Immersion in a relaxing virtual reality environment is associated with similar effects on stress and anxiety as heart rate variability biofeedback

Practicing guided breathing at 0.1 Hz in virtual reality yields psychological and physiological benefits. Nonetheless, it remains uncertain whether these effects surpass those induced in a real-world setting. Indeed, the potential influence of the virtual environment on perceived stress and anxiety is not yet fully understood. In this experiment, we aimed to compare the effects of heart rate variability biofeedback combining both haptic and visual cues in real and virtual reality settings within the same population. Additionally, to decipher whether psychological benefits are caused by viewing an environment in virtual reality or performing guided breathing in this setting, a “control” immersion condition was added. 36 healthy sport students (9 females) participated in this study, performing both the real and virtual reality protocols in a randomized order. At different points in each protocol, modulations of anxiety and stress were measured using the STAI-Y questionnaire and a visual analogic scale, respectively. Physiological effects were assessed with measures of heart rate variability, and the performance of cardiac coherence was compared between both real and virtual implementations of guided breathing. As expected, both real and virtual reality heart rate variability biofeedback resulted in similar physiological changes and cardiac coherence performances. A reduction in stress and anxiety was observed in both protocols, particularly for participants who were already stressed or anxious at the beginning. However, no additional changes in psychological states were observed when performing guided breathing alongside being immersed in the virtual environment.