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

Summary

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.

Conditions

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

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.

Sponsors & Collaborators

• Semmelweis University

  lead OTHER

Principal Investigators

• Xenia Gonda, MA, PharmD, PhD · Semmelweis University, Department of Psychiatry and Psychotherapy

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

65 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-06-01

Primary Completion

2027-01-31

Completion

2027-01-31

Countries

• Hungary

Study Locations