Virtual Reality-Enhanced Behavioral Activation for Older Adults with Major Depressive Disorder: A Case Series (Preprint)

<sec> <title>BACKGROUND</title> <p>Major depressive disorder (MDD) is highly prevalent among older adults and is associated with substantial functional impairment and an increased risk of suicide. Behavioral activation (BA) is an evidence-based treatment for depression; however, physical limitations, medical conditions, and subsequent reduced access to rewarding activities may limit its implementation in older adults. Virtual reality (VR) may provide an accessible method for delivering BA by allowing individuals to experience pleasurable and meaningful activities that would otherwise be difficult to engage in.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to examine the feasibility, acceptability, tolerability, and preliminary clinical outcomes of a VR-enhanced BA intervention for older adults with MDD.</p> </sec> <sec> <title>METHODS</title> <p>This case series represents the five initial participants who completed an ongoing single-arm pilot study designed to recruit 30 older adults with MDD. Participants completed a five-session BA intervention delivered over four weeks, with the use of a MyndVR headset between sessions to engage in self-selected immersive 360° VR activities. Feasibility was assessed through study completion, headset use, and protocol adherence. Acceptability was measured using an adapted Technology Acceptance Model questionnaire, presence was measured using an adapted telepresence scale, and tolerability was measured using the Simulator Sickness Questionnaire. Depressive symptoms were assessed weekly using the 15-item Geriatric Depression Scale (GDS-15), and participants were asked to rate their mood (0-10) before and after each VR activity.</p> </sec> <sec> <title>RESULTS</title> <p>Six participants enrolled in the study, of whom five completed the intervention (mean age 72 years, SD 5.7; 3/5, 60% male). One participant withdrew because of frustration with headset usability and dissatisfaction with the available VR content. No serious adverse events were reported. Participants completed an average of 9.6 VR activities per week, exceeding the prescribed minimum of seven activities per week. Mean presence was 51% (6.1/12), overall acceptability was 55% (28.8/52), and physical tolerability was 91% (43.5/48). Participants demonstrated an average mood improvement of 2.18 points on a scale of 0-10 immediately following VR activities. Mean GDS-15 scores remained relatively stable throughout the intervention.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Preliminary findings suggest that VR-enhanced BA is a feasible and physically tolerable intervention for older adults with MDD, although headset usability and immersion remain important barriers to implementation. While depressive symptoms did not meaningfully change over the four-week intervention, overall, participants experienced consistent short-term improvements in mood following VR activities and engaged with the technology more frequently than required. Ongoing recruitment and evaluation utilizing a more active and user-friendly VR headset will further clarify the feasibility, acceptability, and potential clinical efficacy of this intervention for reducing depression and improving access to rewarding activities among older adults.</p> </sec> <sec> <title>CLINICALTRIAL</title> <p>ClinicalTrials.gov NCT07188623.</p> </sec>