Evaluation of virtual reality-based guided imagery stabilization intervention for post-traumatic stress symptoms: a randomized controlled trial

Abstract

Post-traumatic stress symptoms (PTSS) have been widely reported among individuals affected by the COVID-19 pandemic. Stabilization interventions aim to reduce distress and enhance emotional regulation as a preparatory step for trauma-focused therapy. This study evaluated a virtual reality (VR)–based stabilization program adapted from three validated guided imagery techniques: light stream, mindful breathing, and containment. In a randomized controlled trial comparing the VR intervention with an imagery- and audio-based mobile App delivering the same therapeutic scripts, participants in the VR group showed significantly greater reductions in PTSS on both self-reported and clinician-rated measures. Moreover, only the VR group demonstrated significant improvements in post-traumatic growth, quality of life, and autonomic regulation indexed by heart rate variability (HRV). These findings suggest that immersive VR can enhance the delivery of stabilization techniques and provide additional psychological and physiological benefits beyond conventional app-based methods. © 2025 Elsevier B.V., All rights reserved.