Managing emotional distress in older adults with mental illness: a randomized controlled trial evaluating virtual reality relaxation

Abstract Virtual reality (VR) relaxation offers an innovative, immersive approach to managing negative emotions. Such digital therapies represent a promising, growing field in mental health care but remain under-researched in older populations – a group in critical need of scalable, engaging treatments. We conducted a randomized controlled trial to evaluate the feasibility and effectiveness of VR-based relaxation compared to guided imagery (treatment-as-usual) in older adults with mental illness. 44 older psychiatric patients (aged 58–98) were randomized into either VR or guided imagery (GI). In total, 39 participants completed the study (VR: n = 21, GI: n = 18) and were selected for analysis. Dropout rates, satisfaction, and overall experience were indicators of feasibility in both groups. Additionally, motion sickness and sense of presence were assessed in the VR group. Effectiveness was evaluated through pre-post-measurements of state anxiety (STAI-X1), affect (PANAS), and visual analogue scales for stress, relaxation, and well-being. VR demonstrated strong feasibility, with low dropout rates, high satisfaction and immersion, and minimal motion sickness (M = 0.25 ± 0.91). Mixed repeated measures ANOVA analyses revealed significant improvements in state anxiety, stress, negative affect, relaxation, positive affect, and well-being across both groups (p < 0.001), with no significant differences between VR and GI. Feasibility and effectiveness were consistent across age, gender and severity of illness. Our findings suggest that VR relaxation is a feasible and effective intervention for older adults with mental illness, offering a comparable alternative to traditional relaxation methods. This study underscores the potential of VR to enhance mental health care for older populations, including those with advanced age and serious mental illness.