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- Virtual reality to promote adaptation to psychological responses after early pregnancy lossPublication . Mendes, Diana Carolina Gonçalves; Cameirão, Mónica da Silva; Fonseca, Ana Dias daEarly pregnancy loss, affecting nearly a quarter of identified pregnancies, is generally disenfranchising and can lead to persistent perinatal grief, depression, anxiety and post-traumatic stress disorder. Regardless, professional mental health support is often lacking. Standalone immersive virtual reality has the potential to address this healthcare deficit by tackling the invalidation and isolation that these women typically experience. Therefore, this research aimed to design, develop and validate AViR2, a standalone virtual reality tool to prevent negative post loss mental health responses. To address the unstudied landscape of early pregnancy loss in Portugal, this research started with a nationwide online survey characterizing the psychological impact, needs and medical and technological experiences of these women. Our survey showed that many still experience clinical levels of perinatal grief and comorbidities up to a year post-loss, possibly modulated by their satisfaction with healthcare and information provision. Further, a few already resort to digital alternatives. It further highlighted the need for them to receive early attention to avoid psychological complications. It also emphasized the importance of providing spaces for them to validate and memorialize their loss, facilitating adaptation. The development of AViR2 was informed by various experimental studies that defined the design guidelines for key virtual reality features (environments, virtual agents, body swapping). Results demonstrated that nature-realistic and fractal-based environments reduce stress, a humanoid speaking agent promotes personal self-disclosure, and body-swapping for self dialogue aids perspective-taking. All these elements were integrated into four modules: Emotion Management, Accepting the Loss, Social Sharing and Adapting to the Loss; each of these offering psychoeducation and two to three tasks to practice adaptive coping skills. AViR2 was tested for usability and subsequently evaluated in a feasibility study with two women who had suffered a loss within six months of participation. AViR2 yielded very good levels of usability and resulted in a reliable reduction of perinatal grief symptoms in both participants and of post-traumatic stress disorder symptoms in one of them. Qualitative data showed that these improvements were connected to symbolic closure, creative expression, and emotional disclosure promoted by the system. Ultimately, this work fills a gap in the national clinical literature and advances validation of digital therapeutic tools. It demonstrates that an evidence-based immersive virtual reality intervention can promote psychological adaptation and facilitate coping for women who have suffered an early pregnancy loss.