Virtual Worlds, Real Relaxation? A Pilot Study on a Virtual Reality Breathing Exercise with Respiratory Biofeedback in Primary School Students: Feasibility and Potential Benefits

This pilot study investigated the feasibility and preliminary effectiveness of a low-threshold, gamified virtual reality (VR) breathing exercise with respiratory biofeedback (Flowborne VR) for promoting relaxation in primary school students. 26 students (aged 10-16 years) from the Canton of Schaffhausen, Switzerland, participated in single-session, within-subjects design in a naturalistic school setting. Participants provided self-reports on various facets of user experience and intervention feasibility, as well as their current mood state before and after the intervention. Observational data on task adherence, encountered difficulties, and breathing behavior were also collected, alongside objective breathing data recorded by the VR application. Results indicated that the VR immersion was generally well-tolerated, with no significant symptoms of simulator sickness occurring, despite some practical issues in properly adjusting the VR headset. Participants found the breathing exercise easy to understand, demonstrated high levels of task adherence, and reported low feelings of overwhelm. The intervention received positive ratings, including usability, design, engagement, and biofeedback responsiveness. Most participants were able to adopt a breathing style characterized by strong abdominal movements and prolonged exhalations, although further practice seems necessary to fully master slow diaphragmatic breathing. Significant improvements were observed in self-reported mood and calmness from pre- to post-intervention. The findings provide preliminary evidence for the feasibility of integrating gamified VR-based relaxation exercises into everyday educational contexts and suggest that the engaging nature of VR coupled with biofeedback can offer a valuable tool for promoting stress management skills in children. However, the small sample size, lack of a control group, and single-session design limit the generalizability of the results. Future research with controlled longitudinal designs is needed to further investigate the effects of this promising intervention.