PhD Scientific Days 2026

Mental Health Sciences 4.

Bottom-Up Virtual Nature Versus Top-Down Guided Imagery in Hospitalized Older Adults: Protocol for a Pragmatic Parallel-Group Clinical Trial

Előadó neve

Lajkó, Patrícia, MSc

Előadó munkahelye

Semmelweis University, Center for Geriatric Care and Nursing Science, Budapest, Hungary. Semmelweis University, School of PhD Studies, Budapest, Hungary.

Előadó e-mail címe

lajko.patrcia@semmelweis.hu

Az előadás címe

Bottom-Up Virtual Nature Versus Top-Down Guided Imagery in Hospitalized Older Adults: Protocol for a Pragmatic Parallel-Group Clinical Trial

Szerző(k) neve és munkahelye

P. Lajkó^1,2, B. R. Vásarhelyi³, V. Szabó³, M. Fekete¹, L. Réthy¹, K. Gado^1,4, D. Fazekas⁵, K. Ficsór⁶, X. Gonda^7,8

1: Semmelweis University, Center for Geriatric Care and Nursing Science, Budapest, Hungary
2: Semmelweis University, School of PhD Studies, Budapest, Hungary
3: Semmelweis University, Clinic for Rehabilitation, Budapest, Hungary
4: Semmelweis University, Faculty of Health Studies - Department of Clinical Sciences, Budapest, Hungary
5: Eötvös Loránd University, Faculty of Education and Psychology, Budapest, Hungary
6: Károli Gáspár University of the Reformed Church in Hungary, Institute of Psychology, Budapest, Hungary
7: Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
8: Semmelweis University, Department of Clinical Psychology, Budapest, Hungary

Bemutatás módja

Szóbeli

Szekció

Mental Health Sciences 4.

Language of the presentation

Hungarian

Összefoglaló szövege

Introduction
Hospitalization in older adults is frequently associated with increased psychological distress, reduced autonomy, sensory deprivation, and transient cognitive decline. These factors may negatively influence both emotional well-being and bedside cognitive assessment. Relaxation-based interventions, including immersive virtual reality (VR) and guided imagery, may help reduce hospitalization-related distress and support cognitive functioning through different neurocognitive pathways.

Aims
The study aims to compare bottom-up virtual nature exposure (relying on externally driven sensory stimulation) and top-down guided imagery relaxation (based on internally generated symbolic imagery) in hospitalized older adults, focusing on affective state, attentional functioning, and psychophysiological regulation. A further aim is to investigate how screening-derived cognitive patterns relate to intervention responsiveness and quality of life.

Methods
This ongoing prospective randomized parallel-group study includes hospitalized older adults from the Semmelweis University, Center for Geriatric Care and Nursing Science and the Semmelweis University, Clinic for Rehabilitation. Participants aged 65 years and older undergoing geriatric hospital care and rehabilitation with heterogeneous cognitive status undergo baseline and follow-up assessment using the Montreal Cognitive Assessment (MoCA) / MoCA Memory Index Score (MIS), Trail Making Test A (TMT-A), Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS), and Heart Rate Variability (HRV) monitoring. HRV recordings are obtained using wearable sensors and analyzed in a standardized HRV-analysis environment. Participants are assigned to immersive VR or guided imagery interventions based on randomization and intervention feasibility. Both interventions are based on the same symbolic stimulus structure (“meadow,” “stream,” and “mountain”), allowing comparison of identical psychological content delivered through different modalities. The VR nature videos were specifically developed for the study using 360° recordings, while the guided imagery scripts follow the symbolic imagery framework of Leuner’s KIP, and Symbol Therapy. Within the framework of the project, the Hungarian version of the CASP-19 quality of life questionnaire was also successfully validated.

Results
Preliminary analyses indicate that psychological distress, particularly depressive symptoms (GDS, HADS-D), shows a stronger association with reduced quality of life than global cognitive status in hospitalized older adults. Early observations further suggest that attentional performance and memory-related cognitive patterns may influence the subjective processing of VR and guided imagery interventions. Interpretation of HRV data in this population is substantially complicated by multimorbidity, polypharmacy, cardiovascular conditions, and autonomic-modulating medications. However, within-subject autonomic changes and response patterns appear interpretable across different conditions, including resting state, cognitive load, and immersive interventions. Initial observations suggest the emergence of distinct autonomic response profiles, including relaxation/vagal-dominant, engagement-related, stress-dominant, and low-reactivity patterns. These findings indicate that VR and guided imagery may influence emotional regulation, attentional engagement, and psychophysiological stabilization through partially different mechanisms.

Conclusion
The findings highlight the importance of affective adaptation and perceived control in hospitalized older adults and support the relevance of personalized immersive relaxation interventions in geriatric clinical settings. The study further emphasizes the methodological complexity of psychophysiological assessment in multimorbid older populations and suggests that autonomic response patterns may help identify which patients benefit more from regulatory versus stimulatory interventions.

Funding
No external funding.

University

Semmelweis University

Supervisor

Dr. Gonda Xénia

phd.section.field

in doctoral studies before complex exam (PhD)

Kind

Szabad

Status

elfogadva

Accepted presentation method

szóbeli

Előadás fájl jóváhagyás

jóváhagyta

Előadó

9181

Start

15:15

End

15:25