BACKGROUND: Military and medical training require exposure to operationally relevant stressors while enabling standardized performance assessment and physiological monitoring. Virtual reality (VR) offers the potential to simulate complex stress scenarios across tactical and medical domains. However, evidence integrating stress induction, performance outcomes, and multimodal monitoring across different VR applications remains limited. We have therefore addressed this complex of issues in a series of different simulation approaches. METHODS: Five controlled studies (total n = 109) were conducted using immersive VR scenarios implemented either on the HOLOGATE HGXR-X system or on a VR-version of the Trier Social Stress Test (TSST-VR). Stress exposure was manipulated through physiological preloading, scenario type and complexity, social-evaluative threat, and immersive medical emergency simulations. Outcomes included task and medical performance metrics (e.g., target accuracy, resuscitation quality using resuscitation mannequin), cardiovascular parameters (heart rate and heart rate variability), endocrine and metabolic markers (salivary cortisol, alpha-amylase, blood glucose), and validated subjective measures of stress, immersion, and usability. RESULTS: Across studies, VR scenarios consistently elicited measurable and significant physiological and subjective stress responses. Performance under VR stress was influenced by prior experience, scenario demands, and task context. In medical VR scenarios, it has been shown that stressors significantly reduce the quality of resuscitation. Participants consistently rated usability positively and confirmed the feasibility of physical-virtual training. Notably, TSST-VR enabled the identification of discrete stress responder phenotypes despite identical virtual exposure, revealing substantial interindividual variability in cortisol, cardiovascular activation, and perceived stress. CONCLUSION: Taken together, results from this series of studies demonstrate that VR-based stress exposure is a valid and versatile approach for inducing stress, assessing performance, and monitoring individual responses across tactical and medical training contexts. The convergence of findings highlights VR as an integrative assessment and training platform rather than a single-purpose simulation tool. MILITARY IMPACT: VR-based stress paradigms support military readiness by enabling standardized yet individualized assessment of stress and performance, facilitating adaptive training in tactical and medical domains, and enhancing monitoring of human performance under simulated operational conditions.     «

BACKGROUND: Military and medical training require exposure to operationally relevant stressors while enabling standardized performance assessment and physiological monitoring. Virtual reality (VR) offers the potential to simulate complex stress scenarios across tactical and medical domains. However, evidence integrating stress induction, performance outcomes, and multimodal monitoring across different VR applications remains limited. We have therefore addressed this complex of issues in a series...     »