JMIR Publications

ABSTRACT

Background:

Supervised fresh-air breaks (FABs) were shown to be a promising method that can support individual health. Nevertheless, labor shortage, as well as other concerns related to safety and environment, can hinder its application in many healthcare settings. Virtual reality (VR) may offer an indoor, immersive alternative that replicates natural environments and supports emotional regulation in confined settings.

Objective:

To evaluate the immediate and short-term effects of a brief, nature-based virtual fresh-air break (VFAB) on mood, anxiety, and subjective distress, and to assess feasibility, acceptability, usability, presence, cybersickness, and safety among adult psychiatric inpatients.

Methods:

A prospective, single-arm pilot study was conducted on a 20-bed locked medical–surgical psychiatric unit at Tufts Medical Center between July and August 2025. Eligible adults were English-speaking, able to provide informed consent, and deemed by the treating team to be suitable for participation without any acute behavioral or safety concerns. Participants completed one 15-minute VFAB session using a standalone Meta Quest 2 headset (Nature Treks VR, Greener Games Ltd; Pine Vesta environment) while seated in a monitored private room. Mood, anxiety, and subjective distress were rated using 0–10 numeric scales before, immediately after, and 48 hours after the session. Post-session questionnaires assessed presence (modified Igroup Presence Questionnaire), usability (System Usability Scale [SUS]), and cybersickness (Virtual Reality Sickness Questionnaire [VRSQ]). Acceptability and feedback were collected post-session, and records were reviewed for safety outcomes within 48 hours. Data were analyzed using Friedman tests for repeated measures and Wilcoxon signed-rank tests with Bonferroni correction, with P < .05 considered statistically significant.

Results:

Of 64 patients screened, 39 (60.9 %) were eligible and 26 (66.7 % of eligible) participated. Most participants (19/26, 73.1 %) were restricted from physical FABs. Median anxiety scores decreased from 5.0 (pre-VR) to 2.0 (post-VR; P = .018) and median distress from 5.0 to 1.0 (P = .001), both returning toward baseline by 48 hours (P = .011 and P = .007). Mood increased non significantly from 5.0 to 7.0 (P = .052; overall P = .066). Usability was high (median SUS 80.0, IQR 72.5–86.9) and cybersickness low (median VRSQ 2.0, IQR 0–6). Presence ratings indicated strong immersion (general presence median 2.0). Nearly all sessions were completed (23/26, 88.5 %), and 69.2 % of participants strongly recommended the experience; 76.9 % wished to repeat it. No adverse events, including seizures, agitation, or restraints, occurred within 48 hours.

Conclusions:

VFAB was feasible, acceptable, and safe in an acute psychiatric unit and produced immediate reductions in anxiety and distress. While effects were not sustained at 48 hours, the intervention was well tolerated with minimal cybersickness and high usability. Findings support evaluation of repeated sessions and comparative trials against supervised outdoor breaks.