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Virtual Nature Versus Guided Imagery for Anxiety and Well-Being in Hospitalized Older Adults

ClinicalTrials.gov IDNCT07765355

PhaseNA

Enrollment60

SponsorSemmelweis University

Age65 Years

SexALL

I'm interested View official listing

Conditions studied

Anxiety, Hospitalization, Quality of Life, Psychological Distress, Depression

About this study

Long hospital stays can be difficult for older adults. Being confined to a ward, with limited mobility and little access to the outdoors, may contribute to anxiety, low mood, and reduced well-being. Contact with nature is known to support relaxation and emotional recovery, but hospitalized patients often cannot go outside. This study compares two ways of bringing a nature experience to patients who are staying in hospital. In the first approach, participants wear a virtual reality headset and watch 360-degree videos filmed in real natural settings near Budapest: a meadow, a stream, and a mountain. The nature scene reaches them through their eyes and ears. In the second approach, participants listen to a short recorded audio guide and picture the same three nature scenes in their own minds, with their eyes closed. Here the nature scene is created by their own imagination. Both approaches use exactly the same nature themes. The only difference is how the experience reaches the person: from the outside through the senses, or from the inside through imagination. The study asks whether these two routes have different effects, and whether they can be told apart by measuring heart rate variability, which reflects how the body's automatic nervous system responds. Participants are adults aged 65 or older who have been in hospital for at least two weeks. After joining the study, each participant is first observed for two weeks while receiving only their usual hospital care. This period serves as their own comparison. They are then assigned by chance to one of the two approaches and take part in three sessions over two weeks. Questionnaires and brief cognitive tests are completed at three points: when joining, before the sessions begin, and after the sessions end. The main question is whether anxiety symptoms decrease more during the session period than during the preceding period of usual care. The study also looks at mood, attention and memory, well-being, and resilience.

Interventions

Device: Immersive virtual reality nature exposure — Three sessions of 360-degree nature video viewed through a head-mounted display, delivered over two weeks. Videos were produced by the research team from a fixed tripod perspective at three locations near Budapest, corresponding to the motifs of meadow, stream, and mountain. They contain no narration or added music, only the natural soundscape of the location, and the viewpoint changes every five minutes. Exposure length ranges from 8 to 20 minutes according to participant tolerance. Sessions are conducted at the bedside under supervision, with the device used offline.
Behavioral: Guided imagery — Three sessions of guided imagery delivered over two weeks. Participants listen through headphones, with eyes closed, to a standardized five-minute audio recording that begins with a brief breathing relaxation followed by the motif text. The motifs are identical to those presented in the virtual reality arm and are drawn from the motif repertoire of Katathym Imaginative Psychotherapy. After each session, participants give a free verbal account of their experience.

Primary outcomes

Change in anxiety symptoms (HADS-A) (Baseline, Week 2, and Week 4)
Heart rate variability during intervention sessions (RMSSD) (Week 2 through Week 4)

Eligibility information

Inclusion Criteria: * Aged 65 years or older * Receiving inpatient hospital care, with at least two weeks of hospitalisation at the time of enrolment * Montreal Cognitive Assessment (Hungarian version) score of 18 or above, with education correction * Physically able to safely wear a head-mounted virtual reality display * Adequate corrected or uncorrected vision and hearing * Able to communicate in Hungarian * Stable psychiatric and cardiovascular condition, as determined from medical history and in consultation with the treating physician * Able to provide independent written informed consent Exclusion Criteria: * Epilepsy with recurrent seizures, or photosensitivity * Neurological condition associated with increased risk during virtual reality use, including Meniere's disease and significant carotid stenosis * Active psychosis, hallucinations, or severe depression with psychotic features * Open wound or skin lesion on the face, chronic neck pain, or spinal condition preventing safe use of the head-mounted display * Severe uncorrectable sensory impairment * Unstable psychotropic medication during the preceding eight weeks * Regular use of analgesic or psychotropic medication that may substantially affect perception of the experience * Active alcohol or substance use disorder within the past year * Refusal or inability to provide informed consent Enrolment is deferred, rather than excluded, in the presence of active delirium or infectious illness, until the condition resolves.

Study locations

Semmelweis University, Department of Geriatrics and Nursing Science, Budapest, 1097 Hungary
Semmelweis University, Department of Rehabilitation Medicine, Budapest, 1121 Hungary

Before you participate: Varda Clinical is an independent discovery tool, not the study sponsor or a medical provider. Eligibility can only be determined by the official study team. Discuss potential risks and benefits with a qualified healthcare professional.

Source: ClinicalTrials.gov. Record last refreshed by Varda Clinical: 2026-09-27.