Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG

Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG Gilang Yubiliana, Andri Abdurrochman, Mira Suryani, Zelvya Purnama Rika, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7540723/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Dental fear and anxiety (DFA) is a common problem in clinical dentistry, often leading to avoidance of essential treatments and a negative impact on oral health outcomes. Conventional treatments such as pharmacological interventions and behavioral therapies have variable success rates. This study aimed to investigate the effectiveness of Virtual Reality Dental Hypnosis (VRDH), an integrated intervention combining immersive virtual environments and verbal hypnotic suggestions, in reducing dental anxiety and modulating neurophysiological activity as measured by electroencephalography (EEG). Methods A randomized single-blind controlled trial was conducted with 22 military dental patients exhibiting moderate-to-high dental anxiety (Modified Dental Anxiety Scale [MDAS] scores 9–14). Participants were randomly allocated to two groups: VRDH (n = 11) and conventional VR (n = 11). Subjective anxiety levels were assessed using the MDAS, while physiological arousal was evaluated using Galvanic Skin Response (GSR). EEG recordings were collected at three time points (baseline, during intervention, and post-intervention) to analyze alpha (8–13 Hz), theta (4–8 Hz), and beta (13–30 Hz) brain wave activity. Results The initial demographic and anxiety features were similar between groups (p > 0.05). Following intervention, EEG assessments revealed improvements in alpha and theta wave power in the VRDH group (particularly at FP2-LE, F8-LE, FP1-LE, P3-LE, and O1-LE; p < 0.05), indicating heightened states of relaxation and meditation. Conversely, beta wave activity associated with vigilance and anxiety states was significantly decreased in the parietal and occipital regions (P3-LE, O1-LE) in the VRDH group (p = 0.028, p = 0.047), while the control group showed inconsistent or conflicting variations. The GSR and MDAS scores confirmed these neurophysiological findings, thus supporting the calming effect of VRDH. Conclusions This study provides firm evidence that VRDH has a dual psychophysiological effect of reducing subjective anxiety and cortical relaxation, as manifested in brainwave modulation. Unlike conventional VR distraction, the inclusion of hypnotic elements appears to be key to sustained alpha theta augmentation and beta suppression. These findings validate the neurocognitive basis of VRDH as an attentive, immersive intervention with applied utility in the management of dental anxiety. Trial registration: UMIN-CTR UMIN000059291. Registered on 05/10/2025. Retrospectively registered. Virtual Reality Dental Hypnosis EEG Dental Anxiety Alpha Waves Theta Waves Beta Suppression Neurophysiology Non-Pharmacological Intervention Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Dental fear and anxiety (DFA) are significant barriers to obtaining optimal oral health care, affecting up to 15.3% of the global adult population. High levels of anxiety are closely associated with delayed visits to the dentist, delayed treatment, poor oral health outcomes, and reduced quality of life. The etiology of DFA is multifactorial, often involving past negative experiences, fear of pain, and feelings of loss of control in a clinical setting 1 , 2 . Research suggests that a considerable percentage of the population suffers from dental anxiety at different levels, which may result in avoidance of dentist visits and poor oral health 3 , 4 . The cause of such fear can be attributed to past negative experiences, pain fear, or the dental clinic itself, situations that can cause patients to forego needing preventive or restorative dental treatment 5 , 6 . Therefore, it is important to address this problem, as it is crucial to enhance personal health outcomes and reduce pressure on dental healthcare resources and systems 7 , 8 . The significance of dental anxiety treatment is imperative; the utilization of effective interventions can enhance patient compliance and satisfaction, thereby generating more favorable oral health outcomes 8 . Previous research has indicated a relationship between lower anxiety levels and higher patient cooperation in dental treatment 9 . Current therapeutic methods include pharmacological treatment, behavioral treatments, diversion techniques (for example, music), and non-pharmacological treatments such as hypnosis, all of which have proven to be promising 10 , 11 . Through the diligent application of these methods, dental clinicians aim to not only alleviate anxiety but also improve the overall patient experience and outcome of procedures 12 . Although there has been progress in the knowledge and treatment of dental anxiety using conventional approaches, gaps in research on novel interventions, particularly the pairing of Virtual Reality (VR) with hypnosis, remain. Existing literature indicates the effectiveness of VR in diverting patients' attention away from fear-inducing stimuli; however, limited research has explored its synergistic effect with dental hypnosis, a technique that has been shown to have significant advantages in alleviating anxiety 11 , 13 . Its impact on brain wave patterns, as recorded by electroencephalography (EEG), is also little researched and constitutes a promising avenue for important research development 14 . Investigating the use of VR dental hypnosis could represent a cutting-edge strategy for managing dental anxiety, offering a holistic, non-invasive intervention that leverages technology to decrease anxiety while simultaneously monitoring its effects on brain activity 15 . Understanding the neural mechanisms underlying this combined approach could provide new insights into the efficacy of non-pharmacological treatments in the context of dental anxiety. This knowledge may help refine existing therapies and generate tailored anxiety management protocols to promote better patient outcomes 13 . In previous studies, research has been conducted to see the effect of virtual reality on reducing patients' anxiety and pain during dental implant surgery, in this study it was found that the effectiveness of VR in reducing patient anxiety was quite good but did not explore further on brain wave signals 16 . Thus, the main research question being explored in this research is, "To what extent does Virtual Reality dental hypnosis facilitate dental anxiety alleviation, and what corresponding changes in brain wave activity, as measured using EEG, take place?" Our working hypothesis is that VR dental hypnosis will be effective in significantly lowering dental anxiety among patients, while simultaneously producing measurable changes in brain wave activity in line with relaxation states and lowered anxiety levels 3 , 17 . This study aimed to examine this hypothesis by strictly ascertaining the effectiveness of this novel intervention and whether it is suitable for future clinical dentistry practice. Material and methods Regulatory approvals and Ethical clearances Before conducting this research, we informed the participants of the details of the research that would be provided. This study followed procedures that were in accordance with the Helsinki Declaration of (1964, and its later amendments) and was approved by the Ethics Committee of Dr. Mintohardjo Naval Hospital Jakarta (number B/21/EC/LKS/IV/2023). The trial was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000059291 (receipt R000067776) on 05/10/2025 and is retrospectively registered. All procedures involving humans followed the research standards. All subjects in this study were exposed to research-related materials and agreed to participate in a series of studies from beginning to end without coercion by signing a letter of consent willing to be a research subject. Participation sample size Eligible participants for this study were recruited from a dental clinic with military affiliation, active-duty personnel within the Navy, and undergoing tooth extraction procedures. Gender was not a selection factor in the selection process. Thus, both male and female participants could be recruited 18 , 19 . Before enrolling, all participants provided signed written informed consent, hence adherence to ethical standards 20 . The sample size calculation was based on the two-proportion hypothesis testing method, informed by earlier studies that reported a 99% decrease in cortisol levels in the treatment group and a 45% decrease in cortisol levels in the control group 21 , 22 . Based on a specified significance level (α) of 0.05, and statistical power (1-β) of 80%, the G*Power program version 3.9.1.7, was utilized to determine that a minimum of 10 subjects were required in each group (treatment and control), making a total of 20 subjects 23 . To account for risks due to attrition or loss to follow-up, a buffer space of 10% totaling two extra subjects was added, resulting in an overall sample size of 22 subjects with 11 subjects in each group 22 , 24 . The randomization procedure was performed using a simple randomization method, and the study was performed in a single-blinded fashion. Therefore, the participants were blinded to their assigned group 21 , 25 . Study design We conducted a parallel-group randomized clinical trial with two intervention groups. A precursor phase involving 65 potential participants was conducted, which aimed to obtain baseline information on the number of patients reporting moderate-to-severe levels of dental anxiety at the TNI-AL Health Service Facilities. Dental anxiety was recorded both objectively through the Galvanic Skin Response (GSR) and subjectively using the Indonesian version of the Modified Dental Anxiety Scale (MDAS). Demographic patient data were collected during this stage, including age, sex, military rank, unit assignment, history of unpleasant dental experiences, and previous tooth extractions. An instrument validation test was also conducted to ensure that all measurement instruments used were reliable and valid. The instruments utilized for screening were the SADT to evaluate anxiety and a modified GSR to track physical signs of anxiety. This phase also showed the dental anxiety levels of the patient population (low to high) who visited the TNI-AL health clinics. Patients whose criteria matched the set criteria were recruited into the study and received comprehensive information about all study phases. Participants who understood and agreed to take part fully were requested to sign a form of informed consent. Of the original 65 subjects, 43 were excluded owing to failure to meet the inclusion and exclusion criteria, resulting in 22 eligible participants. These volunteers (20-58-year-old navy personnel with teeth scheduled for extraction in the absence of periodontal pathology and with moderate-to-high SADT scores (9–14)). A randomized, single-blind, parallel-group clinical trial following CONSORT guidelines was divided into two groups (Group 1 and Group 2, n = 11 per group) 26 . Each subject received baseline EEG recordings (5 seconds eyes open, 5 seconds eyes closed). Group 1 received EEG treatment during a Virtual Reality Distraction Hypnosis (VRDH) session. The session was composed of 7 seconds of hypnotic content and 3 seconds of VR presentation. Group 2 was given a VR intervention with no hypnotic content, but of equal length. The EEG responses throughout the intervention were recorded for subsequent analyses. Exclusion criteria were dental phobic patients (SADT ≥ 25), pregnancy, systemic illness, salivary gland-affecting drugs, corticosteroid or hormonal therapy, smoking, xerostomia, drug abuse, or psychological disorders. This setup allowed for a controlled, objective measurement of the neurophysiological effects of VRDH using EEG under extremely standardized conditions (Figure. 1). Hardware Virtual Reality Dental Hypnosis (VRDH) In the current study, a custom-made Virtual Reality Dental Hypnosis (VRDH) headset was used to deliver individualized dental hypnosis (Fig. 2 .C). The headset, which was constructed from a light plastic material and shaped with ergonomic features for maximum comfort, had a smartphone holder to display the 3D stereoscopic content 27 . The virtual reality system featured engaging natural landscape videos combined with verbal suggestions, in line with hypnodontic communication principles. A mixture of visual and auditory stimulations was designed to promote relaxation and distract patients from anxiety-provoking stimuli during dental treatment 28 . Virtual reality technology allows the administration of dental hypnosis in a standardized and controlled manner, which is hypothesized to improve focus and engagement 27 . The design of the headset enabled flexibility in terms of the type of content delivered, thus ensuring compatibility with EEG monitoring throughout the intervention 29 . Hypnotic content in VRDH The content delivered through the Virtual Reality Dental Hypnosis (VRDH) system is carefully designed to mimic authentic and original hypnodontic communication. Verbal suggestions are designed based on a pragmatic analysis of directive, assertive, and expressive language actions, which form the basis of clinical dental hypnosis and serve to facilitate the induction and maintenance of the hypnotic state 30 . The primary objective of the VRDH experience is the presence of the virtual guide Anjani Abimaya, an interactive avatar displayed within a digitally constructed therapeutic environment in the Indonesian language. Through the use of VR devices and specialized software, users with high dental anxiety enter a calming virtual space where the avatar interacts with the user using structured hypnosis language patterns. This design not only enhances the sense of presence in the virtual environment but also reinforces therapeutic suggestions, supporting deeper engagement and psychological acceptance during the intervention. Our VRDH is an original intellectual property that has undergone extensive research and is protected by VRDH intellectual property rights (HKI/C00201502645). Electroencephalography (EEG) Electroencephalography (EEG) data were recorded using the Neuron-Spectrum-5 (Neurosoft, Ivanovo, Russia) system, which is a multichannel, high-resolution EEG system designed for clinical neurophysiology and research applications 31 . The device runs at a 500-Hz sampling rate and is endowed with sophisticated filtering of signals, comprising a low-frequency filter (LFF) at 0.5 Hz, a high-frequency filter (HFF) at 75 Hz, and an active notch filter that can reduce interference due to power line noise 32 . EEG recordings were made with a standard 10–20 electrode placement system using active electrodes, and the signals were continuously monitored in real time using Neuron-Spectrum.NET software, allowing real-time simultaneous visualization of raw EEG traces, spectral power maps, and 2D/3D topographical distributions of brain activity in the main frequency bands (Delta, Theta, Alpha, Beta) 33 . During the data acquisition stage, the participants were seated in a comfort-oriented dental chair with a high-conductivity EEG cap, while an amplifier unit and recording laptop were placed in close proximity to allow real-time monitoring. This setup is crucial for obtaining high-quality signals that are minimized for artifacts, which is necessary for analyzing neurophysiological responses during interventions using Virtual Reality (VR) and Virtual Reality dental hypnosis (VRDH) 34 . Procedure of treatment conditions The experimental procedure was divided into three phases: pre-intervention, intervention, and post-intervention (Fig. 2 A) and different tests taken during study (Fig. 3 ). In the pre-intervention phase, the subjects were recorded with baseline EEG signals at rest using a 21-channel EEG cap (Fig. 2 B) to allow for the acquisition of preliminary brainwave activity data as a baseline before entering the intervention. Additionally, anxiety was initially measured using the Modified Dental Anxiety Scale (MDAS - Indonesian version) and Galvanic Skin Response (GSR). In the intervention phase, the participants were randomly divided into two groups. Group 1 was subjected to a Virtual Reality Dental Hypnosis (VRDH) intervention that involved visual exposure to calming natural environments with verbal suggestions derived from hypnodontic communication approaches. Group 2 received identical installation of the VR headset without content and acted as a control group. The VRDH system was administered through a specially designed VR headset (Fig. 2 C), worn securely over the EEG cap to avoid interference with EEG data collection. At all phases, brain activity was recorded using electroencephalography (EEG) on the neuron-spectrum system. EEG signals were recorded for a second time during the post-intervention period to assess amplitude changes in brainwave patterns as a measure of relaxation or maintenance of anxiety. Figure 3 presents the research detailed study timetable, tests conducted, and respective measured parameters for each study stage. The dental anxiety level for participants was determined by the Modified Dental Anxiety Scale (MDAS, Indonesian version) and the Galvanic Skin Response (GSR), where MDAS 9–12 and 13–14 denoted moderate and high anxiety, and GSR ≤ 4 and ≥ 4 denoted moderate and high anxiety, respectively. The pre-intervention stage involved the documentation of baseline brain activity via electroencephalography (EEG), where delta (0.5-4 Hz, blue) was an indicator of profound sleep/relaxation, theta (4–8 Hz, green) and alpha (8–13 Hz, green) showed a relaxed condition, and beta (13–30 Hz, red) showed alertness/anxiety. The intervention stage consisted of the use of Virtual Reality Dental Hypnosis (VRDH) or traditional VR, and subsequent post-intervention EEG recordings were conducted for measuring brainwave activity changes and anxiety response. Psychometric assessment Modified Dental Anxiety Scale (MDAS) In this study, the level of anxiety experienced by the research subjects was measured for the purpose of this test to see if the subjects to be studied have a level of anxiety that matches the inclusion and exclusion criteria using the Modified Dental Anxiety Scale (MDAS), which is the Indonesian version of the Short-form Dental Anxiety Scale (SADT) 35 . This measurement instrument has five items that assess dental anxiety based on dental experiences in different situations. The questions are rated on a 5-point Likert scale from “not anxious” to “very anxious”, and the overall score ranges from 5 to 25. Scores of 9–12 are classified as moderate anxiety, and 13–14 as high anxiety and previous research has confirmed that the administration of MDAS does not itself induce anxiety 36 . Psychophysiological assessment Galvanic Skin Response (GSR) GSR, or Galvanic Skin Response, is a psychophysiological measure that records variations in electrical conductance of the skin due to sweat gland function, reflecting activation of the sympathetic nervous system in emotional arousal, including anxiety 37 . GSR was used in this study to provide an objective physiological measure of dental anxiety before the intervention. GSR ≤ 4 was categorized as moderate anxiety, and GSR ≥ 4 was categorized as high anxiety. Notably, the GSR measurement was used to validate and corroborate the subject-reported results of the Modified Dental Anxiety Scale (MDAS). Combining subjective (MDAS) and objective (GSR) measurements resulted in a better understanding of the subjects' anxiety levels, which has increased the reliability of the pre-intervention psychological profile 38 . Electroencephalography (EEG) Electroencephalography (EEG) is a non-invasive neurophysiological technique used to monitor electrical activity in the brain via electrodes placed on the scalp. In the present study, EEG recordings were taken at three different time points before, during, and after the VRDH (Virtual Reality Dental Hypnosis) treatment to evaluate changes in brainwave activity in response to treatment. Electrodes were placed according to the international 10–20 system to capture activity across the frontal, temporal, parietal, and occipital lobes 14 . Brainwaves were categorized as follows: Delta (0.5–4 Hz): unconsciousness and deep relaxation Theta (4–8 Hz) and Alpha (8–13 Hz): relaxation and calmness states Beta (13–30 Hz): alertness, attention, and worry EEG assessment was also important for the measurement of neurophysiological change throughout the VRDH treatment. In particular, it enabled the measurement of decreased Beta wave activity and increased Alpha and Theta wave amplitudes, which were markers of decreased anxiety and increased relaxation throughout the treatment 13 . Data collection The clinical information performed, all details of the research procedures, monitoring of questionnaire completion, and GSR and EEG data collection all data obtained from each subject were recorded by the person in charge of the study in an electronic database. Statistical analysis All statistical tests were used to assess the effectiveness of Virtual Reality dental hypnosis (VRDH) treatment and homogeneity of the subject populations. A randomized controlled trial (RCT) design and randomization analysis were employed to ensure group comparability 39 . Specifically, the Mann Whitney U test was used to compare the distribution of age between groups, while chi-square tests were performed to investigate differences in sex and rank distribution, thus ensuring that baseline demographic features were evenly distributed 40 . To compare the anxiety levels derived from the Modified Dental Anxiety Scale (MDAS) and Galvanic Skin Response (GSR) prior to the intervention, Mann Whitney U tests were used, in line with the recommended procedures for analyzing non-parametric data in randomized controlled trials (RCTs) with small to moderate sample sizes 41 . To evaluate brainwave activity, electroencephalogram (EEG) signals from each of the cortical lobes, namely the frontal, temporal, parietal, and occipital lobes, were analyzed across all phases of the intervention: pre-, during, and post-intervention 42 . The Wilcoxon signed-rank test was used to compare differences in the amplitude of brainwaves at each electrode site within single subjects, thus characterizing the neurophysiological impact of VRDH intervention 43 . Results Baseline demographic characteristics of the participants are summarized in (Table 1 ). 22 participants who met the inclusion criteria were randomly assigned to two intervention groups (n = 11 per group). The assessment of patient characteristics revealed no statistically significant differences between the two groups in terms of age, sex, or rank (p ≥ 0.05). Table 2 shows that dental anxiety scores with the Modified Dental Anxiety Scale (MDAS) were 10.00 ± 1.09 for Group 1 and 10.64 ± 1.63 for Group 2, p = 0.438. Galvanic Skin Response (GSR) measures also showed no difference between Group 1 (3.18 ± 0.40) and Group 2 (3.45 ± 0.69), p = 0.438. Upon examination of the EEG signal data for both groups pre- and post-intervention in (Table 3 ), Group 1 revealed increased median absolute values of alpha and theta waves in various left and right cortical regions post-intervention, along with a reduction in beta wave activity in the P3-LE and O1-LE regions. Group 2 presented variable changes in the form of increases and reductions in certain waveforms. Moderate differences between points in time (baseline endline) at several electrode locations were more pronounced in Group 1 (p < 0.05), namely, in absolute alpha and alpha-theta waves, than in Group 2, where limited significance was found. Discussion When assessing the basic characteristics of the intervention and control groups prior to the implementation of Virtual Reality Dental Hypnosis (VRDH), it is crucial to verify the absence of significant differences, as this underpins the internal validity of a randomized controlled trial (RCT) 44 . The Mann-Whitney U test results (p > 0.05) indicated no statistically significant differences in demographic variables such as age, gender, and military rank. This confirms that the groups were equivalent at baseline, validating the randomization process and ensuring that observed effects post-intervention are attributable to VRDH rather than pre-existing differences 45 . In particular, baseline measures including age, sex, and military rank were comparable across the two groups, indicating that the effects observed following the intervention were due to VRDH treatment and not pre-existing differences. Table 1 explains that group 2 consisted entirely of males (100%), while Group 1 included 81.82% males and 18.18% females. Military rank distributions were also slightly different; Group 2 was dominated by non-commissioned officers (63.64%), whereas Group 1 had a more balanced structure. Nonetheless, average ages were similar (Group 1: 53 ± 25; Group 2: 51 ± 22; p = 0.217), supporting demographic parity. These findings underscore the methodological rigor of the study and uphold the RCT principle of unbiased group allocation. Consequently, any differences in outcomes post-intervention can be confidently linked to the effect of VRDH, not to demographic discrepancies. This strengthens the credibility of subsequent EEG and anxiety-related analyses by eliminating baseline bias. Table 1 subject demographic results and statistical analysis results Group 1 Group 2 P-value Gender Male 9 11 0.476 Female 2 0 Age Year 53 ± 25 51 ± 22 0.217 Military rank Enlisted personnel 4 3 0.170 Non-commissioned officer 3 7 Commissioned officer 4 1 The results of analyzing The Modified Dental Anxiety Scale (MDAS) scores and Galvanic Skin Response (GSR) values between the two intervention groups showed no statistically significant differences, as indicated by a p-value of 0.438 for both parameters (Table 2 ), consistent with Alazmah's research that MDAS scores are crucial for assessing anxiety levels prior to intervention 46 . Group 1 recorded an average MDAS score of 10.00 ± 1.09, while Group 2 showed 10.64 ± 1.63. Likewise, GSR readings averaged 3.18 ± 0.40 for Group 1 and 3.45 ± 0.69 for Group 2. This alignment between subjective (MDAS) and objective (GSR) measures confirms the uniform psychological state among participants prior to treatment, which fulfills the inclusion criteria and enhances the internal validity of the intervention analysis 47 . Furthermore, GSR results recognized as physiological markers of sympathetic activity support the notion that both groups began under equivalent stress and arousal conditions 48 . Therefore, any changes in post-intervention neurophysiological or behavioral responses can be attributed to the specific effects of VRDH, not to initial anxiety disparities. This strengthens the interpretability of EEG and outcome comparisons, as the randomization process successfully neutralized potential psychological biases 49 . Table 2 results of subject anxiety observations and statistical analysis results Group 1 Group 2 P-value Mean SD Mean SD MDAS 10.00 1.09 10.64 1.63 0.438 GSR 3.18 0.40 3.45 0.69 0.438 EEG analysis is the primary measurement tool used to demonstrate objective evidence of neurophysiological changes caused by virtual reality (VR)-based treatment interventions, particularly to investigate the effectiveness of Virtual Reality-Based Dental Hypnosis (VRDH) in Group 1 compared with standard VR interventions administered to Group 2. Significant differences were observed between pre- and post-intervention recordings, particularly in terms of the absolute power of the alpha and beta waves across various cortical regions. In Group 1, participants who underwent VRDH demonstrated an increase in the absolute power of the alpha wave activity in both hemispheres. However, the increase at the C3-LE electrode position across the left parietal center did not have the backing of significant statistics with a p-value of 0.799. Likewise, the alterations were observed to occur in the right frontal regions at the FP2-LE and F8-LE electrode positions, with p-values of 0.004 and 0.006, respectively 50 . These transformations are conditions of increased relaxation and focus, which are typical of meditative and hypnotic conditions. This EEG-based evidence provides a robust physiological correlate to the subjective improvements in dental anxiety, bridging the gap between behavioral observations and cortical mechanisms. It emphasizes that VRDH does not merely distract the patient but potentially modulates central nervous system activity in ways consistent with therapeutic hypnosis and deep relaxation states. Brain topography visualization of one subject in Group 1 (Fig. 4 ) showed significant spectral changes after receiving VRDH intervention, which is a combination of a 7-second verbal hypnosis session and 3 s of VR content, with continuous EEG recording during the process. Before the intervention, each subject underwent a 10-second baseline EEG (5 s with eyes open and 5 s with eyes closed) to measure the initial cortical state. In the baseline image of Group 1 (second 10), the dominance of blue across nearly all frequencies reflects low brain wave activity and a lack of relaxation. After the intervention (6:35 min), a shift in color toward green and yellow was observed, particularly in alpha and alpha/theta waves in the frontal (C3-LE, FP2-LE, F8-LE) and posterior (O1-LE) regions, indicating a significant increase in relaxation activity. Quantitatively, alpha increased in C3-LE (5.40 to 8.08), FP2-LE (4.74 to 5.29), and O1-LE (7.52 to 10.10). An increase in theta waves was also observed at FP1-LE and F7-LE, appearing topographically as a greenish color in the left frontal region. The decrease in beta activity, shown in blue, which remained dominant at P3-LE and O1-LE, reinforces the effect of reduced alertness and anxiety following VRDH. In contrast, Group 2 (Fig. 5 ) received VR sessions of the same duration, but without a verbal hypnosis component. Their post-intervention topography showed different color patterns: increased red color in delta waves in the frontal area (FP1-LE, F3-LE), and the emergence of yellow-red color in alpha/theta waves in the parietal and occipital regions (P3-LE, O1-LE). This aligns with an increase in absolute alpha/theta activity in FP1-LE (10.57 to 13.49) and O1-LE (11.96 to 12.69), as well as an increase in absolute alpha activity in C3-LE (5.19 to 8.39). Despite not receiving hypnosis suggestions, these increases indicate that VR content alone can reduce conscious cognitive activity to a certain extent. Theta in FP1-LE and F7-LE also underwent changes, although with more moderate amplitudes compared to Group 1, indicating relaxation but less suggestive engagement. The decrease in beta waves in areas such as F4-LE (5.97 to 7.95) and the dominance of blue in beta topography indicate a reduction in attentional activity. Overall, the warmer color response in alpha and delta, along with the dominance of blue in beta in both groups, indicates the effectiveness of both VRDH and pure VR in reducing cortical hyperactivity, although the hypnotic effect is more strongly facilitated in Group 1, which received the verbal-suggestive component. Simultaneous analysis of absolute alpha and theta waves showed a global increase in Group 1 across the left cortical locations, namely FP1-LE, F3-LE, F7-LE, C3-LE, P3-LE, and O1-LE (p = 0.007–0.026) (Fig. 6 and Table 3 ), reflecting an increase in meditative EEG states, indicating successful induction and maintenance of hypnosis through Virtual Reality Dental Hypnosis (VRDH). Overall, there was an increase in alpha-theta wave values from baseline to endline in both groups at nearly all electrodes; however, this increase was far more consistent and significant in Group 1, particularly at electrode C3-LE (from 10.36 to 13.66 µV²), P3-LE (8.83 to 11.29 µV²), and O1-LE (from 7.52 to 10.10 µV²), indicating activation in the left parietal and occipital regions. While Group 2 also saw increases, the size of these changes was comparatively modest and less consistent; notably, a slight decrease was observed at the F3-LE site (from 13.67 to 13.36 µV²), along with only modest increases at F7-LE. Group 2 had higher alpha-theta scores at certain electrodes at baseline; however, following treatment, Group 1 was able to catch up to and even exceed the performance of Group 2, especially at C3-LE and P3-LE. These results reaffirm that VRDH significantly enhances alpha-theta wave activity linked to relaxation, light attention, and sensorimotor relaxation. At the same time, beta wave activity indicative of active cognitive processing and levels of arousal diminished considerably in Group 1 at the P3-LE and O1-LE electrodes (p = 0.028 and p = 0.047, respectively), which could be an indication of a decline in hypervigilance for anxiety, complementing the relaxing effects of VRDH. Group 2 presented irregular and statistically non-reliable beta responses or even paradoxical responses (e.g., increase at F4-LE: p = 0.033), indicating residual tension or inability to relax as an effect of being exposed to visual stimuli without hypnosis 51 . Table 3 EEG observation results and statistical analysis with baseline and endline Waves Electrode placement area Group 1 Group 2 Median value Difference (baseline-endline) P-value Baseline Endline Baseline Endline Group 1 Group 2 Group 1 Group 2 Alfa Absolute Left C3-LE 5.40 8.08 5.19 8.39 -0.06 -1.55 0.799 0.041 Teta Absolute Left FP1-LE 5.59 6.73 7.21 6.05 -0.87 -0.34 0.657 0.041 F7-LE 3.80 4.55 4.14 3.99 -0.68 0.17 0.594 0.041 T3-LE 2.49 2.37 3.11 3.67 -0.23 -0.01 0.929 0.041 Absolute Alpha-Theta Left FP1-LE 10.95 12.30 10.57 13.49 0.00 -0.19 0.007 0.722 F3-LE 10.95 12.62 13.67 13.36 -5.30 -5.84 0.026 0.722 F7-LE 7.46 8.43 6.50 7.74 -2.39 -1.17 0.026 0.859 C3-LE 10.36 13.66 14.49 14.53 -1.26 -1.85 0.026 0.424 P3-LE 8.83 11.29 13.47 13.95 -0.82 -3.05 0.010 0.656 O1-LE 7.52 10.10 11.96 12.69 0.66 -0.75 0.013 0.594 Alfa Absolute Right FP2-LE 4.74 5.29 3.94 5.44 0.00 -1.00 0.004 0.756 F8-LE 2.91 4.13 3.07 3.92 -0.59 -1.07 0.006 0.799 Absolute Alpha-Theta Right F4-LE 10.73 12.22 13.02 14.88 -1.34 -1.85 0.075 0.041 Absolute Beta Left P3-LE 7.81 6.41 6.20 6.62 0.43 -0.42 0.028 0.929 O1-LE 5.46 5.11 6.42 6.92 0.33 -0.52 0.047 0.929 Absolute Beta Right F4-LE 7.51 7.06 5.97 7.95 0.39 -1.15 0.594 0.033 Overall, the findings of this study support the hypothesis that Virtual Reality Dental Hypnosis (VRDH) can increase alpha and theta wave activity while simultaneously reducing beta wave activity in the cerebral cortex areas responsible for attention, relaxation, and emotional regulation. Wang et al. (2024) demonstrated that virtual reality therapy can have a significant impact on electroencephalogram (EEG) patterns associated with relaxation and cognition 52 . This underscores the immense influence of immersive experience on brain activity. The spatial-spectral pattern of these shifts indicates the effectiveness of content presentation of verbal hypnosis in a VR setting for deep psychophysiological relaxation induction, particularly in patients with elevated anxiety 53 . It has been previously observed that VR can enhance brain wave activity associated with attention and asynchronous alpha waves, which mirrors enhanced relaxation and focus 54 . In addition, increased activity of theta waves experienced during Virtual Reality Dental Hypnosis (VRDH) reveals deeper engagement in meditative and relaxation states, which are often sought after in therapy 55 . These electroencephalogram (EEG) patterns demonstrate the effectiveness of VRDH in creating an immersive environment that promotes relaxation and reduces anxiety, thus confirming the significant difference between a systematic immersive approach and general virtual reality exposure 56 . It is worth noting that, whereas Group 1 showed distinctive alpha and theta signal increases, Group 2 responses were more variable, suggesting that standard VR can provide some cognitive benefits but does not match the same degree of meditative relaxation as VRDH 57 . The observed reduction in beta activity in group 1 is an indicator of reduced anxiety and heightened relaxation levels, thereby corroborating the sedative effect of VRDH over conventional VR treatments 58 . These findings hold important clinical relevance. The inclusion of brief verbal hypnosis within immersive VR experiences appears to induce a psychophysiological state conducive to anxiety reduction, particularly in high-stress populations such as military personnel. This hybrid approach may serve as a valuable adjunct to conventional dental practice, enabling non-pharmacological anxiety management during pre-treatment phases. Given its portability and compatibility, VRDH presents a scalable intervention readily implementable across dental hospitals (RSGM), military clinics (RS TNI), and general dental practices. Limitation This study, though yielding useful insights into the neurophysiological impacts of Virtual Reality Dental Hypnosis (VRDH) in reducing dental anxiety, is not without limitations. First, the small sample size (n = 22) may limit the generalizability of the findings and reduce the statistical power required to detect small effects, especially in subgroup analyses. Although a randomized controlled trial (RCT) design effectively controls for confounding variables, the focus on active-duty military personnel defines a narrow cohort with distinctive stress mechanisms, regulatory frameworks, and hierarchical chain of command, which may inadvertently exclude the civilian population at large. Second, while EEG provides objective cortical activity measurements, brain wave dynamics, especially in the alpha and theta bands, are difficult to interpret and are subject to influences by several extrinsic factors such as fatigue of the participant, attention fluctuations, and environmental stimulation during recording. In addition, the application of a limited number of EEG channels on the scalp might limit both the spatial resolution and cortical signal depth analysis. Third, although this research used validated tools such as the Indonesian version of the Modified Dental Anxiety Scale (MDAS) and a calibrated galvanic skin response (GSR) unit, both of these instruments are still subject to the environment and the variability of patients' previous interactions with digital technology prior to the initiation of the research and the reliability of patients' self-reported information. In addition, the lack of follow-up over a period precludes examination of lasting neurophysiological and psychological changes that can occur after the immediate post-treatment period. Fourth, the 7-second hypnosis suggestion followed by the 3-second virtual reality presentation in the context of VRDH, while created for effectiveness, might not be the best length and order of presentation for everyone. In addition, tailoring hypnosis content is expected to improve the outcomes. To support and extend these findings, it is necessary to carry out more widespread and longer trials that include a broad spectrum of participants, multichannel EEG mapping, and longer follow-up periods. Conclusions This study demonstrates that the integration of hypnosis components in a virtual reality platform (VRDH) provides marked neurophysiological and psychological benefits in reducing dental anxiety in adult military patients. The findings show that VRDH is able to significantly boost alpha and theta brain wave activity, simultaneously reducing beta wave frequencies, indicating a change towards the relaxed and dissociated mental state of hypnosis. These effects were not invariably seen in the control group, which underwent conventional virtual reality without suggestive elements, highlighting the crucial role of suggestive factors in promoting therapeutic modulation of cortical activity. Additionally, the correlation between the subjective (MDAS) and objective (GSR, EEG) measures further supports the validity of VRDH as an adjunct technique for the management of anxiety during dental procedures. The non-invasive design and wide range of customization options that come with VRDH make it an attractive new neurocognitive treatment tool that can easily be integrated into dental clinics and hospital dental departments, especially for patients who show high levels of anxiety. Future studies with larger patient populations and longer follow-up periods are required to determine the long-term effectiveness of this method and its broader clinical use. Declarations Acknowledgment This research was funded by a Universitas Padjadjaran Research Grant (RKDU) from 2023. EEG interpretation was performed by Siti Aminah, dr., Sp.S(K)., M.Si Med a consultant neurologist, who provided expert evaluation of brain wave patterns across experimental conditions. Author contributions G.Y: study design; collection of data; data analysis/interpretation; writing of the manuscript. A.A: study design; writing of the manuscript; review and editing. M.S: study design; writing of the manuscript; review and editing. Z.P: study design; collection of data; data analysis/interpretation. R.N: writing of the manuscript; review and editing. Funding funded by the Padjadjaran University Research Grant (RKDU) from 2023 Data availability Data are available from the corresponding authors. please contact this email [email protected] Conflict of Interest The authors declare that they have no conflict of interest. Consent for publication Written informed consent for publication of the participants’ clinical details and identifying images (Figures 2B and 2C) was obtained from all participants. All images were anonymized, and no personal identifiers appear in the manuscript. The participants reviewed and approved the final images prior to publication. Informed consent Informed consent was obtained from all the participants. Ethics approval and consent to participate This study followed procedures that were in accordance with the Helsinki Declaration of (1964, and its later amendments) and was approved by the Ethics Committee of Dr. Mintohardjo Naval Hospital Jakarta (number B/21/EC/LKS/IV/2023). The trial was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000059291 (receipt R000067776) on 05/10/2025 and is retrospectively registered. All procedures involving humans followed the research standards. All subjects in this study were exposed to research-related materials and agreed to participate in a series of studies from beginning to end without coercion by signing a letter of consent willing to be a research subject. References da Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated Prevalence of Dental Fear in Adults: A Systematic Review and Meta-Analysis. J Dent. Published online 2021. 10.1016/j.jdent.2021.103632 Monson C. Applicability of the Resources of Behavioral Medicine in Dental Anxiety. Global J Anesth Pain Med. Published online 2019. 10.32474/gjapm.2019.02.000129 Kong X, Song N, Chen L, Li Y. Non-Pharmacological Interventions for Reducing Dental Anxiety in Pediatric Dentistry: A Network Meta-Analysis. BMC Oral Health Published online. 2024. 10.1186/s12903-024-04919-x . Liu Y, Zhi-Yu G, Wang Y et al. Effect of Audiovisual Distraction on the Management of Dental Anxiety in Children: A Systematic Review. Int J Paediatr Dent . Published online. 2018. 10.1111/ipd.12430 Hegde A, Suresh LR, Gowdham G, Shetty AA. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent. Published online 2021. 10.5005/jp-journals-10005-1902 Rienhoff J, Splieth CH, Veerkamp J. The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations. Brain Sci Published online. 2024. 10.3390/brainsci14111073 . Hoffmann B, Erwood K, Ncomanzi S, Fischer V, O’Brien DJ, Lee A. Management Strategies for Adult Patients With Dental Anxiety in the Dental Clinic: A Systematic Review. Aust Dent J Published online. 2022. 10.1111/adj.12926 . Murad M, Ingle N, Assery M. Evaluating Factors Associated With Fear and Anxiety to Dental Treatment—A Systematic Review. J Family Med Prim Care. Published online 2020. 10.4103/jfmpc.jfmpc_607_20 Ridho FM, Fauzan Moh. A Narrative Review on the Effectiveness of Therapeutic Communication in Reducing Anxiety in Children During Dental Treatment Procedures. International J Health Published online. 2023. 10.14419/kbf8ak63 . Wolf TG, Faerber KA, Rummel C, Halsband U, Campus G. Functional Changes in Brain Activity Using Hypnosis: A Systematic Review. Brain Sci Published online. 2022. 10.3390/brainsci12010108 . Venkiteswaran A, Tandon S. Role of Hypnosis in Dental Treatment. J Int Soc Prev Community Dent. Published online 2021. 10.4103/jispcd.jispcd_320_20 Sabherwal P, Kalra N, Tyagi R, Khatri A, Srivastava S. Hypnosis and Progressive Muscle Relaxation for Anxiolysis and Pain Control During Extraction Procedure in 8–12-Year-Old Children: A Randomized Control Trial. European Archives of Paediatric Dentistry . Published online 2021. 10.1007/s40368-021-00619-0 Wolf TG, Schläppi S, Benz CI, Campus G. Efficacy of Hypnosis on Dental Anxiety and Phobia: A Systematic Review and Meta-Analysis. Brain Sci Published online. 2022. 10.3390/brainsci12050521 . Yubiliana G, Putra R, Abdurrochman A. Q-Eeg Map of Parietal and Frontal Lobes Out of Brain Waves Recording During Dental Hypnosis Practice. Padjadjaran J Dentistry Published online. 2021. 10.24198/pjd.vol33no3.33382 . Moghadam SA, Yousefi F, Saad S. The Effect of Hypnosis on Pain Relief Due to Injection of Dental Infiltration Anesthesia. Clin Exp Dent Res Published online. 2021. 10.1002/cre2.356 . Ghobadi A, Moradpoor H, Sharini H, Khazaie H, Moradpoor P. The effect of virtual reality on reducing patients’ anxiety and pain during dental implant surgery. BMC Oral Health. 2024;24(1). 10.1186/s12903-024-03904-8 . Mehrotra D, Shetty AA, Kavita R, Kumara. Effect of Audio and Virtual Reality Distraction on the Dental Anxiety of Children With Mild Intellectual Disability. Special Care in Dentistry . Published online 2023. 10.1111/scd.12932 Niemczyk W, Balicz A, Lau K, Morawiec T, Kasperczyk J. Factors Influencing Peri-Extraction Anxiety: A Cross-Sectional Study. Dent J (Basel). Published online 2024. 10.3390/dj12060187 Macleod M, Howells DJ, Kiermer V et al. Did a Change in Nature Journals’ Editorial Policy for Life Sciences Research Improve Reporting? BMJ Open Science . Published online 2019. 10.1136/bmjos-2017-000035 Papalouka S, Kovács M, Munafò MR, Thibault RT. Research Ethics Committees as an Intervention Point to Promote a Priori Sample Size Calculations. Published online 2023. 10.31222/osf.io/5sehd Thibault RT, Zavalis EA, Malički M, Pedder H. An Evaluation of Reproducibility and Errors in Published Sample Size Calculations Performed Using G*Power. Published online 2024. 10.1101/2024.07.15.24310458 Ünalan A. Sample Size in Clinical Researches: Power of the Test and Effect Size. Black Sea J Health Sci. Published online 2021. 10.19127/bshealthscience.866556 Kang H. Sample Size Determination and Power Analysis Using the G*Power Software. J Educ Eval Health Prof. Published online 2021. 10.3352/jeehp.2021.18.17 Jiang Z, Imai K. Statistical Inference and Power Analysis for Direct and Spillover Effects in Two-Stage Randomized Experiments. Published online 2020. 10.48550/arxiv.2011.07677 Rajasekaran A, Chaudhari PK. Letter to the Editor – Re: El-Ashmawi Et Al. Cleft Palate-Craniofacial J. 2022;59(3):377–39. doi:10.1177/1055665621990152. The Cleft Palate-Craniofacial Journal. Published online 2023. 10.1177/10556656231151305 Hopewell S, Chan AW, Collins GS, et al. CONSORT 2025 statement: updated guideline for reporting randomized trials. Nat Med. 2025;31(6):1776–83. 10.1038/s41591-025-03635-5 . Rousseaux F, Panda R, Toussaint C, et al. Virtual Reality Hypnosis in the Management of Pain: Self-reported and Neurophysiological Measures in Healthy Subjects. European J Pain Published online. 2022. 10.1002/ejp.2045 . Zhao FY, Li L, Xu P et al. Mapping Knowledge Landscapes and Evolving Trends of Clinical Hypnotherapy Practice: A Bibliometrics-Based Visualization Analysis. Int J Gen Med . Published online. 2024. 10.2147/ijgm.s497359 Rousseaux F, Dardenne N, Massion P et al. Virtual Reality and Hypnosis for Anxiety and Pain Management in Intensive Care Units. Eur J Anaesthesiol. Published online 2021. 10.1097/eja.0000000000001633 Nani Darmayanti J, Nurhadi G, Yubiliana. TIPE TINDAK TUTUR DALAM KOMUNIKASI DENTAL HIPNOSIS: SUATU KAJIAN PRAGMATIK .; 2014. https://doi.org/10.26499/rnh.v3i2.44 Thilaga M, Ramasamy V, Nadarajan R, Nandagopal D. Shortest Path Based Network Analysis to Characterize Cognitive Load States of Human Brain Using EEG Based Functional brain Networks. J Integr Neurosci . Published online. 2018. 10.3233/jin-170049 Wu W, Keller CJ, Rogasch NC et al. ARTIST: A Fully Automated Artifact Rejection Algorithm for Single-pulse TMS‐EEG Data. Hum Brain Mapp . Published online. 2018. 10.1002/hbm.23938 Cataldo A, Criscuolo S, Benedetto E, De, et al. A Method for Optimizing the Artifact Subspace Reconstruction Performance in Low-Density EEG. IEEE Sens J Published online. 2022. 10.1109/jsen.2022.3208768 . Gofton T, Norton L, Laforge G et al. Cerebral Cortical Activity After Withdrawal of Life-Sustaining Measures in Critically Ill Patients. Am J Transplant. Published online 2022. 10.1111/ajt.17146 Ogawa M, Sago T, Furukawa H. The Reliability and Validity of the Japanese Version of the Modified Dental Anxiety Scale among Dental Outpatients. Scientific World Journal . 2020;2020. 10.1155/2020/8734946 Tajirian M, Juarez B, Martinez T. Adapting a Dental Anxiety Measure to Encourage Empathy. Int J Dent . 2023;2023. 10.1155/2023/4909993 Al-Nafjan A, Aldayel M. Anxiety Detection System Based on Galvanic Skin Response Signals. Appl Sci (Switzerland). 2024;14(23). 10.3390/app142310788 . Caprara HJ, Eleazer PD, Barfield RD, Chavers S. Objective Measurement of Patient’s Dental Anxiety by Galvanic Skin Reaction. J Endod. 2003;29(8):493–6. https://doi.org/10.1097/00004770-200308000-00001 . Cooper L, Stankiewicz N, Sneddon J, Seaton RA, Smith A. Indications for the Use of Metronidazole in the Treatment of Non-Periodontal Dental Infections: A Systematic Review. JAC Antimicrob Resist Published online. 2022. 10.1093/jacamr/dlac072 . Şimşek H, Aytekin BA. Can Dental Anxiety During Impacted Third Molar Surgery Be Measured Biometrically? Clinical Study With the Galvanic Skin Response Technique. Meandros Medical and Dental Journal . Published online. 2021. 10.4274/meandros.galenos.2021.53386 Lin C, Lee C, Wu SY, et al. Translation and Validation of Modified Dental Anxiety Scale Based on Adult Taiwan Population. BMC Oral Health Published online. 2021. 10.1186/s12903-021-02017-w . Soares JP, Cardoso M, Bolan M. Demystifying Behaviour and Dental Anxiety in Schoolchildren During Endodontic Treatment for Primary Teeth—controlled Clinical Trial. Int J Paediatr Dent. Published online 2019. 10.1111/ipd.12468 Caruso S, Valenti C, Marinucci L, et al. Systematic Review of Zinc’s Benefits and Biological Effects on Oral Health. Materials Published online. 2024. 10.3390/ma17040800 . Ahn EJ, Kim JH, Kim TK et al. Assessment of P Values for Demographic Data in Randomized Controlled Trials. Korean J Anesthesiol. Published online 2019. 10.4097/kja.d.18.00333 Liu Z, Hu F, Li Z. Nonparametric Response-adaptive Randomization for Continuous Responses. Pharm Stat Published online. 2018. 10.1002/pst.1900 . Alazmah A, Sharanesha RB, Abushanan A et al. Comparison of Parental and Children’s Dental Anxiety Levels Using the Modified Dental Anxiety Scale and Modified Short State-Trait Anxiety Inventory (EMOJI) Scale. Children . Published online 2024. 10.3390/children11121532 Karasu YÖ, BİÇER D, Özpolat G, ÖZEN GY, Onat FÇ, Orbak R. Investigation of the Relationship Between Mindfulness Awareness, Anxiety, Dental Anxiety, and Oral Hygiene Status in Population. J Health Care Res. Published online 2022. 10.36502/2022/hcr.6213 Groesbeck G, Bach D, Stapleton P, Blickheuser K, Church D, Sims R. The Interrelated Physiological and Psychological Effects of EcoMeditation. J Evid Based Integr Med . Published online. 2018. 10.1177/2515690x18759626 Tomasi J, Zai CC, Pouget JG, Tiwari A, Kennedy JL. Heart Rate Variability: Evaluating a Potential Biomarker of Anxiety Disorders. Psychophysiology . Published online 2023. 10.1111/psyp.14481 Kim D, Goo Y, Cho J et al. Effect of Volatile Organic Chemicals in Chrysanthemum Indicum Linné on Blood Pressure and Electroencephalogram. Molecules . Published online 2018. 10.3390/molecules23082063 Bidzan-Bluma I, Jochimek M, Lipowska M. Cognitive Functioning of Preadolescent Gymnasts, Including Bioelectrical Brain Activity. Percept Mot Skills . Published online 2023. 10.1177/00315125231156722 Wang P, Zhang XQ, Ai X, Wang S. Modulation of EEG Signals by Visual and Auditory Distractors in Virtual Reality-Based Continuous Performance Tests. IEEE Trans Neural Syst Rehabil Eng. Published online 2024. 10.1109/tnsre.2024.3405549 Тарасова ИВ, Трубникова ОА, Кухарева ИН, Kupriyanova DS, Sosnina АS. The Neurophysiological Effects of Virtual Reality Application and Perspectives of Using for Multitasking Training in Cardiac Surgery Patients: Pilot Study. Applied Sciences . Published online 2024. 10.3390/app142310893 Wang Y, Weng T, Tsai IF, Kao J, Chang Y. Effects of Virtual Reality on Creativity Performance and Perceived Immersion: A Study of Brain Waves. Br J Edu Technol. Published online 2022. 10.1111/bjet.13264 Chang WS, Liang W, Li DH et al. The Association Between Working Memory Precision and the Nonlinear Dynamics of Frontal and Parieto-Occipital EEG Activity. Sci Rep. Published online 2023. 10.1038/s41598-023-41358-0 Bernal G, Jung H, Yassı İE et al. Unraveling the Dynamics of Mental and Visuospatial Workload in Virtual Reality Environments. Computers . Published online 2024. 10.3390/computers13100246 Tran Y, Austin P, Lo C et al. An Exploratory EEG Analysis on the Effects of Virtual Reality in People With Neuropathic Pain Following Spinal Cord Injury. Sensors . Published online 2022. 10.3390/s22072629 Jaramillo V, Hebron H, Wong S et al. Closed-Loop Auditory Stimulation Targeting Alpha and Theta Oscillations During REM Sleep Induces Phase-Dependent Power and Frequency Changes. Published online 2024. 10.1101/2024.03.03.582907 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7540723","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532424613,"identity":"7b7c1d6f-ad51-4cc8-80e1-5ed209f07561","order_by":0,"name":"Gilang Yubiliana","email":"data:image/png;base64,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","orcid":"","institution":"Padjadjaran University","correspondingAuthor":true,"prefix":"","firstName":"Gilang","middleName":"","lastName":"Yubiliana","suffix":""},{"id":532424614,"identity":"cfa5add2-6f98-427c-922b-bb0811f213ba","order_by":1,"name":"Andri Abdurrochman","email":"","orcid":"","institution":"Padjadjaran University","correspondingAuthor":false,"prefix":"","firstName":"Andri","middleName":"","lastName":"Abdurrochman","suffix":""},{"id":532424615,"identity":"57610f02-e0f9-41c6-a3c2-418f644e4cab","order_by":2,"name":"Mira Suryani","email":"","orcid":"","institution":"Padjadjaran University","correspondingAuthor":false,"prefix":"","firstName":"Mira","middleName":"","lastName":"Suryani","suffix":""},{"id":532424616,"identity":"cb9d48c8-08c7-4afb-a22c-def277a51f6b","order_by":3,"name":"Zelvya Purnama Rika","email":"","orcid":"","institution":"RS TNI AL Dr. Mintohardjo","correspondingAuthor":false,"prefix":"","firstName":"Zelvya","middleName":"Purnama","lastName":"Rika","suffix":""},{"id":532424617,"identity":"e0e4839d-a05b-4cb3-937a-a4d27f8ff2e6","order_by":4,"name":"Rohmat Nursin","email":"","orcid":"","institution":"SEGi University","correspondingAuthor":false,"prefix":"","firstName":"Rohmat","middleName":"","lastName":"Nursin","suffix":""}],"badges":[],"createdAt":"2025-09-05 04:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7540723/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7540723/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94398283,"identity":"6981efb6-a765-4ef5-92ef-ae39c7e19cbf","added_by":"auto","created_at":"2025-10-27 13:57:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6362619,"visible":true,"origin":"","legend":"","description":"","filename":"draftingkonsepawalpaper19Oct2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/ba6c6b2c0b7affa9b014fd91.docx"},{"id":94398585,"identity":"e729614d-c408-4dec-804d-49dfa8d3a591","added_by":"auto","created_at":"2025-10-27 13:57:08","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8039,"visible":true,"origin":"","legend":"","description":"","filename":"c260124ff52c4e4395281926708d762f.json","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/b57d87f3d0109ab6e15970fd.json"},{"id":94397503,"identity":"6e79e4bc-dd8f-4159-8dc6-7c2b40d1d8f7","added_by":"auto","created_at":"2025-10-27 13:56:42","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155468,"visible":true,"origin":"","legend":"","description":"","filename":"c260124ff52c4e4395281926708d762f1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/320e2b19f034f1ccfee3dc46.xml"},{"id":94396974,"identity":"4acf6d17-8031-4399-950d-a2ae799bba99","added_by":"auto","created_at":"2025-10-27 13:56:23","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":276021,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/380d5d9f8b73243c5aa705f1.png"},{"id":94397008,"identity":"361fb6df-a550-4449-868c-992d2d63c75f","added_by":"auto","created_at":"2025-10-27 13:56:24","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":283194,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/c6f38a7105a299fa7d38d2a9.png"},{"id":94399283,"identity":"cee981c5-f58d-48bc-b197-b6acc462bc0c","added_by":"auto","created_at":"2025-10-27 13:57:26","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57633,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/ebd6a687c46e8aaf040dc67e.png"},{"id":94399454,"identity":"e0cde408-12c9-4e00-aa15-956100d44dda","added_by":"auto","created_at":"2025-10-27 13:57:34","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":318308,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/bb67922b1b07447270b727e6.png"},{"id":94399606,"identity":"9087f0a2-176a-43e3-aac0-cd4c1b51b187","added_by":"auto","created_at":"2025-10-27 13:57:40","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":223581,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/2215d7d9e01f62fe7563e375.png"},{"id":94398867,"identity":"8cdd1e21-b878-41e1-9000-562fd69a108b","added_by":"auto","created_at":"2025-10-27 13:57:13","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18014,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/76c43ebe690cc09433c8694b.png"},{"id":94399787,"identity":"db184a28-194e-4c41-a441-046850d9f422","added_by":"auto","created_at":"2025-10-27 13:57:44","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":152626,"visible":true,"origin":"","legend":"","description":"","filename":"c260124ff52c4e4395281926708d762f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/4547d5e32e1debd37960b7a2.xml"},{"id":94398093,"identity":"5c9dba79-cb8d-4417-ac3d-e11d0550ab79","added_by":"auto","created_at":"2025-10-27 13:56:58","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164602,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/884928f03d94f1d8dc3d121a.html"},{"id":94397010,"identity":"73bed866-7ca2-4740-b73f-8f9115f1172f","added_by":"auto","created_at":"2025-10-27 13:56:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":276021,"visible":true,"origin":"","legend":"\u003cp\u003estudy design and inclusion and exclusion criteria\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/781ffc03469d7e4edf2de3dd.png"},{"id":94396651,"identity":"899446c3-cb6b-4fc0-8e8e-8dba64567b57","added_by":"auto","created_at":"2025-10-27 13:56:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1092397,"visible":true,"origin":"","legend":"\u003cp\u003eresearch procedures and timing\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/ef9ea6fc9c47ef4d4894d928.png"},{"id":94398550,"identity":"1e5ef239-6677-4692-8b37-f25c13230b3b","added_by":"auto","created_at":"2025-10-27 13:57:07","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":286860,"visible":true,"origin":"","legend":"\u003cp\u003eDetailed research procedure illustrating the sequence of examinations, intervention phases, and measured parameters (MDAS, GSR, EEG) conducted during pre-intervention, intervention, and post-intervention stages.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/fba041b9e9ed71541ddce982.jpeg"},{"id":94399825,"identity":"7bbcf011-4e8f-4cd2-86e1-00a007cf9502","added_by":"auto","created_at":"2025-10-27 13:57:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":3275527,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of brain topography mapping in Group 1 subjects and changes therein: A. Brain topography sampled at 10 seconds; B. Brain topography sampled at 6 minutes 35 seconds.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/251b57345912ea901fb0461c.png"},{"id":94399696,"identity":"ec196a82-26b8-40db-9d7a-27a68aa31467","added_by":"auto","created_at":"2025-10-27 13:57:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":917869,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of brain topography mapping in Group 2 subjects and changes therein, A. Brain topography sampled at 10 seconds, B. Brain topography sampled at 6 minutes 35 seconds\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/162eaa35121b9d570bbd5d7b.png"},{"id":94397324,"identity":"5c188659-944c-4c99-af6f-6df9b0af5d3e","added_by":"auto","created_at":"2025-10-27 13:56:37","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":63184,"visible":true,"origin":"","legend":"\u003cp\u003ecomparison between EEG waves in Absolute Alpha-Theta\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/637f296146e944d16d896695.png"},{"id":104404797,"identity":"d6888193-7842-4f2b-baec-cd7b646eaa65","added_by":"auto","created_at":"2026-03-11 12:21:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7761599,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7540723/v1/e222c277-c341-466b-9ad1-49ed2e9ed789.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental fear and anxiety (DFA) are significant barriers to obtaining optimal oral health care, affecting up to 15.3% of the global adult population. High levels of anxiety are closely associated with delayed visits to the dentist, delayed treatment, poor oral health outcomes, and reduced quality of life. The etiology of DFA is multifactorial, often involving past negative experiences, fear of pain, and feelings of loss of control in a clinical setting \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Research suggests that a considerable percentage of the population suffers from dental anxiety at different levels, which may result in avoidance of dentist visits and poor oral health \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The cause of such fear can be attributed to past negative experiences, pain fear, or the dental clinic itself, situations that can cause patients to forego needing preventive or restorative dental treatment \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Therefore, it is important to address this problem, as it is crucial to enhance personal health outcomes and reduce pressure on dental healthcare resources and systems \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe significance of dental anxiety treatment is imperative; the utilization of effective interventions can enhance patient compliance and satisfaction, thereby generating more favorable oral health outcomes \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Previous research has indicated a relationship between lower anxiety levels and higher patient cooperation in dental treatment \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Current therapeutic methods include pharmacological treatment, behavioral treatments, diversion techniques (for example, music), and non-pharmacological treatments such as hypnosis, all of which have proven to be promising \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Through the diligent application of these methods, dental clinicians aim to not only alleviate anxiety but also improve the overall patient experience and outcome of procedures \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough there has been progress in the knowledge and treatment of dental anxiety using conventional approaches, gaps in research on novel interventions, particularly the pairing of Virtual Reality (VR) with hypnosis, remain. Existing literature indicates the effectiveness of VR in diverting patients' attention away from fear-inducing stimuli; however, limited research has explored its synergistic effect with dental hypnosis, a technique that has been shown to have significant advantages in alleviating anxiety \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Its impact on brain wave patterns, as recorded by electroencephalography (EEG), is also little researched and constitutes a promising avenue for important research development \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eInvestigating the use of VR dental hypnosis could represent a cutting-edge strategy for managing dental anxiety, offering a holistic, non-invasive intervention that leverages technology to decrease anxiety while simultaneously monitoring its effects on brain activity \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Understanding the neural mechanisms underlying this combined approach could provide new insights into the efficacy of non-pharmacological treatments in the context of dental anxiety. This knowledge may help refine existing therapies and generate tailored anxiety management protocols to promote better patient outcomes \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn previous studies, research has been conducted to see the effect of virtual reality on reducing\u003c/p\u003e\u003cp\u003epatients' anxiety and pain during dental implant surgery, in this study it was found that the effectiveness of VR in reducing patient anxiety was quite good but did not explore further on brain wave signals \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Thus, the main research question being explored in this research is, \"To what extent does Virtual Reality dental hypnosis facilitate dental anxiety alleviation, and what corresponding changes in brain wave activity, as measured using EEG, take place?\" Our working hypothesis is that VR dental hypnosis will be effective in significantly lowering dental anxiety among patients, while simultaneously producing measurable changes in brain wave activity in line with relaxation states and lowered anxiety levels \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This study aimed to examine this hypothesis by strictly ascertaining the effectiveness of this novel intervention and whether it is suitable for future clinical dentistry practice.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eRegulatory approvals and Ethical clearances\u003c/h2\u003e\u003cp\u003eBefore conducting this research, we informed the participants of the details of the research that would be provided. This study followed procedures that were in accordance with the Helsinki Declaration of (1964, and its later amendments) and was approved by the Ethics Committee of Dr. Mintohardjo Naval Hospital Jakarta (number B/21/EC/LKS/IV/2023). The trial was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000059291 (receipt R000067776) on 05/10/2025 and is retrospectively registered. All procedures involving humans followed the research standards. All subjects in this study were exposed to research-related materials and agreed to participate in a series of studies from beginning to end without coercion by signing a letter of consent willing to be a research subject.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipation sample size\u003c/h3\u003e\n\u003cp\u003eEligible participants for this study were recruited from a dental clinic with military affiliation, active-duty personnel within the Navy, and undergoing tooth extraction procedures. Gender was not a selection factor in the selection process. Thus, both male and female participants could be recruited \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Before enrolling, all participants provided signed written informed consent, hence adherence to ethical standards \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The sample size calculation was based on the two-proportion hypothesis testing method, informed by earlier studies that reported a 99% decrease in cortisol levels in the treatment group and a 45% decrease in cortisol levels in the control group \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Based on a specified significance level (α) of 0.05, and statistical power (1-β) of 80%, the G*Power program version 3.9.1.7, was utilized to determine that a minimum of 10 subjects were required in each group (treatment and control), making a total of 20 subjects \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. To account for risks due to attrition or loss to follow-up, a buffer space of 10% totaling two extra subjects was added, resulting in an overall sample size of 22 subjects with 11 subjects in each group \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. The randomization procedure was performed using a simple randomization method, and the study was performed in a single-blinded fashion. Therefore, the participants were blinded to their assigned group \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eWe conducted a parallel-group randomized clinical trial with two intervention groups. A precursor phase involving 65 potential participants was conducted, which aimed to obtain baseline information on the number of patients reporting moderate-to-severe levels of dental anxiety at the TNI-AL Health Service Facilities. Dental anxiety was recorded both objectively through the Galvanic Skin Response (GSR) and subjectively using the Indonesian version of the Modified Dental Anxiety Scale (MDAS). Demographic patient data were collected during this stage, including age, sex, military rank, unit assignment, history of unpleasant dental experiences, and previous tooth extractions. An instrument validation test was also conducted to ensure that all measurement instruments used were reliable and valid. The instruments utilized for screening were the SADT to evaluate anxiety and a modified GSR to track physical signs of anxiety. This phase also showed the dental anxiety levels of the patient population (low to high) who visited the TNI-AL health clinics. Patients whose criteria matched the set criteria were recruited into the study and received comprehensive information about all study phases. Participants who understood and agreed to take part fully were requested to sign a form of informed consent. Of the original 65 subjects, 43 were excluded owing to failure to meet the inclusion and exclusion criteria, resulting in 22 eligible participants. These volunteers (20-58-year-old navy personnel with teeth scheduled for extraction in the absence of periodontal pathology and with moderate-to-high SADT scores (9\u0026ndash;14)). A randomized, single-blind, parallel-group clinical trial following CONSORT guidelines was divided into two groups (Group 1 and Group 2, n\u0026thinsp;=\u0026thinsp;11 per group)\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Each subject received baseline EEG recordings (5 seconds eyes open, 5 seconds eyes closed). Group 1 received EEG treatment during a Virtual Reality Distraction Hypnosis (VRDH) session. The session was composed of 7 seconds of hypnotic content and 3 seconds of VR presentation. Group 2 was given a VR intervention with no hypnotic content, but of equal length. The EEG responses throughout the intervention were recorded for subsequent analyses. Exclusion criteria were dental phobic patients (SADT\u0026thinsp;\u0026ge;\u0026thinsp;25), pregnancy, systemic illness, salivary gland-affecting drugs, corticosteroid or hormonal therapy, smoking, xerostomia, drug abuse, or psychological disorders. This setup allowed for a controlled, objective measurement of the neurophysiological effects of VRDH using EEG under extremely standardized conditions (Figure. 1).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eHardware\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eVirtual Reality Dental Hypnosis (VRDH)\u003c/h2\u003e\u003cp\u003eIn the current study, a custom-made Virtual Reality Dental Hypnosis (VRDH) headset was used to deliver individualized dental hypnosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.C). The headset, which was constructed from a light plastic material and shaped with ergonomic features for maximum comfort, had a smartphone holder to display the 3D stereoscopic content \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The virtual reality system featured engaging natural landscape videos combined with verbal suggestions, in line with hypnodontic communication principles. A mixture of visual and auditory stimulations was designed to promote relaxation and distract patients from anxiety-provoking stimuli during dental treatment \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Virtual reality technology allows the administration of dental hypnosis in a standardized and controlled manner, which is hypothesized to improve focus and engagement \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The design of the headset enabled flexibility in terms of the type of content delivered, thus ensuring compatibility with EEG monitoring throughout the intervention \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eHypnotic content in VRDH\u003c/h2\u003e\u003cp\u003eThe content delivered through the Virtual Reality Dental Hypnosis (VRDH) system is carefully designed to mimic authentic and original hypnodontic communication. Verbal suggestions are designed based on a pragmatic analysis of directive, assertive, and expressive language actions, which form the basis of clinical dental hypnosis and serve to facilitate the induction and maintenance of the hypnotic state \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. The primary objective of the VRDH experience is the presence of the virtual guide Anjani Abimaya, an interactive avatar displayed within a digitally constructed therapeutic environment in the Indonesian language. Through the use of VR devices and specialized software, users with high dental anxiety enter a calming virtual space where the avatar interacts with the user using structured hypnosis language patterns. This design not only enhances the sense of presence in the virtual environment but also reinforces therapeutic suggestions, supporting deeper engagement and psychological acceptance during the intervention. Our VRDH is an original intellectual property that has undergone extensive research and is protected by VRDH intellectual property rights (HKI/C00201502645).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eElectroencephalography (EEG)\u003c/h3\u003e\n\u003cp\u003eElectroencephalography (EEG) data were recorded using the Neuron-Spectrum-5 (Neurosoft, Ivanovo, Russia) system, which is a multichannel, high-resolution EEG system designed for clinical neurophysiology and research applications \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The device runs at a 500-Hz sampling rate and is endowed with sophisticated filtering of signals, comprising a low-frequency filter (LFF) at 0.5 Hz, a high-frequency filter (HFF) at 75 Hz, and an active notch filter that can reduce interference due to power line noise \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. EEG recordings were made with a standard 10\u0026ndash;20 electrode placement system using active electrodes, and the signals were continuously monitored in real time using Neuron-Spectrum.NET software, allowing real-time simultaneous visualization of raw EEG traces, spectral power maps, and 2D/3D topographical distributions of brain activity in the main frequency bands (Delta, Theta, Alpha, Beta) \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. During the data acquisition stage, the participants were seated in a comfort-oriented dental chair with a high-conductivity EEG cap, while an amplifier unit and recording laptop were placed in close proximity to allow real-time monitoring. This setup is crucial for obtaining high-quality signals that are minimized for artifacts, which is necessary for analyzing neurophysiological responses during interventions using Virtual Reality (VR) and Virtual Reality dental hypnosis (VRDH) \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eProcedure of treatment conditions\u003c/h3\u003e\n\u003cp\u003eThe experimental procedure was divided into three phases: pre-intervention, intervention, and post-intervention (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA) and different tests taken during study (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the pre-intervention phase, the subjects were recorded with baseline EEG signals at rest using a 21-channel EEG cap (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB) to allow for the acquisition of preliminary brainwave activity data as a baseline before entering the intervention. Additionally, anxiety was initially measured using the Modified Dental Anxiety Scale (MDAS - Indonesian version) and Galvanic Skin Response (GSR).\u003c/p\u003e\u003cp\u003eIn the intervention phase, the participants were randomly divided into two groups. Group 1 was subjected to a Virtual Reality Dental Hypnosis (VRDH) intervention that involved visual exposure to calming natural environments with verbal suggestions derived from hypnodontic communication approaches. Group 2 received identical installation of the VR headset without content and acted as a control group. The VRDH system was administered through a specially designed VR headset (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC), worn securely over the EEG cap to avoid interference with EEG data collection. At all phases, brain activity was recorded using electroencephalography (EEG) on the neuron-spectrum system. EEG signals were recorded for a second time during the post-intervention period to assess amplitude changes in brainwave patterns as a measure of relaxation or maintenance of anxiety.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the research detailed study timetable, tests conducted, and respective measured parameters for each study stage. The dental anxiety level for participants was determined by the Modified Dental Anxiety Scale (MDAS, Indonesian version) and the Galvanic Skin Response (GSR), where MDAS 9\u0026ndash;12 and 13\u0026ndash;14 denoted moderate and high anxiety, and GSR\u0026thinsp;\u0026le;\u0026thinsp;4 and \u0026ge;\u0026thinsp;4 denoted moderate and high anxiety, respectively. The pre-intervention stage involved the documentation of baseline brain activity via electroencephalography (EEG), where delta (0.5-4 Hz, blue) was an indicator of profound sleep/relaxation, theta (4\u0026ndash;8 Hz, green) and alpha (8\u0026ndash;13 Hz, green) showed a relaxed condition, and beta (13\u0026ndash;30 Hz, red) showed alertness/anxiety. The intervention stage consisted of the use of Virtual Reality Dental Hypnosis (VRDH) or traditional VR, and subsequent post-intervention EEG recordings were conducted for measuring brainwave activity changes and anxiety response.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePsychometric assessment\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eModified Dental Anxiety Scale (MDAS)\u003c/h2\u003e\u003cp\u003eIn this study, the level of anxiety experienced by the research subjects was measured for the purpose of this test to see if the subjects to be studied have a level of anxiety that matches the inclusion and exclusion criteria using the Modified Dental Anxiety Scale (MDAS), which is the Indonesian version of the Short-form Dental Anxiety Scale (SADT) \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. This measurement instrument has five items that assess dental anxiety based on dental experiences in different situations. The questions are rated on a 5-point Likert scale from \u0026ldquo;not anxious\u0026rdquo; to \u0026ldquo;very anxious\u0026rdquo;, and the overall score ranges from 5 to 25. Scores of 9\u0026ndash;12 are classified as moderate anxiety, and 13\u0026ndash;14 as high anxiety and previous research has confirmed that the administration of MDAS does not itself induce anxiety \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePsychophysiological assessment\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eGalvanic Skin Response (GSR)\u003c/h2\u003e\u003cp\u003eGSR, or Galvanic Skin Response, is a psychophysiological measure that records variations in electrical conductance of the skin due to sweat gland function, reflecting activation of the sympathetic nervous system in emotional arousal, including anxiety\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. GSR was used in this study to provide an objective physiological measure of dental anxiety before the intervention. GSR\u0026thinsp;\u0026le;\u0026thinsp;4 was categorized as moderate anxiety, and GSR\u0026thinsp;\u0026ge;\u0026thinsp;4 was categorized as high anxiety. Notably, the GSR measurement was used to validate and corroborate the subject-reported results of the Modified Dental Anxiety Scale (MDAS). Combining subjective (MDAS) and objective (GSR) measurements resulted in a better understanding of the subjects' anxiety levels, which has increased the reliability of the pre-intervention psychological profile\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eElectroencephalography (EEG)\u003c/h2\u003e\u003cp\u003eElectroencephalography (EEG) is a non-invasive neurophysiological technique used to monitor electrical activity in the brain via electrodes placed on the scalp. In the present study, EEG recordings were taken at three different time points before, during, and after the VRDH (Virtual Reality Dental Hypnosis) treatment to evaluate changes in brainwave activity in response to treatment. Electrodes were placed according to the international 10\u0026ndash;20 system to capture activity across the frontal, temporal, parietal, and occipital lobes \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBrainwaves were categorized as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDelta (0.5\u0026ndash;4 Hz): unconsciousness and deep relaxation\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTheta (4\u0026ndash;8 Hz) and Alpha (8\u0026ndash;13 Hz): relaxation and calmness states\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBeta (13\u0026ndash;30 Hz): alertness, attention, and worry\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eEEG assessment was also important for the measurement of neurophysiological change throughout the VRDH treatment. In particular, it enabled the measurement of decreased Beta wave activity and increased Alpha and Theta wave amplitudes, which were markers of decreased anxiety and increased relaxation throughout the treatment \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eThe clinical information performed, all details of the research procedures, monitoring of questionnaire completion, and GSR and EEG data collection all data obtained from each subject were recorded by the person in charge of the study in an electronic database.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical tests were used to assess the effectiveness of Virtual Reality dental hypnosis (VRDH) treatment and homogeneity of the subject populations. A randomized controlled trial (RCT) design and randomization analysis were employed to ensure group comparability \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Specifically, the Mann Whitney U test was used to compare the distribution of age between groups, while chi-square tests were performed to investigate differences in sex and rank distribution, thus ensuring that baseline demographic features were evenly distributed \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. To compare the anxiety levels derived from the Modified Dental Anxiety Scale (MDAS) and Galvanic Skin Response (GSR) prior to the intervention, Mann Whitney U tests were used, in line with the recommended procedures for analyzing non-parametric data in randomized controlled trials (RCTs) with small to moderate sample sizes \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. To evaluate brainwave activity, electroencephalogram (EEG) signals from each of the cortical lobes, namely the frontal, temporal, parietal, and occipital lobes, were analyzed across all phases of the intervention: pre-, during, and post-intervention \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. The Wilcoxon signed-rank test was used to compare differences in the amplitude of brainwaves at each electrode site within single subjects, thus characterizing the neurophysiological impact of VRDH intervention \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline demographic characteristics of the participants are summarized in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). 22 participants who met the inclusion criteria were randomly assigned to two intervention groups (n\u0026thinsp;=\u0026thinsp;11 per group). The assessment of patient characteristics revealed no statistically significant differences between the two groups in terms of age, sex, or rank (p\u0026thinsp;\u0026ge;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that dental anxiety scores with the Modified Dental Anxiety Scale (MDAS) were 10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 for Group 1 and 10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63 for Group 2, p\u0026thinsp;=\u0026thinsp;0.438. Galvanic Skin Response (GSR) measures also showed no difference between Group 1 (3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40) and Group 2 (3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69), p\u0026thinsp;=\u0026thinsp;0.438. Upon examination of the EEG signal data for both groups pre- and post-intervention in (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), Group 1 revealed increased median absolute values of alpha and theta waves in various left and right cortical regions post-intervention, along with a reduction in beta wave activity in the P3-LE and O1-LE regions. Group 2 presented variable changes in the form of increases and reductions in certain waveforms. Moderate differences between points in time (baseline endline) at several electrode locations were more pronounced in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), namely, in absolute alpha and alpha-theta waves, than in Group 2, where limited significance was found.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhen assessing the basic characteristics of the intervention and control groups prior to the implementation of Virtual Reality Dental Hypnosis (VRDH), it is crucial to verify the absence of significant differences, as this underpins the internal validity of a randomized controlled trial (RCT) \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. The Mann-Whitney U test results (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) indicated no statistically significant differences in demographic variables such as age, gender, and military rank. This confirms that the groups were equivalent at baseline, validating the randomization process and ensuring that observed effects post-intervention are attributable to VRDH rather than pre-existing differences \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. In particular, baseline measures including age, sex, and military rank were comparable across the two groups, indicating that the effects observed following the intervention were due to VRDH treatment and not pre-existing differences.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e explains that group 2 consisted entirely of males (100%), while Group 1 included 81.82% males and 18.18% females. Military rank distributions were also slightly different; Group 2 was dominated by non-commissioned officers (63.64%), whereas Group 1 had a more balanced structure. Nonetheless, average ages were similar (Group 1: 53\u0026thinsp;\u0026plusmn;\u0026thinsp;25; Group 2: 51\u0026thinsp;\u0026plusmn;\u0026thinsp;22; p\u0026thinsp;=\u0026thinsp;0.217), supporting demographic parity. These findings underscore the methodological rigor of the study and uphold the RCT principle of unbiased group allocation.\u003c/p\u003e\u003cp\u003eConsequently, any differences in outcomes post-intervention can be confidently linked to the effect of VRDH, not to demographic discrepancies. This strengthens the credibility of subsequent EEG and anxiety-related analyses by eliminating baseline bias.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003esubject demographic results and statistical analysis results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.217\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMilitary rank\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnlisted personnel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-commissioned officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommissioned officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe results of analyzing The Modified Dental Anxiety Scale (MDAS) scores and Galvanic Skin Response (GSR) values between the two intervention groups showed no statistically significant differences, as indicated by a p-value of 0.438 for both parameters (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), consistent with Alazmah's research that MDAS scores are crucial for assessing anxiety levels prior to intervention \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Group 1 recorded an average MDAS score of 10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09, while Group 2 showed 10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63. Likewise, GSR readings averaged 3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40 for Group 1 and 3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 for Group 2. This alignment between subjective (MDAS) and objective (GSR) measures confirms the uniform psychological state among participants prior to treatment, which fulfills the inclusion criteria and enhances the internal validity of the intervention analysis \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Furthermore, GSR results recognized as physiological markers of sympathetic activity support the notion that both groups began under equivalent stress and arousal conditions \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTherefore, any changes in post-intervention neurophysiological or behavioral responses can be attributed to the specific effects of VRDH, not to initial anxiety disparities. This strengthens the interpretability of EEG and outcome comparisons, as the randomization process successfully neutralized potential psychological biases \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eresults of subject anxiety observations and statistical analysis results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGSR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eEEG analysis is the primary measurement tool used to demonstrate objective evidence of neurophysiological changes caused by virtual reality (VR)-based treatment interventions, particularly to investigate the effectiveness of Virtual Reality-Based Dental Hypnosis (VRDH) in Group 1 compared with standard VR interventions administered to Group 2. Significant differences were observed between pre- and post-intervention recordings, particularly in terms of the absolute power of the alpha and beta waves across various cortical regions. In Group 1, participants who underwent VRDH demonstrated an increase in the absolute power of the alpha wave activity in both hemispheres. However, the increase at the C3-LE electrode position across the left parietal center did not have the backing of significant statistics with a p-value of 0.799. Likewise, the alterations were observed to occur in the right frontal regions at the FP2-LE and F8-LE electrode positions, with p-values of 0.004 and 0.006, respectively \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. These transformations are conditions of increased relaxation and focus, which are typical of meditative and hypnotic conditions. This EEG-based evidence provides a robust physiological correlate to the subjective improvements in dental anxiety, bridging the gap between behavioral observations and cortical mechanisms. It emphasizes that VRDH does not merely distract the patient but potentially modulates central nervous system activity in ways consistent with therapeutic hypnosis and deep relaxation states.\u003c/p\u003e\u003cp\u003eBrain topography visualization of one subject in Group 1 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed significant spectral changes after receiving VRDH intervention, which is a combination of a 7-second verbal hypnosis session and 3 s of VR content, with continuous EEG recording during the process. Before the intervention, each subject underwent a 10-second baseline EEG (5 s with eyes open and 5 s with eyes closed) to measure the initial cortical state. In the baseline image of Group 1 (second 10), the dominance of blue across nearly all frequencies reflects low brain wave activity and a lack of relaxation. After the intervention (6:35 min), a shift in color toward green and yellow was observed, particularly in alpha and alpha/theta waves in the frontal (C3-LE, FP2-LE, F8-LE) and posterior (O1-LE) regions, indicating a significant increase in relaxation activity. Quantitatively, alpha increased in C3-LE (5.40 to 8.08), FP2-LE (4.74 to 5.29), and O1-LE (7.52 to 10.10). An increase in theta waves was also observed at FP1-LE and F7-LE, appearing topographically as a greenish color in the left frontal region. The decrease in beta activity, shown in blue, which remained dominant at P3-LE and O1-LE, reinforces the effect of reduced alertness and anxiety following VRDH.\u003c/p\u003e\u003cp\u003eIn contrast, Group 2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) received VR sessions of the same duration, but without a verbal hypnosis component. Their post-intervention topography showed different color patterns: increased red color in delta waves in the frontal area (FP1-LE, F3-LE), and the emergence of yellow-red color in alpha/theta waves in the parietal and occipital regions (P3-LE, O1-LE). This aligns with an increase in absolute alpha/theta activity in FP1-LE (10.57 to 13.49) and O1-LE (11.96 to 12.69), as well as an increase in absolute alpha activity in C3-LE (5.19 to 8.39). Despite not receiving hypnosis suggestions, these increases indicate that VR content alone can reduce conscious cognitive activity to a certain extent. Theta in FP1-LE and F7-LE also underwent changes, although with more moderate amplitudes compared to Group 1, indicating relaxation but less suggestive engagement. The decrease in beta waves in areas such as F4-LE (5.97 to 7.95) and the dominance of blue in beta topography indicate a reduction in attentional activity. Overall, the warmer color response in alpha and delta, along with the dominance of blue in beta in both groups, indicates the effectiveness of both VRDH and pure VR in reducing cortical hyperactivity, although the hypnotic effect is more strongly facilitated in Group 1, which received the verbal-suggestive component.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSimultaneous analysis of absolute alpha and theta waves showed a global increase in Group 1 across the left cortical locations, namely FP1-LE, F3-LE, F7-LE, C3-LE, P3-LE, and O1-LE (p\u0026thinsp;=\u0026thinsp;0.007\u0026ndash;0.026) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), reflecting an increase in meditative EEG states, indicating successful induction and maintenance of hypnosis through Virtual Reality Dental Hypnosis (VRDH). Overall, there was an increase in alpha-theta wave values from baseline to endline in both groups at nearly all electrodes; however, this increase was far more consistent and significant in Group 1, particularly at electrode C3-LE (from 10.36 to 13.66 \u0026micro;V\u0026sup2;), P3-LE (8.83 to 11.29 \u0026micro;V\u0026sup2;), and O1-LE (from 7.52 to 10.10 \u0026micro;V\u0026sup2;), indicating activation in the left parietal and occipital regions. While Group 2 also saw increases, the size of these changes was comparatively modest and less consistent; notably, a slight decrease was observed at the F3-LE site (from 13.67 to 13.36 \u0026micro;V\u0026sup2;), along with only modest increases at F7-LE. Group 2 had higher alpha-theta scores at certain electrodes at baseline; however, following treatment, Group 1 was able to catch up to and even exceed the performance of Group 2, especially at C3-LE and P3-LE. These results reaffirm that VRDH significantly enhances alpha-theta wave activity linked to relaxation, light attention, and sensorimotor relaxation. At the same time, beta wave activity indicative of active cognitive processing and levels of arousal diminished considerably in Group 1 at the P3-LE and O1-LE electrodes (p\u0026thinsp;=\u0026thinsp;0.028 and p\u0026thinsp;=\u0026thinsp;0.047, respectively), which could be an indication of a decline in hypervigilance for anxiety, complementing the relaxing effects of VRDH. Group 2 presented irregular and statistically non-reliable beta responses or even paradoxical responses (e.g., increase at F4-LE: p\u0026thinsp;=\u0026thinsp;0.033), indicating residual tension or inability to relax as an effect of being exposed to visual stimuli without hypnosis\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEEG observation results and statistical analysis with baseline and endline\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaves\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectrode placement area\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eMedian value Difference (baseline-endline)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlfa Absolute Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTeta Absolute Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFP1-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF7-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eAbsolute Alpha-Theta Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFP1-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.722\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-5.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-5.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.722\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF7-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-2.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.859\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eO1-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.594\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAlfa Absolute Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFP2-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF8-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsolute Alpha-Theta Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF4-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAbsolute Beta Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP3-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eO1-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsolute Beta Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF4-LE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOverall, the findings of this study support the hypothesis that Virtual Reality Dental Hypnosis (VRDH) can increase alpha and theta wave activity while simultaneously reducing beta wave activity in the cerebral cortex areas responsible for attention, relaxation, and emotional regulation. Wang et al. (2024) demonstrated that virtual reality therapy can have a significant impact on electroencephalogram (EEG) patterns associated with relaxation and cognition \u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. This underscores the immense influence of immersive experience on brain activity. The spatial-spectral pattern of these shifts indicates the effectiveness of content presentation of verbal hypnosis in a VR setting for deep psychophysiological relaxation induction, particularly in patients with elevated anxiety \u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e. It has been previously observed that VR can enhance brain wave activity associated with attention and asynchronous alpha waves, which mirrors enhanced relaxation and focus \u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn addition, increased activity of theta waves experienced during Virtual Reality Dental Hypnosis (VRDH) reveals deeper engagement in meditative and relaxation states, which are often sought after in therapy \u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. These electroencephalogram (EEG) patterns demonstrate the effectiveness of VRDH in creating an immersive environment that promotes relaxation and reduces anxiety, thus confirming the significant difference between a systematic immersive approach and general virtual reality exposure \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is worth noting that, whereas Group 1 showed distinctive alpha and theta signal increases, Group 2 responses were more variable, suggesting that standard VR can provide some cognitive benefits but does not match the same degree of meditative relaxation as VRDH \u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. The observed reduction in beta activity in group 1 is an indicator of reduced anxiety and heightened relaxation levels, thereby corroborating the sedative effect of VRDH over conventional VR treatments \u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThese findings hold important clinical relevance. The inclusion of brief verbal hypnosis within immersive VR experiences appears to induce a psychophysiological state conducive to anxiety reduction, particularly in high-stress populations such as military personnel. This hybrid approach may serve as a valuable adjunct to conventional dental practice, enabling non-pharmacological anxiety management during pre-treatment phases. Given its portability and compatibility, VRDH presents a scalable intervention readily implementable across dental hospitals (RSGM), military clinics (RS TNI), and general dental practices.\u003c/p\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eLimitation\u003c/h2\u003e\u003cp\u003eThis study, though yielding useful insights into the neurophysiological impacts of Virtual Reality Dental Hypnosis (VRDH) in reducing dental anxiety, is not without limitations. First, the small sample size (n\u0026thinsp;=\u0026thinsp;22) may limit the generalizability of the findings and reduce the statistical power required to detect small effects, especially in subgroup analyses. Although a randomized controlled trial (RCT) design effectively controls for confounding variables, the focus on active-duty military personnel defines a narrow cohort with distinctive stress mechanisms, regulatory frameworks, and hierarchical chain of command, which may inadvertently exclude the civilian population at large.\u003c/p\u003e\u003cp\u003eSecond, while EEG provides objective cortical activity measurements, brain wave dynamics, especially in the alpha and theta bands, are difficult to interpret and are subject to influences by several extrinsic factors such as fatigue of the participant, attention fluctuations, and environmental stimulation during recording. In addition, the application of a limited number of EEG channels on the scalp might limit both the spatial resolution and cortical signal depth analysis.\u003c/p\u003e\u003cp\u003eThird, although this research used validated tools such as the Indonesian version of the Modified Dental Anxiety Scale (MDAS) and a calibrated galvanic skin response (GSR) unit, both of these instruments are still subject to the environment and the variability of patients' previous interactions with digital technology prior to the initiation of the research and the reliability of patients' self-reported information. In addition, the lack of follow-up over a period precludes examination of lasting neurophysiological and psychological changes that can occur after the immediate post-treatment period.\u003c/p\u003e\u003cp\u003eFourth, the 7-second hypnosis suggestion followed by the 3-second virtual reality presentation in the context of VRDH, while created for effectiveness, might not be the best length and order of presentation for everyone. In addition, tailoring hypnosis content is expected to improve the outcomes. To support and extend these findings, it is necessary to carry out more widespread and longer trials that include a broad spectrum of participants, multichannel EEG mapping, and longer follow-up periods.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that the integration of hypnosis components in a virtual reality platform (VRDH) provides marked neurophysiological and psychological benefits in reducing dental anxiety in adult military patients. The findings show that VRDH is able to significantly boost alpha and theta brain wave activity, simultaneously reducing beta wave frequencies, indicating a change towards the relaxed and dissociated mental state of hypnosis. These effects were not invariably seen in the control group, which underwent conventional virtual reality without suggestive elements, highlighting the crucial role of suggestive factors in promoting therapeutic modulation of cortical activity. Additionally, the correlation between the subjective (MDAS) and objective (GSR, EEG) measures further supports the validity of VRDH as an adjunct technique for the management of anxiety during dental procedures. The non-invasive design and wide range of customization options that come with VRDH make it an attractive new neurocognitive treatment tool that can easily be integrated into dental clinics and hospital dental departments, especially for patients who show high levels of anxiety. Future studies with larger patient populations and longer follow-up periods are required to determine the long-term effectiveness of this method and its broader clinical use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by a Universitas Padjadjaran Research Grant (RKDU) from 2023. EEG interpretation was performed by Siti Aminah, dr., Sp.S(K)., M.Si Med a consultant neurologist, who provided expert evaluation of brain wave patterns across experimental conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.Y: study design; collection of data; data analysis/interpretation; writing of the manuscript. A.A: study design; writing of the manuscript; review and editing. M.S: \u0026nbsp;study design; writing of the manuscript; review and editing. Z.P: study design; collection of data; data analysis/interpretation. R.N: \u0026nbsp; writing of the manuscript; review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003efunded by the Padjadjaran University Research Grant (RKDU) from 2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding authors. please contact this email \u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of the participants\u0026rsquo; clinical details and identifying images (Figures 2B and 2C) was obtained from all participants. All images were anonymized, and no personal identifiers appear in the manuscript. The participants reviewed and approved the final images prior to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed procedures that were in accordance with the Helsinki Declaration of (1964, and its later amendments) and was approved by the Ethics Committee of Dr. Mintohardjo Naval Hospital Jakarta (number B/21/EC/LKS/IV/2023). The trial was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000059291 (receipt R000067776) on 05/10/2025 and is retrospectively registered. All procedures involving humans followed the research standards. All subjects in this study were exposed to research-related materials and agreed to participate in a series of studies from beginning to end without coercion by signing a letter of consent willing to be a research subject.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eda Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated Prevalence of Dental Fear in Adults: A Systematic Review and Meta-Analysis. J Dent. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jdent.2021.103632\u003c/span\u003e\u003cspan address=\"10.1016/j.jdent.2021.103632\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMonson C. Applicability of the Resources of Behavioral Medicine in Dental Anxiety. Global J Anesth Pain Med. Published online 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.32474/gjapm.2019.02.000129\u003c/span\u003e\u003cspan address=\"10.32474/gjapm.2019.02.000129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKong X, Song N, Chen L, Li Y. Non-Pharmacological Interventions for Reducing Dental Anxiety in Pediatric Dentistry: A Network Meta-Analysis. BMC Oral Health Published online. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-024-04919-x\u003c/span\u003e\u003cspan address=\"10.1186/s12903-024-04919-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Zhi-Yu G, Wang Y et al. Effect of Audiovisual Distraction on the Management of Dental Anxiety in Children: A Systematic Review. \u003cem\u003eInt J Paediatr Dent\u003c/em\u003e. Published online. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ipd.12430\u003c/span\u003e\u003cspan address=\"10.1111/ipd.12430\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHegde A, Suresh LR, Gowdham G, Shetty AA. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5005/jp-journals-10005-1902\u003c/span\u003e\u003cspan address=\"10.5005/jp-journals-10005-1902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRienhoff J, Splieth CH, Veerkamp J. The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations. Brain Sci Published online. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/brainsci14111073\u003c/span\u003e\u003cspan address=\"10.3390/brainsci14111073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoffmann B, Erwood K, Ncomanzi S, Fischer V, O\u0026rsquo;Brien DJ, Lee A. Management Strategies for Adult Patients With Dental Anxiety in the Dental Clinic: A Systematic Review. Aust Dent J Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/adj.12926\u003c/span\u003e\u003cspan address=\"10.1111/adj.12926\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurad M, Ingle N, Assery M. Evaluating Factors Associated With Fear and Anxiety to Dental Treatment\u0026mdash;A Systematic Review. J Family Med Prim Care. Published online 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jfmpc.jfmpc_607_20\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_607_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRidho FM, Fauzan Moh. A Narrative Review on the Effectiveness of Therapeutic Communication in Reducing Anxiety in Children During Dental Treatment Procedures. International J Health Published online. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.14419/kbf8ak63\u003c/span\u003e\u003cspan address=\"10.14419/kbf8ak63\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWolf TG, Faerber KA, Rummel C, Halsband U, Campus G. Functional Changes in Brain Activity Using Hypnosis: A Systematic Review. Brain Sci Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/brainsci12010108\u003c/span\u003e\u003cspan address=\"10.3390/brainsci12010108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVenkiteswaran A, Tandon S. Role of Hypnosis in Dental Treatment. J Int Soc Prev Community Dent. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jispcd.jispcd_320_20\u003c/span\u003e\u003cspan address=\"10.4103/jispcd.jispcd_320_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabherwal P, Kalra N, Tyagi R, Khatri A, Srivastava S. Hypnosis and Progressive Muscle Relaxation for Anxiolysis and Pain Control During Extraction Procedure in 8\u0026ndash;12-Year-Old Children: A Randomized Control Trial. \u003cem\u003eEuropean Archives of Paediatric Dentistry\u003c/em\u003e. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40368-021-00619-0\u003c/span\u003e\u003cspan address=\"10.1007/s40368-021-00619-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWolf TG, Schl\u0026auml;ppi S, Benz CI, Campus G. Efficacy of Hypnosis on Dental Anxiety and Phobia: A Systematic Review and Meta-Analysis. Brain Sci Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/brainsci12050521\u003c/span\u003e\u003cspan address=\"10.3390/brainsci12050521\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYubiliana G, Putra R, Abdurrochman A. Q-Eeg Map of Parietal and Frontal Lobes Out of Brain Waves Recording During Dental Hypnosis Practice. Padjadjaran J Dentistry Published online. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.24198/pjd.vol33no3.33382\u003c/span\u003e\u003cspan address=\"10.24198/pjd.vol33no3.33382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoghadam SA, Yousefi F, Saad S. The Effect of Hypnosis on Pain Relief Due to Injection of Dental Infiltration Anesthesia. Clin Exp Dent Res Published online. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cre2.356\u003c/span\u003e\u003cspan address=\"10.1002/cre2.356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhobadi A, Moradpoor H, Sharini H, Khazaie H, Moradpoor P. The effect of virtual reality on reducing patients\u0026rsquo; anxiety and pain during dental implant surgery. BMC Oral Health. 2024;24(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-024-03904-8\u003c/span\u003e\u003cspan address=\"10.1186/s12903-024-03904-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMehrotra D, Shetty AA, Kavita R, Kumara. Effect of Audio and Virtual Reality Distraction on the Dental Anxiety of Children With Mild Intellectual Disability. \u003cem\u003eSpecial Care in Dentistry\u003c/em\u003e. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/scd.12932\u003c/span\u003e\u003cspan address=\"10.1111/scd.12932\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNiemczyk W, Balicz A, Lau K, Morawiec T, Kasperczyk J. Factors Influencing Peri-Extraction Anxiety: A Cross-Sectional Study. Dent J (Basel). Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/dj12060187\u003c/span\u003e\u003cspan address=\"10.3390/dj12060187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMacleod M, Howells DJ, Kiermer V et al. Did a Change in Nature Journals\u0026rsquo; Editorial Policy for Life Sciences Research Improve Reporting? \u003cem\u003eBMJ Open Science\u003c/em\u003e. Published online 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjos-2017-000035\u003c/span\u003e\u003cspan address=\"10.1136/bmjos-2017-000035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapalouka S, Kov\u0026aacute;cs M, Munaf\u0026ograve; MR, Thibault RT. Research Ethics Committees as an Intervention Point to Promote a Priori Sample Size Calculations. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31222/osf.io/5sehd\u003c/span\u003e\u003cspan address=\"10.31222/osf.io/5sehd\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThibault RT, Zavalis EA, Malički M, Pedder H. An Evaluation of Reproducibility and Errors in Published Sample Size Calculations Performed Using G*Power. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1101/2024.07.15.24310458\u003c/span\u003e\u003cspan address=\"10.1101/2024.07.15.24310458\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Uuml;nalan A. Sample Size in Clinical Researches: Power of the Test and Effect Size. Black Sea J Health Sci. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19127/bshealthscience.866556\u003c/span\u003e\u003cspan address=\"10.19127/bshealthscience.866556\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKang H. Sample Size Determination and Power Analysis Using the G*Power Software. J Educ Eval Health Prof. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3352/jeehp.2021.18.17\u003c/span\u003e\u003cspan address=\"10.3352/jeehp.2021.18.17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang Z, Imai K. Statistical Inference and Power Analysis for Direct and Spillover Effects in Two-Stage Randomized Experiments. Published online 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.48550/arxiv.2011.07677\u003c/span\u003e\u003cspan address=\"10.48550/arxiv.2011.07677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRajasekaran A, Chaudhari PK. Letter to the Editor \u0026ndash; Re: El-Ashmawi Et Al. \u0026thinsp;\u003cem\u003eCleft Palate-Craniofacial J. 2022;59(3):377\u0026ndash;39. doi:10.1177/1055665621990152. The Cleft Palate-Craniofacial Journal. Published online 2023.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/10556656231151305\u003c/span\u003e\u003cspan address=\"10.1177/10556656231151305\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHopewell S, Chan AW, Collins GS, et al. CONSORT 2025 statement: updated guideline for reporting randomized trials. Nat Med. 2025;31(6):1776\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41591-025-03635-5\u003c/span\u003e\u003cspan address=\"10.1038/s41591-025-03635-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRousseaux F, Panda R, Toussaint C, et al. Virtual Reality Hypnosis in the Management of Pain: Self-reported and Neurophysiological Measures in Healthy Subjects. European J Pain Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ejp.2045\u003c/span\u003e\u003cspan address=\"10.1002/ejp.2045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao FY, Li L, Xu P et al. Mapping Knowledge Landscapes and Evolving Trends of Clinical Hypnotherapy Practice: A Bibliometrics-Based Visualization Analysis. \u003cem\u003eInt J Gen Med\u003c/em\u003e. Published online. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/ijgm.s497359\u003c/span\u003e\u003cspan address=\"10.2147/ijgm.s497359\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRousseaux F, Dardenne N, Massion P et al. Virtual Reality and Hypnosis for Anxiety and Pain Management in Intensive Care Units. Eur J Anaesthesiol. Published online 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/eja.0000000000001633\u003c/span\u003e\u003cspan address=\"10.1097/eja.0000000000001633\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNani Darmayanti J, Nurhadi G, Yubiliana. \u003cem\u003eTIPE TINDAK TUTUR DALAM KOMUNIKASI DENTAL HIPNOSIS: SUATU KAJIAN PRAGMATIK\u003c/em\u003e.; 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.26499/rnh.v3i2.44\u003c/span\u003e\u003cspan address=\"10.26499/rnh.v3i2.44\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThilaga M, Ramasamy V, Nadarajan R, Nandagopal D. Shortest Path Based Network Analysis to Characterize Cognitive Load States of Human Brain Using EEG Based Functional brain Networks. \u003cem\u003eJ Integr Neurosci\u003c/em\u003e. Published online. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3233/jin-170049\u003c/span\u003e\u003cspan address=\"10.3233/jin-170049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu W, Keller CJ, Rogasch NC et al. ARTIST: A Fully Automated Artifact Rejection Algorithm for Single-pulse TMS‐EEG Data. \u003cem\u003eHum Brain Mapp\u003c/em\u003e. Published online. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/hbm.23938\u003c/span\u003e\u003cspan address=\"10.1002/hbm.23938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCataldo A, Criscuolo S, Benedetto E, De, et al. A Method for Optimizing the Artifact Subspace Reconstruction Performance in Low-Density EEG. IEEE Sens J Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1109/jsen.2022.3208768\u003c/span\u003e\u003cspan address=\"10.1109/jsen.2022.3208768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGofton T, Norton L, Laforge G et al. Cerebral Cortical Activity After Withdrawal of Life-Sustaining Measures in Critically Ill Patients. Am J Transplant. Published online 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ajt.17146\u003c/span\u003e\u003cspan address=\"10.1111/ajt.17146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOgawa M, Sago T, Furukawa H. The Reliability and Validity of the Japanese Version of the Modified Dental Anxiety Scale among Dental Outpatients. \u003cem\u003eScientific World Journal\u003c/em\u003e. 2020;2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2020/8734946\u003c/span\u003e\u003cspan address=\"10.1155/2020/8734946\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTajirian M, Juarez B, Martinez T. Adapting a Dental Anxiety Measure to Encourage Empathy. \u003cem\u003eInt J Dent\u003c/em\u003e. 2023;2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2023/4909993\u003c/span\u003e\u003cspan address=\"10.1155/2023/4909993\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Nafjan A, Aldayel M. Anxiety Detection System Based on Galvanic Skin Response Signals. Appl Sci (Switzerland). 2024;14(23). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/app142310788\u003c/span\u003e\u003cspan address=\"10.3390/app142310788\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaprara HJ, Eleazer PD, Barfield RD, Chavers S. Objective Measurement of Patient\u0026rsquo;s Dental Anxiety by Galvanic Skin Reaction. J Endod. 2003;29(8):493\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00004770-200308000-00001\u003c/span\u003e\u003cspan address=\"10.1097/00004770-200308000-00001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCooper L, Stankiewicz N, Sneddon J, Seaton RA, Smith A. Indications for the Use of Metronidazole in the Treatment of Non-Periodontal Dental Infections: A Systematic Review. JAC Antimicrob Resist Published online. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jacamr/dlac072\u003c/span\u003e\u003cspan address=\"10.1093/jacamr/dlac072\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eŞimşek H, Aytekin BA. Can Dental Anxiety During Impacted Third Molar Surgery Be Measured Biometrically? Clinical Study With the Galvanic Skin Response Technique. \u003cem\u003eMeandros Medical and Dental Journal\u003c/em\u003e. Published online. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4274/meandros.galenos.2021.53386\u003c/span\u003e\u003cspan address=\"10.4274/meandros.galenos.2021.53386\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin C, Lee C, Wu SY, et al. Translation and Validation of Modified Dental Anxiety Scale Based on Adult Taiwan Population. BMC Oral Health Published online. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-021-02017-w\u003c/span\u003e\u003cspan address=\"10.1186/s12903-021-02017-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSoares JP, Cardoso M, Bolan M. Demystifying Behaviour and Dental Anxiety in Schoolchildren During Endodontic Treatment for Primary Teeth\u0026mdash;controlled Clinical Trial. Int J Paediatr Dent. Published online 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ipd.12468\u003c/span\u003e\u003cspan address=\"10.1111/ipd.12468\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaruso S, Valenti C, Marinucci L, et al. Systematic Review of Zinc\u0026rsquo;s Benefits and Biological Effects on Oral Health. Materials Published online. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ma17040800\u003c/span\u003e\u003cspan address=\"10.3390/ma17040800\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhn EJ, Kim JH, Kim TK et al. Assessment of P Values for Demographic Data in Randomized Controlled Trials. Korean J Anesthesiol. Published online 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4097/kja.d.18.00333\u003c/span\u003e\u003cspan address=\"10.4097/kja.d.18.00333\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Z, Hu F, Li Z. Nonparametric Response-adaptive Randomization for Continuous Responses. Pharm Stat Published online. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pst.1900\u003c/span\u003e\u003cspan address=\"10.1002/pst.1900\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlazmah A, Sharanesha RB, Abushanan A et al. Comparison of Parental and Children\u0026rsquo;s Dental Anxiety Levels Using the Modified Dental Anxiety Scale and Modified Short State-Trait Anxiety Inventory (EMOJI) Scale. \u003cem\u003eChildren\u003c/em\u003e. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children11121532\u003c/span\u003e\u003cspan address=\"10.3390/children11121532\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarasu Y\u0026Ouml;, Bİ\u0026Ccedil;ER D, \u0026Ouml;zpolat G, \u0026Ouml;ZEN GY, Onat F\u0026Ccedil;, Orbak R. Investigation of the Relationship Between Mindfulness Awareness, Anxiety, Dental Anxiety, and Oral Hygiene Status in Population. J Health Care Res. Published online 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.36502/2022/hcr.6213\u003c/span\u003e\u003cspan address=\"10.36502/2022/hcr.6213\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGroesbeck G, Bach D, Stapleton P, Blickheuser K, Church D, Sims R. The Interrelated Physiological and Psychological Effects of EcoMeditation. \u003cem\u003eJ Evid Based Integr Med\u003c/em\u003e. Published online. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2515690x18759626\u003c/span\u003e\u003cspan address=\"10.1177/2515690x18759626\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTomasi J, Zai CC, Pouget JG, Tiwari A, Kennedy JL. Heart Rate Variability: Evaluating a Potential Biomarker of Anxiety Disorders. \u003cem\u003ePsychophysiology\u003c/em\u003e. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/psyp.14481\u003c/span\u003e\u003cspan address=\"10.1111/psyp.14481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim D, Goo Y, Cho J et al. Effect of Volatile Organic Chemicals in Chrysanthemum Indicum Linn\u0026eacute; on Blood Pressure and Electroencephalogram. \u003cem\u003eMolecules\u003c/em\u003e. Published online 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/molecules23082063\u003c/span\u003e\u003cspan address=\"10.3390/molecules23082063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBidzan-Bluma I, Jochimek M, Lipowska M. Cognitive Functioning of Preadolescent Gymnasts, Including Bioelectrical Brain Activity. \u003cem\u003ePercept Mot Skills\u003c/em\u003e. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00315125231156722\u003c/span\u003e\u003cspan address=\"10.1177/00315125231156722\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang P, Zhang XQ, Ai X, Wang S. Modulation of EEG Signals by Visual and Auditory Distractors in Virtual Reality-Based Continuous Performance Tests. IEEE Trans Neural Syst Rehabil Eng. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1109/tnsre.2024.3405549\u003c/span\u003e\u003cspan address=\"10.1109/tnsre.2024.3405549\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eТарасова ИВ, Трубникова ОА, Кухарева ИН, Kupriyanova DS, Sosnina АS. The Neurophysiological Effects of Virtual Reality Application and Perspectives of Using for Multitasking Training in Cardiac Surgery Patients: Pilot Study. \u003cem\u003eApplied Sciences\u003c/em\u003e. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/app142310893\u003c/span\u003e\u003cspan address=\"10.3390/app142310893\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Weng T, Tsai IF, Kao J, Chang Y. Effects of Virtual Reality on Creativity Performance and Perceived Immersion: A Study of Brain Waves. Br J Edu Technol. Published online 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bjet.13264\u003c/span\u003e\u003cspan address=\"10.1111/bjet.13264\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChang WS, Liang W, Li DH et al. The Association Between Working Memory Precision and the Nonlinear Dynamics of Frontal and Parieto-Occipital EEG Activity. Sci Rep. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-023-41358-0\u003c/span\u003e\u003cspan address=\"10.1038/s41598-023-41358-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBernal G, Jung H, Yassı İE et al. Unraveling the Dynamics of Mental and Visuospatial Workload in Virtual Reality Environments. \u003cem\u003eComputers\u003c/em\u003e. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/computers13100246\u003c/span\u003e\u003cspan address=\"10.3390/computers13100246\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTran Y, Austin P, Lo C et al. An Exploratory EEG Analysis on the Effects of Virtual Reality in People With Neuropathic Pain Following Spinal Cord Injury. \u003cem\u003eSensors\u003c/em\u003e. Published online 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/s22072629\u003c/span\u003e\u003cspan address=\"10.3390/s22072629\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaramillo V, Hebron H, Wong S et al. Closed-Loop Auditory Stimulation Targeting Alpha and Theta Oscillations During REM Sleep Induces Phase-Dependent Power and Frequency Changes. Published online 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1101/2024.03.03.582907\u003c/span\u003e\u003cspan address=\"10.1101/2024.03.03.582907\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Virtual Reality, Dental Hypnosis, EEG, Dental Anxiety, Alpha Waves, Theta Waves, Beta Suppression, Neurophysiology, Non-Pharmacological Intervention","lastPublishedDoi":"10.21203/rs.3.rs-7540723/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7540723/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eDental fear and anxiety (DFA) is a common problem in clinical dentistry, often leading to avoidance of essential treatments and a negative impact on oral health outcomes. Conventional treatments such as pharmacological interventions and behavioral therapies have variable success rates. This study aimed to investigate the effectiveness of Virtual Reality Dental Hypnosis (VRDH), an integrated intervention combining immersive virtual environments and verbal hypnotic suggestions, in reducing dental anxiety and modulating neurophysiological activity as measured by electroencephalography (EEG).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA randomized single-blind controlled trial was conducted with 22 military dental patients exhibiting moderate-to-high dental anxiety (Modified Dental Anxiety Scale [MDAS] scores 9\u0026ndash;14). Participants were randomly allocated to two groups: VRDH (n\u0026thinsp;=\u0026thinsp;11) and conventional VR (n\u0026thinsp;=\u0026thinsp;11). Subjective anxiety levels were assessed using the MDAS, while physiological arousal was evaluated using Galvanic Skin Response (GSR). EEG recordings were collected at three time points (baseline, during intervention, and post-intervention) to analyze alpha (8\u0026ndash;13 Hz), theta (4\u0026ndash;8 Hz), and beta (13\u0026ndash;30 Hz) brain wave activity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe initial demographic and anxiety features were similar between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Following intervention, EEG assessments revealed improvements in alpha and theta wave power in the VRDH group (particularly at FP2-LE, F8-LE, FP1-LE, P3-LE, and O1-LE; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating heightened states of relaxation and meditation. Conversely, beta wave activity associated with vigilance and anxiety states was significantly decreased in the parietal and occipital regions (P3-LE, O1-LE) in the VRDH group (p\u0026thinsp;=\u0026thinsp;0.028, p\u0026thinsp;=\u0026thinsp;0.047), while the control group showed inconsistent or conflicting variations. The GSR and MDAS scores confirmed these neurophysiological findings, thus supporting the calming effect of VRDH.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study provides firm evidence that VRDH has a dual psychophysiological effect of reducing subjective anxiety and cortical relaxation, as manifested in brainwave modulation. Unlike conventional VR distraction, the inclusion of hypnotic elements appears to be key to sustained alpha theta augmentation and beta suppression. These findings validate the neurocognitive basis of VRDH as an attentive, immersive intervention with applied utility in the management of dental anxiety.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eUMIN-CTR UMIN000059291. Registered on 05/10/2025. Retrospectively registered.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-26 01:12:03","doi":"10.21203/rs.3.rs-7540723/v1","editorialEvents":[{"type":"communityComments","content":14}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e80976c0-7ec2-4895-ac37-8dc35ad7ab14","owner":[],"postedDate":"October 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T21:39:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-26 01:12:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7540723","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7540723","identity":"rs-7540723","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}