Strolling through Vivaldi's "The Four Seasons" during chemotherapy. With virtual reality.

We put on our 3D viewers and choose the season. We hear birds chirping in the background and the music begins. We walk along a tree-lined avenue—you might think it's cherry trees—while pink petals dance in the air (Spring). Or we let ourselves be lulled by the chirping of cicadas along a barren path that leads to the sea, where a small boat and seagulls await us (Summer). The red leaves of a forest guide us to the lookout overlooking a calm lake, to contemplate the reflection of the mountains in the distance (Autumn). The sky is still clear, but now the landscape is that of the great North. There's snow all around, and the road leads to a house illuminated by warm lights, while evening falls on the pier (Winter).

A walk through Vivaldi's Four Seasons

We're inside "The Four Seasons" accompanied by Vivaldi's famous music. A virtual reality project dedicated to cancer patients, designed to help patients spend their oncology infusions in a different way, brings us here. "We called it Distraction Therapy because that's exactly its purpose: to take patients to a pleasant place for a while, at least mentally, while they're physically sitting in the chemotherapy chairs," explains Marina La Norcia , president of Noicisiamo - MBC Italia Metastatic Breast Cancer, the association that conceived and created the project, including the original content.

To date, Noicisiamo has donated state-of-the-art 3D video and viewers to six oncology departments: the National Cancer Institute (IRCCS) "Fondazione G. Pascale" in Naples, the Umberto Parini Regional Hospital in Aosta, the Romagna Institute for the Study of Tumors "Dino Amadori" (IRST IRCCS), the Presidio Unico Ospedaliero of ASL3 in Genoa, the IRCCS San Martino Polyclinic in Genoa, and, just a few days ago, the ASL1 Imperia hospital. "Distraction Therapy is intended to be part of an integrated approach to care," La Norcia continues. "But technology, as essential as it is, alone is not enough. That's why we focused on the content, which was created thanks to funding from a Roche Foundation grant for patients, and was designed to capture attention and direct it toward positive stimuli through images, music, and words."

A moment of escape from the hospital context

The feedback received so far from those who have used them is positive, confirming that patients are able to escape the hospital environment both visually and auditorily. Furthermore, several studies have already shown that virtual reality experiences can be used to address negative emotions, pain, and anxiety during chemotherapy infusions, reducing psychological distress. "The experience was sensational," said Sara (not her real name), a patient who tested the headsets during the donation ceremony at the Imperia Local Health Authority (ASL1) at the Imperiaware Digital Center of Confindustria Imperia. "I didn't know I could transport my mind so far away, to simply beautiful places, where time doesn't exist, pain doesn't exist, and thoughts soar, giving me a sense of peace and tranquility."

Distract yourself from the pain

The perception of time is precisely one of the key factors in Distraction Therapy, as explained by Andrea Chirico , a member of the International Psycho-Oncology Society and associate professor of Psycho-Oncology in the Department of Developmental and Social Psychology at the Faculty of Medicine and Psychology at Sapienza University of Rome. He has been studying the application of virtual reality (VR) in healthcare for years and supervised the content. "According to some theories in neuroscience and psychology, experiencing stress and pain consumes brain energy. This energy, however, is not unlimited. If we can direct it elsewhere, we can have different perceptions of pain, stress, and even the time spent in these conditions. This is where the initial idea of building a purely distracting VR scenario arose about 15 years ago. We conducted the first studies in the US at Temple University in Philadelphia thanks to the foresight of Professor Antonio Giordano, president of the Sbarro Health Research Organization."

The power of music and images

In particular, Chirico continues, day hospital therapy is a stressful time that can facilitate intrusive negative thoughts, for example, about the stigma surrounding medication, which is often seen as something "bad" rather than a cure. Obviously, he agrees, the type of scenario reproduced in VR makes a difference. Technology, he says, can be fun, but it's not motivating: specific sensory stimuli are needed. Even in the field of music, the psychological effects of chord sequences and melodies are well known. To put it simply, it's a common experience to listen to music to feel better and improve one's mood.

How the perception of time changes

Chirico and colleagues then conducted studies to test different settings. "One of the results that struck us most was the change in the perception of time. We tested a 15-minute VR experience: patients in the experimental arm perceived, on average, that 7-8 minutes had passed, while the control arm felt like 20 minutes had passed. The same thing happened even if the control arm was engaged in a pleasant but less engaging activity, such as (precisely) listening to music alone." In the project developed by Noicisiamo, he emphasizes, a very well-known and beautiful musical work was chosen, which resonates very precisely in the mind, triggering specific emotional states. It's not just a distraction. Users can choose from four clips, based on what they feel most connected to at that moment.

From mindfulness to the concept of self-efficacy

The experiments don't stop there. Together with the Sant'Andrea Hospital in Rome, Chirico is testing a true VR mindfulness experience, which is believed to be even more effective than pure distraction. Other studies are based on the concept of self-efficacy: enabling people to virtually live an experience they might later have to face in person. People believe they are capable of facing a given challenge primarily thanks to three motivations: previous experience, that is, having already been through the same situation in the past; vicarious experience, that is, seeing others do it; and persuasion, which works through words or emotional states. With VR, we can recreate both vicarious and previous experience. Let me give a simple but effective example: bodily changes. A woman undergoing chemotherapy can see herself in the mirror without hair and begin to familiarize herself with her image in a calming, virtual environment. Once the headset is removed, however, the experience will remain. In a certain sense, the frightening thing will have already been addressed. In another research project with women giving birth, the possibility of adapting stimuli to the intensity of pain, based on specific physiological signals, such as the fetal heart rate and labor pains, is being studied.

Personalize experiences

In this sector, too, a multidisciplinary approach is crucial: "Discussion between psychologists, doctors, computer scientists, designers, and musicians is needed to integrate technology into healthcare," the expert concludes. "We also know that not everyone reacts the same way or benefits from VR in the same way. Much depends on the individual's characteristics: some prefer to remain constantly in touch with reality, an attitude that may be dictated by a need for control. It will therefore be very interesting to be able to customize the experience to maximize effectiveness and minimize psychological stress."