CoBreath: Designing a VR-Based Dyadic Biofeedback System to Support Breathing Exercise for Breast Cancer Survivors

Chronic stress and anxiety severely affect breast cancer survivors’ (BCSs) mental health and well-being. Peer support has been shown to enhance psychological empowerment, while biofeedback offers a promising approach to improve physiological relaxation through self-regulation. However, few studies explored combining both for BCSs. We conducted a formative study with clinicians and BCSs to identify requirements and preferences for VR biofeedback. Informed by the findings, we proposed a VR-based dyadic biofeedback system, Cobreath, which integrates breathing and heart rate variability (HRV) feedback into a calming virtual environment, allowing two users to practice breathing-focused relaxation simultaneously. Through a clinical user study with ten clinicians and a between-subjects study with 32 BCSs, we demonstrated that Cobreath’s dyadic mode improved biofeedback effectiveness and provided a better user experience compared to the individual mode. We further discuss insights and design considerations for developing dyadic VR-biofeedback applications to support the mental well-being of BCSs and potential applications.