Is Immersion the Key? A Mixed-Methods Feasibility and Acceptability Study of Virtual Reality (VR) Mindfulness in Body Dysmorphic Disorder

INTERVENTION: This is a randomized 2x2 crossover pilot clinical trial investigating brief VR and audio‐based mindfulness. It will be conducted at Swinburne University (single site but state‐wide recruitment), adhering to standardised guidelines (Consolidated Standards of Reporting Trials (CONSORT) and Standard Protocol Items Recommendations for Intervention Trials (SPIRIT) as well as Good Clinical Practice (GCP) guidelines. Participants will participate in both interventions, with the order of the interventions being assigned randomly in a 1:1 ratio across the two arms – VR‐audio and audio‐VR. The randomisation sequence will be computer‐generated by the student investigator. Outcome assessments will occur at baseline and post‐interventions. VR‐based mindfulness An Oculus Quest 2 (OQ2) Head‐Mounted Display will be used with the following specifications: Adreno 650 ( 1.2 TFLOPS) graphics on an LCD display with a resolution of 1,832 X1,920 pixels per eye (2,560 X1,440 combined), a refresh rate of 72‐120 Hertz and a field of view of 101 degrees. The VR‐based mindfulness program will be delivered by the application TRIPP. The program consists of a female voiceover using inviting language to guide the user’s shift in attention and focus and introduces the virtual environment. The VR‐based mindfulness intervention component is fully contained within the VR headset and TRIPP application; there is no need for interaction with a researcher during the intervention process. The intervention will be delivered through the VR headset in person. 1 X20minutes session The intervention will be delivered in clinical research space at Swinburne University of Technology Trained research staff members will sit with participants to perform well‐being checks. Senior researcher wi CONDITION: Body dysmorphic disorder; ; Body dysmorphic disorder Mental Health ‐ Other mental health disorders PRIMARY OUTCOME: Acceptability of each mindfulness condition; [Acceptability of the intervention will be assessed by a specifically designed qualitative interview to explore participants’ experiences and feedback. The delivered semi‐structured interview will be developed by the research team, 11 questions will be asked, encompassing the following topics:; 1)Overall experience; 2)General benefits; 3)BDD symptoms; 4)Expectations vs experience; 5)Structure; ; Another set of qualitative questions will be administered at the end of the session for overall acceptability, encompassing the following questions:; 1)Can you see yourself doing mindfulness again?; 2)Did you prefer the VR mindfulness or audio mindfulness more in this session?; 3)Do you prefer to use the VR mindfulness or audio mindfulness in the future?; ; The interview will be approximately 30 minutes and audio‐recorded. semi‐structured interview: post each intervention; ; overall acceptability interview: post overall intervention] Feasibility of VR‐based mindfulness[The feasibility of the VR‐based mindfulness condition will be assessed based on the completion of the VR‐mindfulness intervention. Post completion of each intervention] Perceived acceptability of intervention[Perceived acceptability of the intervention will be assessed using an adapted version of the credibility/expectancy questionnaire. baseline of each intervention] SECONDARY OUTCOME: Body‐image concerns[State Body Appreciation Scale‐2 (SBAS‐2) and Body Image States Scale (BISS) baseline and post‐completion of each intervention] Emotional regulation[Difficulties in Emotion Regulation Scale (S‐DERS) and Modified Differential Emotions Scale (mDES) baseline and post‐completion of each intervention] Galvanic Skin Response[GSR will be measured through GSR finger electrodes that is connected to the AD Instruments GSR Amplifier. Skin conductance signal will be recorded as a waveform and a change in amplitude from peak to trough will be used to derive the skin conductance response. Duration of the intervention] Heart rate variability[HRV will be measured through Polar 360 devices, a wearable fitness tracking band that monitors heart rate. Pulse lengths and pulse‐to‐pulse intervals will be monitored throughout the testing session to calculate HRV. Duration of intervention] State mindfulness[State Mindfulness Scale (SMS) baseline and post‐completion of each intervention] INCLUSION CRITERIA: Participants will i) be aged between 18‐65 years (inclusive); ii) have a primary diagnosis of BDD according to the SCID‐5 BDD‐DM (diagnostic module); iii) score greater than or equal to 15 on the BDD‐YBOCS (to ensure at least mild symptom severity); iv) have been stabilised on psychiatric medications, if prescribed, for 8weeks; and v) have capacity to consent to the study. Further, BDD patients frequently report co‐morbid depression, social anxiety and psychoses. To ensure our sample is representative, participants with co‐morbidities will be included and may be engaged in current psychological or psychiatric treatment either for BDD or comorbid psychological symptoms.