Comparing immersive mindfulness and nature interventions for managing preoperative distress in breast cancer patients: A pilot randomized controlled trial.
- 1Champalimaud Foundation: Fundacao Champalimaud
Abstract
Preoperative distress in breast cancer patients is highly prevalent and associated with adverse post-surgical outcomes. While both virtual reality (VR) distraction and mindfulness exercises have been increasingly utilized to manage this distress, the clinical impact of integrating active mindfulness meditation into the immersive experience remains under-investigated. Here, we present a pilot randomized controlled trial evaluating the feasibility, acceptability and preliminary efficacy of brief, first-time immersive nature and mindfulness interventions for patients admitted to the holding area prior to the operating room for breast cancer surgery. Sixty participants were randomized to receive an 8-minute preoperative VR experience with mindfulness instruction (VR+Meditation), a standard VR nature experience without audio guidance (VR Only), or Care-as-Usual (CAU). The intervention was feasible and well tolerated with zero patient dropout and minimal indications of cybersickness or general discomfort. Outcomes included patient-reported anxiety and fear, physiological measures, and a computational semantic analysis of post-operative patient interviews. Compared with standard care, both VR interventions significantly reduced self-reported anxiety and heart rate. Although no significant differences were observed between the two active intervention groups, the VR+Meditation group demonstrated a significant and clinically meaningful reduction in surgery-specific fear relative to standard care. Analysis of brief patient interviews provided convergent evidence supporting these findings, showing that patients receiving VR+Meditation used language more strongly aligned with relief than those receiving standard care.
These findings suggest that immersive VR represents a feasible and well-tolerated first-time immersive intervention for reducing preoperative distress in patients undergoing breast cancer surgery. The addition of guided mindfulness may provide additional benefit by specifically addressing surgery-related fear, supporting the hypothesis that different digital interventions may target distinct dimensions of preoperative distress. Larger randomized studies are warranted to confirm these preliminary findings.
Author summaryWaiting for breast cancer surgery is an incredibly stressful experience, and high levels of anxiety before an operation can negatively impact a patients recovery and mental health. Because surgical wards are fast-paced, providing individualized psychological support in the moments just before an operation is challenging. In this study, we tested whether an immersive Virtual Reality (VR) experience may help reduce preoperative distress by transporting patients to a calming digital environment immediately before surgery. We compared standard VR distraction with the same immersive experience combined with guided mindfulness meditation. Both VR interventions reduced anxiety and heart rate compared with standard care. Only the group receiving VR with guided mindfulness showed a significant reduction in surgery-related fear and, when describing their experience after surgery, used language more strongly associated with relief.
Our findings suggest that immersive interventions provided to patients for the first time on the day of surgery can provide simple, well-tolerated psychological support during one of the most stressful moments in the patient journey. They also suggest that different digital approaches may influence different aspects of preoperative distress, with guided mindfulness offering additional support for surgery-related fear.
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BibTeX
@misc{pinto2026comparing,
title = {{Comparing immersive mindfulness and nature interventions for managing preoperative distress in breast cancer patients: A pilot randomized controlled trial.}},
author = {D. Pinto and R. Andres-Luna and R. Sandru and C. Mavioso and J. Correia-Anacleto and G. Pedro and A. Cruz and P. Vaz and L. Travado and Z. F. Mainen and M. J. Cardoso and S. Rennie and L. Fettweis-Netto},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.03.26362134},
url = {https://www.medrxiv.org/content/10.64898/2026.09.03.26362134v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Comparing immersive mindfulness and nature interventions for managing preoperative distress in breast cancer patients: A pilot randomized controlled trial.
AU - D. Pinto
AU - R. Andres-Luna
AU - R. Sandru
AU - C. Mavioso
AU - J. Correia-Anacleto
AU - G. Pedro
AU - A. Cruz
AU - P. Vaz
AU - L. Travado
AU - Z. F. Mainen
AU - M. J. Cardoso
AU - S. Rennie
AU - L. Fettweis-Netto
PY - 2026
DA - 2026/09/03
PB - medRxiv
DO - 10.64898/2026.09.03.26362134
UR - https://www.medrxiv.org/content/10.64898/2026.09.03.26362134v1
AB - Preoperative distress in breast cancer patients is highly prevalent and associated with adverse post-surgical outcomes. While both virtual reality (VR) distraction and mindfulness exercises have been increasingly utilized to manage this distress, the clinical impact of integrating active mindfulness meditation into the immersive experience remains under-investigated. Here, we present a pilot randomized controlled trial evaluating the feasibility, acceptability and preliminary efficacy of brief, first-time immersive nature and mindfulness interventions for patients admitted to the holding area prior to the operating room for breast cancer surgery. Sixty participants were randomized to receive an 8-minute preoperative VR experience with mindfulness instruction (VR+Meditation), a standard VR nature experience without audio guidance (VR Only), or Care-as-Usual (CAU). The intervention was feasible and well tolerated with zero patient dropout and minimal indications of cybersickness or general discomfort. Outcomes included patient-reported anxiety and fear, physiological measures, and a computational semantic analysis of post-operative patient interviews. Compared with standard care, both VR interventions significantly reduced self-reported anxiety and heart rate. Although no significant differences were observed between the two active intervention groups, the VR+Meditation group demonstrated a significant and clinically meaningful reduction in surgery-specific fear relative to standard care. Analysis of brief patient interviews provided convergent evidence supporting these findings, showing that patients receiving VR+Meditation used language more strongly aligned with relief than those receiving standard care. These findings suggest that immersive VR represents a feasible and well-tolerated first-time immersive intervention for reducing preoperative distress in patients undergoing breast cancer surgery. The addition of guided mindfulness may provide additional benefit by specifically addressing surgery-related fear, supporting the hypothesis that different digital interventions may target distinct dimensions of preoperative distress. Larger randomized studies are warranted to confirm these preliminary findings. Author summaryWaiting for breast cancer surgery is an incredibly stressful experience, and high levels of anxiety before an operation can negatively impact a patients recovery and mental health. Because surgical wards are fast-paced, providing individualized psychological support in the moments just before an operation is challenging. In this study, we tested whether an immersive Virtual Reality (VR) experience may help reduce preoperative distress by transporting patients to a calming digital environment immediately before surgery. We compared standard VR distraction with the same immersive experience combined with guided mindfulness meditation. Both VR interventions reduced anxiety and heart rate compared with standard care. Only the group receiving VR with guided mindfulness showed a significant reduction in surgery-related fear and, when describing their experience after surgery, used language more strongly associated with relief. Our findings suggest that immersive interventions provided to patients for the first time on the day of surgery can provide simple, well-tolerated psychological support during one of the most stressful moments in the patient journey. They also suggest that different digital approaches may influence different aspects of preoperative distress, with guided mindfulness offering additional support for surgery-related fear.
ER -