Clinical Research Directory

Inclusion Criteria: Age between 18 and 65 years Hospitalized patients scheduled for elective lumbar disc herniation surgery in the preoperative period American Society of Anesthesiologists (ASA) physical status I-III Able to read and understand Turkish and be literate Sufficient cognitive capacity to understand the informed consent form (no advanced dementia, severe aphasia, impaired consciousness, or neurological/psychiatric condition interfering with communication) Willing to complete the State Anxiety Inventory - State form (STAI-S) for surgical anxiety assessment and to provide a saliva sample using a non-invasive method No severe visual impairment that would prevent the use of a virtual reality headset (visual impairments correctable with glasses or contact lenses are acceptable) Provision of written and verbal informed consent Exclusion Criteria: Presence of an emergency or urgent neurosurgical indication (e.g., traumatic acute subdural hematoma, acute intracranial hemorrhage with herniation signs) History of diagnosed epilepsy, particularly photosensitive epilepsy Severe cognitive impairment, severe aphasia, lack of cooperation, or altered level of consciousness History of psychiatric hospitalization within the last 6 months due to severe psychiatric disorders such as psychotic disorder, bipolar disorder, or severe major depressive disorder Chronic systemic steroid use or endocrine disorders significantly affecting adrenal cortex function (e.g., Cushing syndrome, Addison's disease) Untreated severe thyroid disease that may affect cortisol metabolism History of severe vertigo or vestibular disorders with prior intolerance to VR-like visual stimuli Severe visual impairment not correctable with glasses or contact lenses that would prevent adequate perception of VR content Inability to complete the VR session due to nausea, dizziness, or similar symptoms during headset use (in such cases, the intervention will be discontinued and the participant will be withdrawn from the study) Severe oral lesions, active serious oral infection, or significant salivary gland pathology interfering with saliva sampling Known pregnancy or suspected pregnancy Participation in another randomized controlled trial or VR-based intervention within the last 3 months Withdrawal of consent during the study or cancellation/postponement of the scheduled surgical procedure