IMMERSIVE VIRTUAL THERAPEUTIC GARDEN AS A SUPPORT FOR LATE-LIFE DEPRESSIVE SYMPTOMS: A RANDOMIZED CLINICAL TRIAL

B. Cieślik¹, P. Kiper¹, K. Juszko², J. Szczepańska-Gieracha²

¹IRCCS San Camillo Hospital, Venice, Italy, ²Wroclaw University of Health and Sport Sciences, Faculty of Physiotherapy, Wroclaw, Poland

Background: Late-life depression is a serious and life-threatening disorder that affects every 1 in 5 individuals in a lifetime. The multifactorial genesis of this disorder requires multimodal approaches that combine physical activity and psychosocial interventions, however, there is still a percentage of elderly who do not show satisfactory improvements. In recent years, there has been a growing interest in the use of modern technologies in the treatment of mental disorders. There is little research using the idea of a therapeutic garden to treat people with symptoms of depression. In 2012, in the field of positive technology, Baños et al. proposed two virtual environments that simulate environments in nature. Recently, the study protocol of “Secret Garden” has appeared, which adapts the ideas of a therapeutic garden to VR goggles in order to improve the mood during the COVID-19 pandemic.

Purpose: The objective of this study was to evaluate the effectiveness of virtual reality(VR) therapy in the elderly for whom the previous multimodal therapeutic interventions had not brought the expected results.

Methods: Sixty females with depressive symptoms were randomly assigned to one of the two treatment groups. Both groups received low-intensity general fitness training (GFT). The VR group (n=30) received additional VR-based relaxation, control group (n=30) received group psychoeducation and relaxation (PR). As a virtual reality source, the VRTierOne device (Stolgraf®, Poland) was used. In the Virtual Therapeutic Garden, there is a rich set of symbols and metaphors based on the Ericksonian psychotherapy approach. The most important is the Garden of Revival, which symbolises the patient’s health. The therapeutic cycle consisted of eight GFT, eight virtual therapy sessions, or eight PR sessions, twice a week for four weeks. As outcome measures, the Geriatric Depression Scale (GDS, primary), and Hospital Anxiety and Depression Scale (HADS, secondary) were performed before and after the interventions. Covariance analysis (ANCOVA) was performed to test for treatment effects. The protocol was registered in the government ClinicalTrials.gov PRS database (registration number: NCT05285501).

Results: Analysis of covariance (ANCOVA) showed that patients receiving GFT plus VR therapy exhibited greater improvements in GDS (mean post difference of 4.26, 95% CI 2.43-6.08), and HADS (3.86, 95% CI 1.48-6.24), than those receiving GFT plus relaxation and psychoeducation. In the VR group, the GDS score was reduced by 32%, HADS by 27%, HADS-A by 32%, and HADS-D by 21%.

Conclusions: Immersive virtual therapy significantly reduced the intensity of depressive and anxiety symptoms in older women participating in the group-based multimodal therapeutic program, whose earlier therapy had not exhibited the expected result.

Implications: An immersive virtual reality garden with implemented elements of psychotherapy and relaxation may reduce the severity of depression symptoms among the elderly. The use of a similar device or application in hospital wards seems to be an affordable solution when there is a lack of constant psychological care, but also as a supplement to this care. Moreover, outside the hospital ward, we can find the usefulness of similar solutions in reducing depression symptoms, which seems to be particularly important in the context of supporting late-life depression therapy.

Funding acknowledgements: None

Keywords:
Virtual reality
Depression
Elderly

Topics:
Mental health
Older people

Did this work require ethics approval? Yes

Institution: University School of Physical Education in Wroclaw, Poland

Committee: Research Ethics Committee of the University School of Physical Education

Ethics number: 32/2019