Green VR for Depression

NCT07530952 | Completed

• 1 other identifier: 258745
• Study Type: interventional
• Target: 45
• Locations: 1 country
• Sites: 1

Brief Summary

Depression is a common mental health condition that can cause low mood, lack of energy, sleep problems, and difficulties in daily functioning. Many people with mild to moderate depression do not receive sufficient treatment because of barriers such as limited access to services, stigma, or low motivation to seek help. Physical activity and contact with nature have been shown to improve mental health, and activities performed in natural environments ("green exercise") may provide additional psychological benefits compared with indoor exercise. However, people with depression may experience barriers to engaging in outdoor activities, such as low motivation, limited access to natural environments, or unfavorable weather conditions. Virtual reality (VR) technology can simulate immersive natural environments and may provide a way to experience nature indoors. VR-mediated experiences of nature (or "virtual nature") can provide similar psychological benefits of rea-life nature experiences. Moreover, as virtual nature experiences have been found to elicit increased sense of nature connectedness and intention to perform green exercise, which may in turn support increase participation in actual green exercise. While virtual nature interventions have shown promising results in different health contexts and are considered safe and feasible, little research has examined their effects of integrating such medium within clinical standard treatments for depression. The purpose of this study is to investigate whether virtual nature can be an effective supplement to standard treatment for patients with mild to moderate depression. Specifically, the study will evaluate whether the combination of standard treatment and virtual nature improves mood and reduces depressive symptoms compared with treatment as usual. The study will also explore whether the intervention influences participants' motivation to engage in physical activity and outdoor green exercise over time. Finally, the study will examine possible differences between two approaches to deliver virtual nature experiences to patients in treatment for depression, namely a "high-end" and laboratory-based approach vs a "low-end" and self-managed approach. Participants will be recruited from a psychiatric outpatient clinic that treats individuals with depression and anxiety disorders. Eligible participants will be adults diagnosed with mild to moderate depression. Patients with additional diagnosis for dementia or psychotic illness or other serious somatic illness will be excluded. Participants will be randomly assigned to one of three groups: (1) a "high-end" and laboratory-based VR intervention combined with standard treatment, (2) a "low-end" and self-managed VR intervention combined with standard treatment, or (3) a control group receiving only standard treatment. The intervention will last three weeks, and participants will be assessed at baseline, immediately after the first session, after the intervention period, and at follow-up. The study will examine several outcomes, both to test acute and longitudinal effects. Specifically, to test for acute effects of the two VR approaches, tested outcomes include affect state, feelings of nature connectedness, intention to perform green exercise and experiences with the virtual environment (such as enjoyment, immersion, and possible side effects like cyber sickness). To test the longitudinal effects, tested outcomes include mood, symptoms of depression and anxiety, and changes in physical activity and nature connectedness. The main hypothesis is that patients who receive virtual nature in addition to their usual treatment will experience greater improvements in mood and depressive symptoms compared with patients receiving standard treatment alone. A secondary hypothesis is that exposure to virtual nature may increase participants' motivation and engagement in real-world outdoor physical activity over time. Finally, it is expected that the high-end and lab-based VR intervention will provide more positive overall effects. This research will provide new knowledge about whether virtual nature experiences can support mental health treatment and help people with depression become more physically active and connected to nature. If effective, the intervention could offer a low-cost and accessible supplement to existing treatment approaches for depression.

Conditions

Depression, Mild or Moderate

Outcome Measures

Primary Outcomes (2)

• Beck depression inventory II (BDI-II)

  The BDI-II is a 21-item self-report questionnaire designed to measure the severity of depression. The total score is calculated by summing the ratings (0-3) for all 21 items, with minimum score 0 (no or minimal depressive symptoms) and maximum score 63 (severe, high-level depressive symptoms). A Norwegian translation of the scale commonly used in clinical settings is used in the study.

  Baseline; post-intervention (week 3); follow-up (week 12).

• Beck anxiety inventory (BAI)

  The BAI is a 21-item self-report questionnaire used to measure the severity of anxiety in adults and adolescents. Each item is rated from 0 ("not at all") to 3 ("a lot"). The total score is calculated by summing the ratings for all 21 items (minimum value 0 and maximum value 63), with higher scores indicating greater severity of anxiety. A Norwegian translation of the scale commonly used in clinical settings is used in the study.

  Baseline; post-intervention (week 3); follow-up (week 12).

Secondary Outcomes (5)

• Hopkins symptom checklist (HSCL-10)

  Baseline; post-intervention (week 3); follow-up (week 12).

• Leisure time exercise questionnaire (LTEQ)

  Baseline; post-intervention (week 3); follow-up (week 12).

• Intention to perform green exercise (INT-GE)

  Baseline; immediately after the 1st VR exposure; post-intervention (week 3); follow-up (week 12).

• Connectedness with nature scale (CNS)

  Baseline; immediately after the 1st VR exposure; post-intervention (week 3); follow-up (week 12).

• Affect Scale (PAAS)

  Baseline; immediately after the 1st VR exposure; post-intervention (week 3); follow-up (week 12).

Other Outcomes (4)

• Enjoyment during the VR experience

  Immediately after the 1st VR exposure

• Sense of presence during the VR experience

  Immediately after the 1st VR exposure

• Simulator sickness questionnaire (SSQ)

  Immediately after the 1st VR exposure

Study Arms (3)

Control (TAU)

ACTIVE COMPARATOR

Standard treatment with therapist

Other: Standard Treatment

Studio-based

EXPERIMENTAL

Other: Studio-based VR experiences; Other: Standard Treatment

Self-managed

EXPERIMENTAL

Other: Self-managed VR experiences; Other: Standard Treatment

Interventions

Studio-based VR experiences OTHER

High-end VR experience delivered by the researcher in a studio, delivered weekly, consisting of a simulated nature walk delivered through a high-end VR system connected to a manually-driven treadmill.

Studio-based

Self-managed VR experiences OTHER

Low-end VR experience self-managed by the participants. After an introductory meeting with the researcher, the participants receive, for the duration of the intervention, a standalone VR headset containing a pre-set library of virtual nature experiences. The participants are encouraged to use the headset daily. The time spent using the VR headset is recorded through the device.

Self-managed

Standard Treatment OTHER

Standard treatment with therapist

Control (TAU); Self-managed; Studio-based

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• able to speak and read in Norwegian
• diagnosed with mild to moderate depression

You may not qualify if:

• additional diagnosis for dementia or psychotic illness or other serious somatic illness

Sponsors & Collaborators

• University of South-Eastern Norway: collaborator
• Sykehuset Innlandet HF: lead

Study Sites (1)

Sykehus Innlandet

Hamar, Norway

Location

Related Links

• Calogiuri, G., Litleskare, S., Fagerheim, K. A., Rydgren, T. L., Brambilla, E., \& Thurston, M. (2018). Experiencing nature through immersive virtual environments: Environmental perceptions, physical engagement, and affective responses during a simulated
• Godin, G., \& Shephard, R. (1985). A simple method to assess exercise behavior in the community. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport, 10(3), 141-146.
• Hartig, T. (1996). Validation of a measure of perceived environmental restorativeness. Goteborg psychological reports, 26(7).
• Mayer, F. S., \& Frantz, C. M. (2004). The connectedness to nature scale: A measure of individuals' feeling in community with nature. Journal of environmental psychology, 24(4), 503-515.
• Nichols, S., Haldane, C., \& Wilson, J. R. (2000). Measurement of presence and its consequences in virtual environments. International Journal of Human-Computer Studies, 52(3), 471-491.

MeSH Terms

Conditions

Depression; Lymphoma, Follicular

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Lymphoma, Non-Hodgkin; Lymphoma; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Hemic and Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 26, 2026
• First Posted: April 15, 2026
• Study Start: February 1, 2022
• Primary Completion: April 1, 2025
• Study Completion: April 1, 2025
• Last Updated: May 5, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

NO (1)