{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T20:14:53Z","timestamp":1785183293927,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Current Research Funds 2024, Ministry of Health, Italy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background and aim: While conventional MS rehabilitation primarily addresses physical and cognitive symptoms, recent advances in VR technology offer immersive environments that facilitate both emotional and cognitive skill development. The purpose of this study is to evaluate the impact of VR-based training on emotional self-efficacy in multiple sclerosis (MS) patients and examine its association with cognitive function improvement. Additionally, this study aims to explore potential gender differences in these outcomes, hypothesizing that gender may influence the effectiveness of VR-based rehabilitation, which could inform more tailored approaches for emotional and cognitive rehabilitation in MS. Method: The present retrospective study analyzed data from 43 MS patients undergoing cognitive and behavioral rehabilitation at the IRCCS Centro Neurolesi \u201cBonino Pulejo\u201d in Italy, comparing a VR intervention group (VR-G) and a control group receiving traditional rehabilitation. Emotional self-efficacy, depression, and anxiety were assessed, alongside cognitive function pre- and post-intervention. Results: Findings indicate that the VR-G showed significant improvements in managing negative emotions, reduced depressive and anxiety symptoms, and enhanced cognitive performance, particularly in verbal learning and working memory. Gender-based analysis revealed a trend suggesting that females in the VR-G may exhibit greater improvements in positive emotional self-efficacy, although this difference did not reach statistical significance. Spearman\u2019s correlation highlighted associations between emotional self-efficacy and cognitive gains, supporting the potential of VR to foster both emotional and cognitive resilience. Conclusions: These findings suggest that VR training may provide a tailored approach for MS rehabilitation, enhancing therapeutic outcomes by integrating emotional and cognitive training in an immersive setting. Further research should investigate long-term effects and neurophysiological correlates of VR training to optimize MS rehabilitation.<\/jats:p>","DOI":"10.3390\/brainsci14121227","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T06:24:44Z","timestamp":1733379884000},"page":"1227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Cognitive VR vs. Traditional Training on Emotional Self-Efficacy and Cognitive Function in Patients with Multiple Sclerosis: A Retrospective Study Focusing on Gender Differences"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0757-2389","authenticated-orcid":false,"given":"Maria Grazia","family":"Maggio","sequence":"first","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8303-8386","authenticated-orcid":false,"given":"Alessandra","family":"Benenati","sequence":"additional","affiliation":[{"name":"Department of Psychology \u201cRenzo Canestrari\u201d, University of Bologna, Via Zamboni, 33, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1348-9442","authenticated-orcid":false,"given":"Federica","family":"Impellizzeri","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6229-6463","authenticated-orcid":false,"given":"Amelia","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6872-7931","authenticated-orcid":false,"given":"Martina","family":"Barbera","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Cannav\u00f2","sequence":"additional","affiliation":[{"name":"A.O.U. Policlinico \u201cG. Martino\u201d, Via Consolare Valeria, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Gregoli","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Cracovia, 90, 00133 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3602-4197","authenticated-orcid":false,"given":"Giovanni","family":"Morone","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"},{"name":"San Raffaele Institute of Sulmona, 67039 Sulmona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8737-4368","authenticated-orcid":false,"given":"Francesco","family":"Chirico","sequence":"additional","affiliation":[{"name":"Post-Graduate School of Occupational Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Quartarone","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-3166","authenticated-orcid":false,"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"ref_1","unstructured":"National Multiple Sclerosis Society (2024, November 01). MS Prevalence. Available online: https:\/\/www.nationalmssociety.org."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/S0140-6736(08)61620-7","article-title":"Multiple sclerosis","volume":"372","author":"Compston","year":"2008","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105470","DOI":"10.1016\/j.msard.2024.105470","article-title":"Virtual reality rehabilitation in patients affected by multiple sclerosis: Impact on quality of life and sexual functions","volume":"84","author":"Maggio","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.mayocp.2013.11.002","article-title":"Multiple sclerosis: Current and emerging disease-modifying therapies and treatment strategies","volume":"89","author":"Wingerchuk","year":"2014","journal-title":"Mayo Clin. Proc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1177\/1352458514564487","article-title":"The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review","volume":"21","author":"Marrie","year":"2015","journal-title":"Mult. Scler. J."},{"key":"ref_6","unstructured":"Bandura, A. (1997). Self-Efficacy: The Exercise of Control, Springer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/S1474-4422(08)70259-X","article-title":"Cognitive impairment in multiple sclerosis","volume":"7","author":"Chiaravalloti","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_8","first-page":"362","article-title":"Physical activity behavior in people with multiple sclerosis: Understanding how they can become more physically active","volume":"23","author":"Kalron","year":"2017","journal-title":"Mult. Scler. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/09602010343000183","article-title":"Analysis of assets for virtual reality applications in neuropsychology","volume":"14","author":"Rizzo","year":"2011","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_10","first-page":"869","article-title":"Virtual reality-based rehabilitation speeds up functional recovery of the upper limb after stroke: A randomized controlled pilot study in the acute phase of stroke using the Rehabilitation Gaming System","volume":"34","author":"Duarte","year":"2016","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Dehghan, B., Saeidimehr, S., Sayyah, M., and Rahim, F. (2022). The Effect of Virtual Reality on Emotional Response and Symptoms Provocation in Patients With OCD: A Systematic Review and Meta-Analysis. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.733584"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Prince-Embury, S., and Saklofske, D.H. (2013). Perceived self-efficacy its relationship to resilience. Resilience in Children, Adolescents, and Adults, Springer.","DOI":"10.1007\/978-1-4614-4939-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/occmed\/kqv078","article-title":"The montreal cognitive assessment (MoCA)","volume":"65","author":"Hobson","year":"2015","journal-title":"Occup. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS)","volume":"33","author":"Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1037\/1040-3590.20.3.227","article-title":"Assessing regulatory emotional self-efficacy in three countries","volume":"20","author":"Caprara","year":"2008","journal-title":"Psychol. Assess."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"Beck depression inventory (BDI)","volume":"4","author":"Beck","year":"1961","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1007\/s00415-023-12108-z","article-title":"The brief repeatable battery of neuropsychological tests (BRB-N) version a: Update of Italian normative data from the Italian Neuroimaging Network Initiative (INNI)","volume":"271","author":"Tedone","year":"2024","journal-title":"J. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/JNN.0000000000000423","article-title":"Virtual reality and cognitive rehabilitation in people with stroke: An overview","volume":"51","author":"Maggio","year":"2019","journal-title":"J. Neurosci. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Parsons, T.D., Gaggioli, A., and Riva, G. (2020). Extended reality for the clinical, affective, and social neurosciences. Brain Sci., 10.","DOI":"10.3390\/brainsci10120922"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Park, M.J., Kim, D.J., Lee, U., Na, E.J., and Jeon, H.J. (2019). A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00505"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1002\/cpp.2618","article-title":"Virtual reality for the enhancement of emotion regulation","volume":"28","author":"Colombo","year":"2021","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105970","DOI":"10.1016\/j.parkreldis.2023.105970","article-title":"Effectiveness of telerehabilitation plus virtual reality (Tele-RV) in cognitive e social functioning: A randomized clinical study on Parkinson\u2019s disease","volume":"119","author":"Maggio","year":"2024","journal-title":"Park. Relat. Disord."},{"key":"ref_25","first-page":"59","article-title":"Resilience and perceived social support as predictors of emotional well- being","volume":"8","author":"Turan","year":"2023","journal-title":"J. Health Soc. Sci."},{"key":"ref_26","unstructured":"Vita, S., Morra, C., and Rega, A. (2021, January 4\u20135). Virtual reality and emotion regulation: A systematic review. Proceedings of the Third Symposium on Psychology-Based Technologies, PSYCHOBIT, Naples, Italy."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rizzo, A., Gatto, E., Calandi, L., and Alfa, R. (2024). Embodied Online Therapy, Nova Science Publishers.","DOI":"10.52305\/TCJD1215"},{"key":"ref_28","first-page":"164","article-title":"\u201cEmbodied Online Therapy\u201d: The efficacy of somatic and psychological treatment delivered digitally","volume":"1","year":"2024","journal-title":"Adv. Med. Psychol. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/1368430207088035","article-title":"Gender Differences in Emotion Regulation: An fMRI Study of Cognitive Reappraisal","volume":"11","author":"McRae","year":"2008","journal-title":"Group Process. Intergroup Relat. GPIR"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.biopsych.2007.03.025","article-title":"Oxytocin attenuates amygdala responses to emotional faces regardless of valence","volume":"62","author":"Domes","year":"2022","journal-title":"Biol. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1016\/j.neuropsychologia.2012.03.011","article-title":"Sex differences in brain activation to emotional stimuli: A meta-analysis of neuroimaging studies","volume":"50","author":"Stevens","year":"2012","journal-title":"Neuropsychologia"},{"key":"ref_32","first-page":"15","article-title":"Sex differences in anxiety and depression: Role of testosterone","volume":"45","author":"McHenry","year":"2017","journal-title":"Front. Neuroendocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1073\/pnas.1316909110","article-title":"Sex differences in the structural connectome of the human brain","volume":"111","author":"Ingalhalikar","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Li, B.J., Bailenson, J.N., Pines, A., Greenleaf, W., and Williams, L.M. (2017). A public database of immersive VR videos with corresponding valence and arousal ratings. Front. Psychol., 8.","DOI":"10.3389\/fpsyg.2017.02116"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/0956797617741719","article-title":"The gender-equality paradox in STEM education","volume":"29","author":"Stoet","year":"2018","journal-title":"Psychol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S487","DOI":"10.1016\/j.euroneuro.2012.07.008","article-title":"Neural correlates of emotion processing: From emotional to social brain","volume":"22","author":"Fossati","year":"2012","journal-title":"Eur. Neuropsychopharmacol. J. Eur. Coll. Neuropsychopharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/1534582303002002003","article-title":"The interface between emotion and attention: A review of evidence from psychology and neuroscience","volume":"2","author":"Compton","year":"2003","journal-title":"Behav. Cogn. Neurosci. Rev."},{"key":"ref_38","first-page":"233","article-title":"Virtual environments in brain damage rehabilitation: A rationale from basic neuroscience","volume":"58","author":"Rose","year":"1998","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Drigas, A., and Sideraki, A. (2024). Brain Neuroplasticity Leveraging Virtual Reality and Brain-Computer Interface Technologies. Sensors, 24.","DOI":"10.3390\/s24175725"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Slater, M., and Sanchez-Vives, M.V. (2016). Enhancing our lives with immersive virtual reality. Front. Robot. AI, 3.","DOI":"10.3389\/frobt.2016.00074"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s11031-006-9051-8","article-title":"The motivational pull of video games: A self-determination theory approach","volume":"30","author":"Ryan","year":"2006","journal-title":"Motiv. Emot."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.neuron.2018.01.021","article-title":"Multiple Sclerosis: Mechanisms and Immunotherapy","volume":"97","author":"Kaskow","year":"2018","journal-title":"Neuron"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gonzalez-Franco, M., and Lanier, J. (2017). Model of Illusions and Virtual Reality. Front. Psychol., 8.","DOI":"10.3389\/fpsyg.2017.01125"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Sansoni, M., Scarzello, G., Serino, S., Groff, E., and Riva, G. (2022). Mitigating negative emotions through virtual reality and embodiment. Front. Hum. Neurosci., 16.","DOI":"10.3389\/fnhum.2022.916227"},{"key":"ref_45","first-page":"1","article-title":"Neuroplasticity and cognitive development: Interdisciplinary perspectives on psychotherapeutic and educational approaches","volume":"2","author":"Khabbache","year":"2024","journal-title":"Adv. Med. Psychol. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Jingili, N., Oyelere, S.S., Nystr\u00f6m MB, T., and Anyshchenko, L. (2023). A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression. Front. Digit. Health, 5.","DOI":"10.3389\/fdgth.2023.1239435"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:47:38Z","timestamp":1760114858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,5]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["brainsci14121227"],"URL":"https:\/\/doi.org\/10.3390\/brainsci14121227","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,5]]}}}