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  <front>
    <journal-meta>
      <issn pub-type="ppub">1613-0073</issn>
    </journal-meta>
    <article-meta>
      <title-group>
        <article-title>Model for the analysis of Virtual Reality mindfulness applications</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Alberto Hitos-García</string-name>
          <email>albertohitos@ugr.es</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>André Luiz Satoshi Kawamoto</string-name>
          <email>kawamoto@utfpr.edu.br</email>
          <xref ref-type="aff" rid="aff3">3</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Francisco Luis Gutiérrrez-Vela</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Patricia Paderewski-Rodríguez</string-name>
          <email>patricia@ugr.es</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Pablo Figueroa</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Kattia Cabas</string-name>
          <email>kcabas@unimagdalena.edu.co</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Workshop</string-name>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Universidad de Granada, Dpto. de Lenguajes y Sistemas Informáticos - ETSIIT</institution>
          ,
          <addr-line>Granada</addr-line>
          ,
          <country>España</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Universidad de Los Andes</institution>
          ,
          <addr-line>Bogotá</addr-line>
          ,
          <country country="CO">Colombia</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>Universidad de Magdalena</institution>
          ,
          <addr-line>Facultad de Psicología, Santa Marta</addr-line>
          ,
          <country country="CO">Colombia</country>
        </aff>
        <aff id="aff3">
          <label>3</label>
          <institution>Universidade Tecnológica Federal do Paraná (UTFPR)</institution>
          ,
          <addr-line>Depto. Acadêmico de Computação (DACOM), Campo Mourão, PR</addr-line>
          ,
          <country country="BR">Brasil</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>This paper extends the Technology Acceptance Model (TAM) to evaluate the acceptance of Virtual Reality (VR) for mindfulness practices, focusing on technological usability and therapeutic outcomes. Using a mixed-methods approach, we adapted TAM's core constructs-Perceived Usefulness (PU) and Perceived Ease of Use (PEOU)-to assess mental health benefits (e.g., mood improvement, stress reduction) and VR-specific usability challenges (e.g., hardware comfort, interaction intuitiveness). A pilot study was employed with a sample of university students combining non-parametric statistical analyses (Wilcoxon signed-rank test, efect size calculations) and qualitative thematic exploration. The results showed improved PU and PEOU after VR exposure, including better mood and usability comfort. Qualitative insights highlighted immersion and environmental suitability as critical facilitators of mindfulness, with participants emphasizing VR's capacity to reduce external distractions. The adapted TAM framework integrates therapeutic metrics and VR usability factors, providing a dual perspective on technological acceptance and psychological impact. This study highlights the strengths of mixed-methods designs in pilot research, balancing quantitative precision and qualitative insights. These findings underscore VR's potential as a tool for mental health interventions while identifying key areas for refinement, such as ergonomic design and personalized guidance. Future research should expand participant diversity, incorporate longitudinal physiological measures, and explore environmental variability to optimize VR mindfulness applications.</p>
      </abstract>
      <kwd-group>
        <kwd>virtual reality</kwd>
        <kwd>mindfulness</kwd>
        <kwd>Technology Acceptance Model</kwd>
        <kwd>mental health</kwd>
        <kwd>pilot study</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. Introduction</title>
      <p>
        Mental health represents a significant challenge in contemporary society, afecting individuals of all ages
and backgrounds [
        <xref ref-type="bibr" rid="ref1 ref2 ref3">1, 2, 3</xref>
        ]. Problems such as stress, anxiety, depression, and burnout are increasingly
prevalent, especially among university students [
        <xref ref-type="bibr" rid="ref4 ref5 ref6 ref7">4, 5, 6, 7, 8</xref>
        ] and healthcare professionals [9, 10, 11].
These disorders can negatively impact the quality of life, academic and professional performance, and
overall well-being. Traditional approaches to mental health treatment, such as therapy and medication,
are often limited in terms of accessibility, cost, and efectiveness, which creates the need to explore new
solutions [12, 13].
      </p>
      <p>In this context, Virtual Reality (VR) is a promising tool that complements traditional interventions.
VR ofers the ability to create immersive and interactive environments that can be used to train
mindfulness skills. This practice involves focusing on the present moment in a non-judgmental and
open way. Regular mindfulness practice has shown benefits in reducing stress, anxiety, and depression,</p>
      <p>CEUR</p>
      <p>
        ceur-ws.org
as well as improving emotional regulation, well-being, and attention. According to some studies, VR
can improve adherence to mindfulness programs and also increase retention compared to traditional
practices [
        <xref ref-type="bibr" rid="ref5">5, 9, 10, 11</xref>
        ]. According to the literature, VR-based mindfulness applications can ofer several
advantages compared to traditional approaches:
• Accessibility: VR can make mindfulness practices more accessible to people who have dificulty
travelling to therapy environments or live in remote areas [12, 13].
• Engagement: Immersive virtual environments can increase participant engagement and
motivation, making mindfulness practice more interesting and enjoyable [
        <xref ref-type="bibr" rid="ref3">3, 10, 11</xref>
        ].
• Control: VR allows for control over the environment and customization of mindfulness practices
to meet the individual needs of each person [12, 10, 11].
• Feedback: VR enables using biofeedback and other monitoring forms to provide users with
information about their physiological and emotional state, helping them deepen their mindfulness
practice [10, 11].
• Versatility: VR can be used in various contexts, including clinics, schools, and even at home
[
        <xref ref-type="bibr" rid="ref6">6, 13</xref>
        ].
• Overcoming Barriers: Virtual environments can help people with physical dificulties or
limitations who would not have access to traditional meditation spaces or outdoor activities [10].
However, the application of VR in mindfulness also presents challenges. User acceptance of the
technology is crucial for the success of interventions [13]. Factors such as equipment discomfort,
immersion quality, cost, and lack of familiarity with the technology can be barriers to overcome [13].
      </p>
      <p>The Technology Acceptance Model (TAM) is a widely used theoretical framework to understand
and predict user acceptance of new technologies [14]. The TAM suggests that technology acceptance
is influenced by two main factors: perceived usefulness and perceived ease of use [ 14]. Applying the
TAM in a VR with a mindfulness context can provide valuable insights into how university students
perceive and accept this combination of technologies and practices.</p>
      <p>This study proposes an extension of TAM that integrates mental health metrics and VR-specific
usability factors. Using a mixed-methods approach, i.e. the combination of non-parametric statistical
tests and qualitative thematic analysis, we evaluate not only technological acceptance but also the
psychological impact of VR on mindfulness practices. By bidding on technological acceptance and
therapeutic outcomes, this framework provides a dual perspective to guide the design and evaluation of
VR mindfulness interventions.</p>
    </sec>
    <sec id="sec-2">
      <title>2. VR and mindfulness for mental health</title>
      <p>
        The combination of VR and mindfulness has shown promise for mental health interventions [
        <xref ref-type="bibr" rid="ref1 ref2 ref3">1, 2, 3</xref>
        ].
VR ofers immersive environments that can complement and enhance mindfulness practice, based on
complete attention to the present moment [
        <xref ref-type="bibr" rid="ref3 ref4">3, 4</xref>
        ].
      </p>
      <p>
        VR can create a sense of presence in relaxing virtual environments and serve as an anchor for attention,
reducing distractions. Furthermore, it increases participants’ engagement and motivation and can be
used in guided practices, combining immersive videos and narrations. Some studies utilize natural
scenarios like beaches or forests to create relaxing environments [
        <xref ref-type="bibr" rid="ref3 ref6">3, 6</xref>
        ]. Others combine mindfulness
practice with biofeedback, adding a physiological component [
        <xref ref-type="bibr" rid="ref4">4, 10</xref>
        ].
      </p>
      <p>
        Mindfulness practice, facilitated by VR, can enhance emotional regulation, reduce stress and anxiety,
and promote overall well-being [
        <xref ref-type="bibr" rid="ref3 ref4">3, 4, 10</xref>
        ]. VR enhances mindfulness mechanisms such as decentering,
which helps individuals distance themselves from their thoughts and emotions while increasing
selfawareness and compassion [
        <xref ref-type="bibr" rid="ref3">3, 10</xref>
        ].
      </p>
      <p>
        Among the various VR-based interventions, studies have explored the use of VR in diferent contexts,
including Mindfulness-Based Stress Reduction (MBSR) programs [
        <xref ref-type="bibr" rid="ref1 ref2">1, 2, 10</xref>
        ], Dialectical Behavior Therapy
(DBT) [
        <xref ref-type="bibr" rid="ref3">3, 12, 10</xref>
        ], and treatment of anxiety and pain disorders [
        <xref ref-type="bibr" rid="ref3 ref4">3, 4, 10</xref>
        ].
      </p>
      <p>
        According to Wieczorek’s systematic review, these interventions can significantly improve
mindfulness state, positive afect, and reduce stress and anxiety [ 10]. VR also seems to improve treatment
adherence and retention in mindfulness programs [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. However, the adoption of VR still raises some
controversy, generating debate about the increased efectiveness of mindfulness when using VR
compared to traditional practice. Some studies indicate that VR is as efective as traditional practice but does
not represent a significant improvement [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. Additionally, some study participants reported discomfort
with VR equipment and video quality issues [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]. Another barrier is the heterogeneity of studies and
lack of methodological standardization make it dificult to evaluate efectiveness [ 10].
      </p>
      <p>
        Thus, it is necessary to develop standards and best practices for the use of VR in mindfulness [10], as
well as longitudinal studies to better understand the mechanisms of action and long-term efectiveness
of VR mindfulness interventions [
        <xref ref-type="bibr" rid="ref3">3, 10</xref>
        ].
3. Extension to the Technology Acceptance Model (TAM)
The Technology Acceptance Model (TAM) [15], proposed in 1989, is one of the most widely used
theories to understand and predict the acceptance and use of technologies by users. TAM is based on
two primary constructs: Perceived Usefulness (PU) and Perceived Ease of Use (PEOU). PU refers to the
degree to which an individual believes using a specific system will enhance their job performance or
overall productivity. PEOU is the degree to which an individual believes that using a system will be
free of efort [ 14].
      </p>
      <p>These constructs are associated with Attitude Towards Use (ATU), i.e., the general attitude of the
user towards the use of technology (which can be positive or negative) depending on how they perceive
the benefits and ease of the technology, and Behavioral Intention to Use (BI), defined as the user’s
intention to use the technology, which is directly influenced by PU and indirectly by PEOU, as well as
their attitude towards the technology, are determinants in the actual system use.</p>
      <p>TAM constructs are interrelated to predict whether a person will adopt a technology. For instance, if
someone believes that a technology is useful (PU) and easy to use (PEOU), they are more likely to have
a positive attitude (ATU) and, consequently, a greater intention to use it (BI). The Figure 1 shows the
original TAM.</p>
      <p>TAM has been widely applied in various fields, such as healthcare, education, and business, to
understand the acceptance of new technologies [16]. The simplicity and efectiveness of the model have made
it a valuable tool for researchers and practitioners seeking to implement new technologies efectively.
The model helps identify the factors that influence technology acceptance, allowing organizations to
develop strategies to improve the adoption of new systems and technological tools [17].</p>
      <sec id="sec-2-1">
        <title>3.1. Adaptation of the TAM for VR mindfulness evaluation</title>
        <p>TAM was systematically adapted to address the unique interplay between immersive technology and
therapeutic outcomes to evaluate the acceptance of VR for mindfulness interventions. PU and PEOU
were refined to align with VR mindfulness contexts, incorporating mental health metrics and VR-specific
usability factors.</p>
        <p>
          The original TAM framework emphasizes productivity-oriented utility (e.g., workplace eficiency) [ 14,
15]. However, VR mindfulness prioritizes therapeutic eficacy, necessitating a shift toward psychological
outcomes such as mood regulation and stress reduction [
          <xref ref-type="bibr" rid="ref1">1, 10</xref>
          ]. VR’s immersive nature introduces
usability challenges (e.g., hardware comfort, interaction design) that standard TAM overlooks [18, 16].
This adaptation bridges TAM’s theoretical foundations with the demands of VR-mediated mindfulness,
ensuring relevance to both technological and therapeutic dimensions.
        </p>
      </sec>
      <sec id="sec-2-2">
        <title>3.2. Modifications to Perceived Usefulness (PU)</title>
        <p>TAM’s PU items were redefined to assess VR’s capacity to enhance mental well-being, reflecting
mindfulness goals. For this construct, we considered three external variables: Mood, Depression Level
and the Number of Negative Thoughts. The objective is to measure whether there is a perceived change
in PU, denoting that using VR applications focused on mindfulness has proven helpful for users.</p>
        <p>Mood (PU1) was chosen because a user’s current afective state significantly influences their subjective
evaluation of technology. Positive mood states are associated with enhanced cognitive flexibility and
increased receptivity to new experiences, which can lead users to perceive the VR mindfulness system
as more beneficial for sustaining emotional well-being. Conversely, individuals in a negative mood may
be more critical but may also perceive a more significant relative benefit if the intervention improves
their attitude.</p>
        <p>The second variable, Depression Level (PU2), was selected because depression is typically associated
with diminished motivation, negative expectations, and reduced capacity to experience pleasure
(anhedonia), which can afect initial perceptions of system usefulness. However, for users experiencing
depressive symptoms, even slight improvements in afect or cognitive clarity resulting from VR
mindfulness sessions can lead to heightened perceptions of usefulness, particularly when contrasted with
their baseline state.</p>
        <p>Finally, the Number of Negative Thoughts (PU3) is considered due to the fact that frequent negative
automatic thoughts indicate emotional distress and are strongly associated with cognitive overload
and impaired well-being. A system that efectively interrupts or alleviates such patterns may benefit
users who frequently experience them. This perception is reinforced when the VR experience promotes
attentional refocusing or emotional regulation.</p>
        <p>These psychological variables influence PU by shaping users’ expectations and evaluations of the
system’s ability to enhance their mental health. In interventions where emotional and cognitive relief
are primary goals—as in VR-based mindfulness—these variables are particularly evident predictors of
perceived utility, arguably surpassing technical or usability-related factors.</p>
        <p>By framing PU around mental health outcomes, the adaptation ensures construct validity for
therapeutic contexts, as validated by systematic reviews linking VR to reduced anxiety and improved
emotional regulation [10, 11].</p>
      </sec>
      <sec id="sec-2-3">
        <title>3.3. Refinement of Perceived Ease of Use (PEOU)</title>
        <p>PEOU construct was expanded to address usability barriers specific to VR, which are critical for
mindfulness adherence. In immersive environments such as VR-based mindfulness applications, users’
perceptions of system usability are shaped by various experiential and interaction-related variables.</p>
        <p>The first variable, Ease of Use (PEOU1), refers to the direct operational simplicity of the system.
When users can navigate and operate the VR application with minimal efort, they are more likely
to perceive the system as easy to use. This is particularly important in mindfulness contexts, where
minimizing cognitive load is essential for fostering engagement and sustained usage.</p>
        <p>Another element is Interactivity (PEOU2), which involves high levels of system responsiveness
and meaningful interactions. Smooth and interactive VR mindfulness experiences contribute to an
uninterrupted user experience, reinforcing the perception that the system is manageable and
userfriendly. Conversely, poor interactivity may create discord that negatively afects the perceived ease of
use.</p>
        <p>Intuitiveness (PEOU3) also plays a fundamental role. A system is considered intuitive when users can
operate it without extensive learning or prior experience. In VR applications, intuitiveness allows users
to focus on the mindfulness experience itself rather than the interface, which is especially important
for individuals less familiar with immersive technologies.</p>
        <p>Finally, Comfort of Use (PEOU4) pertains to the physical and ergonomic aspects of the system, such as
the weight and fit of the VR headset, freedom of movement, and absence of physical strain or discomfort.
In VR contexts, physical comfort is vital for enabling users to engage with the system for the intended
duration without distraction or fatigue, thus enhancing their perception of ease of use.</p>
        <p>These external variables directly contribute to the PEOU construct by reducing interaction barriers
and increasing the system’s smoothness and accessibility. In mindfulness, where the goal is to promote
relaxation and presence, the perception that the system is easy to use is a foundational element for
efective adoption and sustained engagement. Figure 2 shows the proposed TAM with VR-Mindfulness
extension.</p>
        <p>The rationale behind these items relies on the fact that VR acceptance hinges on both software and
hardware usability [18, 16]. By including a comfort-related item (PEOU4), we acknowledge VR’s
ergonomic demands, a factor underrepresented in traditional TAM but vital for mindfulness interventions
requiring sustained engagement [9].</p>
        <p>Additionally, we propose incorporating structured scales based on the TAM model and open-ended
questions to assess ATU and BI, adopting a hybrid approach which combines descriptive and inferential
analyses to examine underlying constructs. Thus, integrating these methods provides a robust strategy
for assessing technology acceptance, increasing the reliability and generalizability of the results.</p>
      </sec>
      <sec id="sec-2-4">
        <title>3.4. Methodological enhancements</title>
        <p>Pre-Post Design. We propose shifting verb tenses (e.g., “ will be useful” and “was useful” ) in the
questionnaire items to enable longitudinal analysis of how direct VR exposure alters perceptions. This
approach aligns with TAM extensions advocating for experiential evaluation in emerging technologies
[17].</p>
        <p>Qualitative Triangulation. We also suggest using open-ended questions to complement PU/PEOU
scores by capturing subjective experiences (e.g., “sense of presence”, “post-session mood changes”). This
mixed-methods design strengthens validity, as qualitative insights contextualize quantitative trends—a
best practice in small-sample studies [19].</p>
        <p>This adaptation advances TAM’s applicability to immersive health technologies and VR paradigm by:
• Integrating Mental Health Metrics: Grounding PU in therapeutic outcomes, as advocated in</p>
        <p>
          VR mindfulness literature [
          <xref ref-type="bibr" rid="ref3">3, 10</xref>
          ].
• Addressing Immersive Usability: Expanding PEOU to include hardware comfort and
interaction design, critical for VR adoption [18].
• Balancing Rigor and Flexibility: Combining quantitative TAM metrics with qualitative depth,
a strategy endorsed for exploratory pilots [19].
        </p>
        <p>In summary, by adapting TAM to the context of VR-based mindfulness, this study proposes a
framework for assessing both user acceptance and therapeutic impact. The adjustments made to the
model reflect the dual function of VR as an immersive experience and a mental health intervention,
ofering a valuable guideline for future research in digital therapeutics.</p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>4. The experiment</title>
      <p>The experiment involved the use of two diferent VR headset models: the Meta Quest 3 and the Apple
Vision Pro. These devices were selected to ensure compatibility with diferent mindfulness applications.</p>
      <sec id="sec-3-1">
        <title>4.1. Justification for the pilot study</title>
        <p>This study assesses the feasibility of using VR for mindfulness practices using the proposed Extended
TAM. Conducting a pilot study was essential for several reasons:
1. Exploratory Nature and Initial Insights: Given the innovative intersection of VR and
mindfulness, gathering preliminary data before designing large-scale studies is important. The pilot
study allows us to explore how users initially perceive VR-based mindfulness and identify key
trends that warrant further investigation.
2. Validation of Methodology and Measurement Instruments: The pilot study assesses whether
the proposed survey instruments efectively capture perceived usefulness (PU) and perceived
ease of use (PEOU) in this domain (Immersive VR for mindfulness).
3. Practical Constraints and Need for a Controlled Environment: Recruiting a large sample
for an emerging technological intervention can be challenging. A small-scale study enables
testing the experimental procedure under controlled conditions, ensuring participant safety and
comfort while interacting with VR.
4. Use of Statistical Methods Suitable for Small Samples: The study employs non-parametric
statistical techniques, such as the Wilcoxon signed-rank test and efect size calculations, to derive
meaningful insights despite the small sample size. Additionally, qualitative thematic analysis
complements the statistical findings, providing a richer understanding of participant experiences.
5. Guidance for Future Research: The findings highlight methodological adjustments needed for
subsequent studies, such as refining the experimental protocol and enhancing the survey design.</p>
        <p>These insights will support the development of larger studies with more diverse participant pools.</p>
      </sec>
      <sec id="sec-3-2">
        <title>4.2. VR applications used in the experiment</title>
        <p>The study employed four carefully selected VR applications, each ofering distinct mindfulness-related
experiences. The selection was based on their ability to represent diferent approaches to VR-mediated
mindfulness while covering a spectrum of immersive qualities:
• Tripp: A purpose-built mindfulness and meditation application that combines guided sessions
with abstract virtual immersive environments (Figure 3). This was included as it represents a
direct VR adaptation of traditional mindfulness practices, ofering structured breathing exercises
and visualizations designed to reduce anxiety and promote relaxation.
• Nature Treks VR: Provides an open exploration of natural environments (forests, beaches,
etc.) with minimal interaction requirements. This application was selected as it embodies the
“nature exposure” approach to mindfulness, allowing participants to practice attention-focusing in
serene virtual landscapes without structured guidance. It ofers highly immersive environments
and soothing soundtracks, creating an ideal atmosphere for mindfulness practices and stress
reduction.
• The Room VR: A puzzle-based experience focused on mystery and investigation. The game
evokes a sense of suspense and fascination in locations such as a gothic cathedral, a mausoleum,
and an enigmatic sanctuary. While not explicitly designed for mindfulness, the game encourages
states of concentration and attentiveness by challenging players to focus on solving intricate
puzzles and interacting with objects in detail. This application was included to test whether light
cognitive engagement could support mindful states through focused attention on problem-solving
tasks.
• Thrill of the Fight: A boxing simulator with high physical intensity (Figure 4. This
unconventional choice was included to contrast with traditional mindfulness applications and evaluate
whether physically demanding VR experiences could produce mood-enhancing efects through
diferent mechanisms (e.g., catharsis, physical exertion), promoting an alternative approach to
well-being.
The diversity of applications allowed us to assess diferent pathways through which VR might support
mindfulness and mental well-being, from direct meditation support to more indirect approaches through
environmental immersion and physical engagement.</p>
      </sec>
      <sec id="sec-3-3">
        <title>4.3. Participants</title>
        <p>The study sample consisted of 6 master’s degree students from the University of Granada, aged between
22 and 25 years (mean age = 22.8 years). Among the participants, 5 identified as male and 1 as
female. The participants were recruited voluntarily after the experiment was announced to the students.
All participants were familiar with VR, but none of them had experienced any VR applications for
mindfulness before.</p>
      </sec>
      <sec id="sec-3-4">
        <title>4.4. Methodology</title>
        <p>The objective of this study was to evaluate the willingness of participants to use VR applications for
mindfulness to reduce anxiety and potential depression. This study utilized the extended TAM to assess
the acceptance of this technology.</p>
        <p>The experiment was conducted in three main stages:
1. Profile and Pre-Test Questionnaire (TAM) : In the initial phase, participants completed a
demographic and profile questionnaire and a pre-test based on the TAM. The pre-test used a
7-point Likert scale to evaluate participants’ initial perceptions of the VR technology’s ease of
use (PEOU) and perceived usefulness (PU).
2. Interaction with VR Applications for Mindfulness: Participants were invited to use VR
headsets with applications focused on mindfulness practices in the second phase. The two diferent
VR headset models were used alternately to optimize the time required for the experiment. These
sessions were conducted in a controlled environment to ensure the safety and comfort of the
participants.
3. Post-Test Questionnaire (TAM) and Exploratory Questions: After the VR interaction,
participants completed a post-test TAM using the same 7-point Likert scale to assess changes in their
perceptions of ease of use and usefulness. Additionally, they answered exploratory open-ended
questions to provide qualitative insights into their experiences.</p>
      </sec>
      <sec id="sec-3-5">
        <title>4.5. Measurement instruments</title>
        <p>The extended TAM questionnaires in the pre-test and post-test utilized a 7-point Likert scale, ranging
from “strongly disagree” (1) to “strongly agree” (7). This format allowed for a detailed assessment of
participants’ perceptions of the technology. For each external variable, we proposed a corresponding
question. These questions are presented in Table 1 and Table 2.
I believe VR can help improve my mood. I believe VR helped improve my mood.</p>
        <p>VR has the potential to alleviate depression I believe VR would help alleviate depression
symptoms. symptoms.</p>
        <p>Using VR will be useful for distracting me Using VR was useful for distracting me from
from negative thoughts. negative thoughts.</p>
        <p>The first item (PU1) refers to mood improvement: “I believe VR can help improve my mood” (Pre-Test)
and “I believe VR helped improve my mood” (Post-Test). This item aligns with studies demonstrating
VR’s eficacy in mood modulation through immersive relaxation [ 9, 10].</p>
        <p>
          The second item (PU2) focuses on depression symptom alleviation, evaluating VR’s perceived clinical
value, and addressing mental health applications [
          <xref ref-type="bibr" rid="ref1">1, 12</xref>
          ].
        </p>
        <p>
          The last item (PU3) concerns distraction from negative thoughts, capturing VR’s role in redirecting
attention, a core mechanism in mindfulness practice [
          <xref ref-type="bibr" rid="ref3">3, 12</xref>
          ].
PEOU1
PEOU2
PEOU3
PEOU4
        </p>
        <p>Pre-Test</p>
        <p>Post-Test
I believe it will be easy to use the VR during It seemed easy to use the VR during the
sesthe session. sion.</p>
        <p>Using immersive glasses will be simple and I could move and interact with virtual objects
straightforward. without problems.</p>
        <p>I believe interacting with VR will be intuitive The usage experience was simple and
and easy to learn. straightforward.</p>
        <p>I believe I will feel comfortable using VR head- I felt comfortable using VR headsets during
sets during the session. the treatment.</p>
        <p>The PEOU1 concerns the ease of use, contrasting pre-test expectations (“I believe it will be easy to use
VR”) with post-test experiences (“It seemed easy to use VR”), capturing usability adaptation processes
[14].</p>
        <p>PEOU2 refers to interaction simplicity and focuses on VR’s interaction mechanics, a known barrier
for novices [18].</p>
        <p>The third item, PEOU3, addresses Intuitiveness, estimating the learning curve, which is critical for
minimizing cognitive load during mindfulness sessions [9].</p>
        <p>The fourth item, PEOU4, is related to comfort, explicitly assessing hardware ergonomics, a frequent
obstacle in prolonged VR use [18].</p>
        <p>The questions related to Attitude Toward Use (ATU) and Behavioral Intention (BI) were designed
to evaluate critical dimensions of the extended TAM, prioritizing both therapeutic outcomes and the
technical feasibility of virtual reality (VR).</p>
        <p>The questions in Table 3 (ATU) focused on participants’ subjective perceptions of the technology’s
clinical eficacy, such as their belief in VR’s capacity to alleviate depressive symptoms and their
willingness to recommend its use to others. These responses captured the redefined Perceived Usefulness
(PU), which in this context extends beyond traditional productivity metrics to encompass tangible
psychological impacts, such as emotional regulation and reduced negative thought patterns.
#
ATU1
ATU2
ATU3
ATU4
ATU5
Do you think VR can be an efective tool for treating depression? Why?
Do you have any suggestions for improving the VR experience?
How did your expectations about VR change after participating in the experiment?
Would you recommend the use of VR to other young university students dealing with
depression?
Is there anything else you would like to add about your experience with VR and its potential
use in treating depression?</p>
        <p>The questions in Table 4 (BI) explored practical VR experiences, emphasizing immersion, physical
comfort, and interaction smoothness. For instance, participant reflections on the sense of presence in
virtual environments and hardware discomfort were adapted to address ergonomic challenges unique
to immersive technologies. Questions addressing post-session mood changes and well-being link
immersion to core mindfulness therapeutic mechanisms, such as minimizing external distractions.</p>
        <p>This qualitative approach complemented the quantitative data obtained through the PU and PEOU
questionnaires, allowing a deeper analysis of the participants’ experiences. The textual responses helped
contextualize statistical scores and revealed important nuances about VR acceptance in therapeutic
environments.</p>
      </sec>
      <sec id="sec-3-6">
        <title>4.6. Data Analysis</title>
        <p>The collected data were analyzed using the following statistical methods:
• Wilcoxon Signed-Rank Test: Used to evaluate diferences between the pre-test and post-test
measurements due to the small sample size and the ordinal nature of the data.
• Efect Size (Cohen’s d) : Calculated to measure the magnitude of the observed diferences
between the pre-test and post-test conditions.
• Sign Test: Applied to verify the significance of diferences in individual responses, complementing
the Wilcoxon test analysis.
• ATU and BI Questions Analysis: The qualitative responses were analyzed to identify common
themes and insights about participants’ experiences, perceptions, and suggestions for improving
the VR applications.</p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>5. Results and discussion</title>
      <sec id="sec-4-1">
        <title>5.1. Acceptance of VR</title>
        <p>This study collected pre-test and post-test data to analyze changes in perceptions following an
intervention. The variables analyzed include Perceived Ease of Use (PEOU1, PEOU2, PEOU3, PEOU4) and
Perceived Usefulness (PU1, PU2, PU3). The results are shown in Tables 5.1 and 5.1.</p>
        <p>6
4.67
1.21
3.00
4.00
4.50
5.75
6.00</p>
        <p>The Cronbach’s alpha coeficient, widely used in scientific research to assess the internal consistency
of measurement instruments, requires a suficiently large sample to ensure the stability and validity of
the results. Some methodological studies recommend using samples of at least 30 participants to obtain
reliable estimates of Cronbach’s alpha [20]. This recommendation aims to capture response diversity
and minimize the impact of random variations.</p>
        <p>Therefore, Cronbach’s alpha was not calculated for the sample in this pilot test. However, in studies
with a larger sample of participants, it is recommended to use some measure of reliability before
proceeding with the analysis to obtain precise and meaningful estimates of the instrument’s internal
consistency.</p>
        <p>Despite the diferences in the means not being statistically significant according to the Wilcoxon
test, the Sign Test results show that PU1 exhibits a statistically significant change. Furthermore, the
efect sizes suggest substantial changes in certain variables, particularly PEOU2 and PU2, which showed
large efect sizes. The variables PEOU1, PEOU3, and PU1 exhibited medium efect sizes, with Cohen’s d
values of 0.521, 0.577, and 0.674, respectively, indicating moderate changes. In contrast, the variable
PU3 did not present a significant change.</p>
        <p>The results also indicate that there were perceived improvements in the ease of use and usefulness of
the evaluated technology, as evidenced by the increases in the mean values of the variables. However,
the lack of overall statistical significance suggests a larger sample or additional analysis to confirm
these findings. The efect size provides insight into the changes’ magnitude, highlighting the observed
ifndings’ relevance.
5.1.1. Experience impact
The responses from ATU and BI questions indicate that VR can be a promising tool for mindfulness,
mainly due to its ability to provide immersion and isolation from external stimuli.</p>
        <p>Most participants reported a positive experience with VR, highlighting the high immersion provided
by virtual environments. According to some responses, realistic graphics and ambient sounds increased
the sense of presence in the virtual world. However, some participants mentioned dificulties with
navigation within the environments. Sense of Presence and Immersion Reports indicated that the
feeling of being ”inside” the virtual environment was intense for most participants. Some stated that
they even forgot they were in a simulated world, especially in experiences exploring natural settings.
However, there were variations in the perception of immersion depending on the type of environment
explored.</p>
        <p>Most participants reported feeling more relaxed after the VR session. In particular, mindfulness
within the virtual environment was mentioned as efective in reducing stress and promoting calm. Some
participants compared the experience to traditional meditation and indicated that guidance within VR
could make the practice more accessible and efective.</p>
        <p>Regarding ease of use and comfort, most participants considered the VR headset interface intuitive,
although some mentioned the need for initial instruction to understand the controls better. Most
reported that the headsets were comfortable, but some participants indicated that the experience could
be improved by using headphones for better sound isolation.</p>
        <p>Finally, some participants reported that their expectations regarding VR changed after the experiment,
highlighting that the technology has broader applications than they had imagined. They recommend
VR to other university students dealing with psychological disorders, mainly due to its ability to provide
a controlled and safe space for relaxation.</p>
      </sec>
    </sec>
    <sec id="sec-5">
      <title>6. Conclusion and future work</title>
      <p>This pilot study explored the acceptance of VR for mindfulness practices, using the TAM as an analytical
framework. This work advances its theoretical scope beyond traditional productivity-oriented
applications by extending TAM to address the unique interplay between immersive technology and mental
health outcomes. Specifically, we reframed Perceived Usefulness to prioritize therapeutic benefits (e.g.,
mood enhancement, stress reduction) and expanded Perceived Ease of Use to encompass VR-specific
usability factors, such as hardware comfort and interaction intuitiveness. This adaptation underscores
TAM’s flexibility in evaluating emerging technologies where psychological and ergonomic compatibility
are critical to user acceptance.</p>
      <p>Methodologically, the study demonstrates how a mixed-methods approach — combining quantitative
TAM metrics with qualitative experiential insights — can enrich technology acceptance research in
niche or exploratory contexts. By bridging standardized scales with participant narratives, we captured
nuanced drivers of acceptance, such as immersion and environmental suitability, that quantitative
metrics might overlook. This dual-lens approach provides a blueprint for adapting TAM to complex,
interdisciplinary domains like digital therapeutics.</p>
      <p>The results indicate that, despite the limitations of the small sample size, participants reported a
predominantly positive experience, highlighting VR’s immersion and potential usefulness for mindfulness
practice.</p>
      <p>Quantitative analysis showed increases in the mean values of PU and PEOU, suggesting a favorable
trend toward technology acceptance. However, statistical tests did not identify significant diferences in
all variables, reinforcing the need for studies with larger samples to validate these findings. Qualitative
analysis complemented the quantitative results, revealing that participants perceived VR as a suitable
environment for reducing distractions and promoting relaxation, although some technical dificulties
were mentioned. Additionally, responses to exploratory questions suggested that using headphones
and having greater control over the environment where the experience takes place could enhance
immersion and reduce external distractions, emphasizing the importance of a controlled setting for
future experiments.</p>
      <p>Future research should focus on expanding the sample size and conducting longitudinal studies to
assess the long-term impact of VR-based mindfulness interventions. Additionally, exploring variations
in experimental conditions — such as diferent VR environments, integrating biofeedback mechanisms,
and including personalized mindfulness guidance — could provide deeper insights into optimizing the
user experience.</p>
      <p>Another important approach for future work is investigating the role of individual diferences, such as
prior experience with VR and familiarity with mindfulness practices, in shaping technology acceptance.
Conducting studies with diverse populations, including older adults and individuals with specific mental
health conditions, would also contribute to a more comprehensive understanding of VR’s potential
benefits and limitations for mindfulness.</p>
      <p>Furthermore, improving experimental design by ensuring a fully controlled environment and refining
usability aspects, such as enhancing interaction mechanisms and reducing equipment discomfort, could
lead to better engagement and more reliable results. Future studies could also incorporate mixed-method
approaches, combining physiological measures (e.g., heart rate variability, EEG) with self-reported data
to objectively evaluate VR’s efectiveness in mindfulness training.</p>
      <p>By addressing these research directions, future work can contribute to a more rigorous and
evidencebased understanding of how VR can support mental health interventions and enhance mindfulness
practices.</p>
    </sec>
    <sec id="sec-6">
      <title>Acknowledgments</title>
      <p>This work has been supported by the PLEISAR-Social project, Ref. PID2022-136779OB-C33, funded
by the Ministry of Science and Innovation of Spain (MCIN/AEI/10.13039/501100011033, EU), and the
C-ING-179-UGR23 project, funded by the Regional Ministry of Universities, Research and Innovation
and the FEDER Andalucía 2021-2027 Programme.</p>
    </sec>
    <sec id="sec-7">
      <title>Declaration on generative AI</title>
      <p>During the preparation of this work, the author(s) used CHAT-GPT-4, Copilot and Grammarly in order
to: Grammar and spelling check. After using these tool(s)/service(s), the author(s) reviewed and edited
the content as needed and take(s) full responsibility for the publication’s content.
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