Parenting in the hospital is stressful. Moms and dads naturally focus on their ill child, sometimes to the neglect of their own mental health.
A Stanford Medicine team has found an effective way to help: Using a virtual reality headset, parents of inpatients at Lucile Packard Children's Hospital Stanford can participate in a short, guided meditation that helps them relax and build healthy coping skills.
The VR-guided meditation reduced parental anxiety by about 30% in a study that was published recently in the Journal of Patient Experience. It was especially helpful for Spanish-speaking families, who could complete the meditation in their own language, the study found.
"We know parents and other caregivers suffer acute anxiety when caring for their children in the hospital," said pediatric anesthesiologist Thomas Caruso , MD, senior author of the study. "As part of our mission to provide family-centered care, we should address that."
But it's challenging for a busy children's hospital to offer enough in-person treatment for every parent's mental health needs, said Caruso, a clinical professor of anesthesiology, perioperative and pain medicine.
"We showed that VR is a reasonable alternative — one that can be widely available, quickly scaled and highly effective, not just for English-speaking families but also for those whose first language isn't English," he said.
Transported to a calming environment
In the six-minute guided meditation, the VR headset virtually immerses you in a peaceful mountain scene, showing a creek with a small waterfall, trees and an expanse of sky. The narrator begins by asking that you focus on your breathing, then encourages you to look around at your surroundings. Soft music plays in the background.
As the meditation progresses, the narrator keeps guiding you to take slow, calm breaths. Then she draws attention to the sky as it gradually progresses through twilight. Stars come out; the northern lights appear. Those visuals pulse in a slow rhythm that the narrator suggests you can use to pace your inhalations and exhalations.
As the illusion of "nighttime" continues, clouds of breath appear at the bottom of the field of view in a rhythm you can breathe along to. The narrator continues to talk about the benefits of calm breathing and reminds you that you can always mentally return to the nature scene and bring your focus back to breathing, whenever you need a respite. In this way, the meditation helps build a stress-relief skill that works in a hospital setting.
More benefit for Spanish-speaking families
During the study, 101 parents completed the VR meditation in their preferred language, English or Spanish. They filled out questionnaires before and after the meditation to rate their anxiety levels.
Instead of using the VR meditation, 99 parents in a control group followed their usual tactics for managing anxiety, such as talking to a friend, reading, using their phone or listening to music. They completed the same before-and-after questionnaires about anxiety as parents in the meditation group.
The result: Parents who used meditation reported significantly lower anxiety than the control group that employed their usual anxiety-management activity, and this was still true after controlling for participants' baseline anxiety levels.
Half of participants were primarily English-speaking and half primarily Spanish-speaking, with speakers of each language evenly divided between the meditation and control groups. Parents who primarily spoke Spanish had a bigger improvement in anxiety after the meditation than those whose first language was English, the study found.
"There are very limited mental health resources for Spanish-speaking populations," said medical student Ricardo Jimenez , the study's lead author. "We think the effect was larger because there is a bigger unmet need."
Jimenez was inspired to work on the research because he grew up helping his Spanish-speaking parents navigate the health care system. As a medical student, he has seen additional ways language barriers can play out: For instance, he said, even though an interpreter may be included in meetings with a child's medical team, parents who don't speak English might have difficulty asking their child's bedside nurse a follow-up question, possibly adding to their anxiety.
After families finished the questionnaires, Jimenez had conversations with many of them about their mental health needs. "They would say, 'We haven't heard about meditation as a whole,'" he said. "It would give them a moment to open up with us. It brought a lot of parents to tears."
Spreading the benefits
The new research is part of larger efforts by the Stanford Medicine Chariot Program to design and study technology-based approaches to treating pain and stress in pediatric care. The team plans to continue studying the benefits of VR-guided meditation for patients' parents and guardians, in part by conducting more research to learn why different groups find it helpful.
They are also building their library of VR-based mental health materials for a variety of situations, including offering meditations in languages beyond English and Spanish. The VR headsets are now widely available throughout Packard Children's Hospital, and the researchers are providing clinical staff with information about how to help parents use the equipment.
They also continue to build a wide variety of tools to help kids feel more comfortable in the hospital. Parents' reactions to their children's enjoyment of the hospital's VR tools for reducing anxiety helped inspire the study in the first place, Caruso noted.
"Quite frequently, while we were engaging with a child, parents or caregivers would say 'Man, I wish we had access to something like this!'" he said. Now they do.
