Usability and Feasibility of a Contrast Avoidance Model-Based Virtual Reality Protocol Designed for Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by persistent, excessive, and difficult-to-control worry. The Contrast Avoidance Model (CAM) proposes that individuals with GAD use worry to sustain negative emotional arousal, thereby avoiding sharp negative emotional contrasts that would otherwise follow unexpected adverse events. A virtual reality (VR) protocol was developed to simulate such contrasts by alternating guided relaxation with brief anxiety-inducing scenarios (skyline plank, crowded elevator, and loose dog encounter). This study evaluated the usability and feasibility of this protocol in 20 subclinical adults aged 18–45 (GAD-7 ≥ 5) using a Meta Quest 3 headset and Polar H10 heart rate sensor. Exposure segments produced a significant decrease in RMSSD (β = −0.185, p < .001), confirming reduced parasympathetic activity during anxiety induction, whereas heart rate did not differ significantly between conditions. Subjectively, exposure increased SUDS (β = 2.23, p < .001) and SAM arousal (β = 1.95, p < .001), and decreased SAM valence (β = −2.68, p < .001) and dominance (β = −1.70, p = .005). Higher baseline anxiety was associated with attenuated heart rate reactivity, consistent with CAM predictions. Presence was sufficient for emotional engagement, cybersickness was low, and qualitative feedback yielded concrete design refinements. These results establish a foundation for clinical investigation of contrast-based VR interventions for GAD.