Abstract
BACKGROUND: Insomnia is a prevalent condition with substantial health, economic, and societal burden. Despite evidence supporting the use of cognitive behavioural therapy for insomnia (CBTi) accessibility remains limited, shows high dropout rates, and is ineffective for 30 % of patients. Virtual reality (VR) mindfulness offers a novel, engaging, and scalable alternative, with the potential for enhanced treatment adherence compared to other digital health interventions (e.g., apps, audio, and online programs). VR has demonstrated efficacy in treating conditions such as chronic pain, anxiety, and depression, disorders often co-occurring with insomnia, its potential for treating insomnia remains underexplored. AIMS: This study aimed to (1) assess the acceptability of VR mindfulness for the treatment of insomnia from clinicians and patients with chronic insomnia, and (2) identify barriers and facilitators to its adoption and clinical implementation. METHODS: A mixed-methods design was used, including a questionnaire assessing familiarity with digital health technologies (DHTs) and the perceived utility of VR mindfulness for insomnia, followed by a 2-h in-person focus group. Participants explored and evaluated four VR mindfulness applications. The convenience sample included (1) community-dwelling adults with chronic insomnia (ISI > 10, PSQI > 10) and (2) clinicians registered with the Australian Health Practitioner Regulation Agency (AHPRA) familiar with insomnia treatment. Focus group data were analysed using thematic analysis and inductive reasoning. RESULTS: 19 patients (14 F, 4 M; mean age 46.26 ± 9.19 years) with moderate-to-severe chronic insomnia (mean ISI 17.48 ± 4.29; mean PSQI 14.46 ± 4.22) and 14 clinicians (9 F, 5 M; mean age 43.93 ± 12.01 years) with an average of 15 ± 12.28 years of experience participated. 72.8 % expressed curiosity and 36.4 % excitement at the prospect of trying VR mindfulness; 36.8 % of patients and 57.1 % of clinicians stated prior experience with VR; all welcomed the possibility of a new treatment for insomnia; VR mindfulness was described as "high-tech, futuristic, expensive", and "complicated to use". Post-interaction patients and clinicians were enthusiastic about VR mindfulness, describing it described it as "easy to use" and "more engaging" than other approaches to mindfulness. 89.5% of patients became confident of the potential for VR mindfulness to be an effective treatment for insomnia; expressing willingness to use and recommend. Clinicians recognised its clinical utility and scalability after the brief exposure, describing it as an "on-ramp" to traditional mindfulness; and anticipated strong patient interest. 98 % (n = 13) stated that contingent on its feasibility, incorporating VR mindfulness into clinical practice would immediately improve patient care. Cost was not a barrier to patient adoption; comfort and efficacy were. The safety and commercial availability of VR mindfulness were key facilitators to adoption. CONCLUSION: VR mindfulness is an acceptable, engaging, and scalable treatment for insomnia, with potential for rapid clinical adoption. Further research demonstrating its feasibility and efficacy are important first steps to integration into clinical practice.