Chronic stress and anxiety severely affect breast cancer survivors’ (BCSs) mental health and well-being. Peer support has been shown to enhance psychological empowerment, while biofeedback offers a promising approach to improve physiological relaxation through self-regulation. However, few studies explored combining both for BCSs. We conducted a formative study with clinicians and BCSs to identify requirements and preferences for VR biofeedback. Informed by the findings, we proposed a VR-based dyadic biofeedback system, Cobreath, which integrates breathing and heart rate variability (HRV) feedback into a calming virtual environment, allowing two users to practice breathing-focused relaxation simultaneously. Through a clinical user study with ten clinicians and a between-subjects study with 32 BCSs, we demonstrated that Cobreath’s dyadic mode improved biofeedback effectiveness and provided a better user experience compared to the individual mode. We further discuss insights and design considerations for developing dyadic VR-biofeedback applications to support the mental well-being of BCSs and potential applications.
Immersive technologies are increasingly applied in therapeutic and well-being practices, yet most AR systems focus on dyadic client–avatar interactions and overlook richer therapeutic structures that involve therapists. We introduce AReframedChair, an AR system that reimagines the traditional Empty Chair technique by enabling self-dialogue with a personalized avatar representing one's past or future self. In a between-subjects study with 60 adults, we compared the traditional Empty Chair method with two AR-reframed modes: Dyadic (client–avatar) and Triadic (client–avatar– therapist). Participants' survey responses showed that the Dyadic mode elicited greater positive affect and self-compassion in the past-self scenarios, whereas the Triadic mode produced stronger gains in motivation and reflections in future-self scenarios. Thematic analysis further revealed distinct roles: the Avatar facilitated emotional entry, reassurance, and cognitive reframing, while the Therapists intervened at critical moments to down-regulate intensity, redirect attention, and enhance reflection. These findings open up new design pathways for mental health technologies.
While Virtual Reality (VR) is increasingly employed for stress management, most applications rely heavily on audio-visual stimuli and overlook the therapeutic potential of squeezing engagement. To address this gap, we introduce VR Calm Plus, a multimodal system that integrates a pressure-sensitive plush toy into an interactive VR environment. This interface allows users to dynamically modulate the virtual atmosphere through physical squeezing actions, fostering a deeper sense of embodied relaxation. We evaluated the system with 40 participants using PANAS-X surveys, subjective questionnaires, physiological measures (heart rate, skin conductance, pulse rate variability), and semi-structured interviews. Results demonstrate that, compared to a visual-only baseline, squeeze-based interaction significantly enhances positive affect and perceived relaxation. Physiological data further revealed a state of “active relaxation”, characterized by greater reductions in heart rate and preserved autonomic flexibility (PRV), alongside sustained emotional engagement (GSR). Our findings highlight the value of coupling tangible input with immersive environments to support emotional well-being and offer design insights for future VR-based mental health tools.
To overcome the lack of deep personalization in standard biofeedback methods, we introduce ASafePlace, a system utilizing an AI-powered, art-therapy-inspired exercise called The Safe Place, to create a personalized VR biofeedback experience. In our system, users sketch a personal sanctuary from memory, which is then transformed into a customized 360° virtual environment with personalized audio guidance for relaxation training. A study with 52 participants showed this approach effectively reduced anxiety and increased user presence, while the integration of art-therapy-inspired activity and biofeedback produced strong improvements in physiological relaxation, measured by heart rate variability and respiration rate. Qualitative results showed how participants' sense of familiarity and presence was enhanced by the symbolic elements and natural sanctuaries created from their autobiographical memories. Our findings demonstrate that art-therapy-inspired activity is a powerful tool for creating highly effective and individualized relaxation experiences, naturally connecting the virtual environment to a user's core memories and emotions.
Within body-centered HCI, growing attention has been given to the body not only as an instrument of the mind but as a source of experience and presence. Dance meditation exemplifies this orientation by fostering mindful connection to the body through spontaneous, unstructured movement. In this context, VR has been widely adopted for structured instruction in static meditation and choreographed dance, yet its potential to foster freer, meditative bodily engagement has received little attention. To address this gap, we collaborated with dance meditators and co-designed Bodyfulness VR, a four-module system supporting (1) somatic awareness, (2) movement exploration, (3) emotional release, and (4) physical relaxation. Using the system as a design probe, we examined how VR could mediate somatic meditative practices. Findings from our user study indicate that VR could lower barriers to dance meditation by reducing self-consciousness and supporting bodily engagement, while movement-guiding affordances may also redirect attention toward task-oriented action, constraining bodily expression. By articulating this tension, our work contributes design implications for balancing structure and openness in VR systems that aim to support somatic mindfulness.
Embodying natural entities in Virtual Reality (VR) shows potential to enhance nature connectedness, but design factors that support such embodiment remain underexplored. This study examined whether transitional elements in the physical setting before and after VR and multisensory stimuli during VR can strengthen nature connectedness in a transformative tree-embodiment experience. Through a mixed-methods approach (N=20), where we varied the pre- and post-VR experience (Neutral vs. Transitional) and sensory modalities (Audiovisual vs. Multisensory), we found that both transitional and multisensory experiences significantly enhanced presence, embodiment, and nature connectedness, with increases in emotional connectedness sustained one week later. Drawing on interview insights and impact ratings of specific design features, we derive design recommendations for integrating transitional and multisensory elements. Our findings demonstrate the value of holistic design for enhancing the emotional and transformative potential of VR nature embodiment for fostering environmental awareness.
VR mindfulness meditation has been widely used for stress reduction and psychological rehabilitation owing to its immersion and controllability. However, the common static-body with visual-movement paradigm often disrupts the natural coordination between vision, vestibular sense, and proprioception, inducing sensory conflicts that hinder the stable onset and maintenance of state mindfulness. Despite its relevance, this issue has long been overlooked in both research and practice. To address this gap, we developed a VR meditation system supporting dynamic breathing feedback and eye-tracking, and conducted a three-factor within-subject experiment in a fixed-route navigation scenario. By manipulating visual reference, body posture, and locomotion intention, we induced different types and levels of sensory conflict. Multimodal analyses of questionnaires, eye-movement behaviors, and individual-difference measures suggested that sensory conflict weakens state mindfulness, and that increases in vestibulo-ocular reflex activity and instability in visual attention may help explain this association. Cluster analysis further showed that interoceptive awareness and motion sickness sensitivity significantly moderated these effects.