Introduction:
Children with life-threatening or limiting conditions frequently experience anxiety, fear, and pain. Virtual Reality (VR) offers a non-pharmacological option for symptom management through immersive distraction and relaxation.


Purpose:
This study compares experiential VR with biofeedback-based relaxation VR in reducing psychological distress in pediatric patients.


Method:
An ongoing randomized controlled crossover trial enrolled patients aged 10-17. Participants were randomly assigned to two intervention sequences: (1) BreezeTerraVR relaxation followed by experiential VR (Ocean Rift), or (2) Ocean Rift followed by BreezeTerraVR. Anxiety, pain, and fear were measured before and after each intervention. Additional post-session measures included questionnaires addressing cybersickness, sense of presence, enjoyment, distraction, and relaxation.


Results:
So far, 48 participants have been recruited, with a target of 50. Preliminary observations indicate that both VR modalities are well tolerated and engaging, with minimal cybersickness and high acceptance, while reducing anxiety. Final analyses will determine comparative effectiveness in reducing distress.


Conclusions:
This study advances the use of VR in pediatric care by validating a novel biofeedback-based relaxation application and comparing it with an established experiential program. Findings are expected to contribute to evidence-based strategies for managing anxiety and distress in seriously ill children and adolescents.


Funding: Supported by the Charles University Grant Agency (187724). BreezeTerraVR development was funded by DigiWELL CZ.02.01.01/00/22_008/0004583, co-financed by the European Union.