Medical students frequently experience high levels of stress, anxiety, and depression due to intense academic pressures. While spending time outdoors in nature is a proven way to reduce these negative feelings, students rarely have the time to do so. This study aims to find out if using a 360-degree Virtual Reality (VR) headset to experience immersive nature environments can provide similar relaxing benefits.

The main question this study attempts to answer is whether the type of nature environment matters: Does watching a familiar, local Malaysian nature scene reduce stress more or less effectively than watching a novel, overseas nature scene?

The researchers hypothesize that a brief, 15-minute exposure to either 360-degree VR nature environment will successfully reduce short-term feelings of stress, anxiety, and depression. Furthermore, they hypothesize that there will be a measurable difference in the psychological benefits between the local and overseas environments, driven by either the comfort of familiarity (local) or the distraction of escapism (overseas).

Background and Rationale:

Accessible, non-pharmacological interventions are increasingly necessary to support the mental wellness of university cohorts facing high academic strain. While the restorative effects of natural environments on human psychology are well-documented, physical access to such spaces is often limited in urban academic settings. 360-degree Virtual Reality (VR) offers a highly immersive, scalable alternative. By simulating spatial presence, VR can trigger physiological and psychological relaxation responses similar to actual nature exposure. However, a gap remains in the literature regarding the semantic content of the VR exposure. Specifically, it is unclear whether the therapeutic efficacy of VR nature exposure is heavily influenced by environmental familiarity (which may foster psychological safety and place attachment) versus environmental novelty (which may promote greater cognitive distraction and escapism).

Study Design and Randomization:

This protocol utilizes a randomized, parallel-group behavioral trial design. To ensure group equivalence and minimize gender as a potential confounding variable in psychological stress reporting, a custom-developed Python script will be utilized to execute stratified randomization. This algorithm ensures a strict 1:1 allocation ratio into either the active local environment arm or the active overseas environment arm, while maintaining a perfectly balanced male-to-female ratio within each experimental group.

Intervention Delivery and Statistical Plan:

Participants undergo a structured behavioral intervention consisting of immersive 360-degree VR video viewing via a head-mounted display. The protocol requires two identical exposure sessions, separated by a strict two-week interval to evaluate repeated-dose efficacy and short-term trajectory. All self-reported psychological and well-being metrics are collected at baseline, immediately post-initial exposure, and immediately post-secondary exposure. Data will be evaluated utilizing a repeated-measures analysis of variance (ANOVA). This statistical approach is specifically chosen to assess two primary effects: the main effect of time (evaluating the overall impact of the VR intervention across all participants throughout the two-week study period) and the interaction effect of time and group (determining if there is a statistically significant divergence in the trajectory of symptom reduction between the local and overseas experimental arms).

Inclusion Criteria:

• Academic Status: Actively enrolled as a fourth-year or fifth-year undergraduate medical student at Universiti Kebangsaan Malaysia (UKM).
• Age: 18 years of age or older (necessary for providing legal informed consent).
• Sensory Ability: Normal or corrected-to-normal vision and hearing (the participant can wear contact lenses or glasses that comfortably fit inside the VR headset).
• Availability: Willing and able to commit to the full 2-week study timeline, including both the baseline and follow-up VR sessions.

Exclusion Criteria:

• VR Safety (Neurological): Personal history of epilepsy, seizure disorders, or frequent migraines, as VR screens can occasionally trigger these conditions.
• VR Safety (Vestibular): History of severe motion sickness, vertigo, or inner ear disorders.
• Confounding Medical Factors: Currently receiving active, formal psychiatric treatment or taking prescribed psychoactive medications (such as antidepressants or anxiolytics).
• Physical Limitations: Severe visual or auditory impairments that would prevent full immersion in the visual and auditory elements of the VR environment.

The participants are assigned a unique ID and this ID by itself does not indicate whether they are doing the local or the overseas environment. The completed questionnaires that are then tabulated into a spreadsheet by the investigator before the grouping are revealed at the end by matching the participant ID with their respective group.