Health and Health Care Access Among Afghan Refugee Women in the United States.

While stress is in many cases an adaptive and natural human response that prompts us to address challenges [], prolonged exposure to stressors over a lifetime can lead to various physiological and psychological health issues, including cardiovascular disease, chronic pain, mental illness, and certain types of cancer [-]. Relaxation techniques such as yoga, meditation, guided imagery, or progressive muscle relaxation are cost-effective, safe, and practical ways to manage stress []. An example of a guided imagery exercise is the safe place imagery exercise. This is an exercise in which a person imagines a place, real or made-up, where they feel completely safe and comfortable. The safe place imagery exercise is used in a variety of therapeutic settings and has been shown to be effective in regulating emotions and reducing negative affect, especially after exposure to trauma [-]. Practicing such techniques in everyday life can be challenging. Modern life is filled with constant distraction and sensory stimulation from phones and other media, which can make it difficult to maintain focus and fully engage in relaxation exercises []. Virtual reality (VR) may offer a solution by creating immersive, controlled environments that minimize external distractions and support the practice of techniques such as the safe place imagery exercise. Due to such distractions, people practicing relaxation exercises and mindfulness often report difficulties sitting still, focusing on the exercise, and being fully present in the moment []. VR technology can help address this issue. VR headsets are designed to capture attention, using head-tracking technology to alter the view as the user moves their head. This creates an immersive experience, which enhances the sense of presence in the virtual environment []. Presence is a key factor in reducing distractibility and is defined as the subjective experience of “being there” in a virtual environment, despite physically being elsewhere [,]. Busy schedules also represent a common barrier to the consistent practice of relaxation exercises, as time constraints and competing responsibilities often limit individuals’ ability to engage regularly []. VR may potentially help with this challenge by increasing motivation and engagement through immersive and interactive experiences. Evidence from longitudinal intervention studies indicates that the use of VR can enhance adherence to mindfulness and relaxation practices, indicating its potential to support long-term behavior change even under the time pressure of daily life [,]. Another advantage of relaxation in VR is its ability to provide access to visual experiences such as natural environments that might otherwise be unattainable due to physical or geographical constraints [], since, for example, access to nature remains limited for many people living in urban areas []. Research has shown that exposure to natural environments can enhance the effects of relaxation exercises, both in real life and simulated in VR [-]. Moreover, VR can potentially account for limitations in imagery capabilities, since it externalizes imagery and provides rich multisensory cues instead of relying on internal visualization []. However, to date, there is little empirical evidence examining how individual differences in imagery ability influence the effects of VR-based relaxation interventions.