Abstract
Background:
Insomnia is a highly prevalent and debilitating condition, yet access to treatments remains limited and expensive. Mindfulness-based interventions (MBIs) offer a promising alternative, but traditional delivery methods often fail to engage participants effectively. Building on the potential of MBIs, virtual reality (VR) offers immersive and customizable experiences that may enhance engagement and therapeutic impact. VR can reduce cognitive arousal—a core mechanism of insomnia—and facilitate mindfulness training. However, the feasibility of at-home VR mindfulness for insomnia remains underexplored.
Objective:
To address this gap, this study aimed to evaluate the feasibility of a 4-week at-home VR-delivered mindfulness intervention (VRmind) as a treatment for insomnia.
Methods:
To investigate this, we conducted a two-arm, parallel-group randomized controlled feasibility trial (ANZCTRN12623000892617) with 60 adults (mean age = 45.1 ± 14.9 years) experiencing insomnia. Participants were randomized (2:1) to either at-home VR mindfulness (VRmind, n=40) using an Oculus Quest 2 headset or to an active comparator condition (Control, n=20) watching relaxing imagery and music using a smart device. The intervention was delivered twice weekly over 4 consecutive weeks; each session was approximately 20 minutes. Primary outcomes included feasibility indicators: treatment engagement, adherence (≥6 sessions completed), and acceptability (Multi-Dimensional Treatment Satisfaction Measure, MDTSM > 2). Secondary outcomes included changes in insomnia severity (ISI), sleep quality (PSQI), mood and anxiety (DASS-21), rumination (RRS), negative thoughts (ATQ-N), stress-related insomnia (FIRST), and mindfulness awareness (MAAS). Outcome measures were collected at baseline, weeks 2, 4, and 8.
Results:
VR mindfulness was found to be feasible, with high treatment engagement, adherence, and completion. The target treatment completion rate was exceeded, 83% (33/40) of VRmind participants completed treatment compared to 50% (10/20) in Control condition. The mean session completion for the VRmind condition was 7.6 (SD 2.78) compared to 4.5 (SD3.35) in the Control. At-home VR mindfulness was considered a more acceptable treatment for insomnia than the relaxing music video-based Control condition. VR delivered mindfulness was rated as an acceptable intervention (mean MDTSM > 2) by 74% of participants, compared to 55% of Controls. At-home VR mindfulness is a safe intervention, no serious adverse events were reported, 36% reported minor discomforts (e.g., headset fit issues, transient dizziness). Beyond feasibility and safety, VRmind participants demonstrated a greater reduction in insomnia severity (mean –7.1 ISI points) compared to controls (mean –4.1 points).
Conclusions:
VR-delivered mindfulness was shown to be feasible, acceptable, and engaging for people with insomnia, with promising adherence rates and preliminary efficacy. Taken together, these findings support the scalability and clinical potential of VR mindfulness as a novel approach to insomnia care. Further investigation in larger-scale trials using objective sleep measures is warranted to confirm long-term benefits. Clinical Trial: ANZCTRN12623000892617
Insomnia is a highly prevalent and debilitating condition, yet access to treatments remains limited and expensive. Mindfulness-based interventions (MBIs) offer a promising alternative, but traditional delivery methods often fail to engage participants effectively. Building on the potential of MBIs, virtual reality (VR) offers immersive and customizable experiences that may enhance engagement and therapeutic impact. VR can reduce cognitive arousal—a core mechanism of insomnia—and facilitate mindfulness training. However, the feasibility of at-home VR mindfulness for insomnia remains underexplored.
Objective:
To address this gap, this study aimed to evaluate the feasibility of a 4-week at-home VR-delivered mindfulness intervention (VRmind) as a treatment for insomnia.
Methods:
To investigate this, we conducted a two-arm, parallel-group randomized controlled feasibility trial (ANZCTRN12623000892617) with 60 adults (mean age = 45.1 ± 14.9 years) experiencing insomnia. Participants were randomized (2:1) to either at-home VR mindfulness (VRmind, n=40) using an Oculus Quest 2 headset or to an active comparator condition (Control, n=20) watching relaxing imagery and music using a smart device. The intervention was delivered twice weekly over 4 consecutive weeks; each session was approximately 20 minutes. Primary outcomes included feasibility indicators: treatment engagement, adherence (≥6 sessions completed), and acceptability (Multi-Dimensional Treatment Satisfaction Measure, MDTSM > 2). Secondary outcomes included changes in insomnia severity (ISI), sleep quality (PSQI), mood and anxiety (DASS-21), rumination (RRS), negative thoughts (ATQ-N), stress-related insomnia (FIRST), and mindfulness awareness (MAAS). Outcome measures were collected at baseline, weeks 2, 4, and 8.
Results:
VR mindfulness was found to be feasible, with high treatment engagement, adherence, and completion. The target treatment completion rate was exceeded, 83% (33/40) of VRmind participants completed treatment compared to 50% (10/20) in Control condition. The mean session completion for the VRmind condition was 7.6 (SD 2.78) compared to 4.5 (SD3.35) in the Control. At-home VR mindfulness was considered a more acceptable treatment for insomnia than the relaxing music video-based Control condition. VR delivered mindfulness was rated as an acceptable intervention (mean MDTSM > 2) by 74% of participants, compared to 55% of Controls. At-home VR mindfulness is a safe intervention, no serious adverse events were reported, 36% reported minor discomforts (e.g., headset fit issues, transient dizziness). Beyond feasibility and safety, VRmind participants demonstrated a greater reduction in insomnia severity (mean –7.1 ISI points) compared to controls (mean –4.1 points).
Conclusions:
VR-delivered mindfulness was shown to be feasible, acceptable, and engaging for people with insomnia, with promising adherence rates and preliminary efficacy. Taken together, these findings support the scalability and clinical potential of VR mindfulness as a novel approach to insomnia care. Further investigation in larger-scale trials using objective sleep measures is warranted to confirm long-term benefits. Clinical Trial: ANZCTRN12623000892617
| Original language | English |
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| DOIs | |
| Publication status | Submitted - 7 May 2025 |
Publication series
| Name | JMIR Preprints |
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