Comparing Real and Virtual Nature Exposure on Cognition, Well-Being, and Brain Activity in Adults With and Without Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Experimental Study

BACKGROUND: Natural environments are associated with improved cognitive functioning and psychological well-being, potentially through attentional restoration and stress reduction. Virtual reality (VR) offers an accessible way to simulate natural settings; however, it remains unclear whether VR nature engages the brain and cognition in the same way as real nature, particularly in adults with attention-deficit/hyperactivity disorder (ADHD), who show atypical neural oscillations and heightened sensitivity to environmental demands. OBJECTIVE: This protocol describes a randomized experimental study designed to compare the effects of a single exposure to real vs virtual nature on cognition, well-being, and brain activity in adults with and without ADHD and to examine how neurocognitive profiles and ADHD symptom dimensions shape these responses over time. METHODS: A total of 80 adults (40 with a confirmed ADHD diagnosis and 40 neurotypical controls) will be recruited and randomly assigned to either a real nature condition or an immersive VR-simulated nature condition. After a baseline assessment, participants will complete a 20-minute seated exposure in the assigned condition while 32-channel mobile electroencephalography (EEG) is recorded. Immediately post exposure, they will complete gamified cognitive tasks assessing cognitive flexibility and metacognition, self-report measures of mood, perceived restoration, simulator sickness, and nature connectedness. ADHD symptomatology and functional impact will be assessed with standardized scales at preexposure and postexposure and at the final follow-up. Ecological momentary assessment of emotional well-being, weekly self-reports of real-world nature and VR exposure, and repeated nature connectedness ratings will be collected via a mobile app over an 8-week follow-up period to characterize the decay or maintenance of effects. EEG analyses will focus on alpha-band markers of cognitive restoration, complemented by dimensional modeling of ADHD symptoms in linear mixed-effects models. The study has been preregistered on the Open Science Framework and will be prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) before enrollment of the first participant. Ethical approval has been received from the Research Ethics Committee at Sligo University Hospital. RESULTS: At the time of manuscript submission, participant recruitment had not yet begun and no outcome data were available. The project received funding in May 2025. Participant recruitment is expected to begin in January 2026, followed by data collection in April 2026 to ensure suitable outdoor conditions. Data analysis will follow data collection, and study findings are expected to be published in May 2028. CONCLUSIONS: This study will test whether VR nature can reproduce key cognitive and neural benefits of real-world nature exposure and whether these effects differ between adults with ADHD and neurotypical adults. By integrating EEG, cognitive performance, symptom dimensions, and longitudinal self-report data, the findings are expected to clarify when VR nature may serve as a useful, scalable complement to real nature-based approaches for supporting attention and psychological well-being. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/82970.