Nature Exposure Through Virtual Reality (NET-VR) in Older Adults

NCT07443657 | Completed DMC

• 1 other identifier: PSI-2024-03
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Daily exposure to nature is associated with improved mood and reduced anxiety symptoms in the overall population. Even brief contact with natural environments can lower stress and restore productivity.However, access to natural environments is often limited, particularly for urban and institutionalized older adults, due to physical, financial, and logistical barriers.These challenges highlight the need for new technologies that can facilitate more regular contact with nature. Virtual Reality (VR)-a digital technology that creates realistic scenes and objects to simulate the experience of being in a natural environment-offers a promising solution, particularly for older adults with physical or financial limitations.The aim of this study is to explore how both older adults might benefit from a mental health program that uses virtual reality to simulate exposure to nature.

Conditions

Distress, Psychological; Negative Affect; Cognitive Functioning; Older Adults

Keywords

Nature-based intervention; Mental health; Virtual Reality (VR); Older adults

Outcome Measures

Primary Outcomes (3)

• Mood - Positive and Negative Affect Schedule

  The Positive and Negative Affect Schedule (PANAS) assess two broad domains of affect, termed Positive Affect (PA) and Negative Affect (NA). Both PA and NA represent largely independent constructs ranging from low to high levels of emotional experience . Low PA scores reflect 'sadness and lethargy' whereas high PA scores reflect 'high energy, full concentration, and pleasurable engagement'. Low NA scores describe 'a state of calmness and serenity' whereas high NA scores suggest 'subjective distress and unpleasurable engagement'. The PANAS contains 20 items that yield two subscales (PA, NA) of 10 adjectives each. Participants responded with regards to how they felt 'during the past week' on a 5-point scale from very slightly to very much. Minimum score is 20 and maximum score is 100.

  Baseline and post-intervention (after 5 weeks)

• Beck Depression Inventory-II

  It assesses the severity of depressive symptoms, specifically evaluating the intensity of depression in psychiatric and general populations aged 13 years and older. It consists of 21 items with four response options ranging from 0 (absence of the symptom) to 3 (greater severity of the symptom). It evaluates symptom severity over the past two weeks, including the day the inventory is completed. The total score ranges from 0 (no depression) to 63 (severe depression).

  During and after each session; post-intervention (after 5 weeks)

• State-Trait Anxiety Inventory (STAI)

  The State-Trait Anxiety Inventory (STAI) is a widely used self-report instrument designed to assess anxiety as both a transient emotional state (State Anxiety) and a relatively stable individual difference in anxiety proneness (Trait Anxiety). State Anxiety reflects temporary feelings of tension, nervousness, and apprehension that fluctuate over time and in response to situational stressors, whereas Trait Anxiety reflects a general tendency to perceive situations as threatening and to respond with elevated anxiety. The STAI consists of 40 items divided into two 20-item subscales (State and Trait). Participants rate the intensity or frequency of anxiety-related feelings on a 4-point Likert scale. Higher scores indicate greater levels of anxiety, with total scores ranging from 20 to 80 for each subscale.

  Baseline and post-intervention (after 5 weeks)

Secondary Outcomes (5)

• Mindful Attention Awareness Scale and Nature Exposure Scale-II

  Baseline and post-intervention (after 5 weeks)

• Contact with Nature Scale (ECN)

  Baseline and post-intervention (after 5 weeks)

• Stroop Color and Word Test (SCWT)

  Baseline and post-intervention (after 5 weeks)

• Trail Making Test (TMT A-B)

  Baseline and post-intervention (after 5 weeks)

• Digit Span

  Baseline and post-intervention (after 5 weeks)

Other Outcomes (3)

• Simulator Sickness Questionnaire (SSQ)

  Post-intervention (after 5 weeks)

• System Usability Scale (SUS)

  Post-intervention (after 5 weeks)

• Visual Analogue Scales (VAS) for Immersion, Enjoyment, and Relaxation

  After each VR session (10 sessions per participant over 5 weeks)

Study Arms (2)

Experimental group

EXPERIMENTAL

Nature VR-based Sessions: The intervention lasts 5 weeks, with sessions twice weekly, 30 minutes each (10 sessions total). Participants use a single IVR headset in face-to-face groups of up to five, supervised by a PhD-level mental health expert. Completion requires attending ≥80% of sessions. The Nature-Trek VR software (Greener Games, USA) simulates diverse natural environments such as tropical islands, forests, lakes, and snow-covered landscapes. Each session features a unique environment. Sessions have three stages: (1) Training (first session only, no direct VR use), (2) Tailoring the VR nature environment, and (3) Immersion, where participants relax and experience the VR setting. Participants remain seated in comfortable chairs with wheels throughout.

Other: Nature-Based Virtual Reality Intervention

Control group - waiting list

OTHER

Participants assigned to the waiting list arm will not receive the VR intervention during the initial 5-week study period and will continue their usual daily routines without any study-related intervention. After the study period, they will be offered the opportunity to experience a single VR session

Other: Waiting list

Interventions

Nature-Based Virtual Reality Intervention OTHER

This intervention uses the commercially available Nature-Trek VR software to immerse participants in diverse natural environments through a virtual reality headset. It is delivered face-to-face in small groups, supervised by a mental health expert, over 5 weeks with twice-weekly 30-minute sessions. The intervention includes a training session, customization of the VR nature environment, and a relaxation immersion stage. It specifically targets reduction of psychological distress and enhancement of cognitive functioning in both young and older adults.

Also known as: VR Nature Exposure Intervention, Nature-Trek VR, Nature-Based Immersive VR

Experimental group

Waiting list OTHER

Participants assigned to the waiting list arm will not receive the VR intervention during the initial 5-week study period and will continue their usual daily routines without any study-related intervention. After the study period, they will be offered the opportunity to experience a single VR session

Control group - waiting list

Eligibility Criteria

• Age: 60 Years - 90 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• being between 60 and 90 years old;
• normal or corrected-to-normal vision and hearing.

You may not qualify if:

• high risk of anxiety and depressive disorders, as assessed by the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder (GAD-7)
• Other serious mental disorders with psychotic or manic symptoms (e.g., psychotic disorders, bipolar disorders, etc.), sensory complications that would prevent exposure (e.g., visual or auditory deficits), epilepsy, and other medical conditions (such as, balance/vestibular problem) that would disrupt the VR experience.
• High risk of cognitive impairment as assessed by the Montreal Cognitive Assessment (MoCA test).

Sponsors & Collaborators

• Universitat Internacional de Catalunya: lead

Study Sites (1)

Universitat Internacional de Catalunya

Barcelona, Spain

Location

MeSH Terms

Conditions

Psychological Well-Being

Interventions

Waiting Lists

Condition Hierarchy (Ancestors)

Personal Satisfaction; Behavior

Intervention Hierarchy (Ancestors)

Appointments and Schedules; Organization and Administration; Health Services Administration

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 23, 2025
• First Posted: March 2, 2026
• Study Start: October 9, 2024
• Primary Completion: December 30, 2025
• Study Completion: December 30, 2025
• Last Updated: March 2, 2026

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

ES (1)