Distress, PsychologicalNET-VRNCT07443657
Nature Exposure Through Virtual Reality (NET-VR) in Older Adults
A study testing Nature-Based Virtual Reality Intervention and Waiting list in people with Distress, Psychological and Negative Affect, run by Universitat Internacional de Catalunya at 1 site in Spain.
Trial 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… Read more about this study
- Who is it for?
- Ages 60 to 90 yearsHealthy volunteers can take part
- Conditions the study is for
- Distress, Psychological, Negative Affect, Cognitive Functioning
- What is being tested?
- Nature-Based Virtual Reality Intervention and Waiting list
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteSpain
- Study dates
- 9 Oct 2024to 30 Dec 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 60 to 90 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- being between 60 and 90 years old;
- normal or corrected-to-normal vision and hearing.
Who cannot join
- 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).
Trial locations and contacts
1 site in 1 country.
About this study
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.
Read the detailed description
This study aims to evaluate the feasibility and effectiveness of a virtual reality (VR) system featuring nature-based environments to improve emotional well-being, reduce psychological distress, and enhance cognitive functioning in older adults.
To achieve this, participants will be assigned to one of two groups: an experimental group that will receive the nature-based VR intervention, and a control group placed on a waiting list. The intervention is expected to have a positive impact on self-reported measures such as mindful awareness, anxiety, depression and cognitive functions (particularly attention and executive functioning) Additionally, usability-related aspects of the technology-such as presence, ease of use, and cybersickness-will also be assessed.
A total of 30 participants will be recruited (aged 60 to 90). Participation is voluntary and will take place at the International University of Catalonia (UIC Barcelona), through face-to-face group sessions.
The intervention will span 5 weeks, with two 30-minute session per week. Participants will use a VR headset to explore immersive natural environments (e.g., tropical islands, forests, snowy landscapes) via the Nature Treks VR software. Each session will follow a structured protocol with three stages: a training stage, a personalization stage, and a final immersive relaxation stage.
Before enrollment, participants will undergo an eligibility screening to ensure they meet the inclusion and exclusion criteria, particularly regarding mental and cognitive health. Group allocation will be randomized, and outcome assessments will be conducted by blinded evaluators to reduce bias.
This study aims to contribute new evidence on the psychological and cognitive benefits of nature-based VR interventions and their usability across different age groups, supporting the development of accessible and innovative tools for mental health and well-being.
- Being tested
- Nature-Based Virtual Reality Intervention, Waiting list
- Keywords
- Nature-based intervention, Mental health, Virtual Reality (VR), Older adults
- Medical subject headings
- Psychological Well-Being
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Nature-Based Virtual Reality InterventionOther
Also called VR Nature Exposure Intervention, Nature-Trek VR, Nature-Based Immersive VR
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.
Waiting listOther
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
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: 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 Receives: Other: Waiting list |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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).
Measured: 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.
Measured: Baseline and post-intervention (after 5 weeks)
Secondary outcomes (5)
Mindful Attention Awareness Scale and Nature Exposure Scale-II
The Mindful Attention Awareness Scale (MAAS) is a self-report questionnaire designed to assess dispositional mindfulness, defined as an individual's capacity to maintain attention and awareness of present-moment experiences in everyday life. The scale focuses on the presence or absence of mindful attention, particularly lapses in awareness and automatic pilot behaviors. The MAAS consists of 15 items rated on a 6-point Likert scale (1 = Almost Always; 6 = Almost Never). Total scores range from 15 (minimum) to 90 (maximum), with higher scores indicating greater levels of mindful attention and awareness.
Measured: Baseline and post-intervention (after 5 weeks)
Contact with Nature Scale (ECN)
The Contact with Nature Scale (ECN) is a self-report instrument adapted into Spanish from the Nature Exposure Scale-II to measure individuals' direct contact with the natural environment. The scale consists of 6 items rated on a 5-point Likert scale (1 = Little/Not at all; 5 = Much/A lot), with total scores ranging from 6 (minimum) to 30 (maximum). Higher scores indicate greater contact with nature, covering everyday interactions, exposure outside routine environments, and contact during physical activity.
Measured: Baseline and post-intervention (after 5 weeks)
Stroop Color and Word Test (SCWT)
The Stroop Color and Word Test (SCWT) is a standardized neuropsychological measure of selective attention, cognitive flexibility, processing speed, and inhibitory control. The test consists of three conditions (word reading, color naming, and color-word interference), each administered with a 45-second time limit per condition, resulting in up to 3 scoring intervals of 45 seconds. Participants are asked to read words or name ink colors as quickly and accurately as possible within each time frame. Performance is measured by the number of correctly completed items per condition and the number of errors. The minimum possible score is 0 correct items per condition, and the typical maximum is determined by the number of items completed within the 45-second limit, with higher correct item counts indicating better cognitive performance (faster processing and stronger inhibitory control). Higher error counts indicate worse performance.
Measured: Baseline and post-intervention (after 5 weeks)
Trail Making Test (TMT A-B)
The Trail Making Test (TMT) is a widely used neuropsychological measure of visual attention, processing speed, cognitive flexibility, and executive function. It consists of two parts: TMT Part A, which requires participants to connect 25 numbered circles in sequential order as quickly as possible, assessing visual scanning, attention, and psychomotor speed; and TMT Part B, which requires connecting 25 circles alternating between numbers and letters (1-A-2-B…), assessing set-shifting, cognitive flexibility, and executive control. Performance is measured by completion time in seconds and errors for each part. The minimum possible time is 0 seconds, and there is no strict maximum; longer completion times and more errors indicate worse performance. Lower times and fewer errors indicate better cognitive function.
Measured: Baseline and post-intervention (after 5 weeks)
Digit Span
The Digit Span Subtest is a cognitive assessment tool that is part of the Weschler Adult Intelligence Test (WAIS), assesses auditory attention, immediate memory, working memory, and executive function. It consists of two conditions: Digit Span Forward and Digit Span Backward. In the Forward condition, participants repeat sequences of numbers presented orally in the same order; in the Backward condition, participants repeat the numbers in reverse order. Higher total correct scores indicate better attention, immediate memory (Forward), and working memory/executive control (Backward).
Measured: Baseline and post-intervention (after 5 weeks)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Mar 2026
- Study start9 Oct 2024
- Primary completion30 Dec 2025
- Study completion30 Dec 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Distress, PsychologicalStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 30 participants (actual)
Sponsor and investigators
- Lead sponsor
- Universitat Internacional de Catalunya
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07443657
- Sponsor's protocol ID
- PSI-2024-03
- Acronym
- NET-VR
- Status last verified
- Jul 2025
- First submitted
- 23 Jul 2025
- Last updated
- 2 Mar 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Nature Exposure Through Virtual Reality (NET-VR) in Older Adults
- ClinicalTrials.gov ID
- NCT07443657
- Acronym / sponsor ID
- NET-VR / PSI-2024-03
- Keywords
- Nature-based intervention, Mental health, Virtual Reality (VR), Older adults
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 30 participants (actual)
- Lead sponsor
- Universitat Internacional de CatalunyaUniversity, hospital or other
- Study start
- 9 Oct 2024 (actual)
- Primary completion
- 30 Dec 2025 (actual)
- Study completion
- 30 Dec 2025 (actual)
- First posted
- 2 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
This study aims to evaluate the feasibility and effectiveness of a virtual reality (VR) system featuring nature-based environments to improve emotional well-being, reduce psychological distress, and enhance cognitive functioning in older adults.
To achieve this, participants will be assigned to one of two groups: an experimental group that will receive the nature-based VR intervention, and a control group placed on a waiting list. The intervention is expected to have a positive impact on self-reported measures such as mindful awareness, anxiety, depression and cognitive functions (particularly attention and executive functioning) Additionally, usability-related aspects of the technology-such as presence, ease of use, and cybersickness-will also be assessed.
A total of 30 participants will be recruited (aged 60 to 90). Participation is voluntary and will take place at the International University of Catalonia (UIC Barcelona), through face-to-face group sessions.
The intervention will span 5 weeks, with two 30-minute session per week. Participants will use a VR headset to explore immersive natural environments (e.g., tropical islands, forests, snowy landscapes) via the Nature Treks VR software. Each session will follow a structured protocol with three stages: a training stage, a personalization stage, and a final immersive relaxation stage.
Before enrollment, participants will undergo an eligibility screening to ensure they meet the inclusion and exclusion criteria, particularly regarding mental and cognitive health. Group allocation will be randomized, and outcome assessments will be conducted by blinded evaluators to reduce bias.
This study aims to contribute new evidence on the psychological and cognitive benefits of nature-based VR interventions and their usability across different age groups, supporting the development of accessible and innovative tools for mental health and well-being.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Experimental group | Experimental | Other: Nature-Based Virtual Reality InterventionNature 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. |
| Control group - waiting list | Other | Other: Waiting listParticipants 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 |
Who may qualify
- Ages
- 60 to 90 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- being between 60 and 90 years old;
- normal or corrected-to-normal vision and hearing.
Key exclusion criteria (3 listed)
- 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).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Nature-Based Virtual Reality InterventionAlso: VR Nature Exposure Intervention, Nature-Trek VR, Nature-Based Immersive VRThis 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. | Other | Experimental group |
| Waiting listParticipants 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 | Control group - waiting list |
Primary outcome
Mood - Positive and Negative Affect Schedule
Time frame: Baseline and post-intervention (after 5 weeks)
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.
Beck Depression Inventory-II
Time frame: During and after each session; post-intervention (after 5 weeks)
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).
State-Trait Anxiety Inventory (STAI)
Time frame: Baseline and post-intervention (after 5 weeks)
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.
5 secondary outcomes
Mindful Attention Awareness Scale and Nature Exposure Scale-II
Time frame: Baseline and post-intervention (after 5 weeks)
Contact with Nature Scale (ECN)
Time frame: Baseline and post-intervention (after 5 weeks)
Stroop Color and Word Test (SCWT)
Time frame: Baseline and post-intervention (after 5 weeks)
Trail Making Test (TMT A-B)
Time frame: Baseline and post-intervention (after 5 weeks)
Digit Span
Time frame: Baseline and post-intervention (after 5 weeks)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Mar 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Nature-Based Virtual Reality Intervention and Waiting list in people with Distress, Psychological and Negative Affect, run by Universitat Internacional de Catalunya at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Mood - Positive and Negative Affect Schedule (time frame: Baseline and post-intervention (after 5 weeks)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Mar 2026.