Social media. The climate crisis. Political polarization. The tumult of a pandemic and online learning. Teens today are dealing with unprecedented stressors, and over the past decade their mental health has been in sustained decline. Levels of anxiety and depression . Compounding the problem is a shortage of mental health providers — for every 100,000 children in the U.S., there are .

In response to this crisis, 91̽�� researchers studied whether virtual reality might help reduce stress for teens and boost mental health. Working with adolescents, the team designed a snowy virtual world with six activities — such as stacking rocks and painting — based on practices shown to improve mental health.

In a 3-week study of 44 Seattle teens, researchers found that teens used the technology an average of twice a week without being prompted and reported lower stress levels and improved mood while using it, though their levels of anxiety and depression didn’t decline overall.

The researchers published April 22 in the journal JMIR XR and Spatial Computing. The system is not publicly available.

“We know what works to help support teens, but a lot of these techniques are inaccessible because they’re locked into counseling, which can be expensive, or the counselors just aren’t available,” said lead author , a 91̽��senior research scientist in the human centered design and engineering department. “So we tried to take some of these evidence-based practices, but put them in a much more engaging environment, like VR, so the teens might want to do them on their own.”

The world of Relaxation Environment for Stress in Teens, or RESeT, came from conversations the researchers had with groups of teens over two years at Seattle Public Library sites. From these discussions, the team built RESeT as an open winter world with a forest that users could explore by swinging their arms (a behavior ) to move their avatar. A signpost with six arrows on it sent users to different activities, each based on methods shown to improve mental health, such as dialectical behavior therapy and mindfulness-based stress reduction.

In one exercise, “Riverboat,” users put negative words in paper boats and send them down a river. Another, “Rabbit Hole,” has players stand by a stump; the longer they’re still, the more rabbits appear.

“In the co-design process, we learned some teens were really afraid of squirrels, which I wouldn’t have thought of,” Björling said. “So we removed all the squirrels. I still have a Post-It in my office that says ‘delete squirrels.’ But all ages and genders loved rabbits, so we designed Rabbit Hole, where the reward for being calm and paying attention is a lot of rabbits surrounding you.”

To test the potential effects of RESeT on teens’ mental health, the team enrolled 44 teens between ages 14 and 18 in the study. Each teen was given a Meta Quest 2 headset and asked to use RESeT three to five times a week Because the researchers were trying to see if teens would use RESeT regularly on their own, they did not give prompts or incentives to use the headsets after the start of the study. Teens were asked to complete surveys gauging their stress and mood before and after each session.

On average, the teens used RESeT twice a week for 11.5 minutes at a time. Overall, they reported feeling significantly less stressed while using RESeT, and also reported smaller improvements in mood. They said they liked using the headset in general. However, the study found no significant effects on anxiety and depression.

“Reduced stress and improved mood are our key findings and exactly what we hoped for,” said co-author , an associate professor in the 91̽��School of Nursing who works with children and families. “We didn’t have a big enough participant group or a design to study long-term health impacts, but we have promising signals that teens liked using RESeT and could administer it themselves, so we absolutely want to move the project forward.”

The researchers aim to conduct a larger, longer-term study with a control group to see if a VR system could impart lasting effects on mood and stress. They’re also interested in incorporating artificial intelligence to personalize the VR experience and in exploring offering VR headsets in schools or libraries to improve community access.

Additional co-authors were , a 91̽��lecturer and researcher at Microsoft; , a senior manager at Electronic Arts who completed this research as a 91̽��master’s student in human centered design and engineering; , a research professor in psychiatry and behavioral sciences at the 91̽��School of Medicine; and , a senior product designer at Statsig who completed this research as a 91̽��master’s student in human centered design and engineering. This research was funded by the National Institute of Mental Health through the , which supports 91̽��research on mental health.

For more information, contact Björling at bjorling@uw.edu and Sonney at jsonney@uw.edu.

Teenagers report higher levels of stress than adults, and cite school as the highest contributing factor, according to the ‘s annual report. A summary from 2013 concluded that while stress among Americans was not new, “what’s troubling is the stress outlook for teens in the United States.”

In response, recently as a way to alleviate stress among their students. These programs could benefit from more research into what activities students find most useful.

In a pilot study led by the 91̽��, researchers explored art-based mindfulness activities that schools could use to reduce headaches, a common side effect of stress in adolescent girls. The test group of eight teenage girls gave feedback on which activities they preferred.

After three weeks of twice-weekly mindfulness and art therapy sessions, the girls reported experiencing significantly fewer headaches. At the beginning of the study, the girls reported 7.38 headaches, on average, within the previous two-week period. At the end of the study, that number had dropped to 4.63 — almost a 40% decrease. This drop remained even seven weeks after the study had ended. The researchers May 22 in the journal .

“This study highlights one of my main research missions: We should be making interventions in cooperation with teenagers if we want these strategies to work,” said corresponding author , a senior research scientist in the UW’s human centered design and engineering department. “There’s something powerful about saying ‘I’m inviting you to start thinking about how you could get better. Come have a conversation with me about how we could do this.’ I think that’s why we saw such a strong response even in this tiny study.”

The team recruited eight girls between the ages of 14 to 17 from a high school in Seattle. All of the participants reported experiencing three or more headaches not related to an injury within a two-week period, and five of the eight mentioned tension or stress as the main reason for headaches.

During the program, the students met twice a week for a 50-minute session with the research team. Each session began with an activity in which students would map where they were feeling stressed on a drawing of a body. Then the teens would participate in mindfulness and art activities before closing the session with another body map.

“After the study, we looked at all the before and after body maps side by side. It was so clear that something significant was going on,” Björling said. “In the beginning everything was in pieces, and in the end everything was flowing through the whole body.”

The teens tried different mindfulness techniques in each session so they could find which ones worked the best for them.

What teens liked: , a technique that encourages people to take slow breaths by concentrating and counting.

“I thought: ‘No teen ever wants to do counted breathing, and they’re never going to do it,'” Björling said. “But a few of them said ‘That’s my favorite. I do it all the time now.'”

What teens didn’t like: , a technique that asks people to focus on what and how they’re eating.

“They hated it,” Björling said. “This was a technique straight out of a lot of mindfulness programs for teens, but it didn’t connect with them. It just annoyed them. It goes to show I need them to be experts in their own lives.”

The researchers also asked the students to participate in different mindful art activities. During each session, the students tried a new art medium — they particularly liked using oil pastels — and different types of art therapy projects, including one where they worked together to create mandalas before and after a meditation exercise.

While the teens experienced fewer headaches after the study ended, their overall stress levels didn’t change much. But the students reported feeling better in the moment, saying that they felt like they could handle whatever happened for the rest of the day.

The team was surprised to see any differences, given the small size of the group.

“It’s not just about this study,” Björling said. “This problem of teen mental health and headaches is so big that I’m worried about what happens if we don’t take it on. Some teens will want nothing to do with art mindfulness. So we need to come at this in lots of different ways. We’re going to need an army of people and a cornucopia of options.”

, a nursing professor at 91̽��Tacoma, and , a psychology doctoral student at Seattle Pacific University, are also co-authors on this paper.

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For more information, contact Björling at bjorling@uw.edu.