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

Effect of a Single Immersive Virtual Reality Session on Preoperative Surgical Fear and State Anxiety in Patients Awaiting Bariatric Surgery

To determine whether a single 20-minute immersive VR nature session delivered in the immediate preoperative period reduces surgical fear and state anxiety in patients scheduled for bariatric surgery.

Patients awaiting bariatric surgery face permanent anatomical change, lifelong behavioural adaptation and uncertainty about weight-loss maintenance, and consequently report high levels of surgical fear and state anxiety. Immersive virtual reality (VR) is a low-cost, nurse-deliverable, non-pharmacological option, but its effect on surgical fear specifically, and in bariatric candidates in particular, is largely untested. To determine whether a single 20-minute immersive VR nature session delivered in the immediate preoperative period reduces surgical fear and state anxiety in patients scheduled for bariatric surgery.

A single-centre, two-arm, parallel-group randomised controlled trial was conducted in a general surgery clinic between March 2025 and June 2026 and is reported in accordance with the CONSORT 2025 statement. One hundred and twenty adults scheduled for bariatric surgery were randomly allocated 1:1 to a VR arm or to routine care. Two hours before transfer to theatre, the VR arm viewed 360° nature footage through a head-mounted display for 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-specified primary analysis was an analysis of covariance of post-test scores adjusted for baseline, supported by mixed analysis of variance, change-score analysis, multivariable linear regression, non-parametric and rank-based sensitivity analyses, and the Reliable Change Index.

Inclusion Criteria:

• 18 years or older
• scheduled for elective bariatric surgery
• able to communicate verbally
• without visual or hearing impairment
• without a diagnosed psychiatric disorder
• not concurrently using any other non-pharmacological anxiety-reduction method

Exclusion Criteria:

• younger than 18 years
• those with visual or hearing impairment
• those using another non-pharmacological method during the study period were excluded