Digital twin campus intervention for stress adaptation in university students with depressive symptoms

Background Rates of depression among college students keep rising, with 20–30% showing symptoms worldwide. Academic and life stress, along with poor adaptation, drive this trend. Traditional counseling requires personal disclosure and long sessions, leading to low help-seeking rates. Digital-twin technology creates an immersive virtual campus and offers a VR-based mental-health approach, but its use in stress-adaptation training for depression remains limited. This study integrates a digital-twin campus with Cognitive Behavioral Therapy (CBT) to build a virtual stress-coping system grounded in real settings. The goal is to test its effectiveness in improving depressive symptoms and stress adaptation, supporting intelligent mental-health systems. Methods A single-blind randomized controlled trial recruited 210 university students aged 18 to 24 from two universities, all with Beck Depression Inventory-II (BDI-II) scores between 13 and 28. Participants were randomly assigned to a digital-twin intervention group (n = 105) or traditional CBT control group (n = 105). The intervention used a Unity-based VR “Smart Campus Mental Training System,” delivered via headsets, for 10 weeks. Training included: (1) Exposure training: gradual exposure to 12 types of academic, interpersonal, and daily-life stressors; (2) Cognitive restructuring: AI-guided identification and modification of negative automatic thoughts; (3) Behavioral activation: social, physical, and interest-related activities with gamified reinforcement. Primary outcome: BDI-II. Secondary outcomes: Perceived Stress Scales-14 (PSS-14) and Coping Inventory for Stressful Situations (CISS). Assessments occurred at baseline, week 5, 10, and 16 follow-up. Results The main outcomes are shown in Table 1. As shown in Table 1, at mid-intervention (5 weeks), the digital twins group’s BDI-II score decreased from 21.3 ± 4.2 at baseline to 14.6 ± 3.8, and further to 9.2 ± 3.5 at intervention completion (10 weeks), representing a 12.1-point reduction compared to 9.1 points in the control group (p<.001, Cohen’s d = 0.65). The digital twins group also showed greater reductions in PSS-14 scores (12.7 vs. 8.8 points) and larger improvements in CISS scores (14.6 points), indicating enhanced adaptive coping strategies. At follow-up (16 weeks), therapeutic effects remained stable in the digital twins group (10.1 ± 3.9) compared to controls (12.5 ± 4.6, p<.001, Cohen’s d = 0.57). Discussion This study showed that the digital twin–based VR intervention produced greater reductions in depressive symptoms and perceived stress than traditional CBT across the intervention and follow-up periods. Participants in the VR group also demonstrated more effective coping strategies, suggesting that immersive environments can strengthen cognitive and behavioral change. These findings indicate that integrating VR technology into campus-based mental health services may offer a practical and effective approach for supporting students with mild to moderate depression. Future studies with longer follow-ups and broader samples can further validate the stability and generalizability of these results.