Evaluating the Potential of Metaverse to Elicit Therapy-Related Emotions Among Individuals With Depression: Controlled Pilot Study of Cognitive and Emotional Responses
Fabiha Islam, Purushothaman Muthukanagaraj, Mei-Hsiu Chen, Liang Zhan, Alex Leow, Chao Shi · JMIR XR and spatial computing. · 2025
Abstract Background Depression, a prevalent mental health condition, affects millions worldwide. Many face significant barriers to accessing effective therapy. Metaverse has become a promising platform for addressing these challenges. Its 3D virtual environments allow users to engage through customizable avatars, supporting the elicitation of therapy-related emotions, an essential component of therapeutic interventions. Objective This pilot study investigates the potential of the Metaverse to elicit therapy-related emotional responses in individuals experiencing depression. The objectives are to assess emotional arousal, mental workload (MWL), and affective engagement during an emotional elicitation task in a Metaverse environment and compare them with those observed in a similar real-world setting. Methods We conducted a between-subjects experiment involving 28 participants: 14 had self-reported depression symptoms; 14 had minimal or no depression. Participants were assigned to a real-world environment or a Metaverse environment. Second Life (SL), a persistent 3D virtual world that utilizes human-like avatars for navigation, was the Metaverse environment. A desktop computer represented the real-world setting. Participants watched emotion-eliciting video clips to evoke amusement, anger, disgust, fear, and sadness. They reported their emotional arousal using the 16-item self-report inventory, MWL using the NASA Task Load Index, and emotional engagement using the Positive and Negative Affect Schedule. Results Regardless of the environment, participants with self-reported depression symptoms reported significantly higher amusement ( F 1,24 =4.882, P =.04; self-reported depression: mean 5.00, SD 2.481; minimal or no depression: mean 3.07, SD 1.940), anger ( F 1,24 =7.067, P =.01; self-reported depression: mean 4.79, SD 2.190; minimal or no depression: mean 2.71, SD 1.899), sadness ( F 1,24 =4.353, P =.048; self-reported depression: mean 5.21, SD 2.293; minimal or no depression: mean 3.50, SD 1.912), and perceived performance ( F 1,24 =4.939, P =.04; self-reported depression: mean 91.07, SD 90.302; minimal or no depression: mean 31.07, SD 36.278) than those with minimal or no depression. Participants with minimal or no depression reported lower perceived effort in the SL environment than in the real-world setting (SL: mean 40.71, SD 38.016; real world: mean 158.571, SD 120.411; P =.02), indicating Metaverse’s potential to alleviate cognitive stress during emotionally eliciting tasks. There were no significant differences in perceived MWL or emotional engagement between the real-world and Metaverse settings. Conclusions Individuals with self-reported depression symptoms exhibited heightened emotional responses across environmental settings, indicating the Metaverse may potentially elicit emotional arousal comparable to that in traditional settings. Participants with minimal or no depression symptoms reported lower perceived effort in the Metaverse, suggesting that virtual environments may reduce cognitive strain during emotionally evocative tasks. The lack of significant differences in emotional arousal, overall MWL, or emotional engagement across environments tentatively suggests that the Metaverse may deliver emotional experiences like those of real-world contexts. Collectively, this provides preliminary evidence that screen-based Metaverse platforms can elicit emotional responses like those commonly engaged during therapeutic depression interventions.