Effect of Virtual Reality Combined with Forest Therapy on Psychological Resilience of Submarine Personnel with Insomnia Symptoms

Background: Submarine personnel often experience insomnia and reduced psychological resilience due to extended deployments in confined, high-stress environments. Effective non-pharmacological interventions are needed to improve sleep quality and resilience in this population. This study aimed to investigate the effect of virtual reality (VR) combined with forest therapy interventions on psychological resilience and sleep quality among submarine personnel with insomnia symptoms. Methods: Using convenience sampling, 92 submarine personnel with insomnia symptoms undergoing recuperation at a PLA sanatorium between July 2023 and May 2025 were randomly allocated to experimental and control groups (n = 46 each). The control group received forest therapy intervention, while the intervention group received combined VR and forest therapy interventions. Pre- and post-intervention assessments were conducted using the Pittsburgh Sleep Quality Index (PSQI) and Connor-Davidson Resilience Scale (CD-RISC). Results: There is no significant differences between two groups before the intervention on sleep or psychological resilience. Both groups showed significant pre- to post-intervention improvements in sleep and resilience; however, mixed-ANOVA results showed that the intervention (VR + forest therapy) group achieved significantly better outcomes than the control group at post-intervention after Bonferroni correction, including lower PSQI total and key component scores (subjective sleep quality, sleep efficiency, daytime dysfunction) and higher CD-RISC resilience scores. Conclusions: The integration of virtual reality and forest therapy effectively improved sleep quality and psychological resilience among submarine personnel with insomnia symptoms. This combined intervention shows promise as a non-pharmacological approach in military healthcare settings; however, further studies are needed to validate and generalize these findings.