Implementing a virtual reality-based intervention to support the wellbeing of mental health staff in the workplace: A mixed-methods pilot study

Figures & data

Table 1. Demographic characteristics of participants (N = 43).

Demographics	N (%)
Gender
Female	33 (76.7)
Male	9 (20.9)
Non-binary	1 (2.3)
Ethnicity
Asian	5 (11.6)
Black	11 (25.6)
White	22 (51.2)
Mixed/multiple ethnic groups	5 (11.6)
Occupation
Administrator	1 (2.3)
Assistant psychologist	9 (20.9)
Clinical practitioner and trained psychotherapist	1 (2.3)
Clinical psychologist	4 (9.3)
Employment coach	1 (2.3)
Medical student	2 (4.7)
Nurse	9 (20.9)
Occupational therapist	2 (4.7)
Occupational therapy assistant	1 (2.3)
Psychiatrist	3 (7.0)
Psychology wellbeing practitioner	1 (2.3)
Psychotherapist	2 (4.7)
Service user research ambassador	1 (2.3)
Smoking cessation specialist	1 (2.3)
Social worker	2 (4.7)
Student nurse	1 (2.3)
Therapy enabler	1 (2.3)
Tobacco dependence advisor	1 (2.3)
Main work setting
Inpatient services	13 (30.2)
Outpatient services	15 (34.9)
Other	14 (32.6)
Prefer not to say	1 (2.3)
Virtual reality apps (and their environments) used by sample
Tilt Brush	18 (41.9)
Nature Treks	26 (60.5)
Black Beginning (outer space scene with stars, planets, and galaxies)	5 (11.6)
Blue Deep (underwater landscape with marine life)	17 (39.5)
Blue Moon (moonlit landscape)	2 (4.7)
Blue Ocean (crystal water and white sandy beach with palm trees)	14 (32.6)
Green Bamboo (bamboo trees and cherry blossom trees at dusk)	6 (14.0)
Green Meadow (grassy meadow clearing from dense forest with rainbow and woodland animals)	5 (11.6)
Grey Storm (sea front landscape with thunderstorm)	5 (11.6)
Jade Jurassic (pre-historic land with dinosaurs)	8 (18.6)
Orange Sunset (forest clearing with setting sun)	8 (18.6)
Pine Vista (mountain valley with woodland animals)	1 (2.3)
Red Earth (Australian Outback with kangaroos)	1 (2.3)
Red Fall (woodland mountain range)	3 (7.0)
Red Savana (African plane with mountains and safari animals)	7 (16.3)
Turquoise Cove (hidden beach cove)	4 (9.3)
White Winter (a snowy mountain valley with roaming woodland animals)	7 (16.3)
Maloka	10 (23.3)
Evening wind down	2 (4.7)
Good morning	1 (2.3)
Healing relationships	2 (4.7)
Larimer focused meditation experience (for cleansing negative thoughts)	2 (4.7)
Power and peace	3 (7.0)

Table 2. Pre- and post-virtual reality visual analogue scales (N = 43).

Visual analogue scale (“Please mark on the line…”)	Pre-VR Mean (SD)	Post-VR Mean (SD)	Test	p	Effect (r)
…how POSITIVE you feel about your WELLBEING right now	6.57 (1.81)	7.67 (1.71)	−3.907	<.001	−0.596
…how STRESSED you feel right now	3.85 (2.39)	2.20 (2.34)	−3.997	<.001	−0.610
…how ANXIOUS you feel right now	2.72 (2.30)	1.71 (2.12)	−3.739	<.001	−0.570
…how HAPPY you feel right now	6.32 (1.46)	7.70 (2.00)	−4.075	<.001	−0.621
…how HELPFUL you found the virtual reality experience	–	7.64 (2.61)	–	–	–
…how EASY TO USE you found the virtual reality equipment	–	7.35 (2.21)	–	–	–
…to what extent you FELT YOU WERE ACTUALLY IN THE ENVIRONMENTS THAT YOU EXPERIENCED	–	7.21 (2.34)	–	–	–

Key: VR: virtual reality; SD: standard deviation.

Note. Visual analogue scales were scored from 0 (“Not at all”) to 10 (“Very”). Test = Wilcoxon signed ranks test (rank sum Z).

Table 3. Themes from post-virtual reality qualitative feedback (N = 43).

Theme	Explanation and supporting quotes
Positive and relaxing experience	Almost all participants reported that the VR was a positive and relaxing experience. Participants reported that they felt “calm” (P17), “peaceful” (P19), “grounded” (P40), “more at ease” (P26), and “really felt relaxed – absolutely loved it!” (P14). They said it was a “great way to relax and go somewhere else!” (P14) and “it was very relaxing to see the images whilst meditating [and they] found it very soothing and calming” (P36). For many, this meant it was “good to reduce stress and anxiety” (P7). Others reported that they felt “content” (P25) and the VR “helped to relax my mind and calm my nerves. It was very refreshing” (P22). They reported the VR was “absolutely wonderful – [I felt] relaxed and at one with the environment” (P15) and “it’s a really good tool for meditation and relaxation as it blocks out everything around you” (P35). One participant reported that they felt it was “beautiful” (P19) and experienced the benefit of VR by “just taking 10 or 15 mins out of your day to be in a bit of a dream or relaxed state” (P19). Participants liked specific features of the VR experience. They said, “the visual and auditory combination was great” (P8), the VR had “relaxing music” (P8) and they were “relaxed and astounded by the technology…Very impressed” (P16). These features were linked to how absorbing they found the experience.
Immersive, realistic experience	Participants found the VR experience to be immersive, realistic, and believable. Participants reported they felt “it takes you out of reality” (P39) and “immersed into a different world” (P11). They described it as “an immersive relaxation experience” (P43), “an escape from the world where I could just chill and forget things for a while” (P31), and “you can escape for a little bit which makes it easier to focus on the meditation” (P35). Participants found the VR realistic, and it reminded them of relaxing environments that they were familiar with in the real world, reporting “everything was realistic - as if I am home in the Caribbean” (P27), “it was so nice to escape to a beach and other beautiful locations so quick and easily!” (P18) and the VR “was like being on holiday without leaving the office” (P17). Participants found the immersive element pleasurable, in that it felt “incredible - it made me go to a world that was so beautiful and away from reality and it immersed me into that world” (P3) and “you only need a few moments in the environments to put you in a different state” (P8).
Helpful escapism from work-related stress	Participants reported that the VR experience was a helpful source of escapism from the workplace. They reported it was “a useful distraction from work” (P11), “it helped [them] completely switch off from [their] day-to-day work to such a deep level” (P3), and it could function as “a micro break during a stressful day” (P38) or “a break from workplace stress” (P34), which felt “mindful and it took [their] mind away from work” (P32). Many participants found the VR improved their breaktime, reporting “a bit of escapism is enjoyable at lunch time” (P30) and “the sense of escape in the office was helpful as it made me feel like I'd actually had a real break today” (P31).
Enthusiasm for future VR engagement	Participants reported that they would like more VR sessions, stating that “regular sessions can be invaluable to my mental health” (P3), “we need more of these sessions regularly” (P25), “I'd like to do this regularly” (P5), “I think if I tried it multiple times it would be more relaxing now that I know what to expect” (P35), and “I wish I had this at home as it would support my wellbeing” (P24). Participants said they would like “to have more days and more opportunities to experience the additional landscapes” (P26) and “just sitting in the environment and taking a few minutes to be present is reminding me that I need to do this more” (P17).
Recommendations for future implementation	Participants felt that many of their colleagues could benefit from the VR intervention and reported “I think if this was offered in teams it would be a good experience to escape from work stresses for a short period of time” (P4) and “I would like all staff to have the opportunity to experience this” (P15). Participants recommended particular times and occasions when the VR could be helpful, stating that “it would be great when you’re quite stressed at the beginning of the day” (P13), “it will be good if I can access this when I am low or stressed” (P9), and recommended “increased accessibility of this kind of thing in the future for a change of environment whilst you’re on the ward” (P8). One participant reported “I would highly recommend and encourage more people to experience this as it will truly transform your day” (P26). Others made suggestions for improvements to the VR, such as, they would like to have multiple people in the VR with them and “have a shared experience with a peer, a sort of co-op experience” (P26). Participants said that “I would have liked if it was even more interactive because at times, I felt limited” (P18), “I would have liked the imagery to relate more directly to the meditation” (P37) and “the audio guide was nice and the female voice was calming but you could add a few more lines in between the meditation…otherwise after a while, you forget to keep doing those things” (P34).
Difficulties adjusting psychologically to VR	A very small minority of participants experienced some difficulties in adjusting psychologically to immersion in a virtual environment. These participants reported they felt “really stressed” (P41), they were “a bit stressed as it was hard to use and felt that I wasn’t in real-life” (P1), and “I just didn’t find it relaxing as it’s scary to be in a different reality” (P1). Another participant reported “I found some environments easier to connect with than others, sometimes with the night setting it was unnerving” (P19). One participant reported they “felt like I was in the scenery displaced. I frightened myself several times by objects being near to me. It was so surreal” (P22). Another participant described a negative experience with how realistic they found the VR: “it was quite realistic; at one point I was underwater and felt like I could drown” (P8). These participants generally reported feeling relaxed after settling into the session. One participant reported they were “very overwhelmed and a little claustrophobic at first but then I relaxed a bit more into it and I felt a sense of happiness afterwards” (P35). Three participants reported minor negative sensations, such as “a headache by the end because it strained my eyes” (P18), “sensory overload” (P19), and one felt “dizzy but relaxed” (P28).
Practical and technical issues	Some participants reported technical issues when using the VR, but these were typically minor and did not disrupt the sessions. Participants reported that “getting used to the controls is a bit fiddly” (P5), “sometimes it was difficult to navigate the environments” (P13), and they “found it hard to navigate the controls as I have stiff arthritic fingers” (P30). Participants reported some difficulties in wearing the head-mounted display comfortably, highlighting that it was “difficult to use with glasses” (P11), “tricky to get the headset to stay on” (P21), and the “headset didn’t fit my head-to-nose ratio well” (P24). One participant reported “the VR headset was a bit heavy, there was a gap between my nose and the headset, so I could see a bit of light from the room” (P34). Further implementation issues were reported such as some participants finding the hospital environment of the session too noisy, such as “I felt a bit distracted as there was noise from the room during the session, but overall, it was relaxing” (P38) and “it would be better in a quiet room” (P38).

Data availability statement

The quality improvement project approval did not permit sharing of participants’ data.