Bringing the Outdoors In: Virtual Nature Walks for Depression in Multiple Sclerosis (MS) Patients

This trial explores the use of immersive virtual reality (VR) nature-based experiences as a supplementary treatment for depression in individuals with progressive multiple sclerosis (MS). This study will evaluate the feasibility and efficacy of at-home VR deployment using the Apple Vision Pro, an advanced device that offers enhanced resolution, immersion, and usability compared to earlier VR systems.

The study hypotheses include:

• The integration of VR nature-based experiences with standard care will be feasible, acceptable, and will result in greater reductions in depressive symptoms compared to standard care or VR-only interventions.
• The integration of VR nature-based experiences with standard care will result in greater reductions in stress and anxiety, better sleep, less insomnia, and improved fatigue compared to standard care alone or VR-only interventions.

Study Overview

• Status: Recruiting
• Conditions: Depression; Progressive Multiple Sclerosis
• Intervention / Treatment: Device: Virtual Reality; Other: Standard care

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zee Petrie; Phone Number: 734- 764- 5249; Email: petrieli@umich.edu

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • Recruiting
      • University of Michigan
      • Principal Investigator: Hala Darwish, PhD
      • Contact: Zee Petrie; Phone Number: 734- 764- 5249; Email: petrieli@umich.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Confirmed diagnosis of progressive Multiple Sclerosis (MS, primary or secondary) by a neurologist or an MS center
• Patient-Reported Outcomes Measurement Information System (PROMIS) Depression T-scores >55 at baseline
• Ability to provide informed consent and participate in VR sessions at home
• For Some Participants (Groups 1 and 2) currently receiving antidepressant or psychotherapy treatments (Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), or psychotherapy) for the management of depression

Exclusion Criteria:

• Severe cognitive impairments or visual deficits that may interfere with VR use, including contraindications like agoraphobia, claustrophobia, or motion sickness
• Current participation in other clinical trials targeting depression
• Severe psychiatric conditions that require hospitalization, or suicidal ideation, passive or active, psychosis, or active substance and alcohol abuse (score greater than 1 on CAGE (Cut down, Annoyed, Guilty, Eye-opener) Adapted to Include Drugs (CAGE-AID))
• Another neurological or autoimmune disease per protocol
• Participants that require vision correction, unless that vision correction is mild (± 1), or the participant has prescription contact lenses.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Standard care alone then Virtual reality plus SC- randomized group; Participants in this group are maintained on standard depression treatments and will continue standard care for eight weeks. This will be followed by a 1-week washout period and crossover to VR plus Standard Care.	Device: Virtual Reality; Participant will have 8 weeks of immersive VR nature-based experiences. Participants are expected to use the VR headset three times per week. Headsets will contain a prototype application (app) developed by Explore POV. This app will include approximately one hour of footage showcasing 15-25 different nature experiences, that will shuffle every time participants access it. Participants will have the option to choose between 5, 10, or 15 minutes, sessions while answering weekly surveys regarding their experiences.; Other: Standard care; Participants that are in the randomized groups will continue on antidepressants or psychotherapy during the study per their standard care. Participants in the non-randomized group don't receive any treatment for their depression and will continue not to receive anything for this during the study.
Experimental: Virtual Reality - non-randomized group; Participants that are not receiving any treatment for depression will receive VR nature sessions for 8 weeks without depression treatments for eight weeks followed by 1 week washout and 8 weeks of no VR.	Device: Virtual Reality; Participant will have 8 weeks of immersive VR nature-based experiences. Participants are expected to use the VR headset three times per week. Headsets will contain a prototype application (app) developed by Explore POV. This app will include approximately one hour of footage showcasing 15-25 different nature experiences, that will shuffle every time participants access it. Participants will have the option to choose between 5, 10, or 15 minutes, sessions while answering weekly surveys regarding their experiences.
Experimental: Virtual reality plus standard care (SC) then SC alone - randomized group; Participants in this group are maintained on antidepressants or psychotherapy and will receive VR nature sessions alongside participants' current depression treatments. This will be followed by a 1-week washout period, after which they crossover to standard care only.	Device: Virtual Reality; Participant will have 8 weeks of immersive VR nature-based experiences. Participants are expected to use the VR headset three times per week. Headsets will contain a prototype application (app) developed by Explore POV. This app will include approximately one hour of footage showcasing 15-25 different nature experiences, that will shuffle every time participants access it. Participants will have the option to choose between 5, 10, or 15 minutes, sessions while answering weekly surveys regarding their experiences.; Other: Standard care; Participants that are in the randomized groups will continue on antidepressants or psychotherapy during the study per their standard care. Participants in the non-randomized group don't receive any treatment for their depression and will continue not to receive anything for this during the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Qualitative feedback with Semi-structured interviews for participants that received VR	Semi-structured interviews with 20 random participants (6-7 from each group) who received the VR treatment to capture participants' subjective experiences at the midpoint and end of the intervention. The interview questions will focus on emotional changes, engagement levels, and feedback on the intervention's implementation.	Weeks 9-10, Weeks 20- 21
Enrollment rate	Feasibility will be assessed via enrollment. Recruitment will be quantified by enrollment rates relative to the number of eligibility screenings.	Recruitment period (2 years)
Retention rates	Feasibility: Retention will be evaluated through the percentage of participants who complete the entire study duration, targeting a benchmark of at least 70%.	Baseline - 21 weeks
Adherence to VR intervention	Feasibility: Adherence to 5-15-minute sessions 3 times per week over 8 weeks	8-week VR intervention
Dropout reasons		Baseline - 21 weeks
Hardware/software issues		During 8 weeks of VR
Changes to the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression short form 8b scores	This is an 8-item evaluating various aspects of depression, including negative mood, anhedonia, feelings of worthlessness, and cognitive impairments. Each item is rated on a 5-point Likert scale ranging from never (1) - always (5). Scores range from 8-40 with a higher score indicating greater symptom severity.	Baseline, 9-10 weeks and 20-21 weeks
Virtual Reality (VR) Sessions completed over 8 weeks	A benchmark of 70% will indicate adequate feasibility and acceptability.	8-week VR intervention
Qualitative feedback on the VR Neuroscience Questionnaire during the intervention (groups 1 and 3)	The modified scale for this project uses 10 questions that participants will answer about the VR experience, rated from 1 (extremely low or extremely difficult) to 7 (extremely high or extremely easy). The scores range from 10 to 70, with higher scores indicating greater experience. A benchmark of 70% indicates adequate feasibility and acceptability, with participant satisfaction ratings above 80%.	1-8 weeks (during VR)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change to the PROMIS Anxiety short form scores of the VR experience	This consists of eight items assessing various dimensions of anxiety, including feelings of fear, worry, hyperarousal, and somatic symptoms. Each item is rated on a 5-point Likert scale ranging from never (1) - always (5). Scores range from 8-40 with a higher score indicating greater anxiety.	Baseline, 8 weeks (after VR)
Change to the patient perceived stress scale (PSS-10)	It comprises 10 items that assess how unpredictable, uncontrollable, and overloaded respondents find their lives. Each item is rated on a 5-point Likert scale ranging from Never (0) to Very Often (4). The total score ranges from 0 to 40, with higher scores indicating greater perceived stress. While there are no established cut-off scores, higher scores suggest higher levels of perceived stress.	Baseline, 8 weeks (after VR)
Change in Sleep based on the Pittsburgh Sleep Quality Index (PSQI)	It comprises 19 items, generating seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored from 0 to 3, with higher scores indicating greater dysfunction. The component scores are summed to yield a global PSQI score ranging from 0 to 21. A global score greater than 5 suggests poor sleep quality.	Baseline, 8 weeks (after VR)
Change in the Insomnia Severity Index (ISI)	This is a brief self-report tool that evaluates the nature, severity, and impact of insomnia. It consists of seven items, each rated on a 5-point Likert scale (0 = no problem to 4 = very severe problem), assessing areas such as difficulty falling asleep, staying asleep, satisfaction with sleep, and the extent to which sleep problems interfere with daily functioning. The total score ranges from 0 to 28, with higher scores indicating more severe insomnia. Interpretation of scores is as follows: 0-7 (no clinically significant insomnia), 8-14 (subthreshold insomnia), 15-21 (moderate insomnia), and 22-28 (severe insomnia).	Baseline, 8 weeks (after VR)
Change in the PROMIS Fatigue	The PROMIS Fatigue Short Form 7a is a validated self-report instrument designed to assess fatigue over the past seven days. It consists of seven items that evaluate the frequency and severity of fatigue and its impact on daily activities. Each item is rated on a 5-point Likert scale ranging from "Never" (1) to "Always" (5). The raw scores are summed and converted into standardized T-scores, with a mean of 50 and a standard deviation of 10, based on the U.S. general population. Higher T-scores indicate greater fatigue severity. A change of 3 to 5 T-score points is generally considered clinically meaningful.	Baseline, 8 weeks (after VR)

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: Apple Inc.; The International Organization of Multiple Sclerosis Nurses Inc
• Investigators: Principal Investigator: Hala Darwish, PhD, University of Michigan

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2025
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: January 29, 2026
• First Submitted That Met QC Criteria: January 29, 2026
• First Posted (Actual): February 6, 2026

Study Record Updates

• Last Update Posted (Actual): February 12, 2026
• Last Update Submitted That Met QC Criteria: February 9, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Immersive virtual reality (VR)
• Additional Relevant MeSH Terms: Nervous System Diseases; Pathologic Processes; Chronic Disease; Disease Attributes; Autoimmune Diseases; Immune System Diseases; Behavioral Symptoms; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Pathological Conditions, Signs and Symptoms; Behavior; Multiple Sclerosis; Depression; Multiple Sclerosis, Chronic Progressive; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: HUM00267042

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No