Bio-Aesthetic Resonance: Design and Evaluation of a Physiological Signal-Driven Immersive Art Therapy System for Personalized Stress Reduction
DOI:
https://doi.org/10.4108/eetpht.11.11055Keywords:
Immersive Art Therapy, Physiological Feedback, Personalized Intervention, Heart Rate Variability, Deep Reinforcement LearningAbstract
The escalating prevalence of chronic stress necessitates development of highly personalized non-pharmacological interventions. Traditional art therapy lacks real-time adaptability to match individuals' fluctuating physiological states. This paper introduces the Bio-Aesthetic Resonator (BAR), a novel closed-loop immersive art therapy system driven by real-time physiological feedback. The BAR integrates biosensors for continuous monitoring of Heart Rate Variability (HRV) and Galvanic Skin Response (GSR), utilizing deep reinforcement learning (DRL) to dynamically generate immersive visual and auditory artscapes. We conducted a pilot randomized controlled trial (pRCT) with 60 participants with mild-moderate anxiety. The BAR intervention significantly reduced perceived stress scores (PSS-10: Cohen's d = 0.65, 95% CI [0.22, 1.08], p = 0.003) and increased high-frequency HRV (HF-HRV: Cohen's d = 0.92, 95% CI [0.48, 1.36], p < 0.001) compared to a sham-adaptive control. These results support bio-aesthetic resonance as a viable framework for personalized digital therapeutics.
Downloads
References
[1] McEwen BS. Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York academy of sciences. 1998 May;840(1):33-44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x
[2] Wharton E, Kanas N. Mindfulness-based stress reduction for the treatment of anxiety disorders. International Journal of Group Psychotherapy. 2019 Jul 3;69(3):362-72. https://doi.org/10.1080/00207284.2019.1599289
[3] Bassett H. Occupational Therapy and Mental Health. https://doi.org/10.1111/j.1440-1630.2003.00410.x
[4] Chen Y, Buckingham L. Creative engagement and well‐being: Older Chinese migrants in New Zealand. Australasian Journal on Ageing. 2025 Jun;44(2):e70043. https://doi.org/10.1111/ajag.70043
[5] Zubala A, Kennell N, Hackett S. Art therapy in the digital world: an integrative review of current practice and future directions. Frontiers in psychology. 2021 Apr 8;12:595536. https://doi.org/10.3389/fpsyg.2021.600070
[6] Chunhong H, Jingjing D, Huan H, Peiyao Z, Xiaona Z, Xiaowen Y, Aiming Z. A cross-sectional study of the current status of psychological health and its correlation with academic performance in medical students: taking medical students in a medical university in China as examples. Frontiers in Psychiatry. 2025 Feb 11;16:1496248. https://doi.org/10.3389/fpsyt.2025.1496248
[7] Fraile-Narváez M, Chidean MI. Between machines and art: The impact of cnc technology on artistic creation. Array. 2025 Jul 23:100466. https://doi.org/10.1016/j.array.2025.100466
[8] Zhou SK, Le HN, Luu K, Nguyen HV, Ayache N. Deep reinforcement learning in medical imaging: A literature review. Medical image analysis. 2021 Oct 1;73:102193. https://doi.org/10.1016/j.media.2021.102193
[9] Zhang W. Generative adversarial nets for information retrieval: Fundamentals and advances. InThe 41st International ACM SIGIR Conference on Research & Development in Information Retrieval 2018 Jun 27 (pp. 1375-1378). https://doi.org/10.1145/3209978.3210184
[10] Yoon IA, Slade K, Fazel S. Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis. Journal of consulting and clinical psychology. 2017 Aug;85(8):783. https://doi.org/10.1037/ccp0000214
[11] Riva G, Wiederhold BK, Mantovani F. Neuroscience of virtual reality: from virtual exposure to embodied medicine. Cyberpsychology, behavior, and social networking. 2019 Jan 1;22(1):82-96. https://doi.org/10.1089/cyber.2017.29099.gri
[12] Kuhn E, Saleem M, Klein T, Köhler C, Fuhr DC, Lahutina S, Minarik A, Musesengwa R, Neubauer K, Olisaeloka L, Osei F. Interdisciplinary perspectives on digital technologies for global mental health. PLOS Global Public Health. 2024 Feb 5;4(2):e0002867. https://doi.org/10.1371/journal.pgph.0002867
[13] Goessl VC, Curtiss JE, Hofmann SG. The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological medicine. 2017 Nov;47(15):2578-86. https://doi.org/10.1017/S0033291717001003
[14] Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Frontiers in public health. 2017 Sep 28;5:258. https://doi.org/10.3389/fpubh.2017.00258
[15] Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and heart rate variability: a meta-analysis and review of the literature. Psychiatry investigation. 2018 Feb 28;15(3):235. https://doi.org/10.30773/pi.2017.08.17
[16] Zankowicz K. The art of access: a practical guide for museum accessibility: by Heather Pressman and Danielle Schulz, Lanham, MD, The Rowman and Littlefield Publishing Group, Inc., 2021, vii+ 210 pp., $42.00 (paperback), ISBN 978-1-5381-3051-3. https://doi.org/10.1080/10598650.2021.1959175
[17] Tarrant J, Viczko J, Cope H. Virtual reality for anxiety reduction demonstrated by quantitative EEG: a pilot study. Frontiers in psychology. 2018 Jul 24;9:368656. https://doi.org/10.3389/fpsyg.2018.01280
[18] Sutton RS, Barto AG. Reinforcement learning: An introduction. Cambridge: MIT press; 1998 Mar 1. https://doi.org/10.1017/S0263574799271172
[19] Chen L, Wang Y, Wen Y, Zhang L, Liu S, Xie W. Organic Photoplethysmography Sensors for Wearable Health Monitoring. Laser & Photonics Reviews. 2025 May;19(10):2401992.
[20] Lane RD, McRae K, Reiman EM, Chen K, Ahern GL, Thayer JF. Neural correlates of heart rate variability during emotion. Neuroimage. 2009 Jan 1;44(1):213-22. https://doi.org/10.1016/j.neuroimage.2008.07.056
[21] Wu C, Bi W, Liu H. Proximal policy optimization algorithm for dynamic pricing with online reviews. Expert Systems with Applications. 2023 Mar 1;213:119191. https://doi.org/10.1016/j.eswa.2022.119191
[22] Zhou C, Li J. The development of aesthetic experience through virtual and augmented reality. Scientific reports. 2024 Feb 21;14(1):4290. https://doi.org/10.1038/s41598-024-53840-4
[23] Geršak G, Drnovšek J. Electrodermal activity patient simulator. PLoS One. 2020 Feb 5;15(2):e0228949. https://doi.org/10.1371/journal.pone.0228949
[24] Stuckey HL, Nobel J. The connection between art, healing, and public health: A review of current literature. American journal of public health. 2010 Feb;100(2):254-63. https://doi.org/10.2105/AJPH.2008.156497
[25] Cellina M, Cè M, Alì M, Irmici G, Ibba S, Caloro E, Fazzini D, Oliva G, Papa S. Digital twins: The new frontier for personalized medicine?. Applied Sciences. 2023 Jul 6;13(13):7940. https://doi.org/10.3390/app13137940
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dongjun Wu, Xiaoli Shen, Qianzi You, Jiangping Yang, Lingyan Zhang
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open access article distributed under the terms of the CC BY-NC-SA 4.0, which permits copying, redistributing, remixing, transformation, and building upon the material in any medium so long as the original work is properly cited.
