{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:55:25Z","timestamp":1788191725399,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: While cardiac rehabilitation (CR) primarily focuses on restoring physical strength, preventing relapse, and reducing rehospitalization rates, psychological interventions play a complementary role by supporting mental health, which is crucial for patients\u2019 long-term adherence and overall recovery. The effectiveness of psychological interventions in CR is debated, and while technologies like virtual reality (VR) therapy show promise, they have limitations for patients with coronary artery disease (CAD). Therefore, this study examines non-sleep deep rest (NSDR) relaxation, a novel and easily implementable technique, and compares its impact on depression, anxiety, and stress with VR therapy and standard care. Methods: Forty-five CAD patients undergoing CR in ambulatory conditions were divided into three groups: the NSDR group, which received eight sessions of NSDR relaxation as part of their rehabilitation; the VR group, which received eight sessions of VR therapy as part of their rehabilitation; and the control group, which received standard care including Schultz Autogenic Training (SAT). The outcomes were measured using the Hospital Anxiety and Depression Scale (HADS) and the Perception of Stress Questionnaire (PSQ). Results: Both NSDR relaxation and VR therapy were effective in reducing the HADS total score, anxiety levels, the PSQ general score, and emotional tension. No significant differences were observed between the two treatment approaches. However, SAT was found to be insufficient for effectively improving the mental state of cardiac patients. Conclusions: This study suggests that NSDR relaxation is an effective psychotherapeutic intervention in CR. NSDR and VR therapy showed similar benefits, offering promising alternatives to traditional methods. Integrating these techniques could enhance patient outcomes and adherence in CR. Further research is needed to refine these interventions and optimize their clinical application.<\/jats:p>","DOI":"10.3390\/jcm13237178","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T08:17:42Z","timestamp":1732695462000},"page":"7178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Non-Sleep Deep Rest Relaxation and Virtual Reality Therapy for Psychological Outcomes in Patients with Coronary Artery Disease: A Pilot Randomized Controlled Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0264-8041","authenticated-orcid":false,"given":"Adam","family":"Wrzeciono","sequence":"first","affiliation":[{"name":"Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-7860","authenticated-orcid":false,"given":"B\u0142a\u017cej","family":"Cie\u015blik","sequence":"additional","affiliation":[{"name":"Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5990-5734","authenticated-orcid":false,"given":"Pawel","family":"Kiper","sequence":"additional","affiliation":[{"name":"Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5191-3799","authenticated-orcid":false,"given":"Joanna","family":"Szczepa\u0144ska-Gieracha","sequence":"additional","affiliation":[{"name":"Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-8130","authenticated-orcid":false,"given":"Robert","family":"Gajda","sequence":"additional","affiliation":[{"name":"Gajda-Med District Hospital, 06-100 Pu\u0142tusk, Poland"},{"name":"Institute of Physical Culture Sciences, Jan Dlugosz University in Cz\u0119stochowa, 42-200 Cz\u0119stochowa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2015.10.044","article-title":"Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis","volume":"67","author":"Anderson","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"l2191","DOI":"10.1136\/bmj.l2191","article-title":"Advances in Rehabilitation for Chronic Diseases: Improving Health Outcomes and Function","volume":"365","author":"Richardson","year":"2019","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2991\/jegh.k.201217.001","article-title":"Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review","volume":"11","author":"Ralapanawa","year":"2021","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jacc.2015.09.103","article-title":"Cardiac Rehabilitation and Healthy Life-Style Interventions: Rectifying Program Deficiencies to Improve Patient Outcomes","volume":"67","author":"Lavie","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/aphw.12098","article-title":"Clinical and Subclinical Distress, Quality of Life, and Psychological Well-Being after Cardiac Rehabilitation","volume":"9","author":"Gostoli","year":"2017","journal-title":"Appl. Psychol. Health Well-Being"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e108","DOI":"10.1093\/ejcts\/ezs463","article-title":"The Role of Depressive and Anxiety Symptoms in the Evaluation of Cardiac Rehabilitation Efficacy after Coronary Artery Bypass Grafting Surgery","volume":"42","author":"Morka","year":"2012","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"109888","DOI":"10.1016\/j.jpsychores.2019.109888","article-title":"Negative Emotional States and Negative Life Events: Consequences for Cardiovascular Health in a General Population","volume":"129","author":"Mehlig","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/CRD.0000000000000228","article-title":"Hearts and Minds: Stress, Anxiety, and Depression: Unsung Risk Factors for Cardiovascular Disease","volume":"27","author":"Silverman","year":"2019","journal-title":"Cardiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sakamoto, M., Suematsu, Y., Yano, Y., Kaino, K., Teshima, R., Matsuda, T., Fujita, M., Tazawa, R., Fujimi, K., and Miura, S. (2022). Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9010021"},{"key":"ref_10","first-page":"CD003331","article-title":"Exercise-Based Cardiac Rehabilitation for Adults with Heart Failure","volume":"1","author":"Long","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1177\/2047487319832393","article-title":"Additional Effects of Psychological Interventions on Subjective and Objective Outcomes Compared with Exercise-Based Cardiac Rehabilitation Alone in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis","volume":"26","author":"Albus","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101412","DOI":"10.1016\/j.physio.2024.07.003","article-title":"Psychologically-Enhanced Cardiac Rehabilitation for Psychological and Functional Improvement in Patients with Cardiovascular Disease: A Systematic Review with Meta-Analysis and Future Research Directions","volume":"125","author":"Wrzeciono","year":"2024","journal-title":"Physiotherapy"},{"key":"ref_13","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_14","doi-asserted-by":"crossref","first-page":"169","DOI":"10.31887\/DCNS.2020.22.2\/lvalmaggia","article-title":"Virtual Reality as a Clinical Tool in Mental Health Research and Practice","volume":"22","author":"Bell","year":"2020","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"J\u00f3\u017awik, S., Cie\u015blik, B., Gajda, R., and Szczepa\u0144ska-Gieracha, J. (2021). Evaluation of the Impact of Virtual Reality-Enhanced Cardiac Rehabilitation on Depressive and Anxiety Symptoms in Patients with Coronary Artery Disease: A Randomised Controlled Trial. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102148"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1111\/aphw.12571","article-title":"The Acute Effects of Nonsleep Deep Rest on Perceptual Responses, Physical, and Cognitive Performance in Physically Active Participants","volume":"16","author":"Boukhris","year":"2024","journal-title":"Appl. Psychol. Health Well-Being"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/0962280215588241","article-title":"Estimating the Sample Size for a Pilot Randomised Trial to Minimise the Overall Trial Sample Size for the External Pilot and Main Trial for a Continuous Outcome Variable","volume":"25","author":"Whitehead","year":"2016","journal-title":"Stat. Methods Med. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Szczepa\u0144ska-Gieracha, J., Cie\u015blik, B., Serweta, A., and Klajs, K. (2021). Virtual Therapeutic Garden: A Promising Method Supporting the Treatment of Depressive Symptoms in Late-Life: A Randomized Pilot Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091942"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The Validity of the Hospital Anxiety and Depression Scale. An Updated Literature Review","volume":"52","author":"Bjelland","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_20","unstructured":"Plopa, M., and Makarowski, R. (2010). Kwestionariusz Poczucia Stresu: Podr\u0119cznik, Vizja Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.tcm.2017.02.005","article-title":"The Role of Cardiac Rehabilitation in Patients with Heart Disease","volume":"27","author":"McMahon","year":"2017","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1161\/CIRCULATIONAHA.115.018926","article-title":"Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial","volume":"133","author":"Blumenthal","year":"2016","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2174\/1874192401307010099","article-title":"Comparison of Cardiac Rehabilitation Programs Combined with Relaxation and Meditation Techniques on Reduction of Depression and Anxiety of Cardiovascular Patients","volume":"7","author":"Delui","year":"2013","journal-title":"Open Cardiovasc. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.cpr.2017.10.011","article-title":"Mindfulness-Based Interventions for Psychiatric Disorders: A Systematic Review and Meta-Analysis","volume":"59","author":"Goldberg","year":"2018","journal-title":"Clin. Psychol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.psychsport.2018.07.004","article-title":"Is Your Virtual Self as Sensational as Your Real? Virtual Reality: The Effect of Body Consciousness on the Experience of Exercise Sensations","volume":"41","author":"Matsangidou","year":"2019","journal-title":"Psychol. Sport Exerc."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Xu, L., Zhai, X., Shi, D., and Zhang, Y. (2024). Depression and Coronary Heart Disease: Mechanisms, Interventions, and Treatments. Front. Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1328048"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cojocariu, S.A., Ma\u0219taleru, A., Sasc\u0103u, R.A., St\u0103tescu, C., Mitu, F., Cojocaru, E., Trandafir, L.M., and Leon-Constantin, M.-M. (2021). Relationships between Psychoeducational Rehabilitation and Health Outcomes\u2014A Systematic Review Focused on Acute Coronary Syndrome. J. Pers. Med., 11.","DOI":"10.3390\/jpm11060440"},{"key":"ref_28","first-page":"1000251","article-title":"Exploring the Link between Mental Health and Cardiac Rehabilitation Success","volume":"8","author":"Johnson","year":"2024","journal-title":"J. Card. Pulm. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e43240","DOI":"10.2196\/43240","article-title":"Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review","volume":"10","author":"Lundin","year":"2023","journal-title":"JMIR Ment. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1055\/s-2004-814247","article-title":"Can Visual Distraction Decrease the Dose of Patient-Controlled Sedation Required during Colonoscopy? A Prospective Randomized Controlled Trial","volume":"36","author":"Lee","year":"2004","journal-title":"Endoscopy"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Breznoscakova, D., Kovanicova, M., Sedlakova, E., and Pallayova, M. (2023). Autogenic Training in Mental Disorders: What Can We Expect?. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054344"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:40:02Z","timestamp":1760114402000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":31,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237178"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237178","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]}}}