A mechanism-oriented immersive virtual reality intervention for psychological distress and helplessness-related processes in hospitalized older adults: study protocol for a multicenter randomized controlled trial

Background Prolonged hospitalization in older adults may contribute to reduced autonomy, passivity, diminished perceived control, and psychological distress. Although hospitalization does not necessarily lead to learned helplessness, it may create conditions that increase vulnerability to helplessness-related processes in some patients, particularly when opportunities for self-directed action and visible action–outcome contingencies are limited. Immersive virtual reality (VR) may offer opportunities for safe, accessible, and meaningful interaction in otherwise constrained hospital environments; however, the added value of interactive, agency-supporting VR components remains insufficiently studied in hospitalized older adults. Objective This study aims to evaluate the effectiveness of Zenctuary VR+, a mechanism-oriented, nature-based immersive VR intervention, in reducing psychological distress among hospitalized older adults compared with a passive VR control condition. Secondary aims are to explore changes in helplessness-related constructs, including self-efficacy, self-esteem, hopelessness, depressive symptoms, and learned helplessness. Methods and analysis This is a multicenter, parallel-group, assessor-blinded randomized controlled trial conducted in inpatient hospital settings in Hungary. A total of 100 hospitalized adults aged 60 years or older will be randomly assigned in a 1:1 ratio to either the active Zenctuary VR+ intervention or a passive VR control condition. Both groups will receive six VR sessions over three weeks, delivered twice weekly using the same head-mounted display and the same nature-based virtual environments. The active intervention includes optional low-cognitive-load interactive activities designed to support agency, perceived control, and successful action, whereas the control condition involves passive observation of the same virtual environments without interactive elements. Assessments will be conducted at baseline, post-intervention, and four-week follow-up. The primary outcome is psychological distress measured by the Hospital Anxiety and Depression Scale total score. The primary analysis will use a linear mixed model to examine group-by-time effects. Secondary and mechanism-related analyses will be considered exploratory. Ethics and dissemination The study has received national ethical and regulatory approval in Hungary from the National Centre for Public Health and Pharmacy. The trial has been registered at ClinicalTrials.gov (NCT07712549). Results will be disseminated through peer-reviewed publications, conference presentations, and project-related dissemination activities. Clinical Trial Registration https://clinicaltrials.gov/study/NCT07712549 , ClinicalTrials.gov: NCT07712549.