Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran
Abstract
:1. Introduction
2. Materials and Methods
2.1. Recruitment and Experimental Design
2.2. Ethics
2.3. Treatment Protocol
2.4. Outcome Measures
Primary Outcome Measure
2.5. Secondary Outcome Measures
2.6. Power
2.7. Data Analysis
3. Results
3.1. Primary Outcome Measures
3.2. Secondary Outcome Measures
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; Ho, C.S.; Ho, R.C. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health 2020, 17, 1729. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Halder, S.; Mahato, A.; Manot, S. COVID-19: Psychological Impact and Psychotherapeutic Intervention. EC Psychol. Psychiatry 2020, 9, 32–35. [Google Scholar]
- Wind, T.R.; Rijkeboer, M.; Andersson, G.; Riper, H. The COVID-19 Pandemic: The ‘Black Swan’for Mental Health Care and a Turning Point for e-Health. Internet Interv. 2020, 20, 100317. [Google Scholar] [CrossRef]
- Luo, M.; Guo, L.; Yu, M.; Jiang, W.; Wang, H. The Psychological and Mental Impact of Coronavirus Disease 2019 (COVID-19) on Medical Staff and General Public–A Systematic Review and Meta-Analysis. Psychiatry Res. 2020, 291, 113190. [Google Scholar] [CrossRef]
- Xiong, J.; Lipsitz, O.; Nasri, F.; Lui, L.M.W.; Gill, H.; Phan, L.; Chen-Li, D.; Iacobucci, M.; Ho, R.; Majeed, A. Impact of COVID-19 Pandemic on Mental Health in the General Population: A Systematic Review. J. Affect. Disord. 2020, 277, 55–64. [Google Scholar] [CrossRef] [PubMed]
- Aknin, L.B.; De Neve, J.-E.; Dunn, E.W.; Fancourt, D.E.; Goldberg, E.; Helliwell, J.F.; Jones, S.P.; Karam, E.; Layard, R.; Lyubomirsky, S. Mental Health during the First Year of the COVID-19 Pandemic: A Review and Recommendations for Moving Forward. Perspect. Psychol. Sci. 2022, 17, 915–936. [Google Scholar] [CrossRef]
- Robinson, E.; Sutin, A.R.; Daly, M.; Jones, A. A Systematic Review and Meta-Analysis of Longitudinal Cohort Studies Comparing Mental Health before versus during the COVID-19 Pandemic in 2020. J. Affect. Disord. 2022, 296, 567–576. [Google Scholar] [CrossRef] [PubMed]
- Diseases, T.L.I. The Intersection of COVID-19 and Mental Health. Lancet Infect. Dis. 2020, 20, 1217. [Google Scholar] [CrossRef]
- Holmes, E.A.; O’Connor, R.C.; Perry, V.H.; Tracey, I.; Wessely, S.; Arseneault, L.; Ballard, C.; Christensen, H.; Silver, R.C.; Everall, I. Multidisciplinary Research Priorities for the COVID-19 Pandemic: A Call for Action for Mental Health Science. Lancet Psychiatry 2020, 7, 547–560. [Google Scholar] [CrossRef]
- Gruber, J.; Prinstein, M.J.; Clark, L.A.; Rottenberg, J.; Abramowitz, J.S.; Albano, A.M.; Aldao, A.; Borelli, J.L.; Chung, T.; Davila, J.; et al. Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action. Am. Psychol. 2020, 76, 409. [Google Scholar] [CrossRef]
- Andersson, G.; Titov, N. Advantages and Limitations of Internet-based Interventions for Common Mental Disorders. World Psychiatry 2014, 13, 4–11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cuijpers, P.; Donker, T.; Johansson, R.; Mohr, D.C.; van Straten, A.; Andersson, G. Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis. PLoS ONE 2011, 6, e21274. [Google Scholar] [CrossRef] [PubMed]
- Guderian, S.; Dzieciol, A.M.; Gadian, D.G.; Jentschke, S.; Doeller, C.F.; Burgess, N.; Mishkin, M.; Vargha-Khadem, F. Hippocampal Volume Reduction in Humans Predicts Impaired Allocentric Spatial Memory in Virtual-Reality Navigation. J. Neurosci. 2015, 35, 14123–14131. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Soklaridis, S.; Lin, E.; Lalani, Y.; Rodak, T.; Sockalingam, S. Mental Health Interventions and Supports during COVID-19 and Other Medical Pandemics: A Rapid Systematic Review of the Evidence. Gen. Hosp. Psychiatry 2020, 66, 133–146. [Google Scholar] [CrossRef]
- Riva, G.; Mantovani, F.; Wiederhold, B.K. Positive Technology and COVID-19. Cyberpsychol. Behav. Soc. Netw. 2020, 23, 581–587. [Google Scholar] [CrossRef]
- Ebert, D.D.; Cuijpers, P.; Muñoz, R.F.; Baumeister, H. Prevention of Mental Health Disorders Using Internet-and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research. Front. Psychiatry 2017, 8, 116. [Google Scholar] [CrossRef] [Green Version]
- Heber, E.; Ebert, D.D.; Lehr, D.; Cuijpers, P.; Berking, M.; Nobis, S.; Riper, H. The Benefit of Web-and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis. J. Med. Internet Res. 2017, 19, e32. [Google Scholar] [CrossRef] [Green Version]
- Geraedts, A.S.; Kleiboer, A.M.; Twisk, J.; Wiezer, N.M.; van Mechelen, W.; Cuijpers, P. Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees with Depressive Symptoms: Randomized Controlled Trial. J. Med. Internet Res. 2014, 16, e3539. [Google Scholar] [CrossRef]
- Roepke, A.M.; Jaffee, S.R.; Riffle, O.M.; McGonigal, J.; Broome, R.; Maxwell, B. Randomized Controlled Trial of SuperBetter, a Smartphone-Based/Internet-Based Self-Help Tool to Reduce Depressive Symptoms. Games Health J. 2015, 4, 235–246. [Google Scholar] [CrossRef]
- Villani, D.; Grassi, A.; Cognetta, C.; Toniolo, D.; Cipresso, P.; Riva, G. Self-Help Stress Management Training through Mobile Phones: An Experience with Oncology Nurses. Psychol. Serv. 2013, 10, 315–322. [Google Scholar] [CrossRef]
- Livingston, N.A.; Shingleton, R.; Heilman, M.E.; Brief, D. Self-Help Smartphone Applications for Alcohol Use, PTSD, Anxiety, and Depression: Addressing the New Research-Practice Gap. J. Technol. Behav. Sci. 2019, 4, 139–151. [Google Scholar] [CrossRef]
- Behrendt, D.; Ebert, D.D.; Spiegelhalder, K.; Lehr, D. Efficacy of a Self-Help Web-Based Recovery Training in Improving Sleep in Workers: Randomized Controlled Trial in the General Working Population. J. Med. Internet Res. 2020, 22, e13346. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wei, N.; Huang, B.; Lu, S.-J.; Hu, J.-B.; Zhou, X.-Y.; Hu, C.; Chen, J.-K.; Huang, J.-W.; Li, S.-G.; Wang, Z. Efficacy of Internet-Based Integrated Intervention on Depression and Anxiety Symptoms in Patients with COVID-19. J. Zhejiang Univ. B 2020, 21, 400–404. [Google Scholar] [CrossRef] [PubMed]
- Wahlund, T.; Mataix-Cols, D.; Lauri, K.O.; de Schipper, E.; Ljótsson, B.; Aspvall, K.; Andersson, E. Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial. Psychother. Psychosom. 2021, 90, 191–199. [Google Scholar] [CrossRef]
- Pincus, L.E. Telemental Health During a Global Pandemic: Clinical Lessons from Guided Self-Help, Telephone Therapy Case Studies. Pragmatic Case Stud. Psychother. 2020, 16, 118–123. [Google Scholar] [CrossRef]
- Riva, G.; Riva, E. COVID Feel Good: A Free VR Self-Help Solution for Providing Stress Management and Social Support During the COVID-19 Pandemic. Cyberpsychol. Behav. Soc. Netw. 2020, 23, 652–653. [Google Scholar] [CrossRef]
- Zhou, X.; Snoswell, C.L.; Harding, L.E.; Bambling, M.; Edirippulige, S.; Bai, X.; Smith, A.C. The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemed. e-Health 2020, 26, 377–379. [Google Scholar] [CrossRef] [Green Version]
- Riva, G.; Wiederhold, B.K.; Mantovani, F. Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. Cyberpsychol. Behav. Soc. Netw. 2019, 22, 82–96. [Google Scholar] [CrossRef]
- Riva, G.; Bernardelli, L.; Browning, M.H.E.M.; Castelnuovo, G.; Cavedoni, S.; Chirico, A.; Cipresso, P.; de Paula, D.M.B.; Di Lernia, D.; Fernández-Álvarez, J.; et al. COVID Feel Good—An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus. Front. Psychiatry 2020, 11, 996. [Google Scholar] [CrossRef]
- Chan, S.H.M.; Qiu, L.; Esposito, G.; Mai, K.P.; Tam, K.P.; Cui, J. Nature in virtual reality improves mood and reduces stress: Evidence from young adults and senior citizens. Virtual Real. 2021. [Google Scholar] [CrossRef]
- Frost, S.; Kannis-Dymand, L.; Schaffer, V.; Millea, P.; Allen, A.; Stallman, H.; Mason, J.; Wood, A.; Atkinson-Nolte, J. Virtual Immersion in Nature and Psychological Well-Being: A Systematic Literature Review. J. Environ. Psychol. 2022, 80, 101765. [Google Scholar] [CrossRef]
- Riva, G.; Wiederhold, B.K.; Mantovani, F. Surviving COVID-19: The Neuroscience of Smart Working and Distance Learning. Cyberpsychol. Behav. Soc. Netw. 2021, 24, 79–85. [Google Scholar] [CrossRef] [PubMed]
- Riva, G.; Bernardelli, L.; Castelnuovo, G.; Di Lernia, D.; Tuena, C.; Clementi, A.; Pedroli, E.; Malighetti, C.; Sforza, F.; Wiederhold, B.K. A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up. Int. J. Environ. Res. Public Health 2021, 18, 8188. [Google Scholar] [CrossRef] [PubMed]
- Meyer, M.L.; Kaesler, A.; Wolffgramm, S.; Perić, N.L.; Bunjaku, G.; Dickmann, L.; Serino, S.; Di Lernia, D.; Tuena, C.; Bernardelli, L. COVID Feel Good: Evaluation of a Self-Help Protocol to Overcome the Psychological Burden of the COVID-19 Pandemic in a German Sample. J. Clin. Med. 2022, 11, 2080. [Google Scholar] [CrossRef]
- Riva, G.; Di Lernia, D.; Tuena, C.; Bernardelli, L.; Maldonado, J.G.; Garcia, M.F.; Serino, S. COVID Feel Good—A Self-Help Virtual Therapeutic Experience for Overcoming the Psychological Distress of the COVID-19 Pandemic: Results from a European Multicentric Trial. 2021. [Google Scholar] [CrossRef]
- Tuite, A.R.; Bogoch, I.I.; Sherbo, R.; Watts, A.; Fisman, D.; Khan, K. Estimation of Coronavirus Disease 2019 (COVID-19) Burden and Potential for International Dissemination of Infection from Iran. Ann. Intern. Med. 2020, 172, 699–701. [Google Scholar] [CrossRef] [Green Version]
- Shahriarirad, R.; Erfani, A.; Ranjbar, K.; Bazrafshan, A.; Mirahmadizadeh, A. The Mental Health Impact of COVID-19 Outbreak: A Nationwide Survey in Iran. Int. J. Ment. Health Syst. 2021, 15, 1–13. [Google Scholar] [CrossRef]
- Lovibond, P.F.; Lovibond, S.H. The Structure of Negative Emotional States: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventory. Behav. Res. Ther. 1995, 33, 335–343. [Google Scholar] [CrossRef]
- Kakemam, E.; Navvabi, E.; Albelbeisi, A.H.; Saeedikia, F.; Rouhi, A.; Majidi, S. Psychometric Properties of the Persian Version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a Sample of Health Professionals: A Cross-Sectional Study. BMC Health Serv. Res. 2022, 22, 111. [Google Scholar] [CrossRef]
- Cohen, S.; Kamarck, T.; Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 1983, 24, 385–389. [Google Scholar] [CrossRef]
- Maroufizadeh, S.; Zareiyan, A.; Sigari, N. Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with asthma. Arch. Iran. Med. 2014, 17. [Google Scholar]
- Beck, A.T.; Weissman, A.; Lester, D.; Trexler, L. The Measurement of Pessimism: The Hopelessness Scale. J. Consult. Clin. Psychol. 1974, 42, 861–865. [Google Scholar] [CrossRef]
- Goudarzi, M.A. The study of reliability and validity of beck hopelessness scale in a group of Shiraz University students. J. Soc. Sci. Humanit. Shiraz Univ. 2002, 18, 27–39. [Google Scholar]
- Lee, R.M.; Robbins, S.B. Measuring Belongingness: The Social Connectedness and the Social Assurance Scales. J. Couns. Psychol. 1995, 42, 232–241. [Google Scholar] [CrossRef]
- Ahorsu, D.K.; Lin, C.Y.; Imani, V.; Saffari, M.; Griffiths, M.D.; Pakpour, A.H. The Fear of COVID-19 Scale: Development and Initial Validation. Int. J. Ment. Health Addict. 2020, 20, 1537–1545. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cipolletta, S.; Ortu, M.C. COVID-19: Common Constructions of the Pandemic and Their Implications. J. Constr. Psychol. 2020, 34, 278–294. [Google Scholar] [CrossRef]
- Beatty, L.; Lambert, S. A Systematic Review of Internet-Based Self-Help Therapeutic Interventions to Improve Distress and Disease-Control among Adults with Chronic Health Conditions. Clin. Psychol. Rev. 2013, 33, 609–622. [Google Scholar] [CrossRef]
- Karyotaki, E.; van Ballegooijen, W. Digital Self-Help Interventions for Suicidal Ideation and Behaviour. Lancet Digit. Health 2020, 2, e4–e5. [Google Scholar] [CrossRef] [Green Version]
- Yim, S.H.; Schmidt, U. Experiences of Computer-Based and Conventional Self-Help Interventions for Eating Disorders: A Systematic Review and Meta-Synthesis of Qualitative Research. Int. J. Eat. Disord. 2019, 52, 1108–1124. [Google Scholar] [CrossRef]
- Riva, G.; Wiederhold, B.K. How Cyberpsychology and Virtual Reality Can Help Us to Overcome the Psychological Burden of Coronavirus. Cyberpsychol. Behav. Soc. Netw. 2020, 23, 277–279. [Google Scholar] [CrossRef] [Green Version]
- Di Lernia, D.; Serino, S.; Polli, N.; Cacciatore, C.; Persani, L.; Riva, G. Interoceptive Axes Dissociation in Anorexia Nervosa: A Single Case Study With Follow Up Post-recovery Assessment. Front. Psychol. 2019, 9, 2488. [Google Scholar] [CrossRef] [PubMed]
- Yang, L.; Yin, J.; Wang, D.; Rahman, A.; Li, X. Urgent Need to Develop Evidence-Based Self-Help Interventions for Mental Health of Healthcare Workers in COVID-19 Pandemic. Psychol. Med. 2021, 51, 1775–1776. [Google Scholar] [CrossRef] [PubMed]
- Vargo, D.; Zhu, L.; Benwell, B.; Yan, Z. Digital Technology Use during COVID-19 Pandemic: A Rapid Review. Hum. Behav. Emerg. Technol. 2021, 3, 13–24. [Google Scholar] [CrossRef]
- Salisbury, J.P.; Aronson, T.M.; Simon, T.J. At-Home Self-Administration of an Immersive Virtual Reality Therapeutic Game for Post-Stroke Upper Limb Rehabilitation. In Proceedings of the CHI PLAY 2020-Extended Abstracts of the 2020 Annual Symposium on Computer-Human Interaction in Play, virtual, 2–4 November 2020; Association for Computing Machinery, Inc.: New York, NY, USA, 2020; pp. 114–121. [Google Scholar]
- Donker, T.; van Klaveren, C.; Cornelisz, I.; Kok, R.N.; van Gelder, J.-L. Analysis of Usage Data from a Self-Guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Controlled Trial. J. Clin. Med. 2020, 9, 1614. [Google Scholar] [CrossRef]
- Chirico, A.; Clewis, R.R.; Yaden, D.B.; Gaggioli, A. Nature versus Art as Elicitors of the Sublime: A Virtual Reality Study. PLoS ONE 2021, 16, e0233628. [Google Scholar] [CrossRef]
- Piltch-Loeb, R.; Merdjanoff, A.; Meltzer, G. Anticipated Mental Health Consequences of COVID-19 in a Nationally-Representative Sample: Context, Coverage, and Economic Consequences. Prev. Med. 2021, 145, 106441. [Google Scholar] [CrossRef] [PubMed]
Session | Exercise |
---|---|
Day 1: Fight rumination | Participants were asked to imagine themselves as a different person—a nurse who must care for a patient during his or her final moments of life, a doctor who must treat a patient, a politician who must decide—and write down their emotions and what they would do. |
Day 2: Self-esteem improvement | Participants were asked to write down the five aspects of their personality that they are proud of and value. |
Day 3: Encourage people to use episodic memory to create a consistent sense of self | Participants were asked to write four moments and/or events in their lives that have helped them become who they are, as well as a specific moment during the COVID-19 emergency. |
Day 4: Increase in the sense of community | Participants were invited to name the five most important people in their lives. |
Day 5: Encourage conscious self-regulation and self-organization of life objectives. | Participants were encouraged to write down three concrete goals and two dreams/aspirational goals that they hoped to achieve after the quarantine. |
Day 6: Empathy empowerment | Participants were asked to consider the most recent major interaction they had with each of the five people they named on Day 4 and write down the emotions they felt at the time. |
Day 7: Encourage a long-term psychological change. | Participants were asked to write down three parts of their lives with which they were dissatisfied and then, on a separate sheet, list the possible options in order of likelihood of success and cost/opportunity. On a separate sheet, they were asked to list probable issues and their consequences. |
Mean | Std. Deviation | |
---|---|---|
Age—Years | 49.1 | 10.92 |
Gender | ||
Female | 18 | |
Male | 12 | |
Education (N) | Diploma (5), bachelor’s degree and above (25) | |
Marital Status (N) | Single (2), Married (28) |
Mean | Std. Deviation | |
---|---|---|
Age—Years | 49.70 | 10.40 |
Gender | ||
Female | 15 | |
Male | 15 | |
Education (N) | Diploma (10), bachelor’s degree and above (20) | |
Marital Status (N) | Single (3), Married (27) |
Primary Outcome Measures | Secondary Outcome Measures | |||||||
---|---|---|---|---|---|---|---|---|
Group | TIME | Perceived Stress Level | Depressive Symptoms | Anxiety Symptoms | Stress Symptoms | Perceived Hopelessness | Social Connectedness | Fear COVID-19 |
COVID Feel Good Intervention | Baseline T0 | 36.7 (2.93) | 6.6 (3.1) | 14.7 (4.22) | 20.2 (6.99) | 70.2 (15.3) | 16.1 (4.27) | 29.7 (3.3) |
Post-intervention T1 | 32.3 (2.37) | 6 (2.86) | 10.6 (4.86) | 16.7 (6.66) | 67.7 (16.3) | 20.6 (3.9) | 24.7 (3.58) | |
Two-week follow-up T2 | 31.9 (2.92) | 5.63 (2.95) | 10.1 (5.02) | 16.2 (6.45) | 67.3 (16.1) | 20.2 (3.84) | 25.1 (3.5) | |
Control Group | Baseline T0 | 36.8 (2.99) | 6.93 (2.78) | 15 (3.32) | 20 (7.01) | 70.8 (14.8) | 15.9 (4.34) | 29 (3.48) |
Post-intervention T1 | 36.3 (3.06) | 6.93 (2.38) | 15.1 (3.32) | 20 (6.91) | 70.7 (15) | 16.3 (4.57) | 28.9 (2.12) | |
Two-week follow-up T2 | 37 (2.59) | 6.9 (2.34) | 15.1 (3.07) | 20 (6.76) | 71 (14.7) | 16.2 (4.54) | 29.1 (1.92) |
t | df | p | |
---|---|---|---|
Primary Outcome Measures | |||
Perceived Stress Level | −0.175 | 58 | 0.862 |
Depressive Symptoms | −0.438 | 58 | 0.663 |
Anxiety Symptoms | −0.306 | 58 | 0.761 |
Stress Symptoms | 0.129 | 58 | 0.898 |
Perceived Hopelessness | −0.163 | 58 | 0.871 |
Secondary Outcome Measures | |||
Social Connectedness | 0.12 | 58 | 0.905 |
Fear COVID-10 | 0.761 | 58 | 0.45 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Farahimanesh, S.; Serino, S.; Tuena, C.; Di Lernia, D.; Wiederhold, B.K.; Bernardelli, L.; Riva, G.; Moradi, A. Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran. J. Clin. Med. 2023, 12, 2006. https://doi.org/10.3390/jcm12052006
Farahimanesh S, Serino S, Tuena C, Di Lernia D, Wiederhold BK, Bernardelli L, Riva G, Moradi A. Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran. Journal of Clinical Medicine. 2023; 12(5):2006. https://doi.org/10.3390/jcm12052006
Chicago/Turabian StyleFarahimanesh, Sharareh, Silvia Serino, Cosimo Tuena, Daniele Di Lernia, Brenda K. Wiederhold, Luca Bernardelli, Giuseppe Riva, and Alireza Moradi. 2023. "Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran" Journal of Clinical Medicine 12, no. 5: 2006. https://doi.org/10.3390/jcm12052006
APA StyleFarahimanesh, S., Serino, S., Tuena, C., Di Lernia, D., Wiederhold, B. K., Bernardelli, L., Riva, G., & Moradi, A. (2023). Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran. Journal of Clinical Medicine, 12(5), 2006. https://doi.org/10.3390/jcm12052006