Occupational StressXR2ESILIENCENCT07544498
XR2ESILIENCE - XR-Based Resilience Training for Stress and Mental Health in Healthcare Workers
A study testing XR-based Resilience Training in people with Occupational Stress and Work-Related Stress, run by Medical University of Graz at 8 sites in 5 countries.
Trial summary
This study investigates the effectiveness of an extended reality (XR) based resilience training program designed to support the mental health and well-being of nurses working in hospital settings. Read more about this study
- Who is it for?
- Ages 18 to 65 yearsHealthy volunteers can take part
- Conditions the study is for
- Occupational Stress, Work-Related Stress, Mental Health
- What is being tested?
- XR-based Resilience Training
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 232 participants
- Where
- 8 sitesin 5 countries
- Study dates
- Sep 2026to Mar 2028
- Phase
- Interventional
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- working as a nurse in direct patient care within a clinical setting;
- working at least 10h/week in their profession;
- speaking the language in which the RCT is conducted sufficiently well;
- able and willing to participate in all aspects of the study;
- understanding and signing the appropriate informed consent form.
Who cannot join
- a diagnosed severe mental disorder associated with alterations in reality perception (e.g., delusions, hallucinations, derealization, depersonalization, or dementia), including in particular schizophrenia, bipolar disorder, severe major depressive disorder, or other psychotic disorders (lifetime);
- a current major depressive episode or a current post-traumatic stress disorder (PTSD);
- an acute or clinically significant medical condition that may interfere with the safe use of an XR headset or study participation, including but not limited to epilepsy, pronounced dizziness, balance disorders, or acute cardiovascular conditions;
- an acute eye infection (e.g., conjunctivitis);
- unstable medication related to a mental health condition, defined as recent changes in dosage or class of psychotropic medication;
- initiation of psychotherapy or any structured stress-management training within the past three months.
Trial locations and contacts
8 sites in 5 countries. Contact the study team or a site near you to ask about taking part.
Nina Dalkner Research Prof. Priv.-Doz. Mag. rer.nat. Dr. rer.nat. contact
8 sites in 5 countries
Spain4 sites
Del Henares University Hospital
Coslada, Madrid, 28822
Javier C Fernández, +34 606896258, drocio.diaz@salud.madrid.org
Dania R D Rodríguez, Dr.
Summa 112
Madrid, Madrid, 28005
Cristina V Lorenzo, +34 638210690, cristina.veiras@salud.madrid.org
María J A Carretón, Dr.
Infanta Leonor University Hospital
Madrid, Madrid, 28031
María F González, +34 608732331, maria.fgonzalez@salud.madrid.org
Carmen B León, Dr.
Infanta Sofía University Hospital
San Sebastián de los Reyes, Madrid, 28702
Marta G Granado, +34 638210687, marta.gonzalez.granado@salud.madrid.org
Inés C Hammel, Dr.
Austria1 site
Medical University of Graz, Clinical Division of Psychiatry and Psychotherapeutic Medicine
Graz, Styria, 8036
Melissa L Behrend, MSc, +43 316 385 30081, melissa.behrend@medunigraz.at
Nina Dalkner, Res.-Prof. Priv.-Doz. Mag. Dr.
Croatia1 site
Klinika za psihijatriju Sveti Ivan
Zagreb, 10000
Ena Ivezic, mag. psih., +385 1 3430 171, ena.ivezic@pbsvi.hr
Igor Filipcic, Prof. prim. dr. sc.
Germany1 site
University Medical Center of Johannes Gutenberg University Mainz
Mainz, Rhineland-Palatinate, 55131
Annika Hasch, MSc, +49 6131 89448 00, Annika.Hasch@lir-mainz.de
Klaus Lieb, Prof. Dr.
Portugal1 site
Hospital José Joaquim Fernandes
Beja, Beja District, 7801-849
Fátima Cano, fatima.cano@uevora.pt
Elisabete Alves
About this study
Official title: A Pragmatic Randomized Controlled Trial Study Protocol: XR2ESILIENCE - Pioneering XR Technology for the Promotion of Resilience and Mental Health of the Healthcare Workforce
This study investigates the effectiveness of an extended reality (XR) based resilience training program designed to support the mental health and well-being of nurses working in hospital settings. Nurses are exposed to high emotional, cognitive, and organizational demands and show elevated levels of work-related stress and stress-associated mental health problems. Strengthening resilience and coping capacities is therefore an important preventive approach to support nurses' well-being and sustain quality of care.
The study is conducted as a pragmatic randomized controlled trial with a waitlist control group and includes approximately 232 nurses from hospitals in several European countries. Participants are randomly assigned either to an XR-based resilience training group or to a waitlist control group that continues with care as usual during the waiting period. The XR-based intervention consists of eight immersive training sessions delivered over approximately ten weeks using a head-mounted display. The training focuses on behavioral, cognitive, and emotional coping strategies and aims to enhance key resilience factors such as problem-solving, cognitive reappraisal, emotion regulation, and positive self-care.
Read more
The primary outcome is perceived stress, assessed using the Perceived Stress Scale. Secondary outcomes include resilience, occupational self-efficacy, quality of life, psychological distress, burnout symptoms, coping strategies, work-related rumination, and turnover intentions. Assessments are conducted at baseline, post-intervention, and at a 20-week follow-up. In addition, a subgroup of participants will optionally provide physiological data during selected XR sessions to explore digital biomarkers related to stress and recovery.
The findings of this study will provide evidence on the effectiveness, feasibility, and acceptance of XR-based resilience training for nurses and inform future implementation of digital mental health interventions in healthcare workplaces.
Read the detailed description
This study is part of the XR2ESILIENCE project, a European multicenter research initiative aimed at promoting resilience and mental health among healthcare professionals through innovative extended reality (XR) technologies. The present randomized controlled trial evaluates the effectiveness of a newly developed XR-based resilience training program for nurses working in hospital settings.
Nurses are frequently exposed to high workload, emotional labor, time pressure, and organizational stressors, which are associated with increased stress levels, burnout symptoms, and mental health impairments. Despite the high relevance of resilience promotion in this occupational group, accessible and scalable preventive interventions remain limited. XR technology offers the opportunity to deliver immersive, engaging, and standardized resilience training that can be flexibly integrated into clinical and non-clinical settings.
The study uses a pragmatic, parallel-group, waitlist-controlled randomized design. A total of approximately 232 nurses aged 18 to 65 years will be recruited across multiple hospital sites in Europe. After completion of baseline assessments and provision of informed consent, participants are randomly allocated in a 1:1 ratio either to the XR-based intervention group or to a waitlist control group. The control group continues with care as usual and receives access to the intervention after the waiting period.
The XR-based resilience training consists of eight sessions delivered over approximately ten weeks using a standalone head-mounted display. Each session lasts around 20 to 30 minutes. The training is structured into modules addressing behavioral coping (e.g., problem-solving and proactive coping), cognitive coping (e.g., appraisal and reappraisal of stressors), and emotional coping (e.g., emotion regulation, acceptance, and fostering positive emotions). The intervention is theoretically grounded in contemporary resilience frameworks and the concept of regulatory flexibility. Participants complete the sessions individually, with technical support available if needed.
The primary outcome is perceived stress measured by the 10-item Perceived Stress Scale at post-intervention. Secondary outcomes include resilience, occupational self-efficacy, psychological distress, burnout symptoms, coping strategies, work-related rumination, quality of life, and career-related variables such as turnover intentions. Data are collected at baseline, immediately after the intervention period, and at a 20-week follow-up.
In addition to questionnaire-based outcomes, optional digital biomarker data are collected during selected XR sessions to explore physiological indicators of stress and recovery, such as heart rate variability and other sensor-based measures, depending on study site capabilities. User experience, technology acceptance, satisfaction, and potential side effects of XR use are assessed descriptively after completion of the intervention.
The study follows an intention-to-treat approach for primary analyses. Results are expected to provide robust evidence on whether XR-based resilience training can reduce perceived stress and improve mental health outcomes among nurses. The findings will also inform the feasibility, acceptability, and potential health-economic value of implementing XR-supported resilience interventions in hospital workplaces.
- Conditions
- Occupational Stress, Work-Related Stress, Mental Health, Burnout, Resilience
- Being tested
- XR-based Resilience Training, Waitlist Control
- Keywords
- Extended Reality, Virtual Reality, XR-based Intervention, Resilience Training, Stress Reduction, Nurses, Healthcare Workers, Occupational Health, Mental Well-Being, Digital Mental Health, Preventive Intervention, Randomized Controlled Trial
- Medical subject headings
- Occupational Stress, Psychological Well-Being, Burnout, Psychological
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
XR-based Resilience TrainingBehavioural
The XR-based resilience training is delivered via a standalone extended reality head-mounted display and consists of eight immersive sessions over approximately ten weeks. The training addresses behavioral coping strategies such as problem solving, cognitive coping strategies such as appraisal and reappraisal of stressors, and emotional coping strategies including emotion regulation and positive self-care. Sessions last approximately 20 to 30 minutes and are completed individually with technical support available if needed.
Waitlist ControlOther
Participants assigned to the waitlist control condition receive no active intervention during the initial study period and continue with care as usual. After completion of the post-intervention assessment, participants are offered access to the XR-based resilience training.
| Study group | Role | What they receive |
|---|---|---|
| XR-based Resilience Training | Experimental | Participants in this arm receive an XR-based resilience training consisting of eight immersive sessions delivered over approximately ten weeks using a head-mounted display. The training focuses on behavioral, cognitive, and emotional coping strategies and aims to strengthen resilience and stress management skills. Each session lasts approximately 20 to 30 minutes and is completed individually. Receives: Behavioral: XR-based Resilience Training; Other: Waitlist Control |
| Waitlist Control | No intervention | Participants in this arm are assigned to a waitlist control condition and continue with care as usual during the waiting period. They do not receive the XR-based resilience training during the first ten weeks of the study but are offered access to the intervention after completion of the post-intervention assessment. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Perceived Stress Assessed by PSS-10
Perceived stress measured using the 10-item Perceived Stress Scale (PSS-10). The PSS-10 assesses the degree to which situations in one's life are appraised as stressful during the past month. Scores range from 0 to 40, with higher scores indicating higher perceived stress.
Measured: Baseline, 10 weeks post-randomization & 20 weeks post-randomization
Secondary outcomes (12)
Resilience Assessed by BRS
Self-perceived resilience will be assessed using the Brief Resilience Scale (BRS), a self-report measure consisting of six items rated on a 5-point Likert scale. Total scores are calculated by summing item responses (range: 6 to 30) and dividing by the number of items answered, resulting in a mean score ranging from 1 to 5. Higher scores indicate greater resilience.
Measured: Baseline, 10 weeks post-randomization & 20 weeks post-randomization
Occupational Self-Efficacy Assessed by OSE-SF
Occupational self-efficacy will be assessed using the Occupational Self-Efficacy Scale - Short Form (OSE-SF), a self-report measure consisting of items rated on a 6-point Likert scale ranging from 1 (not at all true) to 6 (completely true). Total scores are calculated by summing item responses, with higher scores indicating greater occupational self-efficacy.
Measured: Baseline and 10 weeks post-randomization
Psychological Distress Assessed by GHQ-12
Psychological distress will be assessed using the General Health Questionnaire-12 (GHQ-12), a 12-item self-report measure with items rated on a 4-point Likert scale (0 to 3). Total scores range from 0 to 36, with higher scores indicating greater psychological distress.
Measured: Baseline and 10 weeks post-randomization
Burnout symptoms Assessed by BAT-12
Burnout symptoms will be assessed using the Burnout Assessment Tool - Short Version (BAT-12), a 12-item self-report measure with items rated on a 5-point Likert scale ranging from 1 (never) to 5 (always). Total scores range from 12 to 60, with higher scores indicating higher levels of burnout-related symptoms.
Measured: Baseline and 10 weeks post-randomization
Coping Strategies Assessed by CSI-SF
Coping strategies will be assessed using the Coping Strategies Inventory - Short Form (CSI-SF). The CSI-SF is a 16-item measure rated on a 5-point Likert scale ranging from 1 to 5. Subscale scores range from 4 to 20, with higher scores indicating greater use of coping strategies.
Measured: Baseline, 10 weeks post-randomization & 20 weeks post-randomization
Coping Flexibility Assessed by CFS-R
Coping flexibility will be assessed using the Coping Flexibility Scale - Revised (CFS-R). The CFS-R is a 10-item measure rated on a 4-point Likert scale ranging from 0 to 3. Total scores range from 0 to 30, with higher scores indicating greater coping flexibility.
Measured: Baseline, 10 weeks post-randomization & 20 weeks post-randomization
Health-Related Quality of Life Assessed by EQ-5D-5L
Health-related quality of life will be assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), a standardized instrument comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each rated on a 5-level scale (1 to 5). Health states are converted into a single index value using a country-specific value set, typically ranging from less than 0 (worse than death) to 1 (full health), with higher values indicating better perceived health status.
Measured: Baseline and 10 weeks post-randomization
Turnover intentions
Turnover intentions assessed using self-developed items measuring intention to leave the profession or current workplace.
Measured: Baseline and 10 weeks post-randomization
User Experience Assessed With the AttrakDiff Mini
User experience will be assessed using the AttrakDiff Mini. The AttrakDiff Mini is a 10-item measure rated on a 7-point bipolar scale ranging from -3 to +3. Higher scores indicate a more positive user experience.
Measured: 10 weeks post-randomization (Training Group) or 20 weeks post-randomization (Control Group)
User Satisfaction Assessed With the Client Satisfaction Questionnaire for Internet-Based Interventions
User satisfaction will be assessed using the Client Satisfaction Questionnaire adapted for Internet-based interventions (CSQ-I). The CSQ-I is an 8-item measure rated on a 4-point Likert scale. Total scores range from 8 to 32, with higher scores indicating greater satisfaction.
Measured: 10 weeks post-randomization (Training Group) or 20 weeks post-randomization (Control Group)
VR-Related Side Effects Assessed With the Virtual Reality Neuroscience Questionnaire
VR-related side effects will be assessed using the Virtual Reality Neuroscience Questionnaire (VRNQ), specifically the Virtual Reality-Induced Symptoms and Effects (VRISE) subscale. Items are rated on a 7-point Likert scale, with higher scores indicating lower intensity of side effects.
Measured: 10 weeks post-randomization (Training Group) or 20 weeks post-randomization (Control Group)
Positive Effects Assessed With Adapted Items From the Oxford VR Side Effects Checklist
Positive effects will be assessed using three adapted items from the Oxford VR Side Effects Checklist (O-VRES). Items are rated on a 5-point Likert scale. Total scores range from 3 to 15, with higher scores indicating greater endorsement of positive effects.
Measured: 10 weeks post-randomization (Training Group) or 20 weeks post-randomization (Control Group)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Apr 2026
- Study startSep 2026 (estimated)
- Primary completionMar 2028 (estimated)
- Study completionMar 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Occupational StressStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Crossover
- Model description
- waitlist-controlled trial
- Masking
- None (open label)
- Enrolment
- 232 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Medical University of Graz
- Sponsor type
- University, hospital or other
- Collaborators
- MINDCONSOLE GMBH, Medizinische Privatuniversität Burgenland, Central Institute of Mental Health, Mannheim, St. Pölten University of Applied Sciences, University of Évora, Leibniz Institute for Resilience Research (LIR), Mainz, Germany, Leuphana Universität Lünenberg, University of Lisbon, Sveti Ivan Psychiatric Hospital, mindconsole, PredictBy Research and Consulting, S.L, Servicio Madrileño de Salud (SERMAS)
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07544498
- Sponsor's protocol ID
- 101137237
- Other IDs
- 101137237
- Acronym
- XR2ESILIENCE
- Status last verified
- Dec 2025
- First submitted
- 15 Apr 2026
- Last updated
- 18 May 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data that underlie the results reported in publications will be made available upon reasonable request. Data will be shared in a pseudonymized form to qualified researchers for purposes of academic research and secondary analyses that are consistent with the original study objectives. Requests will be reviewed by the study steering committee and require a methodologically sound proposal and a data use agreement. Data sharing will be subject to applicable data protection regulations and ethical approvals.