Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors

Tinnitus management by improving resilience using exposure in virtual reality: a scoping review

PURPOSE

To investigate effectiveness of Virtual Reality (VR) on tinnitus burden in adult patients, and which improvements can be implemented. Literature review focuses on VR's usability as a tinnitus management tool, and on comparison with standard care.

METHODS

Systematic search of PubMed and Google Scholar databases, covering articles from 2000 to 2024. We used MeSH terms "VR," "Virtual Reality," and "3D immersion" combined with "tinnitus," applying filters for clinical trials and randomized controlled trials. In Google Scholar, the advanced search function was used. Only English peer reviewed articles were included. Studies were selected based on PICOS (Patient Intervention Comparison Outcome Study) criteria, including adult patients receiving VR therapy with outcomes measured by questionnaires.

RESULTS

Of the 17 initially identified articles, 10 remained after removing duplicates, and 2 studies were ultimately included for detailed review. Data extraction followed the PRISMA-ScR guidelines, with independent reviewers charting data. Primary outcomes included change in functional limitations, mood and distress. Results suggest beneficial findings of VR immersion equivalent to standard care. However, the clinical significance remains unclear due to small sample and effect sizes and short follow-up periods.

CONCLUSIONS

VR therapy shows promise as a potential tool for managing tinnitus, particularly due to its independence from therapists and shorter treatment duration, while being as effective as usual care. Further research with larger sample sizes, extended follow-up periods and incorporation of minimal clinically important differences (MCID) is necessary to validate effectiveness and scalability as an intervention for tinnitus resilience enhancement. Suggestions are given for content optimization.

Investigating Virtual Reality for Alleviating Human-Computer Interaction Fatigue: A Multimodal Assessment and Comparison with Flat Video

Studies have shown that prolonged Human-Computer Interaction (HCI) fatigue can increase the risk of mental illness and lead to a higher probability of errors and accidents during operations. Virtual Reality (VR) technology can simultaneously stimulate multiple senses such as visual, auditory, and tactile, providing an immersive experience that enhances cognition and understanding. Therefore, this study collects multimodal data to develop evaluation methods for HCI fatigue and further explores the fatigue-relieving effects of VR technology by comparing it with flat video. Using a modular design, electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) data in the resting, fatigue-induced, and recovery states, eye movement data in the resting and fatigue-induced states, as well as subjective scale results after each state were collected from the participants. Preprocessing and statistical analysis are performed through data flow architecture. After fatigue induction, it was found that the degree of activation of brain areas, especially the Theta band of prefrontal cortex, occurred significantly higher, the effective connectivity in the Alpha and Theta bands occurred significantly lower, the subjects' pupil diameters decreased, the blink frequency increased, and subjective questionnaire scores increased, which verified the validity of the multimodal data for assessing HCI fatigue. Analyzing fatigue relief through subgroups, it was found that when using the natural grassland scene with soothing music, both flat video and VR had the ability to alleviate fatigue, which was manifested as a significant decrease in the Alpha band in the LPFC brain area and a decrease in the questionnaire score. Moreover, during the recovery state, it was found that compared to the video group, the VR group had significantly higher activation in the Alpha and Theta bands of the prefrontal cortex, while the video group had significantly higher effective connectivity than the VR group in the Alpha band. This study delved deeply into the multidimensional characterization of fatigue and investigated new scenarios for the use of VR, which can help to promote the use of VR and can be migrated to scenarios that require fatigue management and productivity enhancement.

Finding Peace in Pixels: Exploring the Therapeutic Mechanisms of Virtual Nature for Young Adults' Mental Well-Being

Background: This investigation examines the phenomenological dimensions of young adults' engagement with virtual natural environments for psychological stress amelioration through rigorous thematic analysis. Contemporary epidemiological data reveal a concerning prevalence of stress among young adults aged 18 to 29 years, with approximately 30% reporting moderate to severe manifestations. Despite virtual reality (VR)'s emergence as a promising modality for mental well-being interventions, a significant lacuna exists regarding the qualitative understanding of these immersive experiences. Methods: Through semi-structured interviews with 35 young adults following a four-week VR nature intervention, we constructed a conceptual framework comprising five interconnected strata: intervention, experience, process, context, and outcome. Results: Our analysis illuminated intricate bidirectional relationships among sensory elements, emotional responses, immersion depth, interactive affordances, post-session effects, psychological development, implementation challenges, individual variability, and comparative efficacy. The findings demonstrate congruence with both Attention Restoration Theory and Stress Recovery Theory while necessitating consideration of technology-specific mediators. Notably, the identified "stress barrier" phenomenon temporarily inhibited intrusive cognitions, suggesting promising therapeutic mechanisms. Pronounced heterogeneity in environmental preferences and psychophysiological responsiveness underscores the imperative for personalized implementation strategies. Conclusions: These insights provide substantive guidance for VR nature applications across therapeutic, occupational, and educational domains, potentially augmenting our repertoire for addressing stress-related sequelae in contemporary society.

Virtual Reality experiments in the field

Virtual Reality (VR) has paved its way into experimental psychology due to its capacity to realistically simulate real-world experiences in a controlled way. Theoretically, this technology opens the possibility to conduct experiments anywhere in the world using consumer hardware (e.g. mobile-VR). This would allow researchers to access large scale, heterogeneous samples and to conduct experiments in the field in cases where social distancing is required - e.g. during the COVID-19 pandemic. Here, we investigate the feasibility of carrying VR experiments in the field using mobile-VR through a stress inductive (public speaking task) and a relaxation (nature) task and contrast them with results in the laboratory (HTC Vive and mobile-VR). The first experiment employed a 2 (device: HTC Vive Pro (HMD) versus Wearality Sky VR smartphone adapter) x 3 (audience: 'none', 'attentive', 'inattentive') between-subjects design. Thirty-four participants took part in the experiment and completed a public speaking task. No significant difference was detected in participants' sense of presence, cybersickness, or stress levels. In the second experiment, using an inexpensive Google Cardboard smartphone adapter a 3 (between: device setting) x 2 (within: task) mixed-design was employed. Sixty participants joined the experiment, and completed a public speaking and a nature observation task. No significant difference in participants' sense of presence, cybersickness, perceived stress and relaxation were detected. Taken together, our results provide initial evidence supporting the feasibility and validity of using mobile VR in specific psychological field experiments, such as stress induction and relaxation tasks, conducted in the field. We discuss challenges and concrete recommendations for using VR in field experiments. Future research is needed to evaluate its applicability across a broader range of experimental paradigms.

Effects of Landscape Characteristic Perception of Campus on College Students' Mental Restoration

Emerging evidence underscores the beneficial effects of campus green spaces (CGSs) on student well-being and recovery. Previous research has predominantly examined the independent roles of landscape characteristics and preferences in mental restoration. However, limited studies have explored the complex interrelationships among restorative effects, landscape characteristics, preferences, and place-bonding factors, particularly within the context of CGSs. To address this gap, this study developed a validated campus landscape perception scale comprising three dimensions (perception of natural characteristics, perception of artificial characteristics, spatial perception) and 20 related indicators. In the second phase, the scale was used to investigate the influence mechanism of perceived campus landscape characteristics on mental restoration. A total of 36 CGSs across six higher education institutions in Nanjing were selected, representing diverse spatial types. The restoration experiences of 759 participants were measured using psychological indicators when viewing these landscapes. With the help of deep learning techniques, landscape elements were integrated with perceptual factors for partial least squares (PLS)-based statistical analysis. Our findings indicate that the natural and spatial dimensions significantly influence mental restoration, whereas the artificial dimension does not directly impact psychological health. Nevertheless, all dimensions indirectly enhance mental restoration through landscape preference and perceived restorativeness. The study also revealed the moderating effect of objective landscape elements on the relationship between the perception of landscape characteristics and landscape preference. This study confirms the positive role of perceived campus landscape characteristics in fostering mental restoration among students and elucidates the intricate pathway of influence, namely "perception of landscape characteristics → landscape preference → perceived restorativeness → mental restoration". These findings offer new insights into the complex processes of environmental restoration, where psychological and physical factors are intertwined. Finally, theoretical and managerial implications for improving landscape planning in restoration research are proposed.

Exploring the Restorative Effects of Natural Environments in Virtual Reality

Natural environments are known to foster positive emotions and well-being, while Virtual Reality (VR) represents a powerful tool to explore such effects. This study investigates the restorative potential of virtual natural environments for emotional recovery, combining self-report and physiological measures. Fifty-two participants were divided into three Natural groups-formed spontaneously based on their preferred natural scenarios-and a Neutral group-exposed to a neutral scenario. The results reveal that virtual natural scenarios effectively restored positive emotions (valence) after exposure to arousing stimuli. Both neutral and natural scenarios reduced arousal, but the physiological data show higher activation in Natural groups. Interestingly, this activation was positively appraised, supporting emotional recovery. These findings confirm the restorative potential of VR nature, with nuanced arousal effects.

Effect of Virtual Zen Garden on Quality of Life of Residents in Long-Term Care Home

Increasing attention has been paid to the therapeutic effect of gardens on older persons in long-term care homes. However, problems on set up and reliability of implementation were still of concern in studies. This study investigated residents' experiences of Virtual Zen Garden in Hong Kong. Twenty-four residents were interviewed using semi-structured interviews based on the phenomenological research approach in two long-term care homes. This study aligns with the COREQ (Consolidated Criteria for Reporting Qualitative Research Checklist). Nine theme clusters were organized that described the influence of Virtual Zen Garden on residents' quality of life in long-term care homes. They are 'staying engaged despite no change in physical condition', 'embracing current physical functioning', 'being the one to exercise autonomy', 'fostering a sense of relaxation and acceptance to the past, current and future lives', 'fostering a sense of satisfaction, purpose and mastery', 'open to companionship with staffs', 'feeling a sense of connection with other residents', 'perceiving a sense of security and identity in the living environment' and 'accepting the place they stay as a home in the rest of life'. Virtual Zen Garden demonstrated positive beneficial effect on quality of life in physical, psychological, social, and environmental perspectives. The findings were encouraging for the introduction of Virtual Zen Garden as an innovative intervention, into long-term care homes.

Effects and Acceptability of a 1-Week Home-Based Virtual Reality Training for Supporting the Management of Stress and Anxiety: Randomized Pilot Trial

BACKGROUND

Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist's office or hospitals) and content (ie, virtual experiences only for relaxation).

OBJECTIVE

This randomized pilot trial aims to investigate the efficacy and acceptability of a brief remote VR-based training for supporting stress and anxiety management in a sample of Italian health care workers.

METHODS

A total of 29 doctors and nurses (n=21; 72% female; mean age 35.6, SD 10.3 years) were recruited and randomized to a VR intervention group or a control group in a passive control condition. Participants assigned to the VR intervention group received remote VR-based training consisting of 3 sessions at home delivered in 1 week using the VR psychoeducational experience "MIND-VR" and the 360° relaxing video "The Secret Garden." The primary outcome measures were stress, anxiety, depression, and the knowledge of stress and anxiety assessed at baseline and posttreatment. We also evaluated the immediate effect of the remote VR-based training sessions on the perceived state of anxiety and negative and positive emotions. The secondary outcome measure was the usability at home of the VR system and content.

RESULTS

The VR intervention significantly reduced stress levels as assessed by the Perceived Stress Scale (6.46, 95% CI 2.77 to 10.5; P=.046) and increased the knowledge of stress and anxiety, as evaluated by the ad hoc questionnaire adopted (-2.09, 95% CI -3.86 to -0.529; P=.046). However, the home-based VR training did not yield similar reductions in stress, anxiety, and depression levels as assessed by the Depression, Anxiety, and Stress Scale-21 items or in trait anxiety as evaluated through the State-Trait Anxiety Inventory Form Y-1. After the home training sessions with VR, there was a significant decrease in anxiety, anger, and sadness and an increase in happiness levels. Analyses of the questionnaires on usability indicated that the health care workers found using the VR system at home easy and without adverse effects related to cybersickness. Of 33 participants, 29 (88%) adhered to the protocol.

CONCLUSIONS

The results of this randomized pilot study suggest that a week-long home VR intervention, created with content created specifically for this purpose and available free of charge, can help individuals manage stress and anxiety, encouraging further research investigating the potential of remote VR interventions to support mental health.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04611399; https://tinyurl.com/scxunprd.

The Benefits of Virtual Reality Travel on Symptom Burden and Mental Health of Hemodialysis Patients

CONTEXT

Hemodialysis (HD) patients often face a heavy symptom burden, low subjective well-being, and high perceived stress. Traditional nonpharmacological interventions have limited effectiveness in improving this situation. Virtual reality (VR) technology, as an emerging approach, has shown significant advantages in alleviating symptom burden and enhancing mental health.

OBJECTIVE

To assess the feasibility of a single VR travel session for HD patients and to examine its impact on symptom burden, subjective well-being, and perceived stress.

METHODS

This study adopted an embedded design, providing approximately 10 minutes of natural VR travel experience using VR head-mounted displays (HMD). The effectiveness of a single VR travel session for HD patients was evaluated. Quantitative data were collected through self-reported surveys using the Dialysis Frequency Severity and Symptom Burden Index (DFSSBI) to assess symptom burden, the General Well-Being Schedule (GWBS), and the Perceived Stress Scale (PSS) to evaluate well-being and stress. Postintervention, a modified single-item questionnaire assessed patient satisfaction with the VR travel experience. An open-ended question was included to capture patients' experiential feedback.

RESULTS

Twenty HD patients, with a mean age of 41.30 (9.82) years, completed the VR travel and subsequent assessments. The cohort comprised 35% female and 65% male participants. The VR travel significantly improved symptom burden (t = 3.64, P = 0.002), increased subjective well-being (t = -6.12, P < 0.001), and reduced perceived stress (t = 4.16, P = 0.001). The postintervention satisfaction score was 7.35 (1.35) out of 10, and participants provided positive feedback on their VR travel experience.

CONCLUSION

A single VR travel session can alleviate symptom burden, enhance subjective well-being, and reduce perceived stress in HD patients. Participants reported high satisfaction and positive emotional responses, suggesting that this experience could be integrated into care routines as a nonpharmacological intervention to improve symptom burden and mental health in HD patients.

CLINICAL TRIAL REGISTRATION

[www.chictr.org.cn], identifier [ChiCTR2400082781].

Shifting perspectives: an investigation of a virtual reality awe experience in people going through cancer treatment

PURPOSE

Evoking awe using virtual reality appears to be a promising intervention that has potential to positively impact physical and psychological well-being. The purpose of this exploratory study was to investigate the acceptability and potential benefits of a VR experience of awe for patients undergoing cancer treatment.

METHODS

Twenty cancer patients viewed a 5-min VR nature experience designed to induce awe and completed questionnaires assessing anxiety, symptom distress, spirituality, and connectedness to nature. Qualitative interviews assessed acceptability and ways to improve the intervention.

RESULTS

The VR experience effectively induced awe. Following the experience, participants reported decreased anxiety and symptom distress and increased feelings of spirituality and connectedness to nature. Participants enjoyed the experience and said they would use it again and would recommend it to others.

CONCLUSION

VR nature interventions that induce awe are worthy of future investigation as a psychological approach to support cancer patients undergoing treatment.

Harnessing the therapeutic effects of nature for chronic Pain: A role for immersive virtual reality? A narrative review

BACKGROUND AND OBJECTIVE

There is a growing interest in the relationship between nature and pain relief. Evidence from environmental psychology, neuroscience and physiology-based studies point towards analgesic effects of nature being mediated through various cognitive, affective and/or autonomic factors. Being able to harness these therapeutic effects using immersive virtual reality (VR) could help to optimize and improve accessibility of nature-based environments as part of chronic pain management plans. In this narrative review, we present evidence supporting a new theoretical framework for nature-based analgesia and suggest ways for applying this through immersive VR.

DATABASES AND DATA TREATMENT

We provide an overview of the evidence on (1) the therapeutic effects of nature on pain, (2) environmental psychology theory that underpins the health benefits of nature, (3) key mechanistic evidence from nature neuroimaging and physiology-based studies, (4) previous studies that have used VR-based nature in pain research and (5) how to design effective VR interventions that can be used to integrate nature into immersive 360 environments.

RESULTS

We have demonstrated how environmental psychology, neuroscience and physiology-based research can be used to form a novel theoretical framework for nature-based analgesia. Using this framework, we identify how key aspects of nature can act as analgesic and how this can be harnessed using immersive VR.

CONCLUSIONS

Through developing this theoretical framework, we have provided a foundation on which to guide future experimental and clinical studies as well as helping to improve the accessibility of nature for chronic pain patients through immersive VR technologies.

SIGNIFICANCE

This review article summarizes key multidisciplinary evidence to help understand how nature exerts beneficial effects on pain processing. The use of this theoretical framework alongside advances in immersive VR technologies provides a springboard for future research and can be used to help develop new nature-based therapeutics using VR.

Experience of breast cancer patients participating in a virtual reality psychological rehabilitation: a qualitative study

OBJECTIVE

Breast cancer is one of the most common types of cancer in China and worldwide. Apart from cancer, a majority of breast cancer patients suffer from various psychological disorders concurrently. The purpose of this study is to understand the actual experiences of breast cancer patients participating in Virtual Reality (VR) for psychological intervention, and to provide a theoretical basis for the development of VR psychological rehabilitation in China.

METHODS

Twenty-three breast cancer patients who met the inclusion criteria were selected using purposive sampling method for this qualitative study. Semi-structured interviews were conducted to explore their experiences with VR psychological rehabilitation. The data were analyzed, summarized, and generalized using the Colaizzi analysis method.

RESULTS

The results of the interviews were consistent with the PAC structural analysis. Three themes and six sub-themes captured how patients felt about adopting VR for their psychological rehabilitation, including parent ego state (the feeling of loss when expectations are not met, improvement of sleep), adult ego state (relief of psychological stress, optimization, and recommendations for VR therapy), and child ego state (novel and fun immersive experience, contagiousness of variable emotions).

CONCLUSION

Breast cancer patients participating in the VR psychological rehabilitation had a favorable experience. To maximize the benefit of VR psychological rehabilitation, healthcare professionals should comprehensively assess the psychological state of breast cancer, optimize VR technology, and enable patients to enter the adult ego state. The new model of VR psychological rehabilitation needs to be further explored.

Exposure to simulated nature promotes positive body image irrespective of the presentation modality: A comparison of images, 2-dimensional film, and 360° immersive film

Previous studies have shown that exposure to simulated natural environments can elevate state body appreciation, but stimulus sets have been limited to the use of images and 2-dimensional (2D) film. To extend this work, we examined the relative impact of images, 2D film, and a 360° immersive film on immediate, state body appreciation. A total of 136 German-speaking adults from Austria (71.3 % women; age range 18-69 years) were randomly assigned to one of three conditions, in which they viewed an image set, a 2D film, or a 360° film depicting the same natural environment. Before and after viewing the stimuli, they completed measures of state body appreciation, affect, and desire for aesthetics. Our results showed that state body appreciation improved in all three conditions, with effect sizes ranging from Cohen's d = 0.26 (2D film) to 0.52 (360° film). Presentation modality did not significantly shape improvements in state body appreciation; that is, the elevation in state body appreciation was equivalent across all three groups. Participants also experienced improvements in feelings of pleasantness, but again this was independent of the experimental group. These results suggest exposure to simulated nature may improve state body appreciation irrespective of the presentation modality.

The effects of digital nature and actual nature on stress reduction: A meta-analysis and systematic review

Objectives

The study aims to conduct a systematic literature review and meta-analysis to assess the effects of digital nature and actual nature on stress reduction.

Methods

In August 2023, Web of Science, Scopus, ProQuest, PubMed, and EBSCOhost databases were used, and ten articles were in the analysis, with a total sample size of 886 participants. Studies within- or between-subjects design conducted in either a randomized controlled trial or a quasi-experimental design were included. No restriction was put on the year of publication or geographical region. Conference papers and dissertations were also included whereas, book chapters were excluded. Participants included those who were exposed to at least one form of digital nature exposure, such as static images, videos, 360° pictures, and 360° videos. The risk of bias determined through Review Manager 5.4 was used to assess the quality of the studies. STATA software package version 16 was used for visual analysis of funnel plots. For the assessment of potential publication bias, Egger's test was implemented.

Results

Digital natural environments had the same level of stress recovery compared to actual environmental exposures with the same intervention content (SMD = -0.01; 95% CI: -0.15, 0.12). Subgroup analyses and meta-regression indicated that subjective or physiological stress measures, level of immersion, and data extraction method were not associated with pooled effect stress recovery. All subgroups showed comparable stress levels in both conditions. In addition, all included studies had different levels of risk of bias (low, moderate, and high).

Conclusions

The present study concludes that previous research has generally shown that stress levels are reduced in both digital and actual natural environments. The results of the meta-analysis support this conclusion with no significant differences between the two modes of stress recovery through nature viewing.

Ecological brain: reframing the study of human behaviour and cognition

The last decade has seen substantial advances in the capacity to record behaviour and neural activity in humans in real-world settings, to simulate real-world situations in laboratory settings and to apply sophisticated analyses to large-scale data. Along with these developments, a growing number of groups has begun to advocate for real-world neuroscience and cognitive science. Here, we review the arguments and the available methods for real-world research and outline an overarching framework that embeds key ideas proposed in the literature integrating them into a cyclic process of 'bringing the lab to the real world' (recording behavioural and neural activity in real-world settings) and 'bringing the real-world to the lab' (manipulating the environments in which behaviours occur in the laboratory) that combines exploratory and confirmatory research and is interdisciplinary (including those sciences concerned with the natural, built or virtual environment). We highlight the benefits brought by this framework emphasizing the greater potential for novel discovery, theory development and human-centred applications to the environment.

3D built virtual arctic environment increase vigor through connectedness in older people

While the life expectancy of older people has increased significantly, this is often related to more long-term care in healthcare residences and nursing homes. Staying in these facilities can lead to a reduction in the sense of connection with others and the world around, as well as in vigor, with significant psychophysical repercussions in the long term. Although previous studies have shown that the virtual nature can benefit both, there are no significant studies that have tested its effect in generating these positive outcomes in the older population. Therefore, our study sought to investigate, in a sample of 53 older people in care at a nursing home or healthcare residence, the indirect effect of a 3D built virtual arctic environment (vs. a 3D built virtual urban environment) exposure in virtual reality on vigor through connectedness. Both the virtual scenarios were designed with a first-person view, with no translation around the environment and only in-situ rotation. Results highlighted that exposure to the 3D built virtual arctic environment leads to higher connectedness than the 3D built virtual urban environment, and this, in turn, leads to an increase in vigor. Findings were discussed based on the potential of adopting virtual nature in facilities to improve older people's sense of connectedness and, in turn, improve their well-being.

Effect of Relaxation-Based Virtual Reality on Psychological and Physiological Stress of Substance Abusers Under Detoxification: A Randomized Controlled Trial

INTRODUCTION

Substance abuse is a widespread problem, with high rates of treatment dropout. Stress plays a crucial role in this problem, so innovative interventions with stressed patients can assist them in completing treatment.

METHODS

This study is a randomized controlled trial with 60 participants who have substance abuse disorder undergoing detoxification at a residency facility in Tehran, Iran. Participants were randomly assigned to one of three groups: watching a 360° video of nature, a 360° video of a city environment, or no virtual experience. The intervention was performed only for one session. Psychological stress was measured using the Positive and Negative Affect Schedule and Perceived Stress Scale before and after the intervention. Physiological stress was assessed through respiratory rate, skin conductance, and heart rate recordings during the virtual reality (VR) experience. Data analysis was performed using R software (version 4.2).

RESULTS

Paired t-test results indicated significant psychological differences before and after virtual nature experiences, but not in the control and city groups. The repeated measure ANOVA showed a significant reduction in skin conductance (p < 0.01) and respiratory rate (p < 0.01) scores in the nature group.

CONCLUSION

The findings suggest that VR relaxation could be a potentially beneficial intervention for reducing stress in patients during detoxification.

A short simulated nature experience as an effective way to promote restoration from work-related stress

Spending time in nature, and even watching images or videos of nature, has positive effects on one's mental state. However, cognitively stressful work is often performed indoors, in offices that lack easy access to nature during breaks. In this study, we investigated whether watching a 5-min audiovisual video that describes a first-person perspective walk on a forest path could help to restore one's mental state after cognitive stress. Participants were asked to perform cognitive stressor tasks, after which they were shown either a nature walk video or a control video. Subjective restoration was measured using self-reports before and after the videos, while electrodermal activity (EDA) and electroencephalography (EEG) were measured during the video-watching session. The results showed that experiencing the nature walk video enhanced subjective restoration more than watching the control video. Arousal of the autonomic nervous system, measured using EDA, decreased more during the nature walk video than during the control video. Additionally, activity in the EEG's upper theta band (6-8 Hz) and lower alpha band (8-10 Hz) increased during the nature walk video, suggesting that it induced a relaxed state of mind. Interestingly, the participants' connection with nature moderated the effects of the nature video. The subjective and physiological measures both suggest that watching a short, simulated nature walk may be beneficial in relaxing the mind and restoring one's mental state after cognitive stress.

Examining the audiovisual therapy effects on hospital groups of varying linear canopy landscapes and those with hydrodynamic forces

Recent research has highlighted the beneficial effects of urban green spaces on physical and mental health. This study focused on the hospital population and innovatively subdivided the population into four groups: doctors, caregivers, patients and nurses. A total of 96 volunteers participated in this virtual reality experiment to assess the restoration of a linear canopy landscape and a landscape with different levels of hydrodynamics through interactive audiovisual immersion. We utilized pre-research method, brainwave monitoring technique, psychological scales, observation and interviews in this experiment. The research identified five key findings. First, both linear canopy landscapes and those with low to medium hydrodynamic forces significantly enhance physiological and psychological restoration for all groups, with the most substantial physiological benefits observed in doctors and patients, and the greatest psychological relief noted in caregivers. Second, landscapes with medium hydrodynamic forces yield higher restorative effects than those with low forces in hospital settings. Third, green landscapes with medium and low-density canopies prove more conducive to patient recovery compared to those with high-density canopies. Fourth, the inclusion of bird songs does not markedly affect physiological restoration across the hospital groups. Finally, landscapes that incorporate elements of water dynamics, open skies, and lightly foliated canopies draw significant interest from all groups involved. This study advocates for the integration of natural blue and green elements into hospital environments as complementary therapeutic interventions, aiming to alleviate stress and promote health recovery among hospital communities.

The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregivers

Background

Nature-based and other outdoor virtual reality (VR) experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Hospice care services and healthcare need strategies to help patients and informal caregivers with EOL transitions.

Methods

Our study uses the synchronized Tandem VR TM approach where patient-caregiver dyads experience immersive nature-based and other outdoor VR content. This mixed methods study will recruit 20 patient-caregiver dyads (N = 40) enrolled in home hospice services nearing EOL. Dyads will experience a personalized nature-based and other outdoor VR experience lasting 5-15 min. Self-reported questionnaires and semi-structured interviews will be collected pre/post the VR intervention to identify the impacts of Tandem VR TM experiences on the QOL, pain, and fear of death in patient-caregiver dyads enrolled with hospice services. Additionally, this protocol will determine the acceptance of Tandem VR TM experiences by dyads as a non-pharmacological modality for addressing patient and caregiver needs. Acceptance will be quantified by the number of dyads accepting or declining the VR experience during recruitment.

Discussion

Using personalized, nature-based and other outdoor VR content, the patient-caregiver dyads can simultaneously engage in an immersive encounter may help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress.

Trial registration

NCT06186960.

Age-related differences in subjective and physiological emotion evoked by immersion in natural and social virtual environments

Age-related changes in emotional processing are complex, with a bias toward positive information. However, the impact of aging on emotional responses in positive everyday situations remains unclear. Virtual Reality (VR) has emerged as a promising tool for investigating emotional processing, offering a unique balance between ecological validity and experimental control. Yet, limited evidence exists regarding its efficacy to elicit positive emotions in older adults. Our study aimed to explore age-related differences in positive emotional responses to immersion in both social and nonsocial virtual emotional environments. We exposed 34 younger adults and 24 older adults to natural and social 360-degree video content through a low immersive computer screen and a highly immersive Head-Mounted Display, while recording participants' physiological reactions. Participants also provided self-report of their emotions and sense of presence. The findings support VR's efficacy in eliciting positive emotions in both younger and older adults, with age-related differences in emotional responses influenced by the specific video content rather than immersion level. These findings underscore the potential of VR as a valuable tool for examining age-related differences in emotional responses and developing VR applications to enhance emotional wellbeing across diverse user populations.

Susceptibility to stress and nature exposure: Unveiling differential susceptibility to physical environments; a randomized controlled trial

BACKGROUND

Emerging epidemiological evidence indicates nature exposure could be associated with greater health benefits among groups in lower versus higher socioeconomic positions. One possible mechanism underpinning this evidence is described by our framework: (susceptibility) adults in low socioeconomic positions face higher exposure to persistent psychosocial stressors in early life, inducing a pro-inflammatory phenotype as a lifelong susceptibility to stress; (differential susceptibility) susceptible adults are more sensitive to the health risks of adverse (stress-promoting) environments, but also to the health benefits of protective (stress-buffering) environments.

OBJECTIVE

Experimental investigation of a pro-inflammatory phenotype as a mechanism facilitating greater stress recovery from nature exposure.

METHODS

We determined differences in stress recovery (via heart rate variability) caused by exposure to a nature or office virtual reality environment (10 min) after an acute stressor among 64 healthy college-age males with varying levels of susceptibility (socioeconomic status, early life stress, and a pro-inflammatory state [inflammatory reactivity and glucocorticoid resistance to an in vitro bacterial challenge]).

RESULTS

Findings for inflammatory reactivity and glucocorticoid resistance were modest but consistently trended towards better recovery in the nature condition. Differences in recovery were not observed for socioeconomic status or early life stress.

DISCUSSION

Among healthy college-age males, we observed expected trends according to their differential susceptibility when assessed as inflammatory reactivity and glucocorticoid resistance, suggesting these biological correlates of susceptibility could be more proximal indicators than self-reported assessments of socioeconomic status and early life stress. If future research in more diverse populations aligns with these trends, this could support an alternative conceptualization of susceptibility as increased environmental sensitivity, reflecting heightened responses to adverse, but also protective environments. With this knowledge, future investigators could examine how individual differences in environmental sensitivity could provide an opportunity for those who are the most susceptible to experience the greatest health benefits from nature exposure.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

Identify the significant landscape characteristics for the perceived restorativeness of 8 perceived sensory dimensions in urban green space

The restorative benefits of urban green spaces (UGSs) have been supported by many studies. Eight perceived sensory dimensions (PSDs) are regarded as a tool to classify green spaces based on perception. However, little attention has been given to the effects of landscape characteristics (LCs) on the perceived restorativeness (PR) of green spaces. Thus, this study aims to clarify this relationship using the eight PSDs. The research collected information, via video stimulus, from 30 participants on the restorative experiences of urban green parks, according to the eight kinds of PSDs. The skin conductance level obtained via biosensors was used to measure the PR. The subjective satisfaction evaluation of 10 LCs was further obtained using a 5-point Likert scale. The data were analyzed using correlation and regression analyses. The results show that the UGSs with dominant "serene," "open," and "sheltered" PSDs are rated highest for restoration. Furthermore, the findings identify the significant factors affecting the restoration of green spaces using different PSDs. In green spaces controlled by PSD, scene, vegetation, water features, and disturbances are more reliable predictors for restoration. The results indicate how different PSD spaces can be distributed in green urban planning and provide key points for designing each PSD for restoration. The use of physiological indexes rather than subjective feelings provides an alternative for demonstrating the restorative benefits of the environment. However, before it can officially be used by designers, more research is needed.

Effectiveness of Virtual Reality-Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review

BACKGROUND

Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies.

OBJECTIVE

This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored.

METHODS

This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively.

RESULTS

In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics.

CONCLUSIONS

Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions.

Into the wild: uncertain frontiers and sustainable human-nature interactions

Humans seldom consider themselves as animals, and that humans are animals is a truth frequently turned into an insulting metaphor indicating "uncivilized" behavior in many cultures. Interestingly, the "civilizing" aspects of Western Culture in the Global North are historically derived from traditions of democracy based on living in cities from which the wild has been banished. This is embedded in the English language since civilizing and civilization come from the Latin for city, civitas, the place where citizens hold voting rights. Beyond the gates of civilization is the wild. How the wild and nature have been constructed and demarcated is an enormously complex and enduring challenge in western philosophy as it relates to knowledge-making, existence, truth, and reality. Indeed, whilst people generally believe they know what nature means, they rarely realize that little in nature is wild. Furthermore, the concept of uncertainty, central to the pandemic, is compounded by climate instability and a potentially disastrous future. This is breaking down what is known, requiring porous and flexible conceptual frontiers and a transdisciplinary approach. This article traces the linguistic separation of humans from their animal origins and wilder environments for political and increasingly greedy economic purposes. It explores the acknowledged complexity of healthy human-nature interactions, juxtaposing information mainly from the humanities and social sciences. Demonstrating how unhealthy the current paradigm has proven to be for humans and the natural world, it brings together conflicting information to disrupt traditional certainties using an innovative bricolage methodology. It weaves and combines different ways of knowing as it considers forms of knowledge-making, rewilding, foraging, the place of magical thinking, and vital force. It concludes that a new paradigm is needed to enable a way of working toward any vision of healthy human-nature interaction.

How can plant-enriched natural environments benefit human health: a narrative review of relevant theories

Plant-enriched environments, the most common terrestrial landscapes, are usually coded as "green space" in urban studies. To understand how these natural environments can benefit human health, many theories have been developed, such as the well-known Attention Restoration Theory. Nowadays, more theories are emerging with regard to various and complex health dimensions. In this context, we searched online databases (from 2000 to 2022) and conducted a narrative review aiming to introduce relevant theories concerning psychological (e.g. Perceptual Fluency Account and Conditioned Restoration Theory), physiological (e.g. volatile organic compounds and environmental microbiomes), and behavioural (e.g. physical activity and social contact) perspectives. We also slightly mentioned some limitations and directions to be considered when using these theories. These results may offer general readers insights into the value of nature exposure and also help relevant researchers with study design and result interpretation.

Immersive virtual reality and psychological well-being in adult chronic physical illness: systematic review

INTRODUCTION

Individuals with chronic physical illness are at increased risk of negative psychological sequelae. Immersive virtual reality (VR) is an emerging treatment that might reduce these negative effects and increase quality of life in individuals with chronic physical illness.

OBJECTIVE

To systematically review literature examining the use of immersive VR in adult populations with chronic physical illness to understand: (1) how immersive VR is used to improve psychological well-being of adults with chronic physical illness (2) what effect this immersive VR has on the psychological well-being of adults with chronic physical illness.

DESIGN

Systematic literature review and meta-analysis. Searches of Ovid Medline/PubMed, PsycINFO, Embase, Web of Science and Scopus between July 1993 and March 2023 inclusive.

RESULTS

12 811 texts were identified; 31 met the inclusion criteria. Relaxing and engaging immersive VR interventions were shown to be acceptable and feasible among adults with cancer, dementia, cardiovascular disease, kidney disease and multiple sclerosis. Many of the studies reviewed were feasibility or pilot studies and so the evidence about effectiveness is more limited. The evidence, mostly from studies of people with cancer, suggests that immersive VR can have a positive effects on anticipatory anxiety symptoms and pain.

CONCLUSIONS

Environment-based and game-based relaxing immersive VR offer novel interventions, with beneficial effects among people with cancer and, potentially, beneficial effects in those with other long-term physical illness.

Does increasing biodiversity in an urban woodland setting promote positive emotional responses in humans? A stress recovery experiment using 360-degree videos of an urban woodland

Green spaces can support human stress reduction and foster positive emotional well-being. Previous research has suggested that biodiversity (i.e. the variety of species of plants and animals in a given location) can enhance recovery from stress even further. However, there is limited experimental evidence testing this hypothesis and results, to date, have been mixed. This study aimed to provide further understanding of the role of biodiversity (actual or perceived) on human well-being by experimentally manipulating species richness and stress. Participants (372 in total) took part in an online experiment, where they received an episode of mild stress before watching a 360-degree video to recover. The video showed the same location, an urban woodland, but at one of four artificially manipulated levels of biodiversity. The participants reported their Positive and Negative Affect before and after the stress induction and after watching the video, providing a measure of their stress and well-being throughout the experiment. Participants also reported their perceptions of biodiversity (i.e. how diverse they thought the location was) and elaborated on their responses with brief comments. Repeated Measure Analysis of Variance revealed that exposure to all levels of biodiversity reduced the participants' Negative Affect, but with no significant difference between the conditions. However, the analysis showed higher Positive Affect in those participants who perceived the environment as more biodiverse. Comments from participants indicated that those who reported noticing flowers and trees in the environment also showed higher Positive Affect. This suggests that perceiving biodiversity promotes more positive emotions, but critically one needs to actually notice (engage with) the components of biodiversity to elicit these extra benefits.

Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT)

BACKGROUND

Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings.

OBJECTIVE

The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience.

METHODS

A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method.

RESULTS

VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy.

CONCLUSIONS

Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/22406.

Self-Assessed Experience of Emotional Involvement in Sensory Analysis Performed in Virtual Reality

Virtual reality (VR) technology has gained significant attention in various fields, including education for health professionals, sensory science, psychology, and consumer research. The first aim of the paper is to explore the self-assessed experience of emotional involvement in sensory analysis performed in VR. The Positive and Negative Affect Schedule (PANAS) is a widely used self-report measure that assesses positive and negative affective states. VR sensory analysis involves the use of immersive, interactive, and multi-sensory environments to evaluate sensory perception and emotional responses. By synthesizing relevant literature, this paper provides insights into the impact of VR on affective states, the effectiveness of VR in eliciting emotions, and the potential applications of the PANAS in VR sensory analysis. Furthermore, the second aim of the paper is to uncover the effect of VR sensory evaluation on the participant's emotional states, as it has a significant effect on their evaluations. The results suggest an increase in the sum of positive effects and a decrease in the negative ones. Although these results are promising, the relationship between the PANAS and VR sensory analysis is still underexplored, with limited research investigating the specific effects of VR on affective states measured using the PANAS. Further research is needed to better understand the potential of the PANAS in assessing emotional responses in VR environments and its implications for sensory analysis.

Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population

BACKGROUND

Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system).

OBJECTIVE

This study aims to investigate the impact of physical exercise in a VR environment.

METHODS

A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence).

RESULTS

First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality-stimulation=1.90; hedonic quality-identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04).

CONCLUSIONS

These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.

Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review

Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.

Predictors of sustained physical activity: behaviour, bodily health, and the living environment

This study examined the determinants of sustained physical activity. Eighty-four participants undertook a 7-weeks walking regime (i.e., a 1-h biometrically-monitored walk, at least 5 days/week), with bioelectrical impedance (BIA) and total cholesterol capillary blood measurements performed before and after programme. To investigate behavioural habit formation, 7 weeks after walking termination, all participants were interviewed and (health) re-tested. Data were modelled with an artificial neural network (ANN) cascading algorithm. Our results highlight the successful prediction of continued physical activity by considering one's physical fitness state, the environmental living context, and risk for cardiovascular disease. Importantly, those artificial neural network models also taking body mass index (BMI) and blood cholesterol as predictors excel at predicting walking continuation (i.e., predictions with 93% predictability). These results are first to highlight the type and importance of available physiological drivers in maintaining a sustained physical activity regime such as walking. They are discussed within the framework of habit formation and the nowadays health and/or wellbeing focus.

Exploring small stories of older adults elicited by virtual nature videos with a randomized online survey

Objective

Counteracting feelings of loneliness among older adults underscores the need to improve social well-being, for example, by sharing small stories. Interestingly, virtual representation of nature (VN) can stimulate social aspirations and trigger associations, which could be used as conversational material. Especially nature's characteristics of mystery and spaciousness seem promising. Therefore, it was investigated whether VN can elicit small stories in older adults using a randomized 2 (mystery: low vs. high) × 2 (spaciousness: low vs. high) design.

Methods

In total 118 participants (60 years and older) were recruited. Small stories, nature-relatedness, available nature opportunities and demographics were measured. The small stories were analysed with respect to story elements (sum range: 0-4) and storytelling characteristics (ease of storytelling, valence, social intention).

Results

The VN were able to elicited small stories: 97% (N = 115) contained at least one story element. Moreover, when participants felt more related to nature and assigned more positive valence to their story, they also had stronger intentions to use their story for social interaction. The VN characteristics of mystery and spaciousness showed no effects.

Conclusion

Not so much the characteristics of nature (mystery and spaciousness) as the characteristics of the participants (nature-relatedness) played an important role in eliciting and sharing small stories.

Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients

OBJECTIVE

Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting.

DESIGN

Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences.

SETTING

Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment.

PARTICIPANTS

20 adult patients (12 women) with bipolar disorder (n=18) or unipolar depression (n=2).

RESULTS

Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care.

CONCLUSIONS

VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.

The Immediate Effects of Immersive Virtual Reality on Autonomic Nervous System Function in Patients with Disorders of Consciousness after Severe Acquired Brain Injury: A Pilot Study

Disorders of Consciousness (DoCs) after severe acquired brain injury involve substantial impairment of cognition and physical functioning, requiring comprehensive rehabilitation and support. Technological interventions, such as immersive Virtual Reality (VR), have shown promising results in promoting neural activity and enhancing cognitive and motor recovery. VR can induce physical sensations that may activate the Autonomic Nervous System (ANS) and induce ANS-regulated responses. This study aimed to investigate the effects of immersive VR on the ANS in patients with DoCs through the analysis of the electrodermal activity (EDA). EDA was measured with a wearable device during a single immersive VR session consisting of static and dynamic videos depicting naturalistic environments. A pilot case-control study was conducted with 12 healthy participants and 12 individuals with DoCs. Results showed higher EDA values in patients than in healthy participants (p = 0.035), suggesting stronger autonomic activation during immersive VR exposure, while healthy subjects, in turn, showed a decrease in EDA values. Our results revealed a significant interaction between conditions and groups (p = 0.003), with patients showing significantly increased EDA values from the baseline compared to dynamic video observation (p = 0.014) and final rest (p = 0.007). These results suggest that immersive VR can elicit sympathetic arousal in patients with DoCs. This study highlights the potential of immersive VR as a tool to strengthen autonomic responses in patients with impaired consciousness.

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Restorative Effects of Biophilic Workplace and Nature Exposure during Working Time: A Systematic Review

The work environment plays a crucial role in the health and performance of employees. The growing interest in workers' well-being has driven the inclusion of nature in workplaces, despite many employees spending most of their time indoors, away from nature. Studies show that biophilic design in offices can have positive effects and promote workers' well-being. However, research on the beneficial effects of nature exposure in the workplace is limited and scattered. Thus, the aim of this systematic review was to consolidate current knowledge on the restorative effects of nature exposure on workers during work activities. Different types of exposure, both outdoors and indoors, were considered, with a focus on outcomes related to well-being, motivation, job satisfaction, and work performance. Out of the initially identified 1225 articles, only 16 met the criteria for analysis. Although the analysed studies provided compelling evidence regarding the restorative effects of nature exposure in the workplace, the review also points out gaps and limitations concerning the number of specific studies in this area and the need to adequately assess the sensory dimensions involved in these effects. Conducting more comprehensive and multidimensional investigations into the impacts of nature on the work environment could contribute to guiding more effective design strategies and creating healthier and more productive workplaces for employees.

Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic

Background

The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool.

Objective

The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany.

Methods

The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers.

Results

In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05).

Conclusion

A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients.

Clinical trial registration

https://clinicaltrials.gov/, DRKS00027911.

Creating Custom Immersive 360-Degree Videos for Use in Clinical and Nonclinical Settings: Tutorial

The use of virtual reality (VR) stimulation in clinical settings has increased in recent years. In particular, there has been increasing interest in the use of VR stimulation for a variety of purposes, including medical training, pain therapy, and relaxation. Unfortunately, there is still a limited amount of real-world 360-degree content that is both available and suitable for these applications. Therefore, this tutorial paper describes a pipeline for the creation of custom VR content. It covers the planning and designing of content; the selection of appropriate equipment; the creation and processing of footage; and the deployment, visualization, and evaluation of the VR experience. This paper aims to provide a set of guidelines, based on first-hand experience, that readers can use to help create their own 360-degree videos. By discussing and elaborating upon the challenges associated with making 360-degree content, this tutorial can help researchers and health care professionals anticipate and avoid common pitfalls during their own content creation process.

Urban cultural heritage is mentally restorative: an experimental study based on multiple psychophysiological measures

Introduction

Urban cultural heritage sites bear the cultural functions of a city, hold spiritual and cultural value, can recall emotional memories, and serve the cultural leisure activities of the residents. Urban cultural heritage sites can help citizens perceive a sense of belonging and a feeling of relaxation, but whether and to what extent cultural heritage sites affect mental health remains unknown.

Methods

Based on attention restoration theory, multiple research methods are adopted in this study to examine the impact of cultural heritage on human restorative mechanisms. Five representative cultural heritage sites from the cultural heritage-rich city of Xi'an are selected as the research object. In addition, a questionnaire survey and physiological experiments are conducted. Perceived restorative scale, skin conductance response, heart rate variability, and eye movement data while viewing photographs of the cases are collected from the participants.

Results

Results show that cultural heritage sites have psychophysiological restorative effects, which are especially significant in the fascination dimension. Moreover, historical buildings can promote the restorative effects of cultural heritage sites.

Discussion

This finding may lead to new conservation and innovation planning strategies considering the mental health effects of cultural heritage.

The effect of simulated natural environments in virtual reality and 2D video to reduce stress

Stress is a common problem associated with poor physical and psychological health. Exposure to the natural environment is one method for reducing stress. The real and simulated natural environments have a restorative effect on stress reduction. In contrast to the real environment, simulated natural environments, such as virtual reality and 2D video, provide safer and more controllable exposure. Several studies on the restorative effects of the natural environment in virtual reality and 2D video have been conducted. However, the difference between the two in reducing stress must be clarified. This study was conducted to determine the effect of the simulated natural environments in virtual reality and 2D video and their differences in reducing stress. This study hypothesizes that both simulated natural environments in virtual reality and 2D video can reduce stress, but there is a difference between them in reducing stress. Fifty-three subjects were divided into two experimental groups: 2D video (n = 28) and virtual reality (n = 25). The results indicated that simulated natural environments in virtual reality and 2D video reduced stress. However, there was no difference between the two groups regarding stress reduction.

Feeling Virtually Present Makes Me Happier: The Influence of Immersion, Sense of Presence, and Video Contents on Positive Emotion Induction

Immersive technologies, such as Virtual Reality (VR), have great potential for enhancing users' emotions and wellbeing. However, how immersion, Virtual Environment contents, and sense of presence (SoP) influence emotional responses remains to be clarified to efficiently foster positive emotions. Consequently, a total of 26 participants (16 women, 10 men, 22.73 ± 2.69 years old) were exposed to 360-degree videos of natural and social contents on both a highly immersive Head-Mounted Display and a low immersive computer screen. Subjective emotional responses and SoP were assessed after each video using self-reports, while a wearable wristband collected continuously electrodermal activity and heart rate to record physiological emotional responses. Findings supported the added value of immersion, as more positive emotions and greater subjective arousal were reported after viewing the videos in the highly immersive setting, regardless of the video contents. In addition to usually employed natural contents, the findings also provide initial evidence for the effectiveness of social contents in eliciting positive emotions. Finally, structural equation models shed light on the indirect effect of immersion, through spatial and spatial SoP on subjective arousal. Overall, these are encouraging results about the effectiveness of VR for fostering positive emotions. Future studies should further investigate the influence of user characteristics on VR experiences to foster efficiently positive emotions among a broad range of potential users.

Virtual nature experiences and mindfulness practices while working from home during COVID-19: Effects on stress, focus, and creativity

In this study, we focus on the impact of daily virtual nature experiences combined with mindfulness practices on remote workers' creativity, stress, and focus over an extended period (9 weeks) during the COVID-19 pandemic. Our results show a positive effect of virtual reality (VR) nature experience on increasing focus and reducing stress. When VR nature and mindfulness practices were combined, we also found an increase in convergent thinking task performance. Our findings demonstrate that 10-minute daily exposure to VR nature and mindfulness practices could compensate for some of the adverse effects of working remotely by improving some aspects of workers' well-being and creativity.

Daily exposure to virtual nature reduces symptoms of anxiety in college students

Exposure to natural environments offers an array of mental health benefits. Virtual reality provides simulated experiences of being in nature when outdoor access is limited. Previous studies on virtual nature have focused mainly on single "doses" of virtual nature. The effects of repeated exposure remain poorly understood. Motivated by this gap, we studied the influence of a daily virtual nature intervention on symptoms of anxiety, depression, and an underlying cause of poor mental health: rumination. Forty college students (58% non-Hispanic White, median age = 19) were recruited from two U.S. universities and randomly assigned to the intervention or control group. Over several weeks, anxious arousal (panic) and anxious apprehension (worry) decreased with virtual nature exposure. Participants identifying as women, past VR users, experienced with the outdoors, and engaged with the beauty in nature benefited particularly strongly from virtual nature. Virtual nature did not help symptoms of anhedonic depression or rumination. Further research is necessary to distinguish when and for whom virtual nature interventions impact mental health outcomes.

Brief repeated virtual nature contact for three weeks boosts university students' nature connectedness and psychological and physiological health during the COVID-19 pandemic: A pilot study

The COVID-19 pandemic and its associated uncertainties and restrictions have adverse impacts on university students' mental wellbeing. Evidence shows that virtual nature contact has mental health benefits. However, little is known about the potential beneficial health impacts of virtual nature contact during times of social distancing, when access to the natural environment is restricted. This pilot study aimed to examine the effectiveness of a 3-week virtual nature contact in improving nature connectedness and reducing psychophysiological stress. A sample of 56 university students in Hong Kong was randomly assigned to control and nature interventions using 2-D video played for 15 min three times a week for 3 weeks. Nature connectedness, perceived restorativeness and psycho-physiological wellbeing were measured. Our findings show significant changes in psychological stress levels after nature interventions compared with the baseline, including increased happiness and stronger emotions of comfort and relaxation. When compared with the control group, the results show the nature intervention group has significantly higher levels of nature connectedness, happiness, and positive affect, but no significant effects on other psychological and physiological variables (e.g., cardiovascular responses). Our preliminary findings highlight the potential use of virtual nature contacts in bolstering university students' wellbeing at times of pandemic or when in-person visit to the natural environment is not feasible.

Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis

Background

Although the mental health benefits of exposure to simulated natural environments are well established by researchers from environmental psychology, landscape architecture, and public health, it is unclear whether and to what extent technological immersion affects these benefits.

Methods

Systematical literature searches were conducted in May 2022 from six databases. The risk of bias was evaluated using the Cochrane's Risk of Bias tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions tool. We performed a random-effects meta-regression to investigate the heterogeneity. The immersion levels of included studies were classified by projection devices and motion capture, and then subgroup analysis was conducted.

Results

Twenty-six publications were included. Exposure to simulated nature was confirmed to be associated with increased positive affect 0.40 [95% confidence interval (CI): 0.22, 0.58], vigor 0.58 (95% CI: 0.30, 0.86), calmness 0.54 (95% CI: 0.17, 0.92) and decreased perceived stress -0.38 (95% CI: -0.71, -0.06), total mood disturbance -0.87 (95% CI: -1.17, -0.57), tension -0.70 (95% CI: -0.99, -0.41), fatigue -0.60 (95% CI: -0.91, -0.28), anxiety -0.72 (95% CI: -1.43, -0.02), depression -0.33 (95% CI: -0.52, -0.14), confusion -0.79 (95% CI: -1.19, -0.40), and anger -0.54 (95% CI: -0.76, -0.31). Gender, health status, study design, mean age, and single exposure duration were not significant when entered in a meta-regression. For positive affect, medium immersion was observed to produce a larger effect than low and high immersion. All included studies had a moderate to high risk of bias.

Conclusion

Audio-visual exposure to simulated nature contributes to stress relief and emotional arousal. The immersion level explains the heterogeneity of positive affect triggered by simulated nature. Focusing on the technical features will open up new possibilities for combining actual and simulated nature's mental health benefits.

Effects of exposure to immersive computer-generated virtual nature and control environments on affect and cognition

Previous research has shown that exposure to immersive virtual nature environments is able to induce positive affective and physiological effects. However, research on the effects on cognitive performance is scarce. Additionally, the effects of virtual nature exposure compared to a virtual control environment with a comparable amount of virtual objects have not been examined so far. Therefore, we conducted an experiment with 27 participants to study the psychological effects of such exposure. The virtual nature consisted of a 3D model of a typical forest environment, whereas the control environment was an abstract replication of the virtual forest environment. In both environments, a virtual wooden cart was used to transport the users from the start to the end of the virtual road. The typical background noise of moving such a cart was integrated into both environments as well. In addition, the virtual nature environment included typical forest sounds in the background, whereas the control condition did not have such background sounds. Both environments were compared with regard to their effects on cognitive performance (using trail making tests (TMTA, TMTB, and TMTB-A) as well as digit span forward and digit span backward tests), perceived restorativeness, mood, stress, sense of presence, and simulator sickness. The results showed that in comparison to the control environment, exposure to the virtual nature resulted in significantly higher cognitive performance, higher perceived restorativeness, higher positive affect, higher sense of presence, lower perceived stress, and lower simulator sickness.