A Mixed Methods Examination of Immersive Virtual Reality Green Exercise.

There is increasing research suggesting virtual reality (VR) can enhance exercise experience, yielding additional psychophysiological benefits. Combining VR, nature and exercise may provide additional health benefits compared to indoor (control) and virtual urban exercise; thus, this thesis’ aims are: a) to examine how VR environments can influence psychophysiological outcomes of exercise b) to explore individual expectations and reactions to using VR exercise. The first study was designed to assess green (nature) and urban VR environments on psychophysiological outcomes during a controlled cycling-based exercise. Participants (n=12) cycled at an RPE of 12 for ten minutes. Participants reported improvements in positive and negative affect from pre- to post-exercise in the virtual green condition (p0.05). A significant difference was observed in positive affect between the control condition (no VR) and the virtual green condition (p>0.001). Heart rate was significantly higher in the control condition compared to the urban (p=0.005) and green (p=0.02) conditions. Distance travelled (m) was significantly higher in the control condition compared to the urban (p=0.003); there was no significant difference between the green and urban; and green and control condition (p>0.05). Results revealed virtual green exercise can be beneficial to psychological outcomes but compared to urban/indoor environments, the results can vary. Little is known about participant thoughts and beliefs regarding VR, Study 2 was a qualitative study designed to assess expectations and reactions to VR exercise. Participants reported limited VR experience. VR improved enjoyment, and motivation and lowered perceived effort (despite RPE 12 instructions. Participants preferred the green over urban and indoor environments and suggested VR should be a substitute for real outdoor exercise. Overall, VR improved the exercise experience of participants. Future research should branch into clinical populations that may benefit from virtual green exercise

Development and feasibility of a virtual reality group therapy for patients with depression.

PhD Theses.Background: Virtual reality (VR) could improve access and adherence to evidence-based psychological group therapies for people with depression. However, there is limited research into VR group therapy (VRGT) for depression. This thesis aimed to systematically develop a new evidence-based VRGT intervention for depression that can be delivered remotely and investigate its feasibility and acceptability. Methods: This thesis adopted a mixed methods design. The VRGT’s conceptual model was based on evidence synthesised from 4 studies: 1. Secondary data analysis of qualitative studies, which identified the facilitators and barriers to attending community mental health groups. 2. Scoping review, which identified how VR had been used in the treatment of depression 3. Systematic review, which developed a VR Cognitive Behavioural Therapy (CBT) framework 4. Qualitative study with 10 patients and 10 therapists, which identified the potential acceptability of the VRGT. Finally, the feasibility and acceptability of the intervention were assessed in a proof-of-concept study with 6 patients with depression. A process evaluation embedded within the study included interviews with all individuals who had received or delivered the intervention. Results: The intervention consisted of 8 sessions delivered once a week for 45 minutes. The intervention was feasible. The attendance rate for the intervention was 77.8%, with participants reporting improved symptoms of depression. The qualitative evidence suggested that participants were satisfied with the use of avatars and the immersive virtual environments and 5 dissatisfied with the technical elements of the intervention and the lack of face-to-face contact. Some participants were satisfied, and some were dissatisfied by the group dynamics and the treatment content they received. Conclusion: The VRGT intervention is acceptable and potentially beneficial to some patients with depression. Recommendations from this thesis have already been used by clinicians and software developers. Future research should assess the efficacy of VRGT