Emotional Regulation and Physiological Responses to a Cultural Heritage Virtual Reality Experience in Older Adults: Mixed Methods Study.

Background: Against the backdrop of global population aging, the development of low-burden and widely acceptable interventions to support emotional health in older adults has become a critical research priority. Virtual reality (VR) has been increasingly applied in medical rehabilitation and psychological interventions due to its immersive and interactive features. However, its potential as a form of digital therapy that integrates cultural content and artistic design remains underexplored, particularly with respect to the mechanisms through which such experiences facilitate emotional regulation in older populations. Empirical studies combining subjective emotional outcomes with objective physiological indicators are especially scarce. Objective: This study aimed to examine the emotional regulation effects of an artistic cultural heritage-based VR experience among older adults and to explore its underlying mechanisms by integrating subjective psychological assessments with objective physiological responses. Methods: A mixed methods experimental design was adopted using the United Nations Educational, Scientific and Cultural Organization Historic Centre of Macao as the study context. Two VR conditions were developed for comparison: (1) an artistic cultural heritage VR environment and (2) a conventional photorealistic replica VR environment. A total of 49 participants aged 60 years and older were recruited. During the VR experience, electrodermal activity (EDA) was continuously recorded to capture emotional arousal. Physiological data were triangulated with pre- and postintervention psychological questionnaires assessing emotional states, as well as semistructured interviews. Results: Compared with the realistic replication VR condition, the cultural heritage VR condition was associated with significantly higher positive affect and lower negative affect (P<.05). At the physiological level, a significant between-group difference was observed in mean normal-to-normal interval (P=.01; Cohen d=0.91), whereas no significant differences were found in EDA measures (all P>.05). EDA results showed notable interindividual variability but did not demonstrate consistent group-level effects. These findings suggest that emotional changes may be more prominently reflected in subjective experience than in physiological arousal. Conclusions: By integrating subjective and physiological measures, this study provides preliminary empirical evidence that cultural heritage VR is associated with improved emotional outcomes in older adults. The findings propose a conceptual interpretative pathway linking digital cultural experience, emotional engagement, and psychological well-being, while highlighting the importance of individual variability in physiological responses. This study contributes to the development of content- and experience-oriented approaches in digital therapeutics and provides an evidence-based framework for emotion-supportive design in digital heritage and aging-related contexts.