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Comparative Analysis of Restorative Interior Design Elements: Screen-Based Versus Virtual Reality Evaluations for Future Medical Treatment Prospects

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Given the increasing prevalence of anxiety and depression, this research aims to identify design features that enhance the sense of restoration, with the goal of supporting mental and behavioral healthcare facility design. This study employed both screen-based and virtual reality (VR) stimuli to evaluate the perceived restorativeness of different interior settings. The key variables analyzed included window view access, view content, materiality, and room geometry. Thirty-five undergraduate and graduate students assessed 16 distinct interior environments. Findings indicate that the VR presentations generally produced higher restorativeness scores compared with screen-based presentations, though this effect varied across stimuli. Repeated-measures ANOVA revealed that larger windows consistently correlated with higher restorativeness scores in both presentation modes. Views of water were rated as most restorative, followed by wooded areas. Natural materials were perceived as significantly more restorative than other materials, particularly in VR presentations. Varied ceiling designs, especially vaulted ceilings, were associated with evaluations of higher restorativeness compared with flat ceiling designs, with this effect more pronounced in VR. This research underscores the potential of VR technology to simulate and assess interior design interventions, offering insights into creating more effective and personalized restorative environments in mental health treatment facilities. The findings can inform evidence-based design strategies for healthcare spaces, supporting treatment processes and patient well-being.
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Academic Editor: Paul B. Tchounwou
Received: 28 July 2024
Revised: 1 December 2024
Accepted: 26 December 2024
Published: 31 December 2024
Citation: Tural, A.; Tural, E.
Comparative Analysis of Restorative
Interior Design Elements:
Screen-Based Versus Virtual Reality
Evaluations for Future Medical
Treatment Prospects. Int. J. Environ.
Res. Public Health 2025,22, 44.
https://doi.org/10.3390/
ijerph22010044
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
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(https://creativecommons.org/
licenses/by/4.0/).
Article
Comparative Analysis of Restorative Interior Design Elements:
Screen-Based Versus Virtual Reality Evaluations for Future
Medical Treatment Prospects
Alp Tural * and Elif Tural
School of Design, Virginia Tech, Blacksburg, VA 24061, USA; etural@vt.edu
*Correspondence: alp@vt.edu
Abstract: Given the increasing prevalence of anxiety and depression, this research aims to
identify design features that enhance the sense of restoration, with the goal of supporting
mental and behavioral healthcare facility design. This study employed both screen-based
and virtual reality (VR) stimuli to evaluate the perceived restorativeness of different in-
terior settings. The key variables analyzed included window view access, view content,
materiality, and room geometry. Thirty-five undergraduate and graduate students assessed
16 distinct interior environments. Findings indicate that the VR presentations generally
produced higher restorativeness scores compared with screen-based presentations, though
this effect varied across stimuli. Repeated-measures ANOVA revealed that larger win-
dows consistently correlated with higher restorativeness scores in both presentation modes.
Views of water were rated as most restorative, followed by wooded areas. Natural ma-
terials were perceived as significantly more restorative than other materials, particularly
in VR presentations. Varied ceiling designs, especially vaulted ceilings, were associated
with evaluations of higher restorativeness compared with flat ceiling designs, with this
effect more pronounced in VR. This research underscores the potential of VR technology
to simulate and assess interior design interventions, offering insights into creating more
effective and personalized restorative environments in mental health treatment facilities.
The findings can inform evidence-based design strategies for healthcare spaces, supporting
treatment processes and patient well-being.
Keywords: restorative interior environments; virtual reality; mental health treatment;
biophilic design
1. Introduction
The design of interior spaces, particularly in healthcare settings, has garnered in-
creasing attention due to its potential impact on human well-being and restoration. This
study investigates the influence of specific interior design elements on restorative quality,
considering patient mental health and well-being at mental health treatment facilities. This
research is especially timely given the substantial increase in the prevalence of anxiety
and depression due to recent global events, underscoring the need for carefully designed
restorative environments [13].
Unlike ‘client-focused’ approaches to interior design in long-term healthcare set-
tings [
4
], for short-term treatment, medical professionals in mental health treatment, heal-
ing, and psychiatry centers traditionally utilize their offices or examination rooms as the
primary spaces for attending to patients who do not require a higher level of care, such as
those seeking ambulatory anxiety treatment. These spaces, while functional, often serve
Int. J. Environ. Res. Public Health 2025,22, 44 https://doi.org/10.3390/ijerph22010044
Int. J. Environ. Res. Public Health 2025,22, 44 2 of 22
as multi-purpose areas where clinicians conduct assessments, consultations, and therapy
sessions in a clinical setting. Despite their utility and technological advancements, these
traditional spaces may lack the specialized features and restorative atmosphere necessary
to fully support the emotional and psychological needs of patients undergoing treatment.
Additionally, the inherent clinical nature of these environments may inadvertently con-
tribute to feelings of anxiety or discomfort in some patients, underscoring the importance
of designing more tailored and conducive spaces that address the unique challenges and
complexities of mental health interventions.
Furthermore, from the building design and construction perspective, it is crucial to
acknowledge that creating restorative interior environments that fully meet the diverse
treatment and emotional needs of the majority of patients is a significant challenge, par-
ticularly in older buildings. Constraints include limited access to natural light, restricted
outdoor views, issues with view content and quality, difficulties in retrofitting controllable
light sources, and outdated finishes. These challenges highlight the need for innovative
approaches to interior design in healthcare settings.
2. Virtual Reality as an Innovative Approach
Virtual reality (VR) presents significant potential to overcome these challenges by
offering immersive 3D interior settings where spatial aspects of the environment can be
manipulated and tailored to the needs of each patient, caregiver, and service provider [
5
],
for treatment purposes. VR technology and tools can facilitate the creation of customizable
virtual environments that replicate and substitute real-world scenarios, providing indi-
viduals with a sense of presence and immersion. Especially for those who do not have
immediate access to such environments, VR can offer a practical solution [
6
]. These virtual
settings can be adjusted to eliminate or gradually mitigate environmental triggering stimuli.
The use of VR as a research platform for investigating human behavior and environ-
mental preferences is well established, with studies exploring user experiences, spatial
perceptions, and physiological responses across various design disciplines [
7
14
]. In restora-
tive and biophilic design research, VR has been used both as a research tool to study the
different types of stimuli and as a method to collect data in situations where direct access
to natural environments or research settings is not possible [15].
In psychiatric care, VR-based exposure therapy (VRET) has gained traction for treating
phobias and social anxiety [
16
20
]. However, comprehensive studies are needed to eval-
uate the effectiveness of immersive VR interior environments compared with traditional
methods in existing treatment spaces.
3. Theoretical Background on Sense of Restoration
The notion of fostering restoration through interior design draws upon insights from
various theoretical frameworks across environmental psychology, evolutionary biology,
and cultural studies. Key theories underpinning this research include the following:
Biophilic design theory, rooted in the biophilia hypothesis [
21
], suggests an innate
human affinity towards nature and natural processes. The incorporation of natural elements
in interior design is hypothesized to stimulate physiological and psychological responses
that promote well-being and restoration [22].
Ulrich’s stress recovery theory (SRT) underscores measurable outcomes and evidence-
based design and suggests that natural settings elicit positive emotional responses, hold
attention modestly, and inhibit negative thoughts, aiding in stress recovery. Ulrich’s
findings have significantly impacted environmental design, particularly in healthcare
settings, where the integration of natural elements has been shown to contribute to faster
recovery rates and improved patient well-being [2326].
Int. J. Environ. Res. Public Health 2025,22, 44 3 of 22
Attention restoration theory (ART) also explores the restorative effects of exposure to
natural environments but focuses more on the cognitive system and mental fatigue. ART
identifies four key components of restorative environments: being away, extent, fascination,
and compatibility. These components contribute to mental restoration by providing a sense
of escape and engaging the mind in a non-taxing manner [
27
,
28
]. Additional perspectives
include the Kaplans’ studies on environmental preference, suggesting innate human prefer-
ences for environments characterized by coherence, complexity, legibility, and mystery [
29
].
Prospect–refuge theory draws upon evolutionary psychology to explain preferences for en-
vironments with balanced visual access and shelter, while place-attachment theory explores
emotional and cognitive bonds that individuals form with places [30].
From a probabilistic perspective, interior designs that strategically leverage these
principles are hypothesized to have the potential to create spaces that evoke feelings of
comfort, security, and ultimately, restoration [31].
4. Literature, Research Gaps, and Objectives
Despite the rich theoretical foundation, meta-analytic studies on the built environment,
emotional response, and preference highlight the difficulty of proposing generalizable
findings, due to several factors including the subjectivity of human consciousness and
varying definitions of emotional constructs [
32
,
33
], methodological inconsistencies and
contextual differences among studies [
29
,
34
,
35
], oversight of mediating variables such
as cognitive functions and performance [
36
,
37
], and differences in sensory connection to
tested or simulated environments [38].
Previous research on the use of VR in psychiatric care underlined similar limitations
due to lack of comparison groups, as well as varying measurements and protocols, hinder-
ing the generalization of findings [3942].
In light of these challenges, several directions for future research have been suggested
in the literature. These include exploring the restorative effect of interiors on younger
adults [
43
], investigating the impact of finish materials on the sense of restoration [
44
],
incorporating objective measures to complement self-reported perceptions [
45
], replicat-
ing findings in diverse contexts, and identifying specific architectural components that
influence restorative interior settings [46].
This study aims to address several of these research gaps by investigating the influence
of four key design variables on the sense of restoration, utilizing both screen-based stimuli
and immersive VR environments. The variables were identified through the restorative
design theoretical framework, focusing on the elements contributing to restorative envi-
ronments. Two of these variables were related to window design, considering the view
quality and degree of access to the view. Windows are acknowledged as a form of passive
engagement with outdoors and nature [
26
], making them a crucial element in restorative
interior design. The third variable examined the impact of interior surface finish and
materials, while the fourth examined the effect of spatial form, specifically focusing on
various ceiling designs.
The study objectives were as follows:
1.
To investigate the influence of specific interior design elements on restorative quality
in a hypothetical healthcare setting, with a focus on young adult populations;
2.
To utilize a novel approach combining screen-based data collection and VR en-
vironments to examine the relationship between interior design variables and
perceived restoration;
3.
To explore the impact of view access, view content, materiality, and room geometry
on restorative experiences.
Int. J. Environ. Res. Public Health 2025,22, 44 4 of 22
This study demonstrates how space can easily be manipulated within a virtual en-
vironment to create various settings that can meet different treatment needs. By altering
spatial elements such as room size, layout, and visual aesthetics, VR can simulate a range
of environments that may enhance patient comfort and treatment outcomes. This flexibil-
ity allows the customization of treatment spaces to better align with individual patient
requirements, potentially leading to more effective and personalized psychiatric care.
5. Research Variables and Hypotheses
This research employed a survey to quantify participants’ perceptions of restoration
while they observed interior settings via a computer screen or in VR using a headset.
By comparing these viewing methods, this study investigated whether VR’s immersive
presentation format yielded higher restoration ratings than screen-based visualizations.
VR simulations can be leveraged for in-person treatments, creating immersive and
adaptable treatment spaces that respond more effectively to patients’ needs. Additionally,
the findings can provide valuable insights for the use of screen-based visualizations in
telemedicine, where remote consultations can benefit from restorative environments.
H1. Environmental stimuli presented through immersive virtual reality will generate significantly
higher restoration ratings compared with screen-based viewing conditions.
5.1. View Access
View access represents the quantifiable portion of window view observable from
an occupant’s spatial position. It has emerged as a critical consideration across various built
environments, with particular relevance to mental health and well-being. Research suggests
that view access may contribute to reduced stress and improved mood in workplace settings,
enhanced cognitive function and emotional regulation in educational environments, and
potentially accelerated recovery processes in healthcare facilities [
24
,
47
50
]. Research on
view access has prompted the development of view access metrics and daylight access
standards, such as EN 17037 [
51
] and LEED quality views [
52
]; however, there is not yet
an established consensus on how those standards should operationalize the metric [
53
,
54
].
In this research, conditions of access to the view systematically varied from a solid wall (0%)
to three incremental window sizes (33%, 66%, and 100%), to investigate how the degree of
the view from a fixed observation point influenced the restorative effects.
H2. Large window areas will yield significantly higher restoration ratings compared with spaces
with limited window area or windowless conditions.
5.2. View Content and View Quality
The literature on restorative environments suggests that the presence of water features,
vegetation, and views with moderate complexity that foster curiosity are significant factors
affecting well-being. White and colleagues reported that aquatic environments were rated
more positively for restoration than green space alone [
55
]. In indoor environments,
the view area, number of layers, and fragmentation of the view have been identified as
quantitative measures of view quality [
53
,
54
,
56
]. This research evaluated the relationship
between sense of restoration and four categories of natural view content: desert, water,
woods, and lawn.
H3. Particular natural features (e.g., water elements, diverse vegetation) will demonstrate a stronger
positive correlation with perceived sense of restoration compared with other natural elements.
Int. J. Environ. Res. Public Health 2025,22, 44 5 of 22
5.3. Materiality
Materials can introduce a restorative influence in interior design through various
means. From a biophilic perspective, materials can create sensory richness, abstract com-
positions, or motifs of nature, and they can affect one’s connection to space [
57
]. Natural
materials and geometries (the next variable) in interiors are acknowledged as indirect
experiences of nature [
44
]. Aligning with those principles, this study examined the effects
of textured vs. smooth and biophilic vs. conventional materials (brick, concrete, natural,
and resilient), as former studies have mainly focused on applications of single materials,
surface treatments such as green walls [25,58], and vegetation density.
H4. Interior environments incorporating biophilic features and sensory-rich materials (including
natural materials, textures, and patterns) will generate significantly higher restoration ratings
compared with alternative material schemes.
5.4. Room Geometry
Spatial geometric relationships have long been investigated in environmental pref-
erence studies [
59
], with recent neuroarchitecture research offering new insights [
60
62
].
This study explored how interior geometric variations, implemented through ceiling de-
sign modifications (curved, flat, vaulted and angled ceiling designs), influences the sense
of restoration.
H5. Non-flat ceiling designs (vaulted, curved, or angled configurations) will generate significantly
higher perceived restoration levels than flat ceiling conditions.
6. Materials and Methods
6.1. Participants
Thirty-five participants enrolled in the study. The sample comprised college un-
dergraduate and graduate students recruited via the Interior Design program and the
Design School email listservs. There was an imbalance in participants’ sex (92% female),
reflecting the typical distribution within the program cohort from which most participants
were drawn.
The study was approved by the University IRB (IRB 22-322). The study consent docu-
ment was made available with the digital study signup sheet, and each participant received
a $20 gift card at the end of the data collection session, which lasted thirty minutes on
average. The participants provided verbal consent declaring their voluntary participation,
and they were informed about the data collection process and tools (VR headset and AR
glasses) before starting the data collection sessions. Participants were allowed to withdraw
their consent from the study at any time.
6.2. Study Setting and Procedure
The experiment was conducted in an academic office environment. Window coverings
remained closed throughout data collection to ensure optimal VR sensor performance and
maintain consistent lighting conditions. Upon arrival, participants were guided through
the study procedures and received detailed instructions for both phases.
A single-item self-report measure utilizing a 7-point Likert scale was implemented
to evaluate perceived restoration across screen and VR presentations of the settings. This
measurement strategy was adopted due to its practical advantages for repeated measures
in VR and its validated use in analogous studies [
13
]. The item ‘Please rate the degree of
restorativeness this setting offers you’ was developed to capture the overall self-reported
Int. J. Environ. Res. Public Health 2025,22, 44 6 of 22
restorative quality, as conceptualized in healthcare design research [
63
] and environmental
preference studies.
Research shows that while multi-item scales provide comprehensive measurement in
healthcare facility evaluations [
64
], single-item self-report measures achieve comparable
predictive validity in architectural and design studies [
61
,
65
]. This measurement approach
adheres to the conventions of environmental psychology while capturing subjective restora-
tion experiences [
66
]. Also, in this study, survey length was a primary concern, making
single-item measures particularly appropriate.
This research employed a within-subjects design where all participants experienced
both screen-based and VR conditions. The study variables were presented sequentially
rather than in randomized order. This sequential presentation was deliberately cho-
sen to maintain logical coherence in the progression of environmental changes, par-
ticularly for variables like view access where incremental changes were important for
participant evaluation.
6.3. Experimental Stimuli
Sixteen different interior environments were digitally constructed using Autodesk
Revit and rendered via Enscape3D visualization software (Enscape v3.5, Chaos, Sofia,
Bulgaria) to achieve photorealistic quality. For screen-based viewing, single-point perspec-
tive renderings were generated at 2160
×
1440 pixel resolution (Figures 14). The camera
was placed centrally against the back wall; its position replicated the seated eye height of
a 50th-percentile US female. A 100-degree horizontal view angle was implemented to maxi-
mize spatial coverage while avoiding distortion. This configuration resulted in balanced
surface visibility: lateral walls each occupied 20.5% of total pixels, floor 21%, front wall
20%, and ceiling 17.5%. The slight reduction in ceiling visibility resulted from a five-degree
downward camera tilt, simulating natural seated viewing behavior. VR presentations
utilized 8192
×
8192 pixel panoramic renders, generated through Enscape’s panoramic
export feature. While maintaining the same eye height, the viewing position was offset
four feet from the back wall to accommodate 360-degree participant viewing. All spaces
had a square floor area of 15 feet by 15 feet and were furnished as a consultation office with
consistent elements: a couch, two chairs, and a coffee table. The
first three experimental
sets used a standard 9-foot ceiling height. The fourth set, examining ceiling geometry
variations, extended to 12 feet at its peak while preserving overall room volume. Envi-
ronmental variables including screen luminance, surface colors, and lighting spectra were
standardized across all conditions.
The study environments were divided into four categories, as follows:
Set 1, View Access: The first sequence examined incremental changes in access to
outdoor views, ranging from a fully enclosed space to one with complete floor-to-ceiling
transparency on the wall perpendicular to the observer (Figure 1). Two intermediate
conditions provided 33% and 66% wall apertures, respectively. The outdoor scene featured
a natural setting including plants, trees, a water body, and realistically rendered daylight
conditions. The arrangement of trees formed a natural boundary while inviting visual
discovery. Consistent solar angles were maintained within each set to enhance sensory
detail and temporal awareness;
Set 2, View Content: The second sequence included different exterior scenes, while
maintaining consistent opening dimensions, interior finishes, and ceiling geometry. Draw-
ing from research on biophilic design and restoration, four distinct environments were
presented: a dense woodland offering a permeable boundary, an expansive lawn pro-
viding connectedness and spatial extent, a waterscape with distant shoreline facilitating
mental escape, and a desert landscape characterized by varied terrain and clear pathways
Int. J. Environ. Res. Public Health 2025,22, 44 7 of 22
(Figure 2). To maximize visual realism, the exterior scenes were constructed using high
dynamic range (HDR) 360-degree photographs. These panoramic images were integrated
with the digital interior models, enabling exploration of the views from multiple angles
during the VR sessions. Solar angles in the HDR imagery were aligned with the interior
lighting conditions to ensure uniform illumination across all variations in the set;
Set 3, Materiality: Material finishes for walls, floors, and ceiling varied while view
content and opening dimensions remained unchanged (Figure 3). The window size was
maintained at 66% of the front wall area, framing an urban downtown view. The sequence
included (a) an adaptive reuse setting of brick, hardwood, and steel decking; (b) a com-
position with a concrete finish; (c) a biophilic design incorporating green wall panels,
timber acoustic ceiling, and nature-patterned carpeting; and (d) a setting featuring textured
wall surfaces and resilient flooring. The sizes of the green wall and biophilic intervention
areas were controlled, as findings have suggested adverse effects of larger-sized biophilic
interventions [67].
Set 4, Room Geometry: To emphasize geometric variations, this series featured
a reduced, asymmetrically positioned window revealing the urban vista used in the previ-
ous set. Interior surfaces received uniform treatment with matte white paint on gypsum
board, except for the flooring which matched the earlier sets—a design decision supported
by research indicating that floor characteristics have less impact on spatial perception than
wall and ceiling treatments [
68
]. Maintaining a consistent maximum height of 10 feet,
the ceiling configurations explored four distinct geometries: flat, vaulted, curved, and
angled forms.
Int. J. Environ. Res. Public Health 2025, 22, x 7 of 22
(a)
(b)
Figure 1. Set 1, view access and 3D-rendered view content: (a) Interior rendered view; (b) opening
proportions: 100%, 66%, and 33%.
Figure 2. Set 2, view content: 360-degree HDR natural images.
Figure 1. Set 1, view access and 3D-rendered view content: (a) Interior rendered view; (b) opening
proportions: 100%, 66%, and 33%.
Int. J. Environ. Res. Public Health 2025,22, 44 8 of 22
Int. J. Environ. Res. Public Health 2025, 22, x 7 of 22
(a)
(b)
Figure 1. Set 1, view access and 3D-rendered view content: (a) Interior rendered view; (b) opening
proportions: 100%, 66%, and 33%.
Figure 2. Set 2, view content: 360-degree HDR natural images.
Figure 2. Set 2, view content: 360-degree HDR natural images.
Int. J. Environ. Res. Public Health 2025, 22, x 8 of 22
Figure 3. Set 3, materiality.
Figure 4. Set 4, room geometry: ceiling form.
The study environments were divided into four categories, as follows:
Set 1, View Access: The rst sequence examined incremental changes in access to
outdoor views, ranging from a fully enclosed space to one with complete oor-to-ceiling
transparency on the wall perpendicular to the observer (Figure 1). Two intermediate con-
ditions provided 33% and 66% wall apertures, respectively. The outdoor scene featured a
natural seing including plants, trees, a water body, and realistically rendered daylight
conditions. The arrangement of trees formed a natural boundary while inviting visual dis-
covery. Consistent solar angles were maintained within each set to enhance sensory detail
and temporal awareness;
Set 2, View Content: The second sequence included dierent exterior scenes, while
maintaining consistent opening dimensions, interior nishes, and ceiling geometry.
Drawing from research on biophilic design and restoration, four distinct environments
were presented: a dense woodland oering a permeable boundary, an expansive lawn
providing connectedness and spatial extent, a waterscape with distant shoreline facilitat-
ing mental escape, and a desert landscape characterized by varied terrain and clear path-
ways (Figure 2). To maximize visual realism, the exterior scenes were constructed using
high dynamic range (HDR) 360-degree photographs. These panoramic images were inte-
grated with the digital interior models, enabling exploration of the views from multiple
Figure 3. Set 3, materiality.
Int. J. Environ. Res. Public Health 2025, 22, x 8 of 22
Figure 3. Set 3, materiality.
Figure 4. Set 4, room geometry: ceiling form.
The study environments were divided into four categories, as follows:
Set 1, View Access: The rst sequence examined incremental changes in access to
outdoor views, ranging from a fully enclosed space to one with complete oor-to-ceiling
transparency on the wall perpendicular to the observer (Figure 1). Two intermediate con-
ditions provided 33% and 66% wall apertures, respectively. The outdoor scene featured a
natural seing including plants, trees, a water body, and realistically rendered daylight
conditions. The arrangement of trees formed a natural boundary while inviting visual dis-
covery. Consistent solar angles were maintained within each set to enhance sensory detail
and temporal awareness;
Set 2, View Content: The second sequence included dierent exterior scenes, while
maintaining consistent opening dimensions, interior nishes, and ceiling geometry.
Drawing from research on biophilic design and restoration, four distinct environments
were presented: a dense woodland oering a permeable boundary, an expansive lawn
providing connectedness and spatial extent, a waterscape with distant shoreline facilitat-
ing mental escape, and a desert landscape characterized by varied terrain and clear path-
ways (Figure 2). To maximize visual realism, the exterior scenes were constructed using
high dynamic range (HDR) 360-degree photographs. These panoramic images were inte-
grated with the digital interior models, enabling exploration of the views from multiple
Figure 4. Set 4, room geometry: ceiling form.
Int. J. Environ. Res. Public Health 2025,22, 44 9 of 22
6.4. Data Collection Tools
For the VR session in this study, two viewing options were provided: a Meta Quest
Pro wireless VR headset or Xreal Air 2 AR glasses paired with an iPad. This dual-platform
approach was implemented to accommodate neurodiverse users and those with sensory
sensitivities, addressing known VR-related challenges such as reality disconnection anxiety,
sensory overwhelm, and physical discomfort [
69
,
70
]. The VR headset included detachable
side-light shields for customizable immersion levels. While all participants were instructed
about shield removal, they unanimously chose to maintain them. The viewing experience
differed between platforms: VR users could explore environments through natural head
movements, while AR users viewed a 130-inch virtual screen, navigating the 360-degree
views through iPad rotation or touch interaction. To ensure optimal performance, the VR
headset was connected wirelessly to a PC via a dedicated router, running visualizations
through Steam Media Player’s panoramic viewer. The AR glasses maintained a direct cable
connection to an iPad Pro, accessing panoramic content through pre-loaded browser tabs.
6.4.1. Screen Stimuli Session
During the screen-based session, viewing distance was maintained at 25 inches, with
participants able to adjust seat height to their preference. The session included eighteen
slides, beginning with two 25 s informational slides outlining the study protocols and sur-
vey question. The subsequent stimulus slides were presented for 18 s each, with exposure
durations determined by pilot study findings (n= 6). In the screen-based presentations,
a fixed-viewpoint approach was implemented to support eye-tracking analyses, which
will be reported in a separate paper focusing on attention patterns and visual behavior in
restorative environments.
6.4.2. VR/AR Session
After completing the screen-based session, participants selected either the VR headset
or AR glasses for the immersive visualization phase. The chosen device allowed unre-
stricted viewing and rotational movement. For VR users, lens spacing was adjusted to
match individual interpupillary distances. Unlike the timed screen-based session, partic-
ipants controlled their viewing duration for each environment, indicating readiness to
advance at their own pace. Among the 35 participants, 1 opted to use the AR glasses rather
than the VR headset.
7. Results
7.1. Comparison of Display Modalities: Screen and Virtual Reality
H1: Environmental stimuli presented through immersive virtual reality will generate
significantly higher restoration ratings compared with screen-based viewing conditions.
The relationship between display modality and perceived restoration is summarized in
Table 1, which presents mean ratings and cross-modal correlations for four distinct en-
vironmental categories: View Access, View Content, Materiality, and Room Geometry.
Results indicated that VR presentations led to increased restoration scores compared with
screen-based viewing, across all stimulus types. Notably, the “100% View Access” condition
yielded the highest restorativeness ratings in both the screen-based (M = 6.37, SD = 0.690)
and VR (M = 6.51, SD = 0.818) presentations. Additionally, strong positive correlations
were observed between screen-based and VR ratings for most stimuli, with particularly
high correlations in the Materiality set (e.g., r = 0.811, p< 0.01 for the natural finishes).
A series of paired-samples t-tests were conducted to compare perceived restorativeness
scores between screen-based and VR presentations of environmental stimuli. The results
Int. J. Environ. Res. Public Health 2025,22, 44 10 of 22
partially supported the hypothesis that perceived restoration would be significantly higher
in VR compared with screen-based presentations.
Table 1. Perceived restorativeness ratings and correlations between screen-based and VR ratings
(N = 35).
Screen VR
Perceived
Restorativeness–M (SD)
Perceived
Restorativeness–M (SD) Pearson Correlations–ρ
Set 1: View Access
0% 3.89 (1.301) 3.26 (1.482) 0.443 **
33% 4.80 (0.994) 5.11 (1.105) 0.262
66% 5.40 (0.812) 5.51 (0.951) 0.526 **
100% 6.37 (0.690) 6.51 (0.818) 0.538 **
Set 2: View Content
Desert 4.23 (1.457) 4.77 (1.352) 0.654 **
Water 5.11 (1.491) 5.54 (1.268) 0.433 **
Woods 4.83 (0.985) 4.80 (1.208) 0.613 **
Lawn 4.06 (0.998) 4.34 (1.235) 0.556 **
Set 3: Materiality
Brick 4.06 (1.282) 4.60 (1.376) 0.680 **
Concrete 2.77 (1.262) 2.86 (1.498) 0.791 **
Natural 4.46 (1.245) 4.80 (1.346) 0.811 **
Resilient 2.94 (1.056) 3.40 (1.355) 0.407 *
Set 4: Room Geometry
Curve 3.89 (1.278) 3.94 (1.187) 0.713 **
Flat 3.23 (1.330) 3.63 (1.330) 0.648 **
Angled 3.94 (1.211) 3.94 (1.282) 0.471 **
Vault 4.29 (1.202) 4.60 (1.218) 0.663 **
Note: * = p< 0.05 (2-tailed). ** = p< 0.01 level (2-tailed).
Significant differences were found for several environments, with VR presenta-
tions yielding higher restorativeness scores. These included the 33% façade open-
ing (
t(34) = 1.455
,
p= 0.155
, d =
0.246), the desert view (
t(34) = 2.741
,
p= 0.010
,
d = 0.463
), the water view (
t(34) = 1.712
,p= 0.096, d =
0.289), the brick finishes
(t(34) =
3.011, p= 0.005, d =
0.509), and the natural finishes (
t(34) = 2.528
,
p= 0.016
,
d = 0.427
). However, for some environments, the screen-based presentations were associ-
ated with higher restorativeness scores. These included the room with no façade opening
(
t(34) = 2.518
,
p= 0.017
, d = 0.426) and the room with the lawn view (
t(34) = 1.178
,p= 0.247,
d = 0.199), although the latter was not statistically significant.
Several environments showed no significant differences between the on-screen and
VR presentations, including the 66% façade opening (
t(34) = 0.780
,
p= 0.441
, d =
0.132),
100% façade opening (t(34) =
1.152, p= 0.257, d =
0.195), the wooded area view
(
t(34) = 0.172
,p= 0.865, d = 0.029), concrete finishes (t(34) =
0.552, p= 0.585,
d = 0.093
),
and various room geometries (curved: t(34) =
0.361, p= 0.721, d =
0.061; angled:
t(34) = 0.000, p= 1.000, d = 0.000; vaulted: t(34) = 1.872, p= 0.070, d = 0.316).
Effect sizes ranged from small to medium, with the largest effect observed for the
room with brick finishes (d = 0.509), favoring VR presentation.
These results reveal that while VR presentations tended to produce higher perceived
restorativeness for some environments, the effect was not consistent across all stimuli. The
Int. J. Environ. Res. Public Health 2025,22, 44 11 of 22
hypothesis is partially supported, with the relationship between presentation mode and
perceived restoration appearing to be dependent on the specific environmental context.
7.2. Effects of View Access, View Content, Materiality and Room Geometry on Perceived Sense
of Restorativeness
One-way repeated-measures analyses of variance were conducted using SPSS (Version
29) to examine the effects of view access, view content, materiality, and room geometry on
perceived restoration. Given the mixed findings for H1, screen-based and VR conditions
were analyzed separately. Each environmental variable included four levels. The assump-
tion of normality was verified using normal Q-Q plots. Tables 2and 3present the RM
ANOVA results for both display modalities, demonstrating substantial effect sizes across
all models.
Table 2. Repeated-Measures ANOVA Results for the Effect of View Access, View Content, Materiality,
and Room Geometry on Perceived Restorativeness, Screen-Based Evaluations.
Source SS df MS F p η2pε
View Access 114.457 2.095 54.630 59.374 <0.001 0.636 0.698
Error 65.543 71.234 0.920
View Content 25.971 2.237 11.613 11.848 <0.001 0.258 0.746
Error 74.529 76.041 0.980
Materiality 71.914 3 23.971 21.154 <0.001 0.384
Error 115.586 102 1.133
Room Geometry 20.479 3 1.740 12.949 <0.001 0.276
Error 53.771 102 0.662
Note: SS = sum of squares; df = degrees of freedom; MS = mean square;
η2p
= partial eta squared;
ε
= Greenhouse–
Geisser correction, if needed.
Table 3. Repeated-Measures ANOVA Results for the Effect of View Access, View Content, Materiality,
and Room Geometry on Perceived Restorativeness, VR Evaluations.
Source SS df MS F p η2p
View Access 194.886 3 64.962 84.286 <0.001 0.713
Error 78.614 102 0.771
View Content 26.079 3 8.693 11.640 <0.001 0.255
Error 76.171 102 0.747
Materiality 92.286 3 30.762 23.120 <0.001 0.405
Error 135.714 102 1.631
Room Geometry 17.543 3 5.848 9.254 <0.001 0.214
Error 64.457 102 0.632
Note: SS = sum of squares; df = degrees of freedom; MS = mean square; η2p= partial eta squared.
Table 4provides the results from the pairwise comparisons of these variables, for both
screen- and VR-based evaluations. Figure 5shows four clustered boxplots representing
restorativeness scores across two perception types.
Table 4. Results from pairwise comparisons with Bonferroni correction.
Variables Mean Difference SE p
Screen-based evaluations
Set 1: View Access
P1: 0–33% 0.914 * 0.237 0.003
P2: 0–66% 1.514 * 0.240 <0.001
P3: 0–100% 2.486 * 0.202 <0.001
Int. J. Environ. Res. Public Health 2025,22, 44 12 of 22
Table 4. Cont.
Variables Mean Difference SE p
P4: 33–66% 0.600 * 0.131 <0.001
P5: 33–100% 1.571 * 0.165 <0.001
P6: 66–100% 0.971 * 0.145 <0.001
Set 2: View Content
P1: Desert–Water 0.886 * 0.168 <0.001
P2: Desert–Woods 0.600 * 0.193 0.023
P3: Desert–Lawn 0.171 0.226 1.000
P4: Water–Woods 0.286 0.223 1.000
P5: Water–Lawn 1.057 * 0.246 <0.001
P6: Woods–Lawn 0.771 * 0.154 <0.001
Set 3: Materiality
P1: Brick–Concrete 1.286 * 0.248 <0.001
P2: Brick–Natural 0.400 0.266 0.854
P3: Brick–Resilient 1.114 * 0.283 0.002
P4: Concrete–Natural 1.686 * 0.277 <0.001
P5: Concrete–Resilient 0.171 0.211 1.000
P6: Natural–Resilient 1.514 * 0.233 <0.001
Set 4: Room Geometry
P1: Curve–Flat 0.657 * 0.164 0.002
P2: Curve–Angled 0.057 0.188 1.000
P3: Curve–Vault 0.400 0.180 0.196
P4: Flat–Angled 0.714 * 0.167 <0.001
P5: Flat–Vault 1.057 * 0.183 <0.001
P6: Angled–Vault 0.343 0.158 0.226
VR evaluations
Set 1: View Access
P1: 0–33% 1.857 * 0.232 <0.001
P2: 0–66% 2.257 * 0.237 <0.001
P3: 0–100% 3.257 * 0.240 <0.001
P4: 33–66% 0.400 0.184 0.222
P5: 33–100% 1.400 * 0.197 <0.001
P6: 66–100% 1.000 * 0.153 <0.001
Set 2: View Content
P1: Desert–Water 0.771 * 0.184 0.001
P2: Desert–Woods 0.029 0.223 1.000
P3: Desert–Lawn 0.429 0.226 0.396
P4: Water–Woods 0.743 * 0.233 0.019
P5: Water–Lawn 1.200 * 0.178 <0.001
P6: Woods–Lawn 0.457 0.189 0.128
Set 3: Materiality
P1: Brick–Concrete 1.743 * 0.294 <0.001
P2: Brick–Natural 0.200 0.249 1.000
P3: Brick–Resilient 1.200 * 0.306 0.002
P4: Concrete–Natural 1.943 * 0.290 <0.001
P5: Concrete–Resilient 0.543 0.202 0.067
P6: Natural–Resilient 1.400 * 0.299 <0.001
Set 4: Room Geometry
P1: Curve–Flat 0.314 0.173 0.467
P2: Curve–Angled 0.000 0.169 1.000
P3: Curve–Vault 0.657 * 0.164 0.002
P4: Flat–Angled 0.314 0.208 0.841
P5: Flat–Vault 0.971 * 0.186 <0.001
P6: Angled–Vault 0.657 * 0.232 0.046
Note: * mean difference significant at the 0.05 level.
Int. J. Environ. Res. Public Health 2025,22, 44 13 of 22
Int. J. Environ. Res. Public Health 2025, 22, x 13 of 22
P2: 066% 2.257 * 0.237 <0.001
P3: 0–100% 3.257 * 0.240 <0.001
P4: 33–66% 0.400 0.184 0.222
P5: 33–100% 1.400 * 0.197 <0.001
P6: 66–100% 1.000 * 0.153 <0.001
Set 2: View Content
P1: Desert–Water 0.771 * 0.184 0.001
P2: Desert–Woods 0.029 0.223 1.000
P3: Desert–Lawn 0.429 0.226 0.396
P4: Water–Woods 0.743 * 0.233 0.019
P5: Water–Lawn 1.200 * 0.178 <0.001
P6: Woods–Lawn 0.457 0.189 0.128
Set 3: Materiality
P1: Brick–Concrete 1.743 * 0.294 <0.001
P2: BrickNatural 0.200 0.249 1.000
P3: BrickResilient 1.200 * 0.306 0.002
P4: Concrete–Natural 1.943 * 0.290 <0.001
P5: Concrete–Resilient 0.543 0.202 0.067
P6: Natural–Resilient 1.400 * 0.299 <0.001
Set 4: Room Geometry
P1: CurveFlat 0.314 0.173 0.467
P2: CurveAngled 0.000 0.169 1.000
P3: CurveVault 0.657 * 0.164 0.002
P4: Flat–Angled 0.314 0.208 0.841
P5: Flat–Vault 0.971 * 0.186 <0.001
P6: Angled–Vault 0.657 * 0.232 0.046
Note: * mean dierence signicant at the 0.05 level.
Int. J. Environ. Res. Public Health 2025, 22, x 14 of 22
Figure 5. Clustered boxplots of restorativeness scores by variable and perception type.
7.2.1. View Access
H2_screen: Large window areas will yield signicantly higher restoration ratings,
compared with spaces with limited window area or windowless conditions.
One-way repeated-measures ANOVA was conducted to examine the eect of view
access/window size on perceived restorativeness scores. Mauchly’s test indicated that the
assumption of sphericity was violated, χ2(5) = 20.965, p < 0.001; therefore, degrees of free-
dom were corrected using GreenhouseGeisser estimates of sphericity (ε = 0.698).
The results showed a signicant main eect of window size on perceived restorative-
ness, F(2.095, 71.234) = 59.374, p < 0.001, partial η2 = 0.636, indicating a large eect size.
These ndings align with the hypothesis that increased window areas correlates with
higher perceived restoration ratings, compared with limited window area or windowless
conditions.
Post hoc tests using the Bonferroni correction revealed that all pairwise comparisons
between the four levels of window size (0%, 33%, 66%, and 100%) were statistically sig-
nicant (p < 0.05). Perceived restorativeness scores increased signicantly with each in-
crease in window size. The largest mean dierence was observed between the 0% and
100% window conditions (MD = 2.486, SE = 0.202, p < 0.001, 95% CI [1.919, 3.053]).
The results provided robust support for the hypothesis, revealing a strong positive
relationship between window size and perceived restoration. The analysis showed a clear
linear progression; the restoration ratings systematically increased with expanding win-
dow dimensions, from windowless conditions to full-height glazing.
H2_VR: Large window areas will yield signicantly higher restoration ratings, com-
pared with spaces with limited window area or windowless conditions.
Mauchly’s test indicated that the assumption of sphericity was violated, χ2(5) = 9.503,
p = 0.091; therefore, degrees of freedom were corrected using Greenhouse–Geisser esti-
mates of sphericity (ε = 0.845). The results showed a signicant main eect of window size
on perceived restorativeness in virtual reality seings, F(2.536, 86.223) = 84.286, p < 0.001,
partial η2 = 0.713. Post hoc tests using the Bonferroni correction revealed that perceived
Figure 5. Clustered boxplots of restorativeness scores by variable and perception type.
7.2.1. View Access
H2_screen: Large window areas will yield significantly higher restoration ratings,
compared with spaces with limited window area or windowless conditions.
Int. J. Environ. Res. Public Health 2025,22, 44 14 of 22
One-way repeated-measures ANOVA was conducted to examine the effect of view
access/window size on perceived restorativeness scores. Mauchly’s test indicated that
the assumption of sphericity was violated,
χ2
(5) = 20.965, p< 0.001; therefore, degrees of
freedom were corrected using Greenhouse–Geisser estimates of sphericity (ε= 0.698).
The results showed a significant main effect of window size on perceived restora-
tiveness, F(2.095, 71.234) = 59.374, p< 0.001, partial
η2
= 0.636, indicating a large ef-
fect size. These findings align with the hypothesis that increased window areas corre-
lates with higher perceived restoration ratings, compared with limited window area or
windowless conditions.
Post hoc tests using the Bonferroni correction revealed that all pairwise comparisons
between the four levels of window size (0%, 33%, 66%, and 100%) were statistically signifi-
cant (p< 0.05). Perceived restorativeness scores increased significantly with each increase in
window size. The largest mean difference was observed between the 0% and 100% window
conditions (MD = 2.486, SE = 0.202, p< 0.001, 95% CI [1.919, 3.053]).
The results provided robust support for the hypothesis, revealing a strong positive
relationship between window size and perceived restoration. The analysis showed a clear
linear progression; the restoration ratings systematically increased with expanding window
dimensions, from windowless conditions to full-height glazing.
H2_VR: Large window areas will yield significantly higher restoration ratings, com-
pared with spaces with limited window area or windowless conditions.
Mauchly’s test indicated that the assumption of sphericity was violated,
χ2
(5) = 9.503,
p= 0.091; therefore, degrees of freedom were corrected using Greenhouse–Geisser estimates
of sphericity (
ε
= 0.845). The results showed a significant main effect of window size on
perceived restorativeness in virtual reality settings, F(2.536, 86.223) = 84.286, p< 0.001,
partial
η2
= 0.713. Post hoc tests using the Bonferroni correction revealed that perceived
restorativeness significantly increased as the window size increased, with all pairwise
comparisons being statistically significant (p< 0.001) except between the 33% and 66%
window conditions (p= 0.222). These findings support the hypothesis that spaces with
larger windows would be evaluated as significantly more restorative compared with spaces
with smaller windows or no openings.
7.2.2. View Content
H3_Screen: Particular natural features (e.g., water elements, diverse vegetation) will
demonstrate a stronger positive correlation with perceived sense of restoration compared
with other natural elements.
Mauchly’s test indicated that the assumption of sphericity had been violated,
χ2(5) = 15.692
,p= 0.008; therefore, degrees of freedom were corrected using Greenhouse–
Geisser estimates of sphericity (
ε
= 0.746). The results showed a significant main effect
of view content on perceived restorativeness, F(2.237, 76.041) = 11.848, p< 0.001, par-
tial
η2= 0.258
. Post hoc tests using the Bonferroni correction revealed that water views
were perceived as significantly more restorative than desert (p< 0.001) or lawn views
(p< 0.001). Wooded views were also rated significantly more restorative than desert
(p= 0.023) or lawn views (p< 0.001). There were no significant differences between water
and wooded views (
p= n.s.
) or between desert and lawn views (
p= n.s.
). These findings
partially support the hypothesis that particular natural features, specifically water and
diverse vegetation, are associated with a stronger perceived sense of restoration compared
with other natural elements.
H3_VR: Particular natural features (e.g., water elements, diverse vegetation) will
demonstrate a stronger positive correlation with perceived sense of restoration compared
with other natural elements.
Int. J. Environ. Res. Public Health 2025,22, 44 15 of 22
Mauchly’s test indicated that the assumption of sphericity was not violated,
χ2(5) = 9.342
,p= 0.096. The results showed a significant main effect of view content
on perceived restorativeness, F(3, 102) = 11.640, p< 0.001, partial
η2
= 0.255. Post hoc
tests using the Bonferroni correction revealed that water views in VR were perceived as
significantly more restorative than desert (p= 0.001), wooded (p= 0.019), or lawn views
(p< 0.001). There were no significant differences between desert and wooded views
(p= n.s.), desert and lawn views (p= 0.396), or wooded and lawn views (p= 0.128). These
findings partially support the hypothesis that particular natural features in VR, specifically
water elements, demonstrate a stronger perceived sense of restoration compared with other
natural elements.
7.2.3. Materiality
H4_Screen: Interior environments incorporating biophilic features and sensory-rich
materials (including natural materials, textures, and patterns) will generate significantly
higher restoration ratings compared with alternative material schemes.
Mauchly’s test indicated that the assumption of sphericity was not violated,
χ2(5) = 7.752
,p= 0.171. The results showed a significant main effect of materiality on
perceived restorativeness, F(3, 102) = 21.154, p< 0.001, partial
η2
= 0.384. Post hoc tests
using the Bonferroni correction revealed that natural materials were perceived as signif-
icantly more restorative than concrete (p< 0.001), resilient finishes (p< 0.001), or brick
(
p= 0.854, n.s.
). Brick was rated significantly more restorative than concrete (
p< 0.001
) and
resilient materials (p= 0.002). There was no significant difference between concrete and
resilient materials (
p= n.s.
). These findings support the hypothesis that settings with materi-
als providing sensory richness and biophilic design features, particularly natural materials,
would be evaluated as significantly more restorative compared with other settings.
H4_VR: Interior environments incorporating biophilic features and sensory-rich mate-
rials (including natural materials, textures, and patterns) will generate significantly higher
restoration ratings compared with alternative material schemes.
Mauchly’s test indicated that the assumption of sphericity was not violated,
χ2
(5) = 10.847, p= 0.055. The results showed a significant main effect of materiality
(i.e., room finish) on perceived restorativeness, F(3, 102) = 23.120, p< 0.001, partial
η2= 0.405
.
Post hoc tests using the Bonferroni correction revealed that natural materials were perceived
as significantly more restorative than concrete (p< 0.001) or resilient finishes (
p< 0.001
),
but not brick materials (p= n.s.). Brick materials were rated significantly more restorative
than concrete (
p< 0.001
) or resilient materials (p= 0.002). The difference between concrete
and resilient materials approached significance (
p= 0.067
). These findings support the
hypothesis that settings with materials providing sensory richness and biophilic design fea-
tures, particularly natural materials, would be evaluated as significantly more restorative
compared with other settings when experienced in VR.
7.2.4. Room Geometry
H5_Screen: Non-flat ceiling designs (vaulted, curved, or angled configurations) will
generate significantly higher perceived restoration levels than flat ceiling conditions.
Mauchly’s test indicated that the assumption of sphericity was not violated,
χ2
(5) = 2.907, p= 0.714. The results showed a significant main effect of room geome-
try on perceived restorativeness, F(3, 102) = 12.949, p< 0.001, partial
η2
= 0.276. Post hoc
tests using the Bonferroni correction revealed that the vaulted, angled, and curved ceiling
designs were perceived as significantly more restorative than the flat ceiling (p< 0.001,
p< 0.001, and p= 0.002, respectively). There were no significant differences between the
vaulted and angled ceilings (p= 0.226), vaulted and curved ceilings (p= 0.196), or angled
Int. J. Environ. Res. Public Health 2025,22, 44 16 of 22
and curved ceilings (p= 1.000). These results support the hypothesis that non-flat ceiling
designs (vaulted, curved, or angled configurations) would generate significantly higher
perceived restoration ratings compared with flat ceiling conditions.
H5_VR: Non-flat ceiling designs (vaulted, curved, or angled configurations) will
generate significantly higher perceived restoration levels than flat ceiling conditions.
Mauchly’s test indicated that the assumption of sphericity was not violated,
χ2
(5) = 8.926, p= 0.112. The results showed a significant main effect of VR room ge-
ometry on perceived restorativeness, F(3, 102) = 9.254, p< 0.001, partial
η2
= 0.214. Post hoc
tests using the Bonferroni correction revealed that the vaulted ceiling design was perceived
as significantly more restorative than the flat ceiling (p< 0.001), angled ceiling (p= 0.046),
or curved ceiling (p= 0.002). There were no significant differences between the flat and
curved ceilings (p= 0.467), flat and angled ceilings (p= 0.841), or angled and curved ceilings
(p= n.s.). These findings partially support the hypothesis that when experienced in VR,
rooms with varied ceiling designs would be perceived as significantly more restorative
compared with the room with a flat ceiling, with the vaulted ceiling design showing the
strongest effect.
8. Discussion
This study investigated the effects of various environmental design elements on
perceived restorativeness in both screen-based and virtual reality (VR) presentations. The
research examined four key variables: view access, view content, materiality, and room
geometry. The findings provide valuable insights into how these elements influence the
restorative potential of interior environments.
8.1. Comparison of Screen-Based and VR Presentations
The first hypothesis (H1) proposed that perceived restorativeness would be signifi-
cantly higher in VR presentations compared with screen-based ones. This hypothesis was
partially supported, with VR eliciting higher restorativeness scores for some environments,
particularly those with natural elements or rich textures. However, the effect was not
consistent across all stimuli, suggesting that the relationship between presentation mode
and perceived restoration was context-dependent.
These mixed results align with previous research, highlighting the complex rela-
tionship between virtual environments and perceived restoration. The findings suggest
that while VR can enhance the perception of restorative qualities in some cases, it may
not universally outperform traditional screen-based presentations. This underscores the
importance of considering the specific environmental context when designing virtual
restorative environments.
8.2. View Access
The second hypothesis (H2) posited that spaces with larger windows would be eval-
uated as significantly more restorative than those with smaller windows or no openings.
This hypothesis was strongly supported in both the screen-based and VR presentations,
with a clear linear trend of increasing restorativeness as window size increased.
These findings corroborate existing literature on the positive effects of view access
on well-being and restoration [
24
]. The results underscore the importance of incorporat-
ing ample window space in interior design, particularly in settings where restoration is
a priority, such as healthcare facilities.
8.3. View Content
The third hypothesis (H3) suggested that particular natural features, such as water ele-
ments and diverse vegetation, would demonstrate a stronger perceived sense of restoration
Int. J. Environ. Res. Public Health 2025,22, 44 17 of 22
compared with other natural elements. This hypothesis was partially supported. The view
of water was consistently rated as the most restorative across both presentation modes,
but the relationships between other natural elements varied between the screen-based and
VR presentations. These results align with previous research by White et al. (2010), which
found that aquatic environments were rated more positively for restoration than green
spaces alone [
55
]. However, the current findings also reveal nuances in the restorative
potential of different natural elements, with wooded areas showing higher restorativeness
than desert or lawn views in screen-based presentations, but not in VR. These differ-
ences might have beenb due to the differences in cultural backgrounds and experiences
of the participants.
8.4. Materiality
The study’s fourth hypothesis (H4) suggested that interior settings characterized by
biophilic features and sensory-rich materials would yield significantly higher perceived
restorativeness compared with alternative material schemes.
This hypothesis was supported by both the screen-based and VR presentations, with
natural materials consistently rated as the most restorative. These findings reinforce the
principles of biophilic design [
31
] and highlight the importance of materials selection in
creating restorative environments.
8.5. Room Geometry
The fifth hypothesis (H5) suggested that rooms with non-flat ceiling designs would
be perceived to be significantly more restorative compared with flat ceilings. This hy-
pothesis was supported by the screen-based presentations and partially supported by the
VR presentations.
In the screen-based presentations, all varied ceiling designs (vaulted, curved, and
angled) were perceived as more restorative than the flat ceiling. However, in VR, only the
vaulted ceiling design showed a significantly higher restorativeness rating. Previous studies
have suggested that curvilinear architectural forms are preferred. These findings contribute
to the growing body of research on the impact of spatial geometry on environmental
preference and restoration [61,62].
9. Limitations
Several limitations of this study should be noted. First, while the use of a single-item
measure for perceived restorativeness offered practical advantages in terms of reducing
participant fatigue, especially in terms of minimizing potential cybersickness during re-
peated VR exposure, it involved certain methodological constraints. Although single-item
measures have demonstrated validity in architectural and design research, multi-item scales
such as the shortened perceived restorativeness scale [
71
] can provide further insights into
different aspects of restoration. The single-item approach in this study may have made the
study’s focus more apparent to the participants.
The sequential presentation of stimuli, while necessary for maintaining logical co-
herence in the progression of environmental changes (particularly for view access and
materiality), could have introduced order effects. While randomization might have reduced
these effects, it would have complicated the analysis of relationships between incrementally
changing environmental features and could have disrupted participants’ ability to make
meaningful comparative judgments.
A methodological consideration emerged in the manipulation of the room geometry.
While consistent window dimensions were maintained across all ceiling configurations, the
ceiling variations resulted in slight differences in the total wall area housing the window.
Int. J. Environ. Res. Public Health 2025,22, 44 18 of 22
The flat ceiling configuration provided 74.7% wall area around the window, the vaulted
ceiling 71.3%, the curved ceiling 71.6%, and the angled ceiling 69.2%. Given these relatively
minor variations in the wall area and the consistent window size, the observed differences in
restorativeness ratings can be reasonably attributed to the manipulation of ceiling geometry.
The study examined each of the four variables (view access, view content, materiality,
room geometry) independently rather than in a fully crossed design, due to the number of
conditions and levels in each set.
A methodological limitation arose from the different interaction capabilities between
the presentation modes. While VR participants could naturally rotate their heads to explore
the environment, screen-based presentations had fixed viewpoints to enable precise eye-
tracking measurements focusing on attention patterns and visual behavior. The findings
from the eye-tracking analyses will be reported in a separate manuscript.
Additionally, the sample’s gender distribution (92% female) was notably uneven,
which may limit generalizability. While participants included both undergraduate and grad-
uate students, future research should examine these effects across more gender-balanced
populations to ensure broader applicability of the findings.
Finally, this study’s focus on immediate responses to environmental stimuli did
not capture longer-term restorative effects. Future research could benefit from longi-
tudinal designs that examine how different presentation modes affect restoration over
extended periods.
10. Conclusions
The results of this study have significant implications for the design of restorative
environments in both physical and virtual settings. The findings underscore the impor-
tance of integrating natural elements and maximizing access to views in interior spaces.
Future research could further explore the relationship between opening size and sense of
safety and privacy, as larger openings can potentially influence users’ sense of enclosure,
indirectly affecting their sense of restoration. This is particularly crucial in centers for
mental health treatment, where the balance between openness and privacy is essential for
patient well-being.
Materiality and view content play important roles in place attachment and the attribu-
tion of contextual valuations to particular spaces. For instance, medical treatment centers
are often perceived as comparatively sterile environments. However, the integration of
natural materials and restorative views could potentially alter these perceptions, creating
more comforting and healing spaces. In the context of mental health treatment in VR, HDR
views of particular environments, as suggested by medical providers, could potentially
help in alleviating triggering stimuli or gradually exposing patients to anxiety-inducing
scenes in a controlled manner.
While the settings in this study were abstract and hypothetical, with controlled vari-
ables, it is important to note that the findings might have been affected by participants’
intrinsic aesthetic judgments or biases. As previous research suggests, extracting emotional
experiences from study stimuli necessitates sufficient time for participants to engage with
the environment. However, longer data collection sessions may lead to carry-over effects,
potentially influencing subsequent evaluations. This presents a methodological challenge
that future studies should address.
To mitigate these carryover effects and gain more nuanced insights, future research
could incorporate advanced VR technologies and assessment methods. For instance, the
use of VR headsets equipped with eye-tracking capabilities could provide valuable data
on participants’ visual attention patterns and cognitive load during exposure to different
restorative environments. Eye-tracking metrics such as fixation duration, saccade patterns,
Int. J. Environ. Res. Public Health 2025,22, 44 19 of 22
and pupil dilation could offer objective measures of cognitive processing and emotional
responses, complementing self-reported restorativeness scores [72].
Cognitive load assessment using VR eye tracking could help researchers understand
how different design elements impact mental effort and information processing. This
could be particularly relevant when studying the restorative potential of environments for
individuals with varying cognitive capacities or those undergoing mental health treatment.
By analyzing gaze patterns and cognitive load indicators, researchers could identify which
environmental features are most effective in promoting restoration while minimizing
mental strain for patients.
The VR findings in the current study provide valuable insights, but they also raise
questions for future research. For instance, the heightened restorativeness scores in VR
for some variables suggest that virtual environments might offer enhanced restorative
experiences. However, it is crucial to investigate whether these effects persist over extended
periods and are replicable when users perceive the space from different viewpoints.
Additionally, this study’s findings on room geometry, particularly the positive impact
of ceiling design in VR, open up new opportunities for architectural design in both virtual
and physical spaces. Future research could investigate how different spatial configurations,
volume, and scale affect restoration, potentially leading to innovative design solutions in
healthcare, workplace, and recreational environments.
Author Contributions: Conceptualization, A.T. and E.T.; methodology, A.T.; software, A.T.; valida-
tion, A.T.; formal analysis, A.T. and E.T.; resources, A.T.; data collection, A.T.; writing—original draft
preparation, A.T.; writing—review and editing, E.T.; visualization, A.T. and E.T. All authors have
read and agreed to the published version of the manuscript.
Funding: This research received no external funding. This study was partially supported by
an internal grant from Virginia Tech’s Institute of Creativity, Arts, and Technology (ICAT).
Institutional Review Board Statement: The study was approved by the Institutional Review Board
of Virginia Tech (IRB 22-322 and 22 October 2022).
Informed Consent Statement: Informed consent was obtained from all subjects involved in
the study.
Data Availability Statement: Data will be available to interested researchers upon request.
Conflicts of Interest: The authors declare no conflicts of interest.
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