designs for evidence-based rehabilitation: issues and methods","volume":"93","author":"Graham","year":"2012","journal-title":"Arch Phys Med Rehabil"},{"key":"B69","volume-title":"Evaluating Practice: Guidelines for the Accountable Professional","author":"Bloom","year":"2009"},{"key":"B70","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1007\/s11121-015-0585-4","article-title":"Small sample research: considerations beyond statistical power","volume":"16","author":"Etz","year":"2015","journal-title":"Prev Sci"},{"key":"B71","doi-asserted-by":"publisher","first-page":"4421","DOI":"10.3758\/s13428-023-02194-2","article-title":"ESMira: a decentralized open-source application for collecting experience sampling data","volume":"56","author":"Lewetz","year":"2023","journal-title":"Behav Res Methods"},{"key":"B72","volume-title":"PsyTechVR","year":"2020"},{"key":"B73","volume-title":"Meta Quest 3","year":"2023"},{"key":"B74","doi-asserted-by":"publisher","first-page":"16341","DOI":"10.1038\/s41598-022-20524-w","article-title":"Assessing momentary relaxation using the relaxation state questionnaire (RSQ)","volume":"12","author":"Steghaus","year":"2022","journal-title":"Sci Rep"},{"key":"B75","doi-asserted-by":"publisher","first-page":"e0310034","DOI":"10.1371\/journal.pone.0310034","article-title":"Feeling tired versus feeling relaxed: two faces of low physiological arousal","volume":"19","author":"Steghaus","year":"2024","journal-title":"PLoS One"},{"key":"B76","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/B978-0-12-408138-3.00004-2","article-title":"Physiological response measurements","volume-title":"Elsevier EBooks. Eye Tracking in User Experience Design","author":"Bergstrom","year":"2014"},{"key":"B77","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4614-1126-0","volume-title":"Electrodermal Activity","author":"Boucsein","year":"2012"},{"key":"B78","doi-asserted-by":"crossref","DOI":"10.1002\/9781118485309","volume-title":"The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness","author":"Khazan","year":"2013"},{"key":"B79","volume-title":"Varioport","year":""},{"key":"B80","volume-title":"VarioGraf","author":"Mutz","year":"1988"},{"key":"B81","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18332\/ejm\/150582","article-title":"Burnout among midwives and attitudes toward midwifery: a cross-sectional study from Baden-W\u00fcrttemberg, Germany","volume":"6","author":"Paul","year":"2022","journal-title":"Eur J Midwifery"},{"key":"B82","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.ijchp.2020.03.004","article-title":"Measuring stress in clinical and nonclinical subjects using a German adaptation of the perceived stress scale","volume":"20","author":"Schneider","year":"2020","journal-title":"Int J Clin Health Psychol"},{"key":"B83","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"B84","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1026\/0012-1924\/a000291","article-title":"Erfassung der lebendigkeit mentaler vorstellungsbilder","volume":"68","author":"Jungmann","year":"2022","journal-title":"Diagnostica"},{"key":"B85","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/bjop.12050","article-title":"Assessing vividness of mental imagery: the plymouth sensory imagery questionnaire","volume":"105","author":"Andrade","year":"2013","journal-title":"Br J Psychol"},{"key":"B86","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1162\/105474601300343603","article-title":"The experience of presence: factor analytic insights","volume":"10","author":"Schubert","year":"2001","journal-title":"PRESENCE Virtual Augmented Reality"},{"key":"B87","volume-title":"MATLAB","year":"2024"},{"key":"B88","volume-title":"Autonomic nervous system laboratory","author":"Wilhelm","year":"2017"},{"key":"B89","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1111\/j.1469-8986.1985.tb01603.x","article-title":"Standardization within individuals: a simple method to neutralize individual differences in skin conductance","volume":"22","author":"Ben-Shakhar","year":"1985","journal-title":"Psychophysiology"},{"key":"B90","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"B91","doi-asserted-by":"publisher","first-page":"104312","DOI":"10.1109\/access.2025.3579493","article-title":"Can immersive virtual reality environments improve stress reduction? Experimental design with progressive muscle relaxation training","volume":"1","author":"Guillen-Sanz","year":"2025","journal-title":"IEEE Access"},{"key":"B92","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.jclinepi.2013.08.015","article-title":"Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects","volume":"67","author":"McCambridge","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"B93","doi-asserted-by":"publisher","first-page":"1033486","DOI":"10.3389\/fmed.2022.1033486","article-title":"Defining and evaluating the hawthorne effect in primary care, a systematic review and meta-analysis","volume":"9","author":"Berkhout","year":"2022","journal-title":"Front Med"},{"key":"B94","first-page":"87","article-title":"The relaxing effect of virtual nature: immersive technology provides relief in acute stress situations","volume":"16","author":"Liszio","year":"2018","journal-title":"Ann Rev CyberTherapy Telemed"},{"key":"B95","first-page":"65","article-title":"Interactive immersive virtual environments cause relaxation and enhance resistance to acute stress","volume":"17","author":"Liszio","year":"2019","journal-title":"Ann Rev CyberTherapy Telemed"},{"key":"B96","first-page":"132","article-title":"Enhancing virtual restorative environment with generative AI: personalized immersive stress-relief experiences","volume-title":"International Conference on Human-Computer Interaction","author":"Chang","year":"2025"},{"key":"B97","doi-asserted-by":"publisher","first-page":"103866","DOI":"10.1016\/j.brat.2021.103866","article-title":"Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: a randomized controlled trial","volume":"142","author":"Modrego-Alarc\u00f3n","year":"2021","journal-title":"Behav Res Ther"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1665457\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:20:54Z","timestamp":1763619654000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1665457\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":97,"alternative-id":["10.3389\/fdgth.2025.1665457"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1665457","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]},"article-number":"1665457"}}