The study’s rationale rests on a familiar clinical dilemma. General-purpose anxiety questionnaires exist, but they are not tailored to the specific cognitive and emotional concerns that arise in the days surrounding an operation, such as fear of anesthesia, fear of complications, or worry about waking during surgery. Without a focused instrument, nurses and physicians may miss patients whose distress is severe enough to warrant non-pharmacological interventions, such as reassurance, structured information-giving, relaxation training, or psychological support. The researchers set out explicitly to build a scale that could provide the evidentiary foundation for such non-drug interventions, and their design followed a deliberately rigorous, multi-stage pipeline that has become the gold standard in psychometric instrument development.

The first stage was qualitative. At Leshan People’s Hospital, the team conducted semi-structured interviews with eleven surgical patients, using open-ended conversation to surface the language and themes patients themselves use to describe preoperative and postoperative worry. From these interviews the researchers generated an initial pool of candidate items. They then convened a Delphi expert inquiry, a structured consensus method in which sixteen experts independently rated and commented on the items across successive rounds, refining the wording and pruning redundancies. A pilot test with thirty patients followed, allowing the team to adjust the scale in response to real patient feedback about clarity and relevance before any formal statistical testing began.

The psychometric heart of the study involved two large, independent samples of surgical inpatients from the same hospital. The researchers administered the draft scale to all surveyed patients and then split the data into two groups for separate analyses. A randomly selected sample of 376 patients was used for exploratory factor analysis, a statistical technique that asks whether the patterns of correlation among items reveal an underlying structure. A second, separate sample of 386 patients was used for confirmatory factor analysis, which tests whether a predefined structure fits the new data. Splitting the samples in this way is considered best practice, because a structure discovered in one dataset is only convincing if it replicates in another.

The exploratory analysis was conducted with technical care. Because the scale uses a three-point Likert response format, the item responses are ordinal categories rather than continuous measurements, and the researchers therefore based their analysis on a polychoric correlation matrix, which estimates the latent correlation between items more accurately than a standard Pearson matrix when response options are few. Principal axis factoring was used to extract the common factors, and the suitability of the data was confirmed by two standard tests. The Kaiser-Meyer-Olkin measure of sampling adequacy reached 0.937, far above the conventional threshold of 0.60, indicating that the items shared substantial common variance. Bartlett’s test of sphericity produced an approximate chi-square of 2144.652 with 45 degrees of freedom, a result statistically significant at p less than 0.001, showing the correlation matrix was far from identity.

What the exploratory analysis found was striking in its simplicity. Applying the standard criterion of eigenvalues greater than one, the analysis extracted a single common factor accounting for 62.3 percent of the cumulative variance. In plain terms, all ten items appeared to be measuring the same underlying construct, surgery-related anxious condition, rather than several distinct subdimensions. Factor loadings for each individual item ranged from 0.71 to 0.82, all comfortably exceeding the 0.40 acceptance criterion, meaning every item correlated strongly with the common factor and none needed to be discarded. A unidimensional scale is attractive in clinical practice because a single total score can be computed and interpreted quickly at the bedside.

The confirmatory factor analysis on the second sample then tested whether this one-factor structure held up independently. The results met all widely accepted benchmarks. The chi-square to degrees-of-freedom ratio was 4.080, within the commonly cited acceptable range of below five. The Comparative Fit Index reached 0.942 and the Tucker-Lewis Index 0.926, both above the 0.90 threshold that signals good fit, and approaching the stricter 0.95 standard. The Root Mean Square Error of Approximation was 0.058 and the Standardized Root Mean Square Residual 0.067, both below the 0.08 cutoff typically treated as evidence of reasonable model fit. Together, these indices indicate that the single-factor model reproduced the observed data well in a completely new group of patients.

Reliability and convergent validity added further support. The Cronbach’s alpha coefficient for the total scale was 0.893, indicating excellent internal consistency, which means the items respond coherently and patients who score high on one item tend to score high on the others. To examine convergent validity, the researchers administered the SPAC alongside the State portion of the State-Trait Anxiety Inventory, a well-established measure, in a subgroup of 57 patients. The correlation between the two instruments was 0.424 with a p-value of 0.001, a statistically significant positive association demonstrating that the new scale tracks anxiety as expected. The moderate rather than very high correlation is also informative, since it suggests the SPAC captures content specific to the surgical context that a generic state anxiety measure does not fully overlap.

The authors are careful, and rightly so, about the limits of their work. They conclude that the SPAC shows satisfactory psychometric properties and may serve as a screening measure for surgery-related cognitive worry, but they emphasize that its clinical utility remains preliminary. Predictive validity, the demonstration that scale scores actually forecast clinically meaningful outcomes such as anesthetic requirements, postoperative pain, length of stay, or recovery trajectories, has not yet been established. Neither have cut-off scores, the threshold values clinicians would need to decide who counts as a high-anxiety case requiring intervention. Until those studies are done, the researchers recommend the scale be used mainly for research purposes rather than as a decision-making tool in routine care.

Even with those caveats, the study offers a template for how new clinical instruments should be built: grounded in patient interviews, refined through expert consensus, piloted with the target population, and then validated on two independent samples with both exploratory and confirmatory analysis. The work was funded by a Specialised Nursing Research Funding Grant from the Leshan Nursing Association and approved by the hospital’s ethics committee, with written informed consent from all participants. For the surgical teams on the front lines, the promise is tangible. A brief, ten-item questionnaire that reliably flags surgical patients experiencing significant anxiety could make non-pharmacological care more systematic, ensuring that reassurance, education, and psychological support reach the patients who need them most, before the anesthesia ever begins.

Subject of Research: Development and psychometric validation of the Surgical Patient's Anxious Condition Assessment Scale for measuring surgery-related anxiety

Article Title: The Surgical Patient’s Anxious Condition Assessment Scale demonstrates good factorial structure

Article References: WEI, L., JIE, Y., LI JUN, W., LI, Z., FENG JIAO, X., HUI, X., XIN, Z., GUO JUN, Z., & ZE HUA, L. (2026). The Surgical Patient’s Anxious Condition Assessment Scale demonstrates good factorial structure. Discover Psychology. https://doi.org/10.1007/s44202-026-00929-8

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00929-8

Keywords: psychometrics, anxiety, surgical patients, scale validation, factor analysis, Cronbach's alpha, confirmatory factor analysis, nursing research, screening tool, preoperative care, China, non-pharmacological intervention

The trial, led by Narjes Amrollahi and Reyhaneh Faghihian of the Dental Research Center at Isfahan University of Medical Sciences, together with Sanaz Rajaei of Arak University of Medical Sciences and statistician Mohammad Javad Tarrahi, enrolled thirty children who needed pulpotomy on both mandibular primary molars, the lower baby teeth on either side of the mouth. Because each child served as his or her own control in a split-mouth crossover design, the comparison between the two behavioral conditions was unusually clean. Each child experienced both interventions across two treatment sessions, with the order randomized so that fifteen children received the standard technique first and the magic-enhanced version second, while the other fifteen experienced the reverse sequence.

The standard approach was the tell-show-do technique, a cornerstone of pediatric behavioral dentistry that has been used for decades. The dentist tells the child what will happen in age-appropriate language, shows the instruments and demonstrates their use, and only then performs the procedure. It is effective but relies on verbal reassurance and gradual desensitization. In the magic trick condition, the researchers added a live conjuring performance to this routine, capturing the child’s attention with an impossible event at the moments of highest stress, namely during the nerve block injection and the pulpotomy itself.

Measuring anxiety in young children is notoriously difficult, so the team used three complementary instruments. Heart rate was recorded with a pulse oximeter before and after both the nerve block and the pulpotomy, providing a physiological proxy for the autonomic arousal that accompanies fear. The Sound, Eye, Motor scale, known as the SEM scale, allowed a trained observer to grade the child’s behavior during treatment on a continuum from comfortable cooperation to crying and physical resistance. After each procedure, the children rated their own pain on the Wong-Baker Faces Pain Rating Scale, a validated tool in which patients point to a series of cartoon faces ranging from a smiling expression to one crying hard.

The statistical analysis, using chi-square tests, analysis of variance, and independent t-tests at a significance threshold of 0.05, found consistent advantages for the magic trick condition. Mean heart rate, Wong-Baker pain scores, and SEM behavior scores were all significantly lower when children were managed with the magic trick than with the tell-show-do technique alone, both during the nerve block and during the pulpotomy. In practical terms, children whose attention was captured by a conjuring trick kept calmer while the needle went in, reported less pain afterward, and cooperated better throughout the procedure than the same children did in the control session.

One nuance in the data deserves attention. In a crossover design, researchers must check whether the experience of the first session carries over into the second, a phenomenon called the carryover effect. In this trial, the carryover effect was significant only for the Wong-Baker pain scores, meaning that the order in which a child experienced the two conditions influenced self-reported pain, perhaps because children who had already enjoyed a magic trick in the first session expected or remembered it in the second. Heart rate and SEM behavior scores, by contrast, were free of this contamination, strengthening confidence in those findings.

The physiological logic behind the intervention is straightforward. Pain perception and anxiety amplify one another in a feedback loop: fear raises muscle tension and autonomic arousal, which heightens the salience of noxious stimuli, which in turn increases fear. Attention is a limited cognitive resource, and a compelling, surprising stimulus such as a magic trick competes directly with the processing of threatening cues like the dental syringe. By occupying the child’s attentional bandwidth at the critical moment, the magician effectively reduces the cognitive space available for pain and fear processing, an effect documented in adult studies of distraction but rarely tested with live conjuring in a randomized pediatric dental trial.

The choice of population matters as well. Children between five and seven years old are at a developmental stage where dental anxiety often crystallizes into lifelong dental phobia, and where cooperation during invasive procedures is least reliable. The inferior alveolar nerve block is widely regarded as the most painful injection in pediatric dentistry because the needle must reach deeper tissue near the mandibular nerve, and pulpotomy adds the sound and vibration of rotary instruments. An intervention that lowers both physiological arousal and behavioral distress in this setting, without drugs, sedation, or extra chair time for pharmacological monitoring, has obvious appeal for clinicians and parents alike.

The study was registered in the Iranian Registry of Clinical Trials, approved by the ethics committee of Isfahan University of Medical Sciences, and conducted according to the Declaration of Helsinki, with written parental consent for all participants. The authors report no competing interests and received no specific funding for the project. As with any trial of thirty children, the findings should be replicated in larger and more diverse samples before magic becomes standard chairside practice, and the significant carryover effect on pain scores suggests that future crossover designs should account carefully for sequencing. Still, the trial adds rigorous evidence to a growing literature on non-pharmacological anxiety management in pediatric dentistry.

For a specialty long dominated by the choice between restraint, reassurance, and sedation, the image of a dentist pausing to perform a card trick before picking up the syringe is a striking one. It suggests that the most powerful anxiolytic in the operatory may sometimes be not a drug but a moment of genuine wonder, timed precisely to the instant a child needs it most.

Subject of Research: Effect of a magic trick on pain and anxiety in children undergoing dental nerve block and pulpotomy

Article Title: Effect of magic trick on pain and anxiety of 5-7-year-old children during inferior alveolar nerve block and pulpotomy of mandibular primary molars: a cross over randomized clinical trial

Article References: Amrollahi, N., Faghihian, R., Rajaei, S., & Tarrahi, M. J. (2026). Effect of magic trick on pain and anxiety of 5-7-year-old children during inferior alveolar nerve block and pulpotomy of mandibular primary molars: a cross over randomized clinical trial. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07893-1

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07893-1

Keywords: pediatric dentistry, dental anxiety, pain management, magic trick, inferior alveolar nerve block, pulpotomy, randomized clinical trial, tell-show-do technique, heart rate, Wong-Baker Faces Pain Rating Scale, SEM scale, non-pharmacological intervention

The study, published as a study protocol in BMC Psychiatry, is led by researchers at the Esquirol Hospital Center in Limoges and the La Valette Hospital Center in Saint-Vaury. It is designed as a multicenter, two parallel-group, prospective randomized controlled trial, conducted in accordance with the SPIRIT guidelines for interventional trials. Recruitment began on May 7, 2024, and the study is expected to run until May 7, 2028. In total, 128 participants diagnosed with MDD according to DSM-5 criteria, and with a Hamilton Depression Rating Scale score above 16, will be enrolled from full or partial hospitalization units and outpatient clinics. Participants must be between 20 and 60 years old, and individuals with psychiatric comorbidities such as substance use disorders, bipolar disorder, psychosis, or eating disorders are excluded to ensure that any observed effects can be attributed specifically to depression.

The rationale for the trial rests on a substantial and growing body of evidence that psychomotor symptoms constitute a central dimension of depression rather than a peripheral curiosity. A recent meta-analysis confirmed significant psychomotor slowing in depression, along with reduced speed of simple movements and gait, decreased dexterity, and impaired postural control. Earlier work using a standardized semiological approach demonstrated that patients with depression exhibit disorganized muscle tone, slowness and clumsiness in gross and fine motor skills, difficulties with balance and coordination, and disturbances of body image and self-esteem. Behavioral assessments integrating cognitive and motor dimensions have further revealed reduced dual-task cognitive-motor performance and deficits in cognitive inhibition, while other studies point to executive function impairments in attention, working memory, and processing speed that strongly affect daily functioning.

Sensory processing disturbances add another layer to this picture. Studies have shown that hyper- or hyposensitivity across sensory modalities is frequently associated with depressive disorders and may disrupt emotional regulation and sensory integration. High sensory sensitivity, in particular, is known to negatively affect quality of life, producing fluctuations in well-being, daily functioning, and health. Taken together, these findings suggest that psychomotor alterations in depression are multifactorial, directly reducing autonomy and functional capacity, and that motor and cognitive deficits may serve both as markers of disease progression and as potential targets for therapeutic intervention.

Psychomotor therapy, or PMT, is a paramedical discipline practiced in France and several other countries that targets the assessment and treatment of psychomotor disorders. Grounded in the framework of the International Classification of Functioning, Disability and Health, it integrates movement, body awareness, sensory processing, and emotional regulation with the aim of enhancing physical, psychological, and social functioning in daily life. Based on clinical assessment and standardized testing, the psychomotor therapist develops an individualized intervention plan incorporating educational, preventive, rehabilitative, and psychotherapeutic objectives. Although a 2018 study by Bergland and colleagues demonstrated that psychomotor-based physiotherapy improved quality of life in a non-clinical population, no randomized controlled trial has yet evaluated PMT specifically in adults with MDD, leaving the evidence base strikingly thin for such a widely used intervention.

The new trial is designed to fill that gap. Participants are randomly assigned in a 1:1 ratio to an intervention group or a control group, with randomization stratified by center and balanced using permuted blocks of fixed size four to minimize inter-center bias. Allocation codes are kept in numbered sealed envelopes managed by an independent member of the research staff. The intervention group receives twelve weeks of PMT in addition to standard care, consisting of one 45-minute session per week with the same therapist in a dedicated room. The control group continues standard care and receives a weekly ten-minute telephone follow-up in which quality of life and treatments are monitored using the Duke Health Profile. Because the nature of the intervention makes double-blinding impossible, participants and therapists cannot be blinded, but the principal investigator and the associated research team, including the biostatistician, remain blind to group allocation, and outcome evaluations are conducted by a therapist not involved in the patient’s treatment.

Because no standardized PMT protocol exists for MDD, the intervention is built around personalized goals derived from the initial psychomotor assessment, the patient’s self-expressed goals, and the therapist’s clinical analysis. Each session follows a consistent yet flexible structure: it opens with a welcome phase in which patients express their emotional state, proceeds through guided psychocorporal activities, and closes with a relaxation phase focused on muscle tone, breathing, and emotional awareness. The core activities target fundamental psychomotor functions including tonic and postural regulation, static and dynamic balance, coordination and fine motor skills, body awareness, emotional regulation, spatio-temporal structuring through rhythm and synchronization, executive functions such as attention and motor planning, and sensory integration across tactile, vestibular, auditory, visual, and proprioceptive modalities. Therapists draw on a wide repertoire of mediators, from balance boards and therapy balls to emotion cards, textured sensory materials, weighted blankets, and creative supports such as drawing and modeling clay. The exercise selection follows an evidence-based practice approach, drawing on research showing that relaxation techniques, body-oriented interventions, sensorimotor stimulation, and mindfulness-based approaches can reduce depressive symptoms and modulate mood through bottom-up activation of affective neurocircuitry.

The trial’s primary outcome is the change in quality of life, measured with the validated 36-item Short Form Health Survey, from baseline to three months, comparing the two composite scores for physical and mental health. Secondary outcomes are extensive: quality of life at six months, changes in depressive symptoms on the Hamilton Depression Rating Scale, anxiety on the Hamilton Anxiety Rating Scale, psychomotor slowing on the CORE rating scale, self-esteem on the Rosenberg Self-Esteem Scale, and anhedonia on the Snaith-Hamilton Pleasure Scale. Psychomotor functioning is assessed with the standardized NP-MOT battery covering muscle tone, balance, coordination, praxis, and rhythm, supplemented by the Purdue Pegboard Test for fine manual dexterity and a distal gnosopraxic evaluation involving imitation of non-meaningful gestures. Body image is measured with the Body Image Questionnaire, interoceptive awareness with the MAIA-2 questionnaire, and sensory reactivity with the 60-item Adult/Adolescent Sensory Profile. Therapeutic alliance is tracked after every session using the Session Rating Scale, and adherence is quantified by the number of sessions completed.

The statistical plan is equally rigorous. Analyses follow the intention-to-treat principle, with between-group differences at three and six months analyzed using analysis of covariance adjusted for baseline scores, age, and sex. Changes over time will be modeled with linear mixed-effects models including group, time, and their interaction, while correlations will explore associations between psychomotor, sensory, and clinical variables. Notably, the researchers will use multivariable logistic regression to identify baseline psychomotor and sensory measures that predict clinical improvement, defined as at least a 50 percent reduction in depression severity at six months, potentially establishing these measures as prognostic factors. The sample size was calculated from observed changes in SF-36 Physical Functioning in cardiac rehabilitation patients, requiring 90 participants for 90 percent power, inflated to 128 to account for 30 percent attrition.

The researchers acknowledge limitations, including the impossibility of double-blinding and the exclusion of comorbid patients, which may limit generalizability given that roughly 78.5 percent of individuals with MDD present at least one psychiatric comorbidity within a twelve-month period. Still, if the trial demonstrates that PMT meaningfully improves quality of life and psychomotor functioning, the implications could be substantial: justifying the prescription of psychomotor therapy for depression, supporting the integration of psychomotor therapists into multidisciplinary adult psychiatry teams, and providing a methodological template for future trials of body-based interventions in other psychiatric disorders. For millions of patients whose depression lives not only in their mood but in their muscles, senses, and movements, the trial represents a long-overdue step toward treating the whole body of the illness.

Subject of Research: A randomized controlled trial evaluating psychomotor therapy for quality of life and psychomotor skills in major depressive disorder.

Article Title: Study protocol of a randomized controlled trial for the effectiveness of psychomotor therapy on quality of life and psychomotor skills in depression

Article References: Pouilloux, G., Henault, M., Vinais, T., Bodeau, N., Laplace, B., & Paquet, A. (2026). Study protocol of a randomized controlled trial for the effectiveness of psychomotor therapy on quality of life and psychomotor skills in depression. BMC Psychiatry, 26(1), Article 711. https://doi.org/10.1186/s12888-026-08347-9

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08347-9

Keywords: psychomotor therapy, major depressive disorder, quality of life, randomized controlled trial, psychomotor slowing, sensory processing, body image, interoception, non-pharmacological intervention, psychiatry, rehabilitation, mental health

The study focused on patients who had undergone elective curative hepatic resection, the surgical removal of part of the liver to treat hepatocellular carcinoma, the most common primary liver cancer in adults. Hepatocellular carcinoma is a major global health burden, and surgical resection remains one of the most effective curative options for early-stage disease. Yet the operation is a major physiological insult, and the hours and days that follow are typically spent in an intensive care unit, an environment notorious for disrupting sleep. Alarms, lighting, monitoring equipment, noise, and pain all conspire to fragment sleep, and poor sleep in critically ill patients has been linked in prior research to worse outcomes, including postoperative delirium.

The research team, led by nurses at Linkou Chang Gung Memorial Hospital in Taoyuan, Taiwan, together with colleagues at Chang Gung University of Science and Technology and Taipei Medical University, designed a prospective two-group quasi-experimental study. Between 2022 and 2023, they enrolled 52 adults who had undergone elective curative hepatic resection at the tertiary medical center in northern Taiwan. Rather than randomizing patients individually, the researchers enrolled participants sequentially according to the recruitment period: one group received usual postoperative ICU care alone, while the other received inhaled lavender aromatherapy as an adjunct to that same usual care. This design, while less rigorous than a randomized controlled trial, is a common and pragmatic approach in busy clinical settings where contamination between concurrent patients would otherwise be difficult to control.

The intervention itself was strikingly simple. On the evenings of postoperative days one and two, two drops of lavender essential oil were applied to a gauze pad that was held near the patient’s nose for ten breaths and then fixed to the patient’s collar from eight in the evening until eight the following morning. In other words, patients were continuously exposed to a gentle lavender scent throughout the first two nights of their ICU stay, a period when sleep disturbance and discomfort tend to peak. No additional drugs were given, no sedatives were changed, and the control group simply received the standard care that all patients would normally get.

To measure the effects, the team used three validated instruments. Sleep quality was assessed with the Richards-Campbell Sleep Questionnaire, a tool specifically developed to capture how well patients feel they slept in the noisy, interrupt-laden ICU environment. Pain was evaluated with the Critical Care Pain Observation Tool, a behavioral scale that is particularly valuable in intensive care because it relies on observable indicators such as facial expression and body movement rather than self-report, which is useful when patients are too unwell or too fatigued to answer questions reliably. Anxiety was measured with the Visual Analogue Scale for Anxiety, on which patients mark their level of anxiety along a continuous line. Assessments were performed at baseline before the intervention, and again at two postoperative follow-up points, allowing the researchers to track changes over time.

Because the same patients were measured repeatedly, the analysis used generalized estimating equations, a statistical framework designed for longitudinal data that can account for the correlation between repeated measurements within each person while adjusting for covariates. The key question was whether the two groups followed different trajectories over time, which shows up statistically as a significant group-by-time interaction. The results were consistent across all three outcomes. For pain, the interaction test yielded a Wald chi-square of 23.41 with a p-value below .001, indicating a highly significant divergence between the groups. For anxiety, the Wald chi-square was 9.38 with a p-value of .009, and for sleep quality it was 8.33 with a p-value of .016. All three are statistically robust findings, not marginal ones.

The magnitude of the differences at the final follow-up point is what makes the study clinically interesting. By the second assessment, patients who had received lavender aromatherapy had significantly lower pain scores on the Critical Care Pain Observation Tool and significantly lower anxiety scores on the Visual Analogue Scale for Anxiety than patients who had received usual care alone. Their sleep quality scores on the Richards-Campbell Sleep Questionnaire were significantly higher. Most notably, the adjusted between-group difference in sleep quality was 14.81 points, with a 95 percent confidence interval ranging from 4.82 to 24.80. Because that interval lies entirely above zero and its magnitude is large relative to the scale, the authors characterize it as a potentially clinically meaningful improvement in sleep quality, the kind of change a patient would genuinely feel rather than a statistical artifact.

Importantly, the two groups of 26 patients each were comparable at the outset, with no significant differences in demographic or clinical characteristics, which strengthens the argument that the aromatherapy itself, rather than some pre-existing imbalance, drove the observed differences. The study also has transparent limitations that the quasi-experimental design imposes. Because patients were enrolled by recruitment period rather than randomly assigned, unmeasured temporal factors, such as changes in staffing, seasonal variation, or shifts in unit practice, cannot be fully excluded as alternative explanations. The sample size of 52 is modest, and the findings apply specifically to adults recovering from curative resection for early-stage hepatocellular carcinoma at a single tertiary center, so generalization to other surgical populations or other ICUs requires caution. Self-reported sleep and anxiety measures are also inherently subjective, although the use of a behavioral pain tool partially mitigates this concern.

Why would a plant extract delivered through the nose influence pain, anxiety, and sleep at all? The biological plausibility rests on the anatomy of olfaction. Odorant molecules bind to receptors in the nasal epithelium that send signals directly to the olfactory bulb and from there to limbic brain structures, including the amygdala and hypothalamus, which are central to emotion, stress responses, and the regulation of arousal and sleep-wake cycles. Lavender oil contains compounds such as linalool and linalyl acetate, which have been studied for their calming and anxiolytic properties, and systematic reviews have reported anxiolytic effects of Lavandula angustifolia across multiple clinical contexts. Recent reviews of inhalation aromatherapy have also suggested benefits for postoperative pain management, possibly through reduction of anxiety-related amplification of pain perception, since pain and anxiety reinforce one another in a well-known feedback loop.

The practical implications could be considerable. Pharmacologic options for promoting sleep in the ICU are limited, and a rapid systematic review of pharmacologic sleep promotion modalities in intensive care has highlighted how weak the evidence base is for most drug-based approaches, along with concerns about side effects such as next-day sedation and delirium. Against that backdrop, a two-drop, low-cost, low-risk intervention that requires no prescription and no change to existing protocols is attractive, provided it works. This study stops short of proving causation with the certainty of a randomized trial, but its longitudinal analysis, validated measures, and clinically meaningful effect sizes make a credible case that lavender aromatherapy deserves testing in larger randomized studies. For now, the image of an ICU patient drifting to sleep with a lavender-scented gauze clipped to the collar is less a folk remedy than an emerging, evidence-informed candidate for supportive cancer care, one whose biggest virtues, simplicity and safety, may be exactly what critical care medicine needs.

Subject of Research: Effects of inhaled lavender essential oil aromatherapy on sleep, pain, and anxiety in postoperative ICU patients

Article Title: Effects of inhaled lavender essential oil on sleep quality, pain, and anxiety in ICU patients after curative hepatocellular carcinoma resection: a quasi-experimental study

Article References: Lu, Y.-Y., Tsai, P.-C., Hu, Y.-C., & Hsu, W.-C. (2026). Effects of inhaled lavender essential oil on sleep quality, pain, and anxiety in ICU patients after curative hepatocellular carcinoma resection: a quasi-experimental study. Supportive Care in Cancer, 34(10), Article 942. https://doi.org/10.1007/s00520-026-11184-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11184-x

Keywords: lavender aromatherapy, hepatocellular carcinoma, intensive care unit, sleep quality, postoperative pain, anxiety, essential oils, non-pharmacological intervention, liver resection, supportive care, Richards-Campbell Sleep Questionnaire, critical care

The review, led by Marc-Olivier Mainville and Philippe Fournier at Université Laval in Québec City, along with colleagues in Canada and France, set out to map every study that had examined heart rate variability biofeedback in veteran-only populations for these three chronic conditions. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, the team searched PubMed, Embase, and CINAHL in August 2024, with an updated search in February 2025. Of 69 records identified, only five studies met the inclusion criteria, encompassing a total of just 108 participants. Four of the studies were pilot studies with control groups, and sample sizes ranged from a mere 12 to 35 participants each.

The scientific rationale behind heart rate variability biofeedback is rooted in the autonomic nervous system, the branch of physiology that governs involuntary bodily functions such as heart rate, digestion, and stress responses. Heart rate variability — the natural variation in the time intervals between successive heartbeats — serves as a non-invasive window into autonomic regulation, particularly the balance between the sympathetic system, which drives the fight-or-flight response, and the parasympathetic system, which promotes calm and recovery. In a typical biofeedback session, individuals breathe at their so-called resonance frequency, usually around six breaths per minute, with exhalations slightly longer than inhalations, roughly 5.5 seconds out and 4.5 seconds in. This paced breathing stimulates the baroreflex, a key blood-pressure regulatory mechanism, and enhances vagal activity, which is reflected in increased heart rate variability. Proponents argue that repeated practice can improve emotional regulation, stress resilience, and physiological flexibility.

The connection to veterans’ chronic conditions is more than speculative. Post-traumatic stress disorder has been repeatedly associated with reduced parasympathetic, or vagal, activity, and meta-analytic evidence confirms autonomic dysfunction indexed by heart rate variability in PTSD. Chronic pain shows a similar pattern, with a meta-analysis of studies in pain patients finding decreased heart rate variability that implicates parasympathetic dysregulation. Chronic pain-related activation of the body’s stress response has been linked to reduced heart rate variability power and lower resilience and self-regulatory capacity. Tinnitus, by contrast, presents a murkier picture: evidence linking the phantom sound perception to autonomic nervous system dysfunction remains limited and inconsistent, though some studies have reported associations between autonomic imbalance and tinnitus-related distress.

What did the five studies actually find? Four examined heart rate variability biofeedback in relation to PTSD symptoms, with mixed results. Two reported improvements in overall PTSD symptoms, and one of these found that the benefits persisted 16 weeks after the end of training. One study reported reductions limited to intrusion symptoms — the intrusive memories, dreams, and flashbacks that characterize one cluster of PTSD — while another found that biofeedback was not significantly more effective than standard care. The sole study to measure depressive symptoms alongside PTSD reported meaningful decreases in depression. A single pilot study, conducted at a U.S. Department of Veterans Affairs medical center, examined chronic pain and reported significant reductions in perceived pain, perceived stress, negative emotions, and physical activity limitations following four weeks of weekly biofeedback sessions. All four studies that measured heart rate variability reported that the intervention increased it at rest.

Yet the researchers urge strong caution in interpreting these findings. The studies were small, methodologically heterogeneous, and used wildly different approaches to measuring heart rate variability. Some relied on electrocardiography, others on photoplethysmography or blood volume pulse sensors attached to the finger, wrist, or forearm. The metrics used to quantify variability differed across studies, including the coherence ratio, the root mean square of successive differences between normal heartbeats, the standard deviation of inter-beat intervals, and high- and low-frequency power. Non-ECG methods are more susceptible to peak-detection errors and may artificially inflate or attenuate variability estimates, while lower sampling rates can obscure the high-frequency, vagally mediated components of the signal. In some cases, it was unclear whether changes in treatment groups actually differed significantly from changes in control groups, because the statistical analyses were not fully presented.

There is a deeper physiological puzzle as well. The review highlights that reported increases in heart rate variability may reflect transient responses during paced breathing — reductions in heart rate and short-term shifts in parasympathetic activity — rather than sustained changes in autonomic regulation. Because vagal modulation of the heart’s pacemaker operates rapidly, increases in beat-to-beat variability are more pronounced at lower heart rates and may simply occur as individuals enter a more relaxed state, rather than representing a specific therapeutic mechanism. Notably, none of the five studies examined the statistical relationship between changes in heart rate variability metrics and improvements in clinical symptoms, leaving open the question of whether the physiological changes are a mechanism of action or merely a non-specific correlate of feeling calmer.

The tinnitus gap is perhaps the most striking finding of the review. Despite tinnitus being the most prevalent service-connected disability among U.S. veterans, and despite its frequent co-occurrence with PTSD — one study found that 34 percent of the first 300 patients enrolled in the Veterans Affairs Medical Center Tinnitus Clinic also had a PTSD diagnosis — no studies have ever investigated heart rate variability biofeedback in relation to tinnitus in veterans. Large-scale cohort data involving more than 570,000 Iraq and Afghanistan veterans receiving care through the U.S. Department of Veterans Affairs found that PTSD alone was significantly associated with hearing loss and tinnitus, with veterans in this group having greater odds of tinnitus than those without PTSD, depression, or traumatic brain injury. Several pain-related conditions, including headache, neck pain, and jaw pain, were also associated with tinnitus. In the general population, only a single publication, covering three case studies, reported a potential effect of the technique on tinnitus handicap — and only in one of the three tested patients.

The rationale for exploring the technique in veterans is strengthened by clinical guidelines. The Veterans Affairs/Department of Defense guidelines for managing chronic conditions emphasize the underutilization of non-pharmacological interventions, which may provide symptom relief while reducing the risks associated with polypharmacy — a significant concern in veteran populations, where high rates of multimorbidity and medication use are common. The review also points to evidence that evidence-based PTSD psychotherapies produce measurable changes in psychophysiological responses, including reduced trauma-potentiated startle and altered heart rate reactivity, providing additional rationale for investigating interventions that target physiological processes directly.

Despite the limitations, the review highlights the feasibility of studying heart rate variability biofeedback in veterans with chronic conditions. The intervention is non-invasive, requires minimal equipment, and has not been associated with any adverse effects — none of the reviewed studies reported negative side effects. Several studies reported some level of improvement in the targeted chronic condition, and it is plausible that additional, unmeasured benefits may have occurred, although this remains to be validated. The authors conclude that the current evidence does not allow conclusions regarding the technique’s efficacy as a standalone intervention for PTSD or chronic pain, although it may have potential as an adjunctive or supportive approach. They call for rigorously designed, adequately powered studies to evaluate the feasibility, safety, and potential relevance of the technique in well-characterized veteran populations, including those with tinnitus and co-occurring conditions — and they stress that future research should avoid assuming shared underlying mechanisms across conditions, instead adopting designs that account for clinical heterogeneity, individual differences, and tinnitus subtypes.

Subject of Research: Heart rate variability biofeedback for tinnitus, PTSD, and chronic pain in veterans

Article Title: Heart rate variability biofeedback and implications for tinnitus, PTSD and chronic pain in veterans: a scoping review

Article References: Mainville, M.-O., Lacasse-Rioux, É., Noreña, A. J., Vallet, G. T., & Fournier, P. (2026). Heart rate variability biofeedback and implications for tinnitus, PTSD and chronic pain in veterans: a scoping review. Frontiers in Audiology and Otology, 4, Article 1917408. https://doi.org/10.3389/fauot.2026.1917408

Image Credits: AI Generated

DOI: 10.3389/fauot.2026.1917408

Keywords: heart rate variability biofeedback, veterans, PTSD, tinnitus, chronic pain, autonomic nervous system, vagal activity, non-pharmacological intervention, scoping review, paced breathing, baroreflex, polypharmacy

The trial, led by Mengyuan Li and colleagues at the University of Southern Queensland and partner institutions in Australia and China, enrolled 108 women who had completed chemotherapy for early-stage breast cancer between one month and three years earlier. Each participant reported at least moderate levels of fatigue, sleep disturbance and depression, scoring four or higher on a standard 0-to-10 rating scale. The women were randomly allocated in equal numbers to one of three groups: a true self-acupressure group, a sham self-acupressure group, or a usual care group. Ninety-three participants completed the study, with 31 in each arm, and the retention rate of 86 percent was notably strong for a trial of this length and population.

The intervention itself was elegantly simple. Women in the true acupressure group were trained in a 20-minute face-to-face session to apply firm pressure to eleven acupoints, seven of them bilateral, chosen for their traditional and emerging scientific relevance to fatigue, sleep and mood. These included well-known points such as Zusanli (ST36) on the lower leg, Neiguan (PC6) on the forearm, Shenmen (HT7) on the wrist, and Yintang (EX-HN3) between the eyebrows. Each point was stimulated for two minutes, adding up to a daily 36-minute practice continued for seven weeks. Participants in the sham group followed an identical regimen but pressed eleven non-acupoints located one to three centimetres away from the real points and deliberately off the classical meridians. Because both groups performed an active, plausible technique, neither the participants nor the self-rated outcome assessments could distinguish true from sham treatment, providing a rigorous test of whether acupressure’s benefits depend on stimulating specific points or simply on the ritual of self-care.

The results were unambiguous. Using a sophisticated statistical approach—generalised estimating equations with covariate selection guided by penalised regression—the researchers found significant group-by-time interactions for every clinical outcome. The true self-acupressure group showed substantially greater reductions in the composite symptom cluster score than both comparison groups, not only at the end of the seven-week intervention but also at the twelve-week follow-up, with large standardised effect sizes reaching as high as 2.33 against usual care. Crucially, the benefits were sustained: the advantage over the sham group actually grew over time, suggesting that continued practice deepened the therapeutic effect rather than fading like a placebo response.

At the level of individual symptoms, the pattern was equally compelling. Sleep disturbance, measured with the Pittsburgh Sleep Quality Index, and depression, measured with the Hospital Anxiety and Depression Scale, both improved significantly more in the true acupressure group than in either comparison group at both assessment points. Fatigue, measured with the Brief Fatigue Inventory, showed a large advantage over usual care throughout, while the difference between true and sham acupressure reached statistical significance only at the twelve-week follow-up. Quality of life, assessed with the Functional Assessment of Cancer Therapy-Breast instrument, rose markedly in the true acupressure group, with the gap over the sham group widening from a non-significant trend at week seven to a highly significant difference by week nineteen.

One of the most scientifically interesting findings concerns the sham group itself. Women who pressed non-acupoints also fared significantly better than those receiving usual care, with moderate effect sizes. The authors attribute this to placebo and psychosocial mechanisms: the strong desire for symptom relief, positive expectations, and the act of actively engaging in a daily self-care ritual can all modulate symptom perception through genuine psychological and physiological pathways. This does not diminish the value of the true intervention—whose effects were consistently larger and more durable—but it does highlight how much of symptom management in cancer survivorship may be harnessed through expectation and self-efficacy. The trial’s design, following a sham-controlled structure refined through an earlier phase II pilot study, allowed the researchers to separate these non-specific effects from the specific benefits of stimulating authentic acupoints.

Why might pressing specific points on the body influence fatigue, sleep and mood at all? The prevailing biological explanation for this symptom cluster is cytokine-induced sickness behaviour: cancer treatments trigger persistent low-grade inflammation, and pro-inflammatory signalling molecules act on the brain to produce the lethargy, sleep disruption and low mood that survivors describe. Non-pharmacological interventions such as exercise, acupuncture and acupressure have been shown in prior research to reduce circulating pro-inflammatory cytokines, offering a plausible mechanistic bridge. The trial’s authors acknowledge, however, that they did not directly measure cytokines in this study, leaving the precise biological pathway an open question for future work.

Safety and cost are where the findings become genuinely striking for clinical practice. Not a single adverse event was reported across the entire trial, a stark contrast to acupuncture, which carries small risks of infection and bruising due to its invasive nature, and to pharmacological approaches, which raise concerns about drug interactions in patients already on complex regimens. The economic picture was similarly favourable: during the trial, only one participant in the true acupressure group and one in the usual care group used healthcare resources for symptom relief, with total costs of 931.06 and 2,247.44 yuan respectively, while the only direct intervention cost was a one-off 2,879 yuan for producing instructional videos. The researchers caution that these numbers are too sparse for a formal cost-effectiveness analysis, but the direction of the data is hard to ignore.

The trial was not without limitations. All outcomes relied on self-reported questionnaires, which, although well-validated, are inherently subjective; the authors recommend that future studies incorporate objective measures such as actigraphy or inflammatory biomarkers. The composite cluster score assumed equal weighting of the three symptoms, and adherence to the full 49-day practice schedule was challenging, with only about 28 percent of the true acupressure group completing every day. Yet even partial adherence produced large effects, and the researchers suggest that real-world implementation could allow individualised adjustments to session length based on each woman’s energy and symptom burden.

The implications reach well beyond breast cancer. With more than 53 million people worldwide now living five or more years past a cancer diagnosis, accessible, self-managed strategies for the lingering burden of survivorship are urgently needed. Cognitive behavioural therapy demands multiple sessions with trained therapists; exercise programmes can be exhausting for women already depleted by fatigue. Self-acupressure, by contrast, requires only a short training, can be practised anywhere at any time, and costs almost nothing once learned. The authors argue that the intervention could be readily integrated into routine survivorship care and primary healthcare settings, particularly where professional resources are scarce. As the first fully powered phase III trial to demonstrate sustained, cluster-level benefits of self-acupressure in breast cancer survivors, the study transforms an ancient technique into a modern, evidence-based prescription—one that patients can literally hold in their own hands.

Subject of Research: Self-acupressure for managing the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors

Article Title: Effects of self-acupressure on the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a phase III randomised controlled trial

Article References: Li, M., Kwok, W. H., Wang, T., Deng, R., Wang, H., Yao, L., Deravin, L., Yang, L., Tian, X., & Tan, J.-Y. B. (2026). Effects of self-acupressure on the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a phase III randomised controlled trial. Supportive Care in Cancer, 34(10), Article 981. https://doi.org/10.1007/s00520-026-11155-2

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11155-2

Keywords: self-acupressure, breast cancer survivors, symptom cluster, fatigue, sleep disturbance, depression, randomised controlled trial, quality of life, traditional Chinese medicine, cancer survivorship, non-pharmacological intervention, placebo effect

The study recruited 30 healthy, experienced breathwork practitioners who performed high-ventilation breathwork while lying inside a magnetic resonance imaging scanner. This design allowed the researchers to capture both physiological and subjective changes in real time, combining continuous measurement of cerebral blood flow with retrospective reports of the participants’ conscious experiences. Such a combination is rare in consciousness research, where altered states are often studied either through pharmacological manipulation with controlled substances or through meditation and sensory deprivation protocols that produce subtler shifts in awareness. Breathwork, by contrast, is legal, inexpensive, and free of the regulatory constraints that complicate psychedelic research, making it an attractive model system for scientists seeking to understand how consciousness can be systematically altered without drugs.

Participants reported experiencing strong altered states of consciousness during the scanning sessions. The dominant quality of these experiences was what the researchers describe as an oceanic state, a deep and pervasive feeling of connection to the universe and to other people. Many participants also reported altered perception, vivid mental imagery, a diminished or transformed sense of self, and a subjective sense of unity. When these reports were compared against established characterizations of psychedelic experiences, the researchers found that they resembled those produced by a moderate to high dose of LSD or psilocybin, although the breathwork-induced states involved less pronounced visual effects than are typically associated with classical psychedelics. This convergence between a breathing practice and a serotonergic drug state is one of the most intriguing aspects of the work, because the two interventions reach the brain through entirely different physiological pathways.

The imaging data revealed a substantial physiological effect. Global grey-matter cerebral blood flow fell by approximately 45 percent during the breathwork sessions, dropping on average from 16.24 to 9.81 milliliters per 100 grams of tissue per minute, a difference that was highly statistically significant across the 30 participants. This magnitude of reduction is remarkable for a voluntary behavioral intervention and reflects the intense hyperventilation that characterizes high-ventilation breathwork, which alters blood carbon dioxide levels and thereby constricts cerebral vessels. Yet the researchers emphasize that this dramatic reduction in blood supply does not by itself explain the intensity of the experiences participants reported. The brain, it appears, continues to function and to generate extraordinary states of consciousness even while its overall blood supply is sharply curtailed.

Instead, the key to understanding the altered states may lie in how the brain’s networks communicate with one another during the practice. The researchers found that participants who reported stronger and more profound altered states also showed greater changes in the default mode network, a set of interconnected brain regions involved in self-reflection, autobiographical thinking, and the construction of the sense of self. The default mode network has long been a focal point of psychedelic research, because drugs such as psilocybin and LSD are known to disrupt its normally synchronized activity, and the degree of this disruption correlates with experiences of ego dissolution. The new findings suggest that intensive breathing may converge on the same neural target through a fundamentally different mechanism, one driven by blood gas changes and vascular dynamics rather than by receptor pharmacology.

Lead researcher Dr Christian Schmitz of the Central Institute of Mental Health in Mannheim noted that although many practitioners of intensive breathwork report profound changes in perception and self-experience, the underlying brain mechanisms have remained poorly understood. According to Schmitz, the study indicates that these experiences are linked not only to marked changes in cerebral blood flow but also to alterations in how key brain networks communicate. This distinction matters because it reframes the question of how breathwork works. If reduced blood flow alone were responsible, one might expect any condition that lowers cerebral perfusion to produce similar states, which does not appear to be the case. The specificity of the network-level changes suggests that the pattern of reorganization, not the reduction in supply, carries the experiential signature.

Hana Adolphi, co-coordinator of the research, highlighted the practical implications of the work. Breathwork, she noted, is a legal, inexpensive, and non-pharmacological intervention that may provide a valuable tool for studying altered states of consciousness in laboratory settings. Understanding the mechanisms through which voluntary breathing patterns reshape brain communication could also inform future research into novel approaches for mental health treatment. This is a significant point given the current surge of interest in psychedelic-assisted therapies for depression, anxiety, and post-traumatic stress disorder. If breathwork can reliably induce states that overlap with those produced by psychedelics, and if those states can be harnessed therapeutically, an accessible and drug-free route to similar benefits may become available to a much broader population than psychedelic medicine can currently reach.

Independent commentators welcomed the study while cautioning that its conclusions remain preliminary. Dr Guy Fincham of Brighton and Sussex Medical School in the United Kingdom, who was not involved in the research, described the work as intriguing because it extends recent breathwork research suggesting that intensive breathing practices can yield altered states of consciousness that individuals describe in ways analogous to psychedelic compounds, and it does so under controlled brain-imaging conditions. He emphasized that such altered subjective experiences may be harnessed for the improvement of mental health, and that an accessible non-pharmacological route such as breathwork could prove invaluable for many people. At the same time, he pointed out that the study was uncontrolled and that its sample consisted entirely of experienced practitioners, so replication in breathwork-naive participants using a randomized controlled design will be needed to determine whether the findings translate more widely and produce genuine therapeutic benefit.

Professor David Nutt of Imperial College London, also commenting independently, framed the work in the context of the broader psychedelic research program. Breathwork, in his view, represents a non-pharmacological bridge to research into psychedelics, and studies that help clarify how it functions are a welcome addition to the field. The bridge metaphor captures an important scientific opportunity: because breathwork does not require controlled substances, special licensing, or supervised dosing of psychoactive drugs, it allows researchers to probe altered states of consciousness in settings that would otherwise be difficult to approve. Comparing the neural signatures of breathwork-induced states with those of psychedelic states could help isolate which aspects of network reorganization are essential to the therapeutic and experiential effects, and which are incidental to a particular method of induction.

The researchers themselves acknowledge the limitations of the current work. With 30 participants, all of them experienced practitioners, and no control condition, the study cannot yet establish whether the observed brain changes have clinical relevance or whether they would appear in people attempting intensive breathwork for the first time. Larger studies with controlled designs will be required to answer those questions. Nevertheless, the study marks a meaningful step forward in the science of consciousness. It demonstrates that a voluntary, drug-free behavioral practice can produce measurable reductions in cerebral blood flow alongside network-level reorganization that tracks with the intensity of subjective experience, and it points researchers toward a specific neural mechanism, altered communication within the default mode network, as the likely key to understanding how breathwork transforms the mind. For a field increasingly interested in non-pharmacological routes to altered states and mental health, the message is clear: the breath may be a more powerful instrument for probing and shaping consciousness than previously appreciated.

Subject of Research: Effects of intensive breathwork on cerebral blood flow, brain network communication, and altered states of consciousness

Article Title: Intensive breathing alters consciousness by changing brain communication

Article References: Intensive breathing alters consciousness by changing brain communication. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: breathwork, consciousness, default mode network, cerebral blood flow, psychedelics, MRI, altered states, mental health, ECNP Congress, neuroscience, non-pharmacological intervention, self-experience

A team of Turkish nursing researchers, led by Aydanur Aydin of Gumushane University together with Gülcan Bağcivan and Aleyna Özkan of Koç University, conducted a systematic review and meta-analysis published in Supportive Care in Cancer. The team searched five major databases, including Ovid MEDLINE, PubMed, CINAHL, Web of Science, and Scopus, for studies published between 2000 and November 2025. After independent reviewers screened the literature, twenty-one publications met the strict inclusion criteria, spanning randomized controlled trials and quasi-experimental studies evaluated with the Joanna Briggs Institute critical appraisal tools. The protocol was prospectively registered in the PROSPERO database, a step that guards against selective reporting in evidence syntheses.

The headline result is a standardized mean difference of −0.793, with a 95 percent confidence interval stretching from −1.403 to −0.184 and a statistically significant p-value of 0.011. In plain terms, patients who received virtual reality interventions reported substantially lower anxiety than those who did not, with an effect size in the moderate-to-high range by conventional statistical benchmarks. Because standardized mean differences allow studies that measured anxiety with different instruments to be pooled, this figure represents one of the clearest quantitative signals yet that immersive technology can move the needle on psychological distress in oncology populations.

The breadth of the evidence is as notable as its strength. Statistically significant reductions in anxiety scores appeared across multiple cancer types, including breast, prostate, and ovarian cancers, and across a striking variety of clinical contexts. Some trials tested VR as a distraction during chemotherapy infusions, drawing on the well-established principle that absorbing sensory experiences can crowd out anticipatory distress. Others deployed virtual environments before a patient’s first chemotherapy dose, in gynecologic oncology surgery preparation, during radiation therapy education, and even at home for patients with advanced or metastatic disease receiving palliative care. The consistency of benefit across such heterogeneous settings suggests the effect is not an artifact of one particular protocol or patient group.

The mechanisms researchers propose are grounded in cognitive science rather than science fiction. Immersive virtual reality occupies a large share of the user’s attentional resources, effectively competing with the rumination and catastrophic thinking that fuel anxiety. In distraction-based applications, the brain’s limited capacity for processing competing stimuli means a vivid virtual forest or ocean scene can genuinely displace awareness of an infusion pump or a waiting room. In more therapeutic applications, such as the virtual reality adaptations of cognitive behavioral therapy and mindfulness training included in the review, the technology serves as a delivery vehicle for proven psychological techniques, allowing patients to practice relaxation and coping skills in simulated environments that feel real enough to trigger, and then retrain, their stress responses.

Safety data from the synthesis will reassure clinicians who worry about adding hardware to the bedside. No major side effects were reported across the included studies. The one recurring complaint was cyber sickness, the nausea and disorientation that can arise when visual motion cues conflict with vestibular signals, and even these minor instances were managed simply by adjusting session durations. That profile stands in sharp contrast to pharmacological anxiolytics, particularly benzodiazepines, which can cause sedation, cognitive impairment, falls, and dangerous interactions in patients already managing complex medication regimens. For oncology teams, an intervention whose worst documented downside is mild, manageable motion discomfort represents an unusually favorable risk-benefit equation.

Patient enthusiasm may be the most commercially and clinically consequential finding of all. Satisfaction scores reported in the reviewed studies reached 4.47 on a five-point scale and 7.35 on a ten-point scale, levels of acceptance that few medical interventions achieve. This matters because even the most effective therapy fails if patients refuse to use it. Earlier feasibility work cited in the review, including codesigned interventions incorporating compassionate mind training and pilot trials in home palliative care, found that patients with cancer not only tolerated the headsets but frequently described the experiences as meaningful, restorative, and a welcome escape from the psychological weight of their diagnosis.

The authors argue that the evidence now supports integrating virtual reality into routine oncology nursing and palliative care, particularly around stressful treatment moments such as chemotherapy administration. The practical implications are tangible. A nurse could offer a patient a ten-minute immersive relaxation session before an infusion, requiring no additional medication, no physician order in many settings, and equipment that has become dramatically cheaper and lighter over the past decade. Because the intervention is non-pharmacological, it sidesteps the regulatory and dependency concerns that complicate anxiolytic prescribing, and it can be layered on top of standard psychological care rather than replacing it.

Cautions remain, and the researchers are candid about them. The included studies varied in design quality, sample size, and the specific VR content and duration used, and the wide confidence interval around the pooled effect size reflects that heterogeneity. The authors explicitly call for further research to support wider clinical implementation, including investigations of whether virtual reality benefits extend to other physical and psychological symptoms and whether gains persist over longer follow-up periods. Questions about which patients respond best, whether effects fade with repeated use, and how to standardize content across institutions remain open. The review also notes that the underlying datasets are not publicly available but can be requested from the corresponding author, a limitation typical of evidence syntheses in nursing science.

Even with those caveats, the synthesis marks a turning point in how the field can talk about immersive technology in cancer care. What began two decades ago as small pilot studies of distraction during chemotherapy has matured into a body of evidence robust enough for meta-analysis, with a statistically significant pooled effect, an encouraging safety record, and satisfaction scores that most drug developers would envy. As headset costs continue to fall and clinical content libraries expand, the barrier to adoption is shifting from hardware to workflow: training nurses, designing evidence-based virtual environments, and embedding sessions into crowded treatment schedules. If ongoing trials confirm the durability of these effects, the humble VR headset may soon sit alongside infusion chairs and radiation machines as standard equipment in the fight not just against cancer itself, but against the fear that shadows it.

Subject of Research: Effectiveness of virtual reality interventions for managing anxiety in patients with cancer

Article Title: Virtual reality as a non-pharmacological adjuvant for anxiety in oncology care: a systematic review and meta-analysis

Article References: Aydin, A., Bağcivan, G., & Özkan, A. (2026). Virtual reality as a non-pharmacological adjuvant for anxiety in oncology care: a systematic review and meta-analysis. Supportive Care in Cancer, 34(10), Article 1024. https://doi.org/10.1007/s00520-026-11265-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11265-x

Keywords: virtual reality, anxiety, oncology, cancer care, meta-analysis, systematic review, non-pharmacological intervention, supportive care, chemotherapy, palliative care, symptom management, nursing

Attention-deficit/hyperactivity disorder, commonly abbreviated as ADHD, is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning at school and at home. While stimulant and non-stimulant medications remain the best-established treatments, many parents and clinicians are eager for non-pharmacological alternatives, whether because of side effects, incomplete medication response, or family preference. Computerized cognitive training has emerged as one of the most heavily marketed options in this space, promising to strengthen the underlying attentional and executive systems through repeated, game-like practice. The scientific evidence, however, has been inconsistent, with some trials reporting gains on trained tasks and symptom scales and others finding little more than placebo-like effects.

The intervention tested in the new trial, known as IBT-AC01, is a multicomponent cognitive training program developed with input from medical advisors, including some of the study’s authors, and technical support from Infinite Brain Technologies. Rather than targeting a single skill such as working memory, the program combines multiple training tasks aimed at different executive functions, the family of cognitive control processes that includes sustained attention, inhibitory control, and cognitive flexibility. The rationale is that ADHD is a heterogeneous condition and that a broader training battery might engage a wider network of neural systems than single-task programs, which have often shown benefits that fail to generalize beyond the exercises themselves.

To test the program fairly, the researchers conducted a double-blind, parallel-group randomized controlled trial involving 105 children aged 6 to 12 years who had been diagnosed with ADHD. Participants were randomly assigned in equal numbers to receive either the IBT-AC01 training or a control condition. Children in the training arm completed daily sessions lasting 25 minutes, five days a week, for a total of four weeks, a dosing schedule designed to deliver an intensive but manageable course of practice. The trial was registered with the Chinese Clinical Trial Registry under number ChiCTR2200057306 before recruitment, and it was approved by the Ethics Committee of Shenzhen Children’s Hospital in accordance with the Declaration of Helsinki, with written informed consent obtained from all parents or guardians and from the children themselves when they were eight years old or older.

The investigators chose two primary outcomes to capture both laboratory-measured cognition and real-world clinical symptoms. The first was the Attention Comparison Score on the Test of Variables of Attention, or TOVA, a computerized continuous performance test widely used to quantify sustained attention and impulsivity. The second was the total score on the ADHD Rating Scale-IV, a clinician- and parent-oriented instrument that tallies the severity of the eighteen diagnostic symptoms of ADHD. Statistical models adjusted for baseline scores, age, and sex were used to compare the two groups, and the analysis followed an intention-to-treat approach, meaning that every randomized participant was analyzed according to their original assignment regardless of adherence, a conservative strategy that preserves the randomization and reduces bias.

The headline result was sobering for proponents of cognitive training. In the primary analysis, there were no statistically significant differences between the training group and the control group on either primary outcome. For the TOVA Attention Comparison Score, the adjusted between-group difference was a modest 0.33 points, with a 95 percent confidence interval spanning from minus 0.54 to 1.20 and a p-value of 0.45, well short of conventional significance thresholds. For the ADHD Rating Scale-IV total score, the adjusted difference was minus 1.07 points, with a confidence interval from minus 3.73 to 1.59 and a p-value of 0.43. In plain terms, after four weeks of intensive daily training, the children who completed the multicomponent program could not be distinguished from controls on either objective attention testing or rated symptom severity.

Yet the trial did not stop at the overall null result. In a methodologically interesting twist, the team applied an exploratory technique called model-based recursive partitioning, a form of statistical decision-tree analysis that searches a data set for subgroups of participants who respond differently to treatment. Rather than pre-selecting candidate subgroups based on theory alone, this approach lets the data reveal where treatment effects may diverge. The analysis flagged three characteristics associated with potentially greater benefit from IBT-AC01: younger age, the presence of comorbid oppositional defiant disorder, and higher baseline ADHD symptom severity. Children with more severe starting symptoms and those whose ADHD was complicated by defiant and oppositional behavior appeared, in this exploratory analysis, to derive more advantage from the training than the sample as a whole.

These subgroup findings come with important caveats that the authors themselves emphasize. Exploratory analyses of this kind are hypothesis-generating rather than confirmatory; because the subgroups were identified after the fact within a modest sample of 105 children, the signals could reflect statistical noise, and the confidence in any single partition is limited. Still, the patterns are biologically and clinically plausible. Younger children may have more malleable attentional systems and greater room for developmental gains, while children with more severe baseline symptoms have more distance to travel, leaving more scope for measurable improvement. The link with comorbid oppositional defiant disorder is intriguing and suggests that cognitive training might interact with the broader behavioral profile of a child in ways that uniform group averages conceal.

The trial’s design strengths deserve attention in a field where commercial cognitive-training products have often been evaluated with weak methodology. The double-blind structure, active control condition, registered protocol, intention-to-treat analysis, and adjustment for baseline covariates all reduce the risk of inflated effects. At the same time, the study raises questions about dosing and duration: four weeks of training, while intensive, may simply be too short to produce durable changes in the neural circuits supporting attention, or the gains may be too narrow to register on generalized outcome measures. Prior research on cognitive training has repeatedly documented the gap between improvement on trained tasks and transfer to everyday functioning, a phenomenon sometimes called the transfer problem, and the present results are consistent with that literature.

For families and clinicians, the practical message is one of tempered expectations. Multicomponent computerized cognitive training, at least in the form and dose tested here, cannot currently be recommended as a stand-alone treatment for ADHD in children, and the overall evidence base continues to suggest that its effects, when present, are modest and uneven. The exploratory subgroup results, however, offer a constructive direction for future research: larger trials designed from the outset to test whether younger children, those with comorbid behavioral difficulties, or those with severe symptoms respond preferentially could clarify who, if anyone, benefits most. The authors call for studies with larger samples to confirm efficacy and to probe the mechanisms underlying any differential response. Until then, the trial stands as a reminder that in cognitive intervention research, the average effect can hide as much as it reveals, and that careful, registered, randomized evidence remains the only reliable compass for navigating a crowded and commercially appealing treatment landscape.

Subject of Research: Efficacy of multicomponent computerized cognitive training for children with ADHD in a randomized controlled trial

Article Title: Efficacy of multiple-component cognitive training for ADHD children: a randomized controlled trial with subgroup analysis

Article References: Wu, Y., Xu, L., Cao, X., Wu, Z., Wang, Y., Xue, G., & Yang, B. (2026). Efficacy of multiple-component cognitive training for ADHD children: a randomized controlled trial with subgroup analysis. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08683-w

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08683-w

Keywords: ADHD, cognitive training, randomized controlled trial, children, executive function, TOVA, ADHD Rating Scale-IV, oppositional defiant disorder, non-pharmacological intervention, subgroup analysis, BMC Psychiatry, Shenzhen Children's Hospital

The patients in question arrived with what clinicians call hypertensive urgency: blood pressure readings of 180 mmHg or higher on the systolic, or top, number, or 110 mmHg or higher on the diastolic, or bottom, number, but without any symptoms or signs of acute damage to organs such as the heart, brain or kidneys. This presentation is extremely common, according to Dr Safa Dönmez, associate professor of emergency medicine at the University of Health Sciences, Ankara City Health Application and Research Center, who led the study. These patients receive standard blood pressure medication, but Dönmez noticed that many were also visibly anxious and frightened. That matters medically, not just emotionally. Anxiety triggers the release of stress hormones that constrict blood vessels and drive blood pressure even higher, and the emergency department itself, with its noise, bright lights and uncertainty, can amplify the problem.

That observation prompted a deceptively simple question: if patients could be made to feel calmer, would their blood pressure come down faster? To find out, Dönmez and his colleague Dr Kadir Yenal, an emergency medicine specialist at Ankara Bilkent City Hospital, randomised 130 patients into two groups of 65. Everyone received the same standard medication to lower blood pressure. The control group received nothing further. The intervention group, however, donned VR headsets of the kind familiar from gaming and were transported to a peaceful nature scene: a river winding through a forest, tall trees swaying overhead and a wooden suspension bridge spanning the water. Simultaneously, they listened to a carefully curated playlist of classical music on a smartphone, chosen for the calming, structured qualities of composers including Bach, Mozart, Debussy, Vivaldi, Tchaikovsky, Saint-Saëns, Haydn and Corelli.

The researchers tracked blood pressure at five time points: 15, 30, 60, 90 and 120 minutes after presentation. Rather than relying solely on the familiar top-and-bottom readings, they focused on mean arterial pressure, or MAP, a single figure that combines systolic and diastolic values to represent the average pressure in the arteries across one cardiac cycle. A normal MAP sits roughly between 70 and 100 mmHg; the patients in this study arrived with MAP readings of around 130 to 138 mmHg, well into dangerous territory. Anxiety was assessed with the State Anxiety Inventory, a validated questionnaire that distinguishes between state anxiety, how anxious a person feels in the moment, and trait anxiety, anxiety as an enduring personality characteristic, both scored from 20 to 80 with higher numbers indicating greater anxiety.

The results revealed a striking early advantage for the virtual forest. At 15 minutes, MAP in the control group had fallen from 138 mmHg to 126 mmHg, while in the VR group it dropped from 132 mmHg to 116 mmHg. At 30 minutes the figures were 119 mmHg for controls versus 112 mmHg for the VR group. Expressed as percentage reductions, the control group achieved 8 percent at 15 minutes and 14 percent at 30 minutes, compared with 12 percent and 15 percent respectively in the VR group. Because randomisation had left the VR group with slightly lower starting blood pressures, the team analysed both absolute values between groups and the magnitude of reduction within each group, a methodologically careful approach. Dr Yenal reported that after 15 minutes the VR group’s blood pressure had fallen approximately 4 to 5 mmHg more than the control group’s, a difference that was statistically significant, meaning it was unlikely to be due to chance.

The advantage, however, proved time-limited. From 60 minutes onwards, the two groups were essentially equivalent, a pattern the researchers interpret as evidence that the intervention accelerates early stabilisation rather than providing long-term blood pressure control. Even so, Dönmez argues that this early window carries real clinical weight. In a busy emergency department, bringing blood pressure under control quickly matters both for patient safety and for the efficient use of resources, and if a non-drug intervention can modestly speed that process, it has practical value. The technology involved is inexpensive, easy to use and free of side effects, which makes the prospect of routine adoption considerably less daunting than a new pharmacological agent would be.

The anxiety data told an equally compelling story. At baseline, the VR patients were significantly more anxious than the controls, with trait anxiety scores of about 46 compared with about 38, an unlucky quirk of randomisation that ultimately made the results more impressive rather than less. Over the observation period, trait anxiety fell by an average of eight points in the VR group versus four points in the control group, a statistically significant difference. By the end of the two hours, both groups had reached similar post-intervention anxiety levels, but the VR group had travelled much further from a higher starting point of anxious temperament. As Yenal noted, that greater improvement from a worse baseline is precisely what makes the finding notable.

The study has clear strengths: it was randomised, it used the same standardised equipment for blood pressure measurement in both groups, and not a single patient dropped out. But the limitations are honest and instructive. The baseline difference in blood pressure between groups complicates interpretation. It was a single-centre trial with only two hours of follow-up. Crucially, because the headset and the music were always delivered together, it is impossible to say which component drove the effect, or whether both are necessary. And since patients and staff could see who was wearing the headsets, a placebo effect cannot be excluded. The team now plans larger multi-hospital studies with longer follow-up, separate testing of VR and music, and an investigation of whether letting patients choose their own music changes the outcome.

Independent experts are cautiously encouraged. Dr Felix Lorang, head of the emergency department at Klinikum Lippe in North Rhine-Westphalia, Germany, and a member of the EUSEM abstract selection committee who was not involved in the research, said that although the study was single-centre, the results are interesting and deserve further investigation. In his view, they raise the possibility that the approach is not only safe and feasible but offers meaningful benefits, particularly in reducing anxiety and achieving faster blood pressure control in the early stages of treatment, and might even avoid unnecessary medication. He emphasised that the intervention was used in addition to, not instead of, adjustment of blood pressure medication. For patients, Dönmez offers a vivid summary: if you arrived in the emergency department frightened, with markedly elevated blood pressure, a few minutes in a peaceful virtual forest listening to Mozart would likely be very welcome indeed.

Subject of Research: Virtual reality and classical music therapy for reducing blood pressure and anxiety in emergency department patients with hypertensive urgency

Article Title: Virtual reality and classical music help to reduce blood pressure in patients in an emergency department

Article References: Virtual reality and classical music help to reduce blood pressure in patients in an emergency department. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: virtual reality, classical music, hypertensive urgency, emergency medicine, blood pressure, mean arterial pressure, anxiety, randomised controlled trial, non-pharmacological intervention, patient care, stress hormones, European Emergency Medicine Congress