Flow and Technology Acceptance in Extended Reality Leisure Participation During Mental Health Occupational Therapy

This convergent mixed-methods study examined extended reality (XR)-supported leisure participation among 12 long-term psychiatric inpatients completing an 8-week virtual reality and augmented reality program within occupational therapy. Flow experience and technology acceptance were assessed quantitatively alongside qualitative thematic analysis of weekly semi-structured interviews. Flow experience increased significantly (p < .05, r = .82), while technology acceptance remained stable. Perceived usefulness significantly predicted flow (R² = .575); perceived ease of use did not. Five qualitative themes emerged: novelty-driven immersion, just-right challenge, therapist-mediated facilitation, embodied constraints, and occupational inertia limiting real-world leisure generalization. Immersive XR enhanced intrinsically motivated occupational engagement independent of generalized technology attitudes. Effective implementation requires therapist-led bridging strategies to support the transition from virtual immersion toward authentic leisure participation. XR functions as a mediating tool for expanding occupational possibilities in restricted mental health environments, with therapist facilitation constituting an active ingredient of participation.