Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Nov 20, 2025)
Date Submitted: Feb 28, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Effect of Mindful Breathing Virtual Reality with Biofeedback on Stress and Symptom Severity in Breast Cancer Patients Undergoing Chemotherapy: Randomized Controlled Trial
ABSTRACT
Background:
Breast cancer patients undergoing chemotherapy often experience high levels of stress and symptom burden. Mindful breathing virtual reality with biofeedback may offer an effective non-pharmacological intervention for stress management, yet its efficacy remains underexplored.
Objective:
This study evaluated the effect of mindful breathing virtual reality with biofeedback in reducing stress and symptom severity in breast cancer patients undergoing chemotherapy.
Methods:
A three-arm parallel randomized controlled trial was conducted from August to November 2023 at a medical center in Taiwan. A total of 82 participants were randomly assigned to the mindful breathing virtual reality group (n = 25), the mindful breathing audio training group (n = 28), and the control group (n = 29). Outcomes included stress, symptom severity, and physiological features such as electroencephalography, heart rate variability, respiratory signals, and galvanic skin response. Machine learning analyses were used to identify stress response patterns.
Results:
Participants in the mindful breathing virtual reality group showed a significant reduction in stress level (p < .05) and symptom severity (p < .001) compared to the other groups. Additionally, physiological features demonstrated improvements in electroencephalography, heart rate variability, respiratory signals, and galvanic skin response. Machine learning analyses further confirmed the superior accuracy of the mindful breathing virtual reality intervention in detecting and differentiating stress responses.
Conclusions:
Mindful breathing virtual reality effectively reduces stress and symptom severity in breast cancer patients undergoing chemotherapy, with measurable physiological benefits. These findings highlight the potential of virtual reality as an innovative, non-pharmacological intervention to support stress management in oncology care. Clinical Trial: This study was registered on ClinicalTrials.gov under the identifier NCT06541587.
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Copyright
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