Effect of a Single Immersive Virtual Reality Session on Preoperative Surgical Fear and State Anxiety

Patients awaiting bariatric surgery face permanent anatomical change, lifelongbehavioural adaptation and uncertainty about weight‐loss maintenance, and consequentlyreport high levels of surgical fear and state anxiety. Immersive virtual reality (VR) isa low‐cost, nurse‐deliverable, non‐pharmacological option, but its effect on surgicalfear specifically, and in bariatric candidates in particular, is largely untested. Todetermine whether a single 20‐minute immersive VR nature session delivered in theimmediate preoperative period reduces surgical fear and state anxiety in patientsscheduled for bariatric surgery.A single‐centre, two‐arm, parallel‐group randomised controlled trial was conducted in ageneral surgery clinic between March 2025 and June 2026 and is reported in accordancewith the CONSORT 2025 statement. One hundred and twenty adults scheduled for bariatricsurgery were randomly allocated 1:1 to a VR arm or to routine care. Two hours beforetransfer to theatre, the VR arm viewed 360° nature footage through a head‐mounted displayfor 20 minutes; the control arm received the standard clinical protocol. Surgical fear(Surgical Fear Questionnaire, SFQ) and state anxiety (State Anxiety Inventory, STAI‐S)were measured before and after the intervention period in both arms. The pre‐specifiedprimary analysis was an analysis of covariance of post‐test scores adjusted for baseline,supported by mixed analysis of variance, change‐score analysis, multivariable linearregression, non‐parametric and rank‐based sensitivity analyses, and the Reliable ChangeIndex.