JMIR Publications

ABSTRACT

Background:

Adolescent anxiety is a growing public health concern and is associated with significant academic, social, and emotional impairment. Mindfulness-based interventions (MBIs) have shown promise in reducing anxiety and improving well-being; however, engagement and acceptability remain challenges. Virtual reality (VR)–based delivery may enhance immersion and attention, potentially addressing barriers associated with traditional mindfulness formats. To date, evidence on VR-based mindfulness interventions for adolescents, particularly in Hong Kong, remains limited.

Objective:

This study aimed to evaluate the feasibility and acceptability of a virtual reality mindfulness-based intervention (VR-MBI) delivered via a Cave system for adolescents with mild-to-moderate anxiety symptoms in Hong Kong. Secondary aims were to explore preliminary effects on psychological outcomes and physiological stress regulation, and to identify facilitators and barriers influencing engagement.

Methods:

A mixed-methods single group pre–post study was conducted with adolescents experiencing mild-to-moderate anxiety symptoms, recruited from secondary schools and youth service organizations in Hong Kong. Participants completed an 8-week group-based VR-MBI program. Feasibility and acceptability were assessed using recruitment, attendance, retention, homework practice frequency, dropouts, and adverse events. Psychological outcomes were measured using the Depression Anxiety Stress Scale–21 (DASS-21) and the Mindful Attention Awareness Scale (MAAS). Heart rate variability (HRV) indices (SDNN, RMSSD) were collected at baseline and post-intervention using a wearable device. Post-intervention focus group interviews explored participants’ experiences.

Results:

A total of 42 participants were enrolled and completed both baseline and post-intervention assessments. Attendance was high, with 73.8% of participants attending at least 80% of sessions, and participants engaged in regular homework practice. No dropouts or adverse events were reported. Quantitative analyses showed no significant pre–post changes in self-reported anxiety, depression, stress, or mindfulness. However, significant improvements were observed in HRV indices, indicating enhanced physiological stress regulation. Qualitative findings suggested perceived benefits in emotional regulation, stress reduction, focus, and sleep, with the immersive CAVE environment and group-based format identified as key facilitators of engagement.

Conclusions:

The CAVE-based VR-MBI was feasible and acceptable for adolescents with mild to moderate anxiety symptoms in Hong Kong. Although self-reported psychological outcomes did not show significant change, improvements in physiological indicators of stress regulation and positive qualitative feedback suggest early benefits not fully captured by self-report measures. These findings support further investigation of VR-delivered mindfulness interventions using controlled study designs and longer follow-up periods. Clinical Trial: n/a