Background: Virtual reality (VR) offers various benefits in anxiety reduction. The effect of active vs passive immersive environment, involved in this reduction is rarely investigated. This study aimed to investigate the effect of active and passive immersive virtual reality on anxiety reduction and user experience (UX) during the conditions.

Method: A double-blinded randomized controlled trial was conducted in September and October 2025. Fifty-eight healthy volunteers were randomly allocated to AFI (Active Fully Immersive, N=15), API (Active Partially Immersive, N=15), PFI (Passive Fully Immersive, N=14) and PPI (Passive Partially Immersive, N=14). Meta Quest 3 HMD (Head Mounted Display) with controllers were deployed for 5 minutes intervention. Heart rate (HR) and breathing rate (BR) were acquired using Zephyr wearable sensor, while STAI (State-Trait Anxiety Index), MPS (Multidimensional Presence Scale), SUS (System Usability Scale) and SSQ (Simulation Sickness Questionnaire) were obtained through Qualtrics.

Result: All group showed reduction in anxiety state and cardiopulmonary rates. Significant STAI reductions were only evident in AFI (p=0.02, F= 0.39) and PPI (p=0.015, F=7.76). Highest arousal of HR and BR was captured in high immersive groups (AFI and PFI). Similarly, high presence was found in AFI and PFI. While the lowest usability was reported in API, the same group reported the highest simulation sickness.

Discussion: VR might contribute to anxiety reduction. The synergy of immersion and interactivity levels in virtual environment play vital on user experience. Cognitive load and attentional bias should be taken into account. Future study should focus on populations with specific anxiety disorders.