System usability and cybersickness in VR cognitive training with adolescents: associations with internalizing symptoms and sex/gender differences

Abstract Virtual reality (VR) is an emerging tool for cognitive training with adolescents, offering immersive environments that may enhance engagement and learning. However, individual factors such as sex/gender and internalizing symptoms may influence how adolescents experience VR. This pilot study evaluates a VR cognitive training program for adolescents, focusing on feasibility, usability, cybersickness and exploratory sex/gender-related patterns in enjoyment, immersion, and associations between internalizing symptoms and user experience. Sixty-one Spanish-speaking adolescents received a gamified VR cognitive training program. The intervention lasted five weeks and consisted of ten 30-minute group sessions. Feasibility measures included the System Usability Scale and the Simulator Sickness Questionnaire at the end of the intervention. Session-level measures of immersion and enjoyment were collected via Visual Analogue Scales. Baseline internalizing symptoms were assessed using the Revised Child Anxiety and Depression Scale. Adolescents reported consistently high levels of immersion, enjoyment, and usability. Linear mixed-effects models showed no significant change across sessions and no Session × Sex/Gender interaction for either immersion or enjoyment. Immersion did not differ significantly by sex/gender, whereas boys reported higher enjoyment than girls across sessions. Post-intervention SUS scores did not differ significantly by sex/gender. Similarly, SSQ nausea and oculomotor symptoms did not show significant sex/gender differences. In exploratory sex/gender-stratified regression analyses, baseline internalizing symptoms significantly predicted SSQ nausea and oculomotor symptoms among girls, but not among boys. These findings support the feasibility and acceptability of VR-based cognitive training among adolescents. They also suggest that internalizing symptoms may be relevant to adolescents’ subjective cybersickness experiences, although potential sex/gender-specific patterns should be interpreted cautiously and confirmed in adequately powered studies.