Bringing the outdoors in: Virtual reality for hospital-bound patients – @theU

Reposted from U of U Health’s Good Notes blog.

A waterfall cuts through moss-covered cliffs. Lush greenery fills the landscape as rushing water drowns out the sounds of the hospital. For 15 minutes, the patient is somewhere else.

Then the virtual reality (VR) headset comes off. The waterfall disappears, and the patient is once again looking at the hospital room where they may spend days or even weeks.

For patients with drug-resistant epilepsy, those long hospital stays can take a toll on mental health. My research asks whether bringing nature into the hospital through VR can do more than provide a temporary escape. Could it reduce symptoms of depression and improve quality of life for patients who cannot easily venture outside?

A first-of-its-kind view of the brain

Researchers at University of Utah Health are conducting the first study to pair VR nature immersion with simultaneous recordings from electrodes placed deep in the brain. These electrodes are already implanted as part of patients’ epilepsy care, giving the research team a rare opportunity to observe how the brain responds to virtual nature in real time.

Previous studies of nature exposure have relied on self-reported questionnaires, scalp recordings or fMRI machines to measure responses to nature photographs or time spent outdoors. Recordings from within the brain can provide a more detailed picture of the changes that occur during and after VR immersion.

The study compares a patient’s responses to natural and urban VR environments to better understand how virtual nature may influence mood, stress and attention.

Weeks of monitoring with little access to nature
Sam Petersen, an undergraduate research assistant in the University of Utah’s Neurosmiths Laboratory, demonstrates the VR headset used to immerse study participants in natural and urban environments.

For some people with drug-resistant epilepsy, medication can’t effectively prevent seizures. These patients may undergo surgery in which neurosurgeons place multiple electrodes in the brain. The electrodes monitor activity in deep brain structures to help pinpoint where seizures begin.

After surgery, patients stay in an epilepsy monitoring unit. Because the electrodes are tethered to a round-the-clock recording device, patients can’t leave their beds unaccompanied. Under a neurologist’s care, they wait to have seizures, so that the clinical team can observe their brain activity. Days or weeks may pass this way, all without access to nature.

Long stretches in bed can be stressful and monotonous, compounding the anxiety and depression that are already common among people with drug-resistant epilepsy. Together with my research colleagues, I wanted to find a way to bring nature to these patients and potentially improve their quality of life.

Our interdisciplinary team includes Elliot Smith, PhD; David Strayer, PhD; Jeanine Stafanucci, PhD; and Amy McDonnell, PhD. We also collaborate with neurosurgeons Shervin Rahimpour, MD, and Ben Shofty, MD, PhD, who perform the electrode implantation surgery.

Bringing nature into the hospital
Patients experience either an urban streetscape or a natural waterfall through the VR headset, allowing researchers to compare how the two environments affect mood, stress, attention and brain activity. Visuals courtesy of HabitatXR.

HabitatXR, a production company, created high-resolution, 3D videos with immersive audio that transport patients into two very different environments. One takes them into nature; the other places them in an urban cityscape. Put on the headset, and for a few moments, the hospital gives way to an entirely different setting.

A pedestrian walks past on a city street. A waterfall rushes through the landscape. As patients turn their heads, they can look down an avenue or take in the forest surrounding them. Sitting upright in a hospital bed, they experience the scene much as they might from a park bench or a busy intersection.

That contrast is central to our study of nature deprivation. A few days after admission, patients experience one environment. Several days later, they experience the other. By comparing responses, we can begin to understand whether virtual exposure to nature offers benefits that an immersive urban environment does not. So far, patients have responded positively to the experience.

What the early results suggest
Rhiannon Cowan conducts a single-neuron analysis of data collected during the virtual reality study. The analysis helps researchers understand how individual brain cells respond to immersive natural and urban environments. Photo: Rhiannon Cowan

With implanted electrodes already in place, we have a rare opportunity to observe brain activity as patients experience VR nature and complete cognitive tasks before and after immersion. We’re particularly interested in the idea that nature can be “softly fascinating.” It captures our attention without consuming it, potentially allowing the brain’s attention system to rest and reset.

In our small preliminary sample, patients reported lower stress and negative affect after nature immersion compared with the urban setting. We also observed changes in brain activity during nature immersion, along with signs that patients may be better able to handle distracting or conflicting information afterward. The study is ongoing, so we need data from more patients before drawing firm conclusions.

The implanted electrodes also allow us to look more closely at what may be happening in the brain. They provide information from deep brain regions, including the anterior cingulate cortex, which is associated with depression severity. We can compare how signals in that region change during nature immersion versus the urban setting.

In early observations, alpha brain wave activity increased throughout nature immersion but not during the urban condition. Alpha waves are associated with alertness and mood. These preliminary findings offer an early glimpse into how nature exposure may influence the brain.

Expanding the reach of VR nature

We want to better understand these changes and whether VR nature immersion eventually serves as a therapeutic tool for people with limited access to nature. Although this study involves patients with implanted electrodes, the findings could have broader implications for people who spend extended periods indoors, including those in long-term care, correctional facilities or hospitals.

VR may offer meaningful ways to bring some of the benefits of nature to people who cannot easily experience it firsthand. But it is not a replacement for the real thing. If you can get outside and spend time in nature, you should. We believe access to nature is a necessity, not just a luxury. Our hope is to make the benefits of nature available to everyone.

This is the second installment in a multi-part blog series that looks at the connection between nature and human health. The series features interdisciplinary research supported through a pilot grant program from Nature and Human Health-Utah.

Other blogs in this series: