The mental health of young adults, particularly university students, has become a global concern. Nature-based interventions have shown promise in alleviating anxiety and negative emotions. This study explored the effectiveness of Virtual Reality (VR)-based nature therapy in reducing anxiety, negative mood, and stress while enhancing mindfulness among university students. A three-armed randomised controlled trial was conducted. Two hundred thirty-six students with anxiety symptoms were randomly assigned to either a VR intervention group, a placebo control group, or an inactive control group after the baseline assessment. We developed a VR intervention system called Mind Nature , featuring nature-based activities such as planting, observing natural environments, rowing across the water, and personal reflection, all accompanied by mindful audio guidance within a fully immersive 360-degree, three-dimensional VR environment. The placebo control group engaged in a VR sports game using a VR headset, while the control group received no intervention. Each session lasted approximately 30 min. Anxiety, mood, stress, mindfulness, and nature-relatedness were measured three times: pre- and post-intervention and at a 2-week follow-up. Results revealed significant group-time interaction effects, with greater reductions in anxiety, negative affect, and stress in the VR intervention group compared to the placebo and control groups. This study highlights the effectiveness of VR-based nature therapy and its potential as an effective and convenient mental health intervention for university students, offering a promising complement to traditional therapeutic approaches. The study was registered online at the Chinese Clinical Trial Registry (ID: ChiCTR2400089445)
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