Comparative Efficacy of Virtual Reality-Assisted Cognitive Behavioral Therapy Versus Yoga-Based Interventions for Reducing Performance Anxiety in Students: Protocol for a Randomized Controlled Trial.

Abstract

Background: Performance anxiety represents a significant challenge for students, manifesting as a fear of failure and difficulties managing examination-related concerns and academic pressures. According to recent statistics, anxiety affects >4% of the global population, underscoring the need for effective management methods. Studies indicate that yoga and virtual reality (VR) training can alleviate symptoms of performance anxiety.

Objective: This trial aims to compare VR-assisted cognitive behavioral therapy (CBT) with yoga interventions to find effective treatments.

Methods: A single-blinded randomized controlled trial will be conducted with 60 participants (n=30, 50% per intervention group) recruited from university and preuniversity counseling centers. The trial will measure whether the interventions reduce performance anxiety in students. Stratified randomization will be used to ensure equal distribution of baseline anxiety levels and gender across both groups. The primary outcome is a reduction in anxiety, measured using the State-Trait Anxiety Inventory-Y1 and State-Trait Anxiety Inventory-Y2 subscales. Secondary outcomes include emotional regulation and quality of life. Data will be collected at baseline, after the intervention, and during follow-up assessments. Statistical analyses will include parametric tests (eg, repeated-measures ANOVA and t tests) to compare anxiety reduction, emotional regulation, and quality of life across groups. The intention-to-treat approach will be applied to minimize bias due to participant dropouts. Sensitivity analyses will assess the robustness of the findings.

Results: This study is planned to start in September 2025 and end in June 2026. VR-assisted CBT is expected to reduce anxiety very quickly, whereas yoga is predicted to have long-term benefits.

Conclusions: More generally, this research highlights the need for new, accessible forms of mental health support. VR-assisted CBT is an emerging digital mental health intervention, and it enables individuals to access and explore anxiety in virtual, safe environments. In contrast, yoga is a more conventional, all-encompassing discipline that enhances mental health through physiological and psychological processes that may have long-term effects.

Trial registration: ClinicalTrials.gov NCT06639841; https://clinicaltrials.gov/study/NCT06639841.

International registered report identifier (irrid): PRR1-10.2196/66112.