Virtual reality (VR) has been used successfully and effectively in psychotherapy for a variety of disorders. In the field of depression, there are only a few VR interventions and approaches. Although simple social interactions have been successfully modeled in VR for several mental disorders, there has been no transfer to the field of depression therapy. VR may be employed for psychodynamic psychotherapy to work on interpersonal conflict patterns. In this study, we developed and evaluated a VR intervention for the simulation of roleplay situations in the context of supportive-expressive therapy. We conducted a clinical user experience (UX) study at a psychotherapeutic clinic in Düsseldorf, Germany. Eight inpatients with depression and four therapists were included. Semi-structured interviews and qualitative content analysis were used to identify UX issues of the developed VR intervention. Usability questionnaires and technical usage data were also considered. The VR intervention consisted of two therapist-controlled roleplay scenarios designed to support work on the core conflictual relationship theme by allowing patients to interact in typical problematic social situations. Recorded VR roleplays allow for therapeutic debriefing with a change of perspective. Therapists were given the option of using the roleplay in multiple sessions. All therapists conducted one session per patient with the VR intervention. From the patient interviews, 26 UX issues were extracted, of which one technical malfunction and two unclarities in the interaction with the VR agent were rated as major problems. From the therapist interviews, 14 UX issues were extracted, of which five were rated as major problems related to the interface in the dialog control or the complex system setup. The main problem was designing a dialog structure that allows both complex conversational flows and a clear control interface. In principle, VR roleplays could be integrated well and safely into therapy. The VR intervention shows promise for providing an emotional experience of interpersonal conflict patterns in the context of psychotherapy. Additionally, other roleplay situations involving various social problem areas must be created and evaluated in terms of the fit to the patients' core conflictual relationship themes.

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients.

Purpose: Single motherhood is associated with increased psychosocial risks, affecting both mothers and their minor children. However, little is known about the specific psychosocial impact of maternal cancer in single mothers (SMs). This study compared psychological burden, quality of life, specific problems, and parental concerns between SMs and partnered mothers (PMs) affected by cancer and caring for minor children. Methods: Cross-sectional analysis of baseline data from a multicenter, non-randomized, controlled trial in Germany (Family-SCOUT). SMs and PMs affected by cancer were assessed for psychological burden (anxiety, depression, distress), quality of life, practical, family, emotional, spiritual/religious, and physical problems and parental concerns. Results: A total of 54 SMs and 245 PMs were included. SMs reported more practical problems (p = 0.008, d = 0.44) and parental concerns than PMs (p = 0.011, d = 0.40). After controlling for demographic and clinical group differences, practical problems (p = 0.009, OR = 1.53) and parental concerns (p = 0.015, OR = 1.73) remained significantly associated with single motherhood. SMs and PMs did not differ in anxiety, depression, distress or quality of life. Overall, a large proportion of mothers reported clinically relevant elevated levels of anxiety (71.9%), depression (46.8%) and heightened distress (82.3%). Conclusion: In this sample, the psychological burden of mothers with cancer who care for minor children did not differ based on whether they were parenting alone or together with a co-parent. However, SMs reported more practical problems and parental concerns than PMs, emphasizing the need for targeted support in practical problem-solving and child care for SMs. Trial Registration Number: NCT04186923, 5. December 2019.

Psychologische Interventionen während einer Chemotherapie können Patient*innen mit einer Krebserkrankung unterstützen und dazu beitragen, das subjektive Belastungserleben zu reduzieren. Die Nutzung von Virtueller Realität (VR) kann deren Wirksamkeit steigern. Ziel der vorliegenden Studie war die Evaluation von Machbarkeit und Akzeptanz einer VR-basierten Achtsamkeitsintervention während ambulanter Chemotherapie. In einer monozentrischen, dreiarmig randomisiert-kontrollierten Studie wurden in der ambulanten Chemotherapie-Einheit eines Onkologischen Zentrums Patient*innen mit Krebserkrankungen in eine von drei Gruppen randomisiert: (a) VR-Achtsamkeitsintervention, (b) rezeptive Musikintervention, (c) Kontrollgruppe. Die Interventionen wurden während zweier konsekutiver Chemotherapie-Applikationen durchgeführt. Zur Machbarkeit wurden Informationen zum Screening vor der Rekrutierung und während der Intervention durch eine teilnehmende Beobachtung standardisiert erhoben; die Akzeptanz wurde mittels eines Fragebogens nach der Intervention erfasst. Die Daten wurden deskriptiv analysiert. Von 3.072 angesprochenen Patient*innen erfüllten 1.590 formal die Einschlusskriterien. Es wurden N=85 Personen eingeschlossen (Teilnahmequote 5,4%). Häufige Gründe für Nichtteilnahme waren das Tragen einer Kühlkappe, Sprachbarrieren, fehlendes Interesse und das Vorhandensein eigener Bewältigungsstrategien. Die Durchführung beider Interventionen war grundsätzlich machbar; Störungen während der Interventionen waren häufig. Die VR-Achtsamkeit war mit hohem personellem Aufwand verbunden. Bei insgesamt positiver Bewertung durch die Teilnehmenden zeigte sich keine höhere Akzeptanz für die VR-Achtsamkeitsintervention im Vergleich zur Musikintervention. Der hohe Anteil nicht teilnehmender Patient*innen kann ein Hinweis sein, dass eine aktive VR-Achtsamkeitsintervention während der Infusion einer Chemotherapie für Patient*innen nicht bedarfsgerecht ist und als potenziell überfordernd erlebt wird. Der antizipierte Nutzen der VR-Achtsamkeitsintervention könnte zu einem anderen Zeitpunkt während der aktiven Therapie (zu Hause, zwischen den Sitzungen) oder zu einem späteren Zeitpunkt nach Ende der Therapie (Survivorship) möglicherweise besser zur Entfaltung kommen. Für unmittelbare Entlastung während einer Chemotherapie erscheint die Musikintervention als eine niederschwellig umsetzbare Möglichkeit. Die Integration digitaler psychologischer Interventionen in onkologische Routineversorgungspfade bedarf der stärkeren Beachtung der spezifischen Bedürfnisse der Patient*innen sowie der situativen und organisationsbezogenen Kontexte. Psychological interventions delivered during chemotherapy can help cancer patients reduce their subjective distress. The use of virtual reality (VR) may enhance their effectiveness. This study aimed to evaluate the feasibility and acceptability of a VR-based mindfulness intervention during outpatient chemotherapy. In a monocentric, three-arm randomized controlled trial, patients with cancer undergoing treatment in the outpatient chemotherapy unit of an oncology center were randomized to one of three groups: (a) VR-based mindfulness intervention, (b) receptive music intervention, or (c) control group. Interventions were delivered during two consecutive chemotherapy sessions. Feasibility was assessed through standardized screening information collected prior to recruitment and structured participant observation during the interventions; acceptability was measured using a post-intervention questionnaire. Of 3,072 patients approached, 1,590 formally met the inclusion criteria, and N=85 were enrolled (participation rate: 5.4%). Common reasons for non-participation included wearing a cooling cap, language barriers, lack of interest, and reliance on personal coping strategies. Both interventions were feasible; disruptions during sessions were common. The VR-based mindfulness intervention required substantial personnel support. Despite overall positive ratings from participants, VR mindfulness did not show higher acceptability than music. The high proportion of non-participating patients may indicate that an active VR-based mindfulness intervention during chemotherapy infusion is not well aligned with patient needs and may be experienced as potentially overwhelming. Its benefits might be better realized at a different point in the care trajectory (e. g., at home, between sessions) or later after treatment completion (survivorship phase). For immediate relief during chemotherapy, music interventions appear to be a simpler, more easily implemented alternative. Integrating digital psychological interventions into routine oncology care requires stronger consideration of patients’ specific needs and the situational and organizational contexts in which these interventions are delivered. ^* gleichberechtigte Erst-Autorenschaft. Received: 31 August 2025 Accepted: 11 November 2025 Article published online: 15 December 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Zusammenfassung: Extended-Reality-Technologien (XR; Virtual, Augmented und Mixed Reality) eröffnen neue Möglichkeiten für Psychotherapie und psychosomatische Versorgung. Ziel dieser Arbeit ist es, aktuelle Anwendungen und die Evidenzlage zu XR in der Psychotherapie und Psychosomatik in einer Übersicht darzustellen. Es wurde ein narrativer Review konzeptueller Arbeiten sowie Studien zu konkreten Anwendungsbereichen und Akzeptanz von XR in der klinischen Versorgung durchgeführt. Betrachtet werden psychosomatisch relevante Anwendungsfelder im Rahmen der psychotherapeutischen Richtlinienverfahren, bei der Entwicklung innovativer störungsspezifischer Interventionen sowie in ergänzenden Verfahren wie Achtsamkeit, Entspannung oder künstlerischen Therapien. Konzeptuell können der stark kontrollierte Charakter von XR, die intensive Darbietung und die Möglichkeit von Perspektivwechseln auch in andere Personen für den Einsatz von XR sprechen. Für viele Interventionen aus Richtlinienverfahren existieren bereits XR-Varianten, wobei die virtuelle Exposition bisher am besten untersucht ist. Innovative Entwicklungen zielen vor allem auf Perspektivwechsel und Embodiment anderer Personen oder Varianten des Selbst ab. Darüber hinaus finden sich vielfältige Einsatzmöglichkeiten in Entspannungsverfahren, Achtsamkeit, Aufmerksamkeitslenkung und künstlerischen Therapien. Bei grundsätzlich offener Haltung der Therapeut*innen wurden jedoch einige praktische Hürden einer breiten Implementierung in die Versorgung identifiziert. XR ist ein ergänzendes Medium, das neue Erfahrungsräume eröffnet. Für die psychosomatische Versorgung bietet es Potenzial, erfordert jedoch eine enge Einbettung in therapeutische Gesamtkonzepte. Hürden bestehen in technischem und personellem Aufwand, Datenschutz sowie fehlender Kostenerstattung. XR bietet ein breites Anwendungspotenzial in der psychosomatischen Medizin, doch bedarf es weiterer klinischer Studien, standardisierter Konzepte und tragfähiger Versorgungsstrukturen, um dieses Potenzial in der Praxis nutzbar zu machen.

Introduction: Patients undergoing chemotherapy often experience side effects during treatment, including psychological distress and symptoms of anxiety and depression. Interventions during chemotherapy that divert attention from potentially aversive environmental factors have been demonstrated to have a beneficial impact on these symptoms. Virtual reality (VR) offers the potential to visually and audibly disengage from the surrounding environment and can create an alternative sense of presence. This could facilitate the implementation of active guided interventions that may prove more effective than receptive interventions, such as listening to music. The present study examines the feasibility, acceptance and effectiveness of a VR intervention and a music intervention during chemotherapy. Methods: The single-centre three-arm, randomised-controlled trial investigates the efficacy of a VR mindfulness intervention and a music intervention in patients with cancer undergoing chemotherapy at the University Hospital Düsseldorf, Germany. Patients were randomly assigned to receive either (a) the VR mindfulness intervention, (b) the receptive music intervention or (c) the standard care (control group) in two consecutive chemotherapy sessions. A comprehensive psychological assessment and self-ratings using visual analogue scales will be conducted with situational anxiety as the primary outcome measure. Additionally, secondary measures will be employed to assess cancer-related anxiety, self-efficacy and chemotherapy-related side effects. Furthermore, salivary cortisol, heart rate and blood pressure will be recorded. At the end of the study, an evaluation questionnaire will be completed. It is planned to enrol 82 patients. Ethics and dissemination: The study has been approved by the ethics committee of the medical faculty of the Heinrich-Heine-University Düsseldorf (2022-1880). Written informed consent is obtained from the patients prior to participation. The results will be published in international scientific, peer-reviewed journals. Conference presentations are also planned. Trial registration number: German Clinical Trials Register (DRKS00029738).