Grön VR för Depression (VR&depression)

Aktiv komparator: Kontroll (TAU)

Standardbehandling med terapeut

Övrig: Standardbehandling

Standardbehandling med terapeut

Experimentell: Studio-baserad

Övrig: Standardbehandling

Standardbehandling med terapeut

Övrig: Studio-baserade VR-upplevelser

Exklusiv VR-upplevelse levererad av forskaren i en studio, levererad veckovis, bestående av en simulerad naturvandring levererad genom ett exklusivt VR-system kopplat till en manuellt driven löpband.

Experimentell: Självadministrerad

Övrig: Standardbehandling

Standardbehandling med terapeut

Övrig: Självadministrerade VR-upplevelser

Lågklassig VR-upplevelse som deltagarna själv administrerar. Efter ett introduktionsmöte med forskaren får deltagarna, under interventionens varaktighet, ett fristående VR-headset som innehåller ett förinställt bibliotek med virtuella naturupplevelser. Deltagarna uppmuntras att använda headsetet dagligen. Tiden som spenderas med att använda VR-headsetet registreras via enheten.

Beck depression inventory II (BDI-II)

The BDI-II is a 21-item self-report questionnaire designed to measure the severity of depression.

The total score is calculated by summing the ratings (0-3) for all 21 items, with minimum score 0 (no or minimal depressive symptoms) and maximum score 63 (severe, high-level depressive symptoms).

A Norwegian translation of the scale commonly used in clinical settings is used in the study.

Beck anxiety inventory (BAI)

The BAI is a 21-item self-report questionnaire used to measure the severity of anxiety in adults and adolescents.

Each item is rated from 0 ("not at all") to 3 ("a lot"). The total score is calculated by summing the ratings for all 21 items (minimum value 0 and maximum value 63), with higher scores indicating greater severity of anxiety.

A Norwegian translation of the scale commonly used in clinical settings is used in the study.

Hopkins symptom checklist (HSCL-10)

The HSCL-10 is a 10-item self-report questionnaire designed to screen for symptoms of anxiety and depression, commonly used in both clinical and epidemiological studies to measure psychological distress. It includes 4 items related to anxiety and 6 items related to depression, focusing on symptoms experienced during the past week.

Each item is rated on a four-point scale (1 = "Not at all"; 2 = "A little"; 3 = "Quite a lot"; 4 = "Extremely"). The score is calculated by taking the mean of all item scores. The minimum Value is 1.0 (no psychological distress) while the maximum Value 4.0 (extreme psychological distress). A Cut-off Point is set at a mean score of 1.85 to identify individuals experiencing significant mental health distress.

A Norwegian translation of the scale commonly used in clinical settings is used in the study.

Leisure time exercise questionnaire (LTEQ)

The LTEQ is a self-administered tool designed to assess the frequency and intensity of a person's leisure-time physical activity in a regular week (7 days). It measures how many times per week a person engages in strenuous, moderate, and mild/light physical activity for at least 15 minutes.

In this study, a modified version was also used to measure "active commuting", defined in a caption as "Walkin, running, biking to and from destinations such as work, the grocery, etc." The participant is required to report the number of times they engage in each level of intensity (strenuous, moderate, and mild/light) during a regular week. Examples are provided for each level of intensity. Higher scores indicate higher levels of activity.

The total score is calculated through the following formula: (n strenuous x 9) + (n moderate x 5) + (n mild/light x 3).

A Norwegian translation is used.

Intention to perform green exercise (INT-GE)

The INT-GE is a questionnaire component designed to measure an individual's motivation, plans, and likelihood of engaging in physical activity within natural environments (e.g., parks, forests, coasts). It is often developed based on the Theory of Planned Behaviour (TPB) to predict future green exercise behaviour.

The scale contains five items, each rated on a 1-7 Likert scale, with the total score calculated as the mean of all items. The minimum score is 1.0 (no intention to perform green exercise), while the maximum is 5.0 (strong intention to perform green exercise).

A Norwegian translation of the scale is used.

Connectedness with nature scale (CNS)

The state version of the CNS measures an individual's affective, experiential connection to the natural world at a given moment ("right now"). Based on the previous trait version of the scale, the state version is sensitive to acute changes. It contains 13 items, which are rated on a 1-7 Likert scale (1 = "Strongly disagree"; 7 = "Strongly agree"). The total score is calculated as the mean of all items, with lower scores (minimum value = 1.0) indicating a weaker sense of connectedness, while the higher scores (maximum value = 7.0) indicate a stronger sense of connectedness.

A Norwegian translation of the scale is used.

Affect Scale (PAAS)

The PAAS is a 12-item self-report questionnaire designed to measure feeling states. It evaluates emotional responses across four distinct subscales (Positive affect, Negative affect, Tranquillity, and Fatigue) and is especially sensitive to acute changes associated with physical activity.

The PAAS consists of 12 items (three items per subscale), each describing a feeling (e.g., "Energetic", "Discouraged", "Relaxed", "Worn-out"). Participants rate their current feelings on a 5-point Likert scale, commonly ranging from 0 ("do not feel") to 4 ("feel very strongly"). Mean scores are calculated for each subscale, with a minimum possible score of 0 and a maximum of 4, with higher scores indicating higher levels for the subcategory.

A Norwegian translation is used.

Nöje under VR-upplevelsen

Detta är ett enskilt objekt, utformat av forskarna, som ber deltagaren att betygsätta sin nivå av samstämmighet med följande uttalande: "Denna upplevelse var njutbar".

Objektet bedöms på en Likert-skala från 0 till 10, där lägre värden (minimum = 0) indikerar ingen njutning, medan högre värden (maximum = 10) indikerar högre nivåer av njutning.

En norsk översättning används.

Sense of presence during the VR experience

The scale assesses the extent to which participants perceive themselves to be immersed or embedded within a virtual environment (i.e., presence). Each item relates to different aspects that can influence a person's sense of presence either positively (Being there, Realism, Sense of reality) or negatively (Awareness, Other persons, External noises, Flatness, Movement lag). The items are formulated as statements, each participant being asked to rate the extent to which they agreed with each of them on an 11-point Likert scale (0 = absolutely disagree, 10 = absolutely agree). Each item is scored and treated individually.

For Being there, Realism, and Sense of reality, higher scores indicate stronger sense of presence, hence greater effectiveness of the VR experience. For the other items, higher scores indicate a poorer sense of presence.

Simulator sickness questionnaire (SSQ)

The SSQ measures symptoms similar to motion sickness but tailored to computer-based simulations. It asks participants to rate 16 symptoms (e.g., headache, eye strain, dizziness, nausea) on a four-point scale (0 = None; 1 = Slight; 2 = Moderate; 3 = Severe).

The 16 symptoms are grouped into three subscales (Nausea, Oculomotor, and Disorientation), which are weighted and summed to calculate a total score.

The minimum score is 0 (no symptoms, ideal outcome), and the maximum is 300 (extremely severe symptoms).

A Norwegian translation is used

Perceived Environmental Restorativeness

The Perceived Environmental Restorativeness is a self-reported measure of an environment's potential to help individuals recover from mental fatigue, stress, and cognitive overload according to the Attention-Restoration Theory.

It contains 16 items, grouped in four subcategories: Fascination (5 items), Being Away (2 items), Extent/Coherence (4 items), and Compatibility (5 items).

Each item is rated on a 0-10 Likert scale. The score of each subcategory is calculated as the mean of the related items.

For Fascination, Being Away, and Compatibility, lower scores (minimum = 0.0) indicate smaller restorative potential, while higher scores (maximum = 10.0) indicate larger restorative potential. Unless the scores for Extent/Coherence are reversed, lower scores (minimum = 0.0) indicate larger restorative potential, while higher scores (maximum = 10.0) indicate smaller restorative potential.

A Norwegian translation of the scale is used.