# Psychoeducation on Stress and Anxiety Using Virtual Reality: A Mixed-Methods Study
## 4 Discussion
### Principal Results
In this context, the use of VR and other technologies- as well as, for example, commercial off-the-shelf (COTS) video games [109; 110]--could \"normalize\" and make more appealing psychological support programs, decreasing the associated stigma and increasing the request for help. Regarding MIND-VR, first of all, analyses on questionnaires (i.e., SUS, NPS, SDM) showed that healthcare workers considered this psychoeducational virtual experience highly usable and satisfying. Moreover, participants declared during the interviews that using MIND-VR was easy, and any of them reported side effects (i.e., nausea, vertigo). These results appear important since usability was considered one of the key qualities of the VR psychoeducational experience during its conception and development. Indeed, breakdowns or other interaction issues can reduce VR's ability to induce both emotions [111; 112; 113] and a satisfying sense of presence [112; 114], with potential detrimental effect on learning outcomes [49; 115]. Secondly, MIND-VR was considered by healthcare workers to be pleasant and relaxing. Specifically, the results of the analyses on the self-report scales (i.e., STAI-Y1, VAS-E) showed after the use of the virtual psychoeducational experience a significant increase in the intensity of positive emotions (i.e., happiness and surprise) and a decrease of state anxiety and negative emotions (i.e., fear and sadness). The interviews also revealed participants' particular appreciation/relaxation toward the visual and sound aspects of MIND-VR. The fact that MIND-VR was able to promote relaxation and positive emotions in users appear to be an essential feature of this virtual experience. Indeed, through its use even for a short period of time, it is possible to induce a state of relaxation in the individual, with immediate positive psychological effects. In addition, as underlined by the broaden-and-build model [116], experiencing positive emotions can enhance the interaction with others or the engagement in creative challenges [117; 118]. Furthermore, a positive emotional state has a favorable impact on learning processes, promoting the acquisition of the information provided [119; 120]. Thirdly, the sense of presence measured after the use of MIND-VR through the questionnaires (i.e., SUS-II and IPQ) was found to be high, especially regarding spatial presence. This fact appears important because VR offers advantages over traditional, non-immersive, education only when the experience is enjoyable, engaging, and able to elicit a sense of presence [49; 115]. Thanks to VR, people have the possibility, unlike in the traditional non-immersive education instruments (e.g., books and PowerPoint presentations), \"to be in the lesson\". The sense of presence positively influences the students' interest and motivation to interact with the simulation [121; 122], positively affecting the learning outcome [123]. However, in order not to negatively affect the learning process, it is good that individuals are not overwhelmed by the virtual environment [124; 125]. For this reason, it seems important that involvement, as measured by the IPQ-INV, was found to be not high but with average scores in this study. Finally, MIND-VR was perceived by the healthcare workers to be clear, motivating, and engaging for learning information about stress and anxiety. Participants reported in the ad hoc questionnaire on learning using VR high mean scores in understanding, motivation, and interest for the subject explained in the virtual experience. In contrast, mean effort scores resulted low. Furthermore, from the analyses of the data collected through interviews, VR was described as practical, motivating and engaging for learning. These results suggest that MIND-VR is a potentially valuable tool for improving knowledge and awareness about stress and anxiety. By exploring the virtual environment, individuals may feel in a safe and nonjudging setting, increasing insight into their mental conditions [30].