Involuntary Attention Restoration During Exposure to Mobile-Based 360° Virtual Nature in Healthy Adults With Different Levels of Restorative Experience: Event-Related Potential Study

Application of immersive virtual reality (IVR) for the care of common diseases of older adults course: A mixed methods study

OBJECTIVE

This study aimed to enhance understanding, engagement, and learning efficiency in the course "The Care of Common Diseases of Older Adults" using a developed Immersive Virtual Reality(IVR) system.

METHODS

A mixed-methods study with 32 students was conducted. The quantitative part involved a randomized controlled trial, and the qualitative part included thematic interviews with students and teachers.

RESULTS

The intervention group using the IVR system showed significant improvements in positivity and performance evaluation scores (P < 0.05) compared to the control group. Negative affect scores also decreased significantly (P < 0.05). Qualitative data from interviews supported the quantitative findings, highlighting increased curiosity, learning enthusiasm, and academic performance.

CONCLUSION

IVR significantly enhances learning by stimulating curiosity and active participation, making education more accessible and improving student performance. Future IVR enhancements should focus on user-friendliness and empathetic feedback in adult care.

Virtual reality and immersive technologies to promote workplace wellbeing: a systematic review

BACKGROUND

Work-related stress negatively impacts employee wellbeing. Stress-management interventions that reduce workplace stress can be challenging. Immersive technologies, such as virtual reality (VR), may provide an alternative.

AIMS

This systematic review aimed to evaluate feasibility, acceptability, and effectiveness of immersive technologies to promote workplace wellbeing (PROSPERO 268460).

METHODS

Databases MEDLINE, Web of Science, PsycINFO and Embase were searched until 22nd July 2021. Studies were included if they tested a workforce or were designed for a workplace. Effective Public Health Practice Project quality assessment tool (EPHPP) was used for quality ratings.

RESULTS

There were 17 studies (N = 1270), published 2011-2021. Over half were conducted in Europe. Eight studies were controlled trials. Most studies involved brief, single sessions of immersive VR and provided evidence of feasibility, acceptability, and effectiveness when measuring wellbeing-related variables such as stress, relaxation, and restoration. VR environments included relaxation tasks such as meditation or breathing exercises, and nature-based stimuli, such as forests, beaches, and water. Studies tested office workers, healthcare professionals, social workers, teachers, and military personnel. EPHPP ratings were "strong" (N = 1), "moderate" (N = 13), and "weak" (N = 3).

CONCLUSIONS

VR relaxation appears helpful for workplaces. However, limited longer-term data, controlled trials, and naturalistic studies mean conclusions must be drawn cautiously.

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.

The impact of virtual reality natural and built environments on affective responses: a systematic review and meta-analysis

This study aims to evaluate the extent to which virtual reality (VR) natural and built settings affect emotional states. Web of Science, SCOPUS, and PubMed were searched for relevant articles prior to February 2022. Of 15 articles identified for systematic review, 6 met the inclusion criteria for meta-analysis (studies with only pre- and post-condition measures of the Positive and Negative Affect Schedule (PANAS) were included). Both positive affect (g = 0.20, p = 0.001) and negative affect (g = - 0.30, p = 0.001) change scores for the VR natural environment were statistically significant. On the other hand, change scores for VR built environment were not significant in both positive affect (g = - 0.08, p = 0.355) and negative affect (g = - 0.08, p = 0.058). The findings revealed that, in addition to a VR natural environment, a VR built environment is capable of providing restorative experiences against negative mood in some circumstances.

Virtual Reality Sickness Reduces Attention During Immersive Experiences

In this paper, we show that Virtual Reality (VR) sickness is associated with a reduction in attention, which was detected with the P3b Event-Related Potential (ERP) component from electroencephalography (EEG) measurements collected in a dual-task paradigm. We hypothesized that sickness symptoms such as nausea, eyestrain, and fatigue would reduce the users' capacity to pay attention to tasks completed in a virtual environment, and that this reduction in attention would be dynamically reflected in a decrease of the P3b amplitude while VR sickness was experienced. In a user study, participants were taken on a tour through a museum in VR along paths with varying amounts of rotation, shown previously to cause different levels of VR sickness. While paying attention to the virtual museum (the primary task), participants were asked to silently count tones of a different frequency (the secondary task). Control measurements for comparison against the VR sickness conditions were taken when the users were not wearing the Head-Mounted Display (HMD) and while they were immersed in VR but not moving through the environment. This exploratory study shows, across multiple analyses, that the effect mean amplitude of the P3b collected during the task is associated with both sickness severity measured after the task with a questionnaire (SSQ) and with the number of counting errors on the secondary task. Thus, VR sickness may impair attention and task performance, and these changes in attention can be tracked with ERP measures as they happen, without asking participants to assess their sickness symptoms in the moment.

Effects of residential greenness and genetic predisposition on hemoglobin A1c and type 2 diabetes: Gene-environment interaction analysis from a nationwide study

BACKGROUND

Current evidence on the relations of residential greenness with glucose homeostasis and type 2 diabetes (T2D) remained largely uncertain. Most importantly, no prior studies have investigated whether genetic predisposition modifies the above associations.

METHODS

We leveraged data from the UK Biobank prospective cohort study, with participants enrolled between 2006 and 2010. Residential greenness was assessed by using the Normalized Difference Vegetation Index, and the weighting T2D-specific genetic risk score (GRS) was constructed based on previously published genome-wide association studies. Linear regression models and logistic regression models were used to investigate associations of residential greenness with glycated hemoglobin (HbA_1c) and T2D prevalence, respectively. Interaction models explored whether genetic predisposition modifies greenness-HbA_1c/T2D associations.

RESULTS

Among 315,146 individuals (mean [SD] age, 56.59 [8.09] years), each one-unit increase in residential greenness was associated with reduction in HbA_1c (β: -0.87, 95% CI: -1.16 to -0.58) and a 12% decrease in odds of T2D (OR: 0.88, 95% CI: 0.79 to 0.98), respectively. Additionally, interaction analyses further demonstrated that residential greenness and genetic risk had cumulative effects on HbA_1c and T2D. Compared with individuals who were exposed to low greenness and had high GRS, participants with low GRS and high greenness had a significant decline in HbA_1c (β: -2.96, 95% CI: -3.10 to -2.82, P for interaction = 0.04) and T2D (OR: 0.47, 95% CI: 0.45 to 0.50, P for interaction = 0.09).

CONCLUSIONS

We add novel evidence that residential greenness has protective effects on glucose metabolism and T2D, and those beneficial effects can be amplified by low genetic risk. Our findings may facilitate the improvement of the living environment and the development of prevention strategies by considering genetic susceptibility to T2D.

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.

An Analysis of Theoretical Perspectives in Research on Nature-Based Interventions and Pain

Chronic pain results from a complex series of biomechanical, inflammatory, neurological, psychological, social, and environmental mechanisms. Pain and pain-related diseases are the leading causes of disability and disease burden globally. Employing nature-based interventions for the treatment of pain is an emerging field. Current theory driving the suggested mechanism(s) linking the pain reducing effects of nature-based interventions is lacking. A two-step approach was taken to complete a theoretical review and analysis. First, a literature review was completed to gather a substantive amount of research related to theoretical frameworks on the topic of nature-based interventions and pain. Secondly, a theoretical analysis as proposed by Walker and Avant was completed to explore current theoretical frameworks accepted in the literature on nature-based interventions and pain. Stress reduction theory and attention restoration theory were the most common theoretical frameworks identified. Neither theoretical framework explicitly identifies, describes, or intends to adequately measure the concept of pain, revealing a limitation for their application in research with nature-based interventions and pain. Theoretical development is needed, as it pertains to nature-based interventions and pain. Without this development, research on nature-based interventions and pain will continue to use proxy concepts for measurement and may result in misrepresented findings.

Connecting to Nature through 360° Videos during COVID-19 Confinement: A Pilot Study of a Brief Psychological Intervention

Psychological interventions have been shown to be beneficial in mitigating stress related to COVID-19 confinement. According to theories of restorative environments, exposure to natural surroundings has positive effects on well-being and stress through its restorative qualities. With 360° video-based Virtual Reality (VR), people can be exposed to nature and so better manage the consequences associated with mobility restrictions during confinement. The main aim of this pilot study was to examine whether a 360° video-based VR intervention composed of five 13-minute sessions (once a day) has positive effects on affect, well-being, and stress. The sample was made up of 10 participants (4 men and 6 women; age : M = 46.5, SD = 11.7) who were confined at home (voluntarily or not) during the COVID-19 pandemic. Participants were instructed to watch a 360° video each day (of a “beach” or “lake” environment) using their smartphone and VR glasses sent to them by mail. Participants responded with several self-reports before and/or after each session (emotions and sense of presence) and before and/or after the intervention (affect, well-being, perceived stress, perceived restorativeness of nature, and the usefulness and acceptability of the intervention). Results showed a tendency to improve positive (e.g., happiness) and negative (e.g., anxiousness) emotions and experience a high sense of presence after each session. Moreover, perceived restorative qualities of the environment and their cognitive and behavioral effects were high. A significant decrease in negative affect was found after the intervention. Usefulness and acceptability were also high. This is the first study to show that an affordable and accessible technology can be used to overcome the negative consequences of confinement and counteract its harmful psychological effects.

A Comparative Study of Colour Effects on Cognitive Performance in Real-World and VR Environments

This research explores the influence of colour on cognitive performance and intellectual abilities (i.e., logical and lateral thinking abilities and people’s attention to detail) in a conventional laboratory setting and an approximately identical virtual reality (VR) environment. Comparative experiments using psychological methods were carried out in both settings to explore the impact of immersive colour experience. This work builds on earlier studies that suggest that the VR environment enhances user experiences, with results evidencing that a considered approach to colour design can trigger a positive impact on user engagement. The experiments further evaluated the positive effects of immersive colour stimuli in VR by evaluating participants’ logical and lateral thinking abilities, as well as their attention to detail. Their response time and error rate when completing each psychometric test were recorded with different hue backgrounds in both environments. The data collected from participants reveal the differential impacts of colour between the reality setting using standard colour imaging displays and in an approximately identical VR environment. Analysis of the psychometric tests shows the differential influence of colours on logical and lateral thinking abilities and people’s attention to detail between the physical environment and the VR environment. Our findings add to the data demonstrating that a well-designed immersive colour experience in VR can trigger positive user engagement and, as explored in this study, improve cognitive performance. This again positions immersive colour experience as an important design tool to be fully considered in the creation of effective VR research and applications.

Attention Detection in Virtual Environments Using EEG Signals: A Scoping Review

The competitive demand for attention is present in our daily lives, and the identification of neural processes in the EEG signals associated with the demand for specific attention can be useful to the individual’s interactions in virtual environments. Since EEG-based devices can be portable, non-invasive, and present high temporal resolution technology for recording neural signal, the interpretations of virtual systems user’s attention, fatigue and cognitive load based on parameters extracted from the EEG signal are relevant for several purposes, such as games, rehabilitation, and therapies. However, despite the large amount of studies on this subject, different methodological forms are highlighted and suggested in this work, relating virtual environments, demand of attention, workload and fatigue applications. In our summarization, we discuss controversies, current research gaps and future directions together with the background and final sections.

The Differential Impact of Mystery in Nature on Attention: An Oculometric Study

Nature exposure can provide benefits on stress, health and cognitive performance. According to Attention Restoration Theory (ART), the positive impact of nature on cognition is mainly driven by fascination. Fascinating properties of nature such as water or a winding hiking trail may capture involuntary attention, allowing the directed form of attention to rest and to recover. This claim has been supported by studies relying on eye-tracking measures of attention deployment, comparing exposure to urban and nature settings. Yet, recent studies have shown that promoting higher engagement with a nature setting can improve restorative benefits, hence challenging ART's view that voluntary attention is resting. Besides, recent evidence published by Szolosi et al. (2014) suggests that voluntary attention may be involved during exposure to high-mystery nature images which they showed as having greater potential for attention restoration. The current study explored how exposure to nature images of different scenic qualities in mystery (and restoration potential) could impact the engagement of attention. To do so, participants were shown nature images characterized by either low or high mystery properties (with allegedly low or high restoration potential, respectively) and were asked to evaluate their fascination and aesthetic levels. Concurrently, an eye tracker collected measures of pupil size, fixations and spontaneous blinks as indices of attentional engagement. Results showed that high-mystery nature images had higher engagement than low-mystery images as supported by the larger pupil dilations, the higher number of fixations and the reduced number of blinks and durations of fixations. Taken together, these results challenge ART's view that directed attention is merely resting during exposure to restorative nature and offer new hypotheses on potential mechanisms underlying attention restoration.

Effect of a Virtual Reality-Based Restorative Environment on the Emotional and Cognitive Recovery of Individuals with Mild-to-Moderate Anxiety and Depression

In this study, restorative environment theory and virtual reality (VR) technology were combined to build different 3D dynamic VR interactive scenes. We discuss the effects of a VR restorative environment on the emotional and cognitive recovery of individuals with mild-to-moderate anxiety and depression. First, we built a VR restorative garden scene, divided into four areas: forest, lawn, horticultural planting, and water features. The scene was verified to have a good recovery effect in 26 participants. Then, 195 participants with mild-to-moderate anxiety and depression were selected as experimental subjects. Through psychological testing and EMG (Electromyography) and EEG (Electroencephalography) data feedback, we further explored the differences in the sense of presence in VR restorative scenes and their effect on individual emotional and cognitive recovery. The results showed that (1) both the restorative environment images and the VR scenes had a healing effect (the reduction in negative emotions and the recovery of positive emotions and cognition), with no difference in the subjective feeling of recovery among the different scenes, but the recovery score of the VR urban environment was higher than that of the natural environment (differing from the results in real environments); (2) a high sense of presence can be experienced in different VR scenes, and interactive activities in VR scenes can provide a great presence experience; (3) the recovery effects of VR restorative environment on emotion and self-efficacy are realized through the presence of VR scenes; (4) a VR restorative environment is helpful for the emotional improvement and cognitive recovery of individuals with mild-to-moderate anxiety and depression. VR urban scenes also have good recovery effects. In terms of cognitive recovery, self-efficacy improved significantly. In addition, from the perspective of EEG indicators, the VR restorative scene experience activated the prefrontal lobe, which is conducive to cognitive recovery in individuals with mild-to-moderate anxiety and depression. In terms of emotional improvement, negative emotions were significantly reduced in the different VR scene groups. In conclusion, we further explored ways to help individuals with mild-to-moderate anxiety and depression, in order to promote the development and application of mental health.

EEG Cortical Activities and Networks Altered by Watching 2D/3D Virtual Reality Videos

Abstract. Virtual reality (VR), which can represent real-life events and situations, is being increasingly applied to many fields, such as education, entertainment, and medical rehabilitation. Correspondingly, the neural information processing of VR has attracted attention. However, the underlying neural mechanisms of VR environments have not yet been fully revealed. The purpose of this study was to examine the possible differences in brain activities and networks between the less immersive 2D and the fully immersive 3D VR environments. 3D VR videos and the same 2D scenes were presented to the participants and the scalp electroencephalogram (EEG) was recorded, respectively. Power spectral density (PSD) and the functional connectivity of these EEG signals were analyzed. The results showed that 3D VR videos significantly enhanced the PSD of θ rhythm (4–7 Hz) in the frontal lobe; decreased the PSD of α rhythm (8–13 Hz) in the parietal and the occipital lobes; increased the PSD of β rhythm (14–30 Hz) in the frontal, the parietal, the temporal, and the occipital lobes, relative to 2D VR watching. Furthermore, 3D versus 2D VR-induced alterations in the patterns of brain networks were similar to the patterns of PSD. Specifically, for the θ rhythm, 3D VR significantly enhanced the frontal and the temporal brain functional connectivity; for the α rhythm, 3D VR increased the parietal and the occipital networks; for the β rhythm, 3D VR remarkably increased the frontal, the occipital, the frontal-temporal and the frontal-occipital brain functional connectivity, relative to 2D VR. These significant differences between 3D and 2D VR video-watching suggest that the neural information processing of cortical activities and networks is correlated to the degree of immersion. The present results, collected with previous researches, implicate that some visual-related information processes, such as visual attention, visual perception, and visual immersion are more robust in 3D VR environments.

Effects of exposure to immersive videos and photo slideshows of forest and urban environments

A large number of studies have demonstrated the benefits of natural environments on people's health and well-being. For people who have limited access to nature (e.g., elderly in nursing homes, hospital patients, or jail inmates), virtual representations may provide an alternative to benefit from the illusion of a natural environment. For this purpose and in most previous studies, conventional photos of nature have been used. Immersive virtual reality (VR) environments, however, can induce a higher sense of presence compared to conventional photos. Whether this higher sense of presence leads to increased positive impacts of virtual nature exposure is the main research question of this study. Therefore, we compared exposure to a forest and an urban virtual environment in terms of their respective impact on mood, stress, physiological reactions, and cognition. The environments were presented via a head-mounted display as (1) conventional photo slideshows or (2) 360[Formula: see text] videos. The results show that the forest environment had a positive effect on cognition and the urban environment disturbed mood regardless of the mode of presentation. In addition, photos of either urban or forest environment were both more effective in reducing physiological arousal compared to immersive 360[Formula: see text] videos.

Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial

Background

Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements.

Objective

To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises.

Methods

A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance.

Results

Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t₁₆₈₄=−2.02, 95% CI −18.70 to −0.28; P=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t₁₆₈₄=−3.24, 95% CI −6.86 to −1.69), sadness (t₁₆₈₄=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t₁₆₈₄=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms.

Conclusions

If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments.

Trial Registration

Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096

Immersive Virtual Reality and Persons with Dementia: A Literature Review

Dementia of any type is incurable and treatment is primarily focused on slowing its progression and managing symptoms, typically accomplished through a combination of medication and lifestyle factors. Social workers are uniquely positioned to suggest new and innovative strategies for improving the quality of life. Technology opens a variety of options, and virtual reality is one of the more recent additions to the available toolkit. This review describes the state of the literature as it relates to the use of immersive virtual reality technology with persons with dementia. One hundred fifty-eight articles were returned by keyword search, but just three of those used modern virtual reality systems. Each of the three studies found positive results in their respective uses of virtual reality with persons with dementia. VR was well tolerated by participants and engagement was high, though sample sizes were small across studies. Results demonstrated immersive VR is a viable pathway for a variety of novel interventions with this population, but more research using modern immersive devices is required. Social workers in a variety of care settings can build on these early findings and develop an array of novel palliative and leisure-time experiences for this population.

MacIntyre T, Calogiuri G. Enable, Reconnect and Augment: A New ERA of Virtual Nature Research and Application

Being exposed to natural environments is associated with improved health and well-being, as these environments are believed to promote feelings of “being away” from everyday struggles, positive emotional reactions and stress reduction. Despite these positive effects, humanity is becoming increasingly more distanced from nature due to societal changes, such as increased urbanization and the reduced accessibility of natural environments. Technology is also partly to blame, as research suggests that people replace nature contact with increased screen time. In this cross-section between nature and technology, we find technological nature which is progressing towards a point where we may be capable of simulating exposure to real nature. Concerns have been raised regarding this technology, as it is feared it will replace real nature. However, research suggests that virtual nature may have a more positive impact on society than a mere replacement of real nature, and this review propose several areas where virtual nature may be a beneficial addition to actual nature (Enable), help people reconnect with the real natural world (Reconnect) and “boost” human-nature interactions (Augment). Based on the current research and theoretical framework, this review proposes guidelines for future research within these areas, with the aim of advancing the field by producing high quality research.

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

Nature exposure in virtual reality (VR) can provide emotional well-being benefits for people who cannot access the outdoors. Little is known about how these simulated experiences compare with real outdoor experiences. We conduct an experiment with healthy undergraduate students that tests the effects of 6 min of outdoor nature exposure with 6 min of exposure to a 360-degree VR nature video, which is recorded at the outdoor nature exposure location. Skin conductivity, restorativeness, and mood before and after exposure are measured. We find that both types of nature exposure increase physiological arousal, benefit positive mood levels, and are restorative compared to an indoor setting without nature; however, for outdoor exposure, positive mood levels increase and for virtual nature, they stay the same. The nature-based experience shows benefits above and beyond the variance explained by participants’ preferences, nature and VR experiences, and demographic characteristics. Settings where people have limited access to nature might consider using VR nature experiences to promote mental health.

The Effect of Cycling Through a Projection-Based Virtual Environment System on Generalized Anxiety Disorder

Virtual reality (VR) has the potential to help clinical medicine manage generalized anxiety disorder (GAD). However, patients with GAD who use traditional head-mounted VR to cycle may cause them to feel motion sickness and fatigue. To solve this problem, a projection-based virtual environment (VE) system was built to provide GAD patients with a sense of immersion while they are cycling. This projection-based VE system allows patients with GAD to interact with the virtual environment and produce experiences similar to cycling in the outdoors. Sixty GAD patients met several screening criteria and were selected as participants. All participants were randomly assigned to one of the two 20-min conditions: (1) Observing watercolor paintings projected by the projector while engaged in cycling with a stationary bicycle; or (2) observing the scenes (i.e., forest or park) projected by the VE system and engaging in cycling with a stationary bicycle. Finally, this study confirmed that patients with GAD in the projection-based VE group exhibited higher alpha values and lower galvanic skin responses (GSR) after cycling than those cycling in the control group. These results showed that cycling in the projection-based VE group allowed the patient with GAD to achieve higher exercise intensity and lower perceived emotional stress.