The Impact of Self-Managed Virtual Reality Relaxation on Non-invasive Ambulatory Physiological Markers in Home-Based Psychiatric Care

Virtual reality (VR)-based relaxation interventions show promising effects, yet evidence on how self-guided interventions influence real-world physiological and subjective responses among psychiatric patients remains limited. Given the exploratory and preliminary nature of this study, we examined acute and longer-term autonomic and subjective responses to self-guided VR versus audio-guided relaxation, both during at-home relaxation sessions and across daily life (ClinicalTrials.gov: NCT05440825). In a single-blind randomized controlled trial, 53 outpatients with burnout or DSM-5 psychiatric diagnoses were assigned to VR (VRelax: n = 24) or audio-guided relaxation (n = 29). Participants engaged in their assigned method at least five times weekly for six weeks while wearing an Empatica E4 during weeks 1 and 6. Heart rate (HR), electrodermal activity (EDA), heart rate variability (HRV), movement, and subjective relaxation were assessed. Both interventions produced acute reductions in HR and phasic EDA during sessions, with comparable effects across modalities and partial attenuation over time. Physiological changes did not systematically predict subjective changes, aligning with evidence that psychological experience and autonomic responses often diverge in everyday contexts. Movement was positively associated with HR and EDA, reflecting activity-related variation. Tonic HR and EDA indices showed trait-like stability, whereas phasic EDA demonstrated state-like variability. This is the first study characterizing real-world autonomic and subjective responses to both modalities among psychiatric patients. Findings indicate that both modalities downregulate autonomic arousal in everyday settings, supporting momentary relaxation without altering trait-like physiology. Results highlight the feasibility and clinical potential of integrating personalized, ambulatory relaxation interventions into routine outpatient care.