A mindfulness-based, remotely used, virtual reality intervention for university students

Title: A one-session, remote mindfulness-based intervention for psychological wellbeing. Rationale: The transdiagnostic potential of mindfulness-based VR interventions for anxiety, stress, and depression, has shown promising results (Navarro-Haro et al., 2017; Riva et al., 2021; Seabrook et al., 2020). One randomised control trial conducted by Liszio and colleagues (2018) with a university student sample, found decreases in anxiety and negative affect and increases of positive affect, and this was comparative to the computer-based and control condition. Materials: The virtual environments were recorded using a 360-degree VR camera (GoPro Hero) and hosted via YouTube VR. The one-session mindfulness intervention components (i.e., psychoeducational videos with audio) were adapted from Barlow's (2010) trans-diagnostic treatment manual referred to as the unified protocol. The module on emotion recognition, present focussed awareness, and non-judgmental emotional awareness was recorded by a provisionally registered psychologist. The one-session mindfulness intervention components (i.e., psychoeducational videos with audio) were adapted from Barlow's (2010) trans-diagnostic treatment manual referred to as the unified protocol. The intervention included 2 x 4-minute psychoeducation videos, recorded in a therapy room. Content reflected Barlow's (2010) module on emotion recognition, present focussed awareness, and non-judgmental emotional awareness. The two psychoeducative videos were played consecutively and followed by a brief reflective activity which prompted participants to consolidate content and consider its application in the future. Following this, the virtual therapist narrated a ten-minute guided mindfulness meditation intervention. The audio recording was played in conjunction with a 10-minute recording of a virtual environment of a creek and natural bush land. While viewing the scenery, participants listened to the voice over and focused their attention to their feelings, thoughts, breathing, and the environment. This was consistent across the three active treatment conditions (Arm 1 - virtual reality, Arm 2 - Computer, and Arm 3 - mobile phone), The content of the active treatment components was identical across each treatment condition, with participants in the phone and computer conditions viewing all content as two-dimensional video recordings.. The total duration of the single-session intervention across each condition was between 20 - 30 minutes. Participants in the virtual reality (VR) condition accessed the mindfulness intervention using the Google Cardboard VR head mounted display (https://arvr.google.com/cardboard/) which was posted to the participants that were randomly allocated to the VR condition. Participants in this condition were required to insert their personal smartphone into the Google Cardboard VR and access the mindfulness intervention by clicking on the links to the Youtube VR videos. Head tracking allowed the participant to visually explore the virtual environments of the intervention. Participants in the computer, phone, and active control conditions accessed the relevant intervention using either their personal computer or phone. Participants followed the study information prompts to access a link to the intervention landing page (developed using Microsoft Sway) via their preferred web browser. The virtual environments were embedded using YouTubeVR and participants could use their mouse or touchscreen to navigate the virtual environment. Adherence and completion of the intervention was monitored via a Microsoft Teams meeting with the participant and research assistant, website analytics from YouTube VR (VR, computer, and phone conditions) and Microsoft Sway (active control condition), and post-intervention study-specific qualitative data. Procedure: The study was granted ethics approval from the associated university’s Human Research Ethics Committee. Participants completed their registration to participate via an online form and were provided with the link to the pre-intervention questionnaire package and consent form through LimeSurvey (Schmitz, 2003). Participants were then randomly allocated to one of the four conditions using a computer-based random sequenced number generator: active control condition (n = 42), computer condition (n = 44), smartphone condition (n = 46), or a virtual reality intervention (n = 39). Those allocated to the VR condition were posted the Google Cardboard VR HMD to an address of their choosing. Upon completion of the pre-questionnaires, and group allocation, participants selected a time for a virtual meeting with one of the investigators via Microsoft Teams. During the online meeting, participants completed the intervention condition and post intervention questionnaires independently. Although the intervention was unguided, participants were able to contact researchers via the chat or audio functions on Microsoft Teams with any queries or concerns throughout the intervention. Primarily though, participants were left to complete the intervention in an unguided manner and were not therapeutically assisted by researchers. Upon completion of the intervention, participants were directed to the online post intervention questionnaire package. Two to four weeks following participation, participants completed a follow-up online questionnaire that was disseminated via email.