## 3 Results
### Characteristics of the Included Studies
Protocol for Mixed Reality Instruments: Delivering Cognitive Behavioral Therapy to Mitigate Symptoms of Severe Psychological Stress in Young People with Asthma  
A qualitative protocol, proposed by [PERSON] and colleagues [37], was devised to explore the potential of employing mixed reality tools, encompassing augmented reality (AR), virtual reality (VR), and holographic technology, for administering cognitive behavioral therapy to manage symptoms of heightened psychological distress in young individuals with asthma. \"Mixed reality\" refers to a spectrum of technologies that blend elements of both the physical and digital worlds, allowing users to interact with both simultaneously. In the context of this study, mixed reality encompasses several specific technologies: augmented reality (AR) overlays digital information onto the real-world environment, typically viewed through a device such as a smartphone or smart glasses. Users can see virtual objects or information superimposed on the physical world; virtual reality (VR) creates immersive, computer-generated environments that users can interact with via specialized headsets or goggles. VR typically blocks out the physical world entirely, replacing it with a simulated digital environment; holographic technology creates three-dimensional images or projections that appear to exist in physical space, allowing users to interact with virtual objects as if they were real. The efficacy of this protocol is anchored in the utilization of mixed reality tools such as AR, VR, and holographic technology for delivering evidence-based cognitive behavioral therapy (CBT) to young individuals experiencing elevated psychological distress. Mixed reality technologies possess the ability to address low health literacy [41; 42], can be tailored based on population characteristics, enhance engagement with content [43], broaden the geographic reach and accessibility of information [44], and facilitate real-time content updates. The project intends to employ a qualitative action research framework, moderator guides, and qualitative research to examine the feasibility and acceptability of using mixed reality tools for delivering CBT to manage symptoms of heightened psychological distress in young individuals with asthma. The project would also develop mixed reality-enabled CBT resources and evaluate their acceptability and usability through one-on-one interviews with young people, parents, and health professionals. The data would be analyzed through three pre-determined perspectives, and the mixed reality resources would be refined based on qualitative feedback. Upon completion of the project, the data would be compiled for use in publications and conferences, and reports would be disseminated to participants and relevant stakeholders. The study plans to involve 30 participants, comprising 10 young individuals with asthma, 10 parents of these young individuals, and 10 healthcare professionals. The information gathered from this study would be utilized to refine the mixed reality resources for future feasibility studies, and the objective of the study is to mitigate the impact of asthma by improving access to evidence-based treatments for heightened psychological distress in young individuals with asthma.