Developing low-cost and scalable virtual reality mindfulness interventions for older psychiatry inpatients

Introduction Virtual Reality (VR)-based meditation interventions have been widely deployed in younger adults to reduce stress, anxiety, anger, and depression. However, these interventions have not been extensively applied in older adults. Thus, little is known about the feasibility and acceptability of VR mindfulness interventions in clinical settings. VR has become much more accessible as a wide variety of content is publicly available and more affordable hardware has come on the market, providing more opportunities to use these interventions in different settings. The goal of this study is to offer and implement low-cost and easily scalable VR mindfulness interventions in the geriatric psychiatry inpatient units at McLean Hospital in Belmont, Massachusetts. Methods We deployed low-cost VR using a Destek V5 headset and smartphones to conduct a guided 3-day mindfulness intervention in a psychiatric inpatient unit for older adults at McLean Hospital. We used the free Sites for VR mobile app with the Destek V5 headset, as it provides a variety of nature scenes ideal for guided mindfulness sessions. We assessed depressive symptoms using the Geriatric Depression Scale (GDS), anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7), and positive and negative affect using the Positive and Negative Affect Scale (PANAS) before each intervention session and one week after the final session. After each session, participants completed the Simulator Sickness Questionnaire (SSQ) and PANAS immediately to assess the intervention's tolerability and any change in affect. In the first intervention session, study staff demonstrated how to fit the VR headset and addressed participants’ questions about the intervention. Research staff then provided a scripted mindfulness intervention, which talked participants through a guided body scan and focused on awareness of the five senses while the participants navigated the visual stimuli of a nature scene through the VR headset. Results At the time of writing the project is ongoing with data analysis anticipated to be completed by March 2023. We encountered some challenges in implementing VR mindfulness interventions for older adults in an inpatient setting. Primary challenges included: i) Some older adult patients expressed anxiety about handling technology and not knowing how to use it, and ii) patients were more reluctant to participate if there was too much preparation and paperwork involved. Study staff allowed participants to try the intervention at their own pace and participate alongside others using the VR headsets to mitigate anxiety. To address the second challenge, we reduced the number of measures we assessed. Observations and self-reports from participants indicated that the VR mindfulness interventions in this setting facilitated powerful therapeutic processes. Reminiscence was reported to be a particularly powerful experience as it brought memories and emotions from the past into present awareness. Patients also reported that the intervention also facilitated connection to the present moment. Conclusions This pilot study indicates that mindfulness interventions augmented with virtual reality may be an effective way to address stress and mood symptoms in older adults. The use of VR may also facilitate important therapy processes such as reminiscence and awareness. However, there are many considerations when implementing these interventions in older adults. This study is a first step to developing, implementing, and standardizing low-cost VR mindfulness interventions in older adults in an inpatient setting. This research was funded by This work was supported in part by an unrestricted gift from Eric Warren Goldman to the Technology and Aging Lab at McLean Hospital Virtual Reality (VR)-based meditation interventions have been widely deployed in younger adults to reduce stress, anxiety, anger, and depression. However, these interventions have not been extensively applied in older adults. Thus, little is known about the feasibility and acceptability of VR mindfulness interventions in clinical settings. VR has become much more accessible as a wide variety of content is publicly available and more affordable hardware has come on the market, providing more opportunities to use these interventions in different settings. The goal of this study is to offer and implement low-cost and easily scalable VR mindfulness interventions in the geriatric psychiatry inpatient units at McLean Hospital in Belmont, Massachusetts. We deployed low-cost VR using a Destek V5 headset and smartphones to conduct a guided 3-day mindfulness intervention in a psychiatric inpatient unit for older adults at McLean Hospital. We used the free Sites for VR mobile app with the Destek V5 headset, as it provides a variety of nature scenes ideal for guided mindfulness sessions. We assessed depressive symptoms using the Geriatric Depression Scale (GDS), anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7), and positive and negative affect using the Positive and Negative Affect Scale (PANAS) before each intervention session and one week after the final session. After each session, participants completed the Simulator Sickness Questionnaire (SSQ) and PANAS immediately to assess the intervention's tolerability and any change in affect. In the first intervention session, study staff demonstrated how to fit the VR headset and addressed participants’ questions about the intervention. Research staff then provided a scripted mindfulness intervention, which talked participants through a guided body scan and focused on awareness of the five senses while the participants navigated the visual stimuli of a nature scene through the VR headset. At the time of writing the project is ongoing with data analysis anticipated to be completed by March 2023. We encountered some challenges in implementing VR mindfulness interventions for older adults in an inpatient setting. Primary challenges included: i) Some older adult patients expressed anxiety about handling technology and not knowing how to use it, and ii) patients were more reluctant to participate if there was too much preparation and paperwork involved. Study staff allowed participants to try the intervention at their own pace and participate alongside others using the VR headsets to mitigate anxiety. To address the second challenge, we reduced the number of measures we assessed. Observations and self-reports from participants indicated that the VR mindfulness interventions in this setting facilitated powerful therapeutic processes. Reminiscence was reported to be a particularly powerful experience as it brought memories and emotions from the past into present awareness. Patients also reported that the intervention also facilitated connection to the present moment. This pilot study indicates that mindfulness interventions augmented with virtual reality may be an effective way to address stress and mood symptoms in older adults. The use of VR may also facilitate important therapy processes such as reminiscence and awareness. However, there are many considerations when implementing these interventions in older adults. This study is a first step to developing, implementing, and standardizing low-cost VR mindfulness interventions in older adults in an inpatient setting.