Abstract Virtual reality (VR) has become popular in mental health research. Several studies have explored the use of VR in the context of biofeedback protocols. In the present paper, we report on the development and evaluation of a VR-based respiratory biofeedback game to foster diaphragmatic breathing. The game integrates respiratory biofeedback, restorative VR and gamification. The game is designed to run on a mobile, all-in-one VR headset. Notably, an integrated VR hand controller is utilized as a sensor to detect respiration-induced movements of the diaphragm. In a longitudinal within-subjects study, we explored the feasibility of the game and tested the effectiveness of six training sessions. Participants reported a pleasant user experience. Moreover, the results show that the brief VR-based breathing training increased perceived breath awareness, improved diaphragmatic breathing, increased relaxation, decreased perceived stress, reduced symptoms of burnout and boosted relaxation-related self-efficacy. Future studies need to address the generalizability and long-term stability of the results, compare the approach with existing treatments and fine-tune the training components.
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