Virtual Reality Mindfulness Training for Veterans in Residential Substance Use Treatment: Pilot Study of Feasibility and Acceptability

Background: Mindfulness training is effective in aiding recovery from substance use disorders; however, its adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness and helping users focus on the present moment. However, there is currently limited knowledge regarding patient and provider experiences and perceptions of VR-based interventions and tools. Objective: The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT). Methods: Participants (N = 32) were recruited from a 30-day residential substance use program and provided both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability of each exercise and of the overall intervention, as well as usability and global satisfaction. Using a within-subjects design, patients (n = 20) provided pre-post emotion ratings and reported on state mindfulness and VR presence. Patients provided qualitative interview data on their overall impressions of the intervention, while providers gave the same information via open-ended survey questions. Results: Descriptive analyses indicated that both patients and providers found the intervention acceptable, helpful, and reported high satisfaction and confidence in the intervention. Results of dependent samples t-tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre- to post-intervention. In addition, patients reported experiencing high levels state mindfulness and presence in the intervention. Results of thematic qualitative analysis revealed that the intervention facilitated a calming and relaxing experience, relief from negative thoughts and emotions, and focused attention on the present moment. In addition, participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness training experiences including reduced distractions and a sense of safety and privacy. Conclusions: Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions and may provide some of the traditional benefits of mindfulness training. VR may provide an additional relaxation, stress-relief, and scaffolding tool to set the stage for deepening mindfulness skills. Feedback from the present study could be used in future intervention development efforts.