Virtual Worlds, Volume 4, Issue 4 (December 2025) – 5 articles

This feasibility study explored the integration of physiological monitoring into a virtual reality (VR) intervention for pediatric pain management. The goal of this study is to identify a feasible strategy for collecting physiologic data in the context of a VR intervention currently being developed for youth with chronic pain. We assess the potential of Cognitive Load (CL)—derived from heart rate and pupillometry/eye-tracking data—as a marker of arousal and user engagement in a VR simulation to promote school functioning in youth with chronic pain. The HP Reverb G2 Omnicept headset and Polar H10 heart-rate sensor were utilized. The Child Presence Questionnaire (CPQ) assessed participants’ self-reported immersion and engagement. Data collection focused on feasibility and utility of physiologic data in assessing arousal and correlations with self-reported experience. Nine participants engaged in the simulation, with eight yielding complete data. The simulation and headset were well tolerated. CPQ Transportation subscale showed trend-level correlation with mean CL. Due to small sample and feasibility focus, individual-level results were examined. Combining multiple physiologic markers into a construct like CL is intriguing, but data interpretability was limited. Pupillometry and related metrics show promise as feasible markers of engagement and arousal for VR-based intervention but require appropriate expertise to fully interpret. The study found that integration of physiologic monitoring is feasible, but further work is needed to standardize metrics and identify the most useful and user-friendly markers. Full article

Emerging virtual reality (VR) technologies provide objective and immersive methods for assessing cognitive–motor function, particularly in elite sport. This study evaluated the reliability and validity of VR-based cognitive–motor assessments in a large sample of elite male athletes (n = 829). Ten cognitive–motor tests, delivered via Oculus Quest 2 headsets, were used, covering four domains: Balance and Gait (BG), Decision-Making (DM), Manual Dexterity (MD), and Memory (ME). A Confirmatory Factor Analysis (CFA) was conducted to establish a four-factor model and generate data-driven weights for domain-specific composite scores. The results demonstrated that the composite scores for BG, MD, ME, and a Global Cognitive–Motor (CM) score were all normally distributed. However, the DM score significantly deviated from normality, exhibiting a pronounced ceiling effect. Test–retest reliability was high across all cognitive–motor domains. In summary, VR assessments offer ecologically valid and precise measurements of cognitive–motor abilities by capitalising on high-fidelity motion tracking and standardised test delivery. In particular, the Global CM Score offers a robust metric for parametric analyses. While future work should address the DM ceiling effect and validate these tools in diverse populations, this approach holds significant potential for enhancing the precision and sensitivity of psychological and clinical assessment. Full article

Colour is a fundamental determinant of affective experience in immersive virtual reality (VR), yet the emotional and physiological impact of individual hues remains poorly characterised. This study investigated how fifteen calibrated Munsell hues influence subjective and autonomic responses when presented in immersive VR. Thirty-six adults (18–45 years) viewed each hue in a within-subject design while pupil diameter and skin conductance were recorded continuously, and self-reported emotions were assessed using the Self-Assessment Manikin across pleasure, arousal, and dominance. Repeated-measures ANOVAs revealed robust hue effects on all three self-report dimensions and on pupil dilation, with medium-to-large effect sizes. Reds and red–purple hues elicited the highest arousal and dominance, whereas blue–green hues were rated most pleasurable. Pupil dilation closely tracked arousal ratings, while skin conductance showed no reliable hue differentiation, likely due to the brief exposure times (30 s). Individual differences in cognitive style and personality modulated overall reactivity but did not alter the relative ranking of hues. Taken together, these findings provide the first systematic hue-by-hue mapping of affective and physiological responses in immersive VR. They demonstrate that calibrated colour shapes both experience and ocular physiology, while also offering practical guidance for educational, clinical, and interface design in virtual environments. Full article

Background: Young children have experienced increased emotional difficulties, including anxiety, emotion dysregulation, and tantrums. Limited access to mental health services has created an urgent need for accessible interventions to equip professionals with effective strategies for managing children’s strong emotions. This study piloted an innovative virtual reality (VR) simulation designed to teach professionals emotion management techniques. Methods: Participants included 107 early childhood professionals (e.g., educational, healthcare, and allied health) working with children aged 3–6 years from the southeastern United States. The multilingual VR simulation taught professionals emotion management strategies. Participants self-selected whether to complete a temper tantrum management simulation (n = 71) or a separation anxiety simulation (n = 36). Participants’ responses to children’s strong emotions were assessed at baseline, post-intervention, and at one-month follow-up, along with a satisfaction survey. Results: Participants reported a significant increase in intent to use effective emotion regulation strategies immediately following VR completion. However, actual use of effective strategies showed no significant change at one-month follow-up. Being a Spanish-speaking professional was associated with significantly greater improvements in both intent and actual use of effective strategies at follow-up. Participants reported high satisfaction ratings with the VR simulations. Conclusions: VR simulations show promise as an innovative tool for teaching emotion management strategies, particularly benefiting Spanish-speaking early childhood professionals. While effective for immediate motivation, additional support mechanisms (e.g., repeated practice, workplace supports) may be needed to sustain long-term behavior change in professional practice. Full article

Background: Virtual reality has been shown to reduce pain during labour. We aimed to determine whether virtual reality reduces analgesia use and shortens labour duration. Methods: A non-randomised pilot study was conducted, using a matched case–control design (1:2 ratio). Cases were women who voluntarily used virtual reality alongside standard intrapartum pain management, including non-pharmacological methods and/or epidural analgesia. Controls received standard intrapartum pain management. Results: A total of 108 women were included for analysis (36 cases vs. 72 controls). Perceived pain scores before and after virtual reality use did not differ significantly (p = 0.43, p = 0.73), suggesting a limited immediate analgesic effect under current conditions. Epidural analgesia rates and cervical dilation at initiation of analgesia did not show significant differences between cases and controls (p = 0.13, p = 0.42). After adjusting for induction of labour and cervical dilation at admission, there were no significant differences for duration of epidural analgesia (p = 0.86, p = 0.56), duration of labour (p = 0.64, p = 0.55), or vaginal birth (p = 0.23). Adjusted models indicated a non-significant trend toward shorter durations of labour, birth, and epidural exposure for cases. Conclusions: Our pilot study did not reveal a decrease in perceived pain or epidural analgesia use or an effect on duration of labour and vaginal birth. Full article