Nature-based virtual reality relaxation to improve mental health and sleep in undergraduate students: A randomized controlled trial

Background Undergraduate students are particularly vulnerable to mental health problems due to academic pressure, financial concerns, and interpersonal stressors. Nature-based virtual reality (VR) technologies, which replicate natural settings, may offer psychological benefits by compensating for limited access to real-world natural environments in urban contexts.Purpose This study aimed to evaluate the effectiveness of a nature-based VR relaxation program in improving mental health and sleep outcomes among Korean undergraduate students.Method Participants from five Korean universities were randomly assigned to one of three groups: VR relaxation, progressive muscle relaxation (PMR), or wait-list control. Self-reported measures of depression, anxiety, perceived stress, and sleep patterns were collected at baseline, post-intervention, and follow-up. Objective sleep efficiency was assessed using wrist-worn actigraphy devices. Data were analyzed using generalized estimating equations to examine changes over time and between groups.Results A total of 41 participants completed the study. The VR intervention group showed significant reductions in perceived stress levels (p = .001) and improvements in subjective sleep patterns (p = .046), with these effects sustained at follow-up. Notably, sleep efficiency measured via actigraphy improved significantly in the PMR group compared to the other groups (p = .033).Conclusions A nature-based VR relaxation program appears to be an effective digital intervention for reducing stress and enhancing subjective sleep quality among undergraduate students. These findings highlight the potential of nature-simulating digital environments to support mental health and wellness in settings with limited access to natural spaces.