Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis

Development and testing of the nightscape affect index

Despite growing evidence linking urban landscapes to human affect, there remains limited understanding of which environmental aspects of landscapes contribute to positive affect and how they exert their influence. Moreover, the role and significance of urban nightscapes have been largely underexplored. To investigate the affective connections between nighttime environments and individuals, a psychometric tool-the Nightscape Affect Index (NAI)-was designed, developed, and validated. The NAI was systematically assessed for its psychometric properties, including reliability, factor structure, and subsequent retest validation. Comprising three subscales-nightscape attraction, adaptation, and attachment-the NAI demonstrated strong internal consistency and excellent reliability. The scale also provided robust evidence for convergent, discriminant, and structural validity. We discuss how the NAI can be applied in both research and practice to enhance our understanding of the relationship between urban nightscapes and public affective responses, as well as its potential in evaluating the effectiveness of interventions and strategies to reduce light pollution.

Effects of a combined nature-based and audio-based virtual mindfulness intervention on stress and wellbeing of COVID-19 healthcare workers: a randomized controlled trial

Background

The global COVID-19 pandemic and its subsequent transition to an endemic phase has highly increased psychosocial distress among healthcare workers. This chronic stress may culminate into burnout, which has been associated with impaired patient care and increased medical errors. Exposure to nature-based programs have been shown to reduce levels of perceived stress and promote well-being. However, benefits derived from nature programs can be short-lived. Mindfulness-based interventions represent a promising additive option to enhance benefit. The present study proposes to combine a nature-based program with an audio-based mindfulness intervention to address stress and promote psychosocial-spiritual wellbeing in COVID-19 healthcare workers.

Methods

Between June 2021 and October 2023, 78 healthcare workers were randomized into a Nature only group (Nature), a Combined Nature-Mindfulness group (Combined), and a control group (Control), with 19, 16, and 18 subjects completing the study, respectively (23-46 years, mean = 35, SD = 6). The nature program was a three or five-day retreat during which participants engaged in rock climbing, surfing or kayaking. The virtual audio mindfulness intervention was a 10-day program offered online and included mindful breathing, body scan, and loving-kindness meditation. Participants completed self-administered assessments at three or four time points during the study, including at baseline and following study procedures. Assessments included a measure of stress, the Perceived Stress Scale, and a measure of wellbeing, the National Institute of Health Healing Experience of All Life Stressors (NIH-HEALS).

Results

The mean baseline Perceived Stress Scale score was 21.2 ± 3.2 in the Combined group, 22.3 ± 2.8 in the Nature group, and 23.2 ± 3.3 in the Control group. Perceived Stress Scale levels did not change following nature-based and mindfulness-based interventions. The mean baseline NIH-HEALS score was 123.1 ± 19.4 in the Combined group, 118.1 ± 17.1 in the Nature group, and 114.3 ± 17.8 in the Control groups. NIH-HEALS scores increased in both the Nature and Combined groups when compared to the Control group. At follow-up, the Combined group maintained improvements in wellbeing when compared to the Nature group.

Conclusions

Findings suggest that nature-based programs can be used to improve overall wellbeing among COVID-19 healthcare workers. Additionally, integrating audio-based mindfulness practices to these programs may enhance their benefits. Notably however, these interventions may not effectively reduce perceived stress among COVID-19 healthcare workers. Due to diminished power of the present study, further research is needed to validate and refine the present findings.

Association between greenness and suicide attempts in patients with depression: A nationwide longitudinal cohort study

BACKGROUND

Although multiple emerging studies have suggested the relationship between greenness and mental health, evidence regarding associations among green space, suicide attempts, and depression is still limited. In this study, we aimed to estimate the association of greenness with suicide attempts in patients with depression.

METHODS

This study used the National Health Insurance Service database in South Korea to construct a cohort of patients diagnosed with depression during 2012-2013 (n = 677,498) with an 8-year follow-up period. Residential greenness was measured as the district-level annual average of the Enhanced Vegetation Index. The primary outcome was the suicide attempt, and categorized suicide attempts (non-violent and violent methods) were also examined. A Cox regression with time-varying variables was performed to assess the association between greenness and suicide attempts, and stratified analyses were conducted by sex, age, insurance premium, and disability status.

RESULTS

A higher level of greenness was associated with lower suicide attempts among patients with depression (HR: 0.789; 95% CI: 0.677, 0.918). The protective association was higher for suicide attempts by violent methods (HR: 0.733; 0.545, 0.987) than non-violent methods (HR: 0.812; 0.680, 0.970), based on point estimates. Among patients with depression, males, individuals aged 35-64 years, and Medical Aid beneficiaries showed a more prominent association with greenness.

CONCLUSIONS

This nationwide cohort study provides epidemiological evidence for the benefits of residential greenness in reducing suicide among patients with depression and suggests the appropriateness of public health policies for increasing green spaces.

Mother Earth kinship: Centering Indigenous worldviews to address the Anthropocene and rethink the ethics of human-to-nature connectedness

European-derived perspectives that position humanity as having dominion over Nature drive ecological crises and erode interrelatedness between human communities and natural ecosystems. In contrast, Indigenous worldviews recognize kincentric ecology, emphasizing reciprocal relationships between people and the Natural World. By centering these worldviews, we illuminate gaps in scientific literature on understanding, measuring, and cultivating nature connectedness that are central to Indigenous embodied understanding and practice. We then propose an ethical framework for respectful collaborative exchange, grounded in relational accountability, that acknowledges the rights and responsibilities inherent in human relationships with land. By rethinking the ethics of human-to-nature relationships, we highlight how Indigenous Knowledges offer critical guidance to address the Anthropocene and foster sustainable, reciprocal ways of living with the Earth.

Nature-based mind-body intervention for test anxiety in adolescents: a feasibility study

Introduction

Traditional interventions for test anxiety often fall short of addressing the specific needs of adolescents and educational institutions due to issues of stigmatization and professionalization. In contrast, nature-based interventions (NBIs) have gained traction for their potential to enhance mental health, as they are generally accepted and cost-effective, thereby offering a promising alternative for alleviating test anxiety.

Methods

This study seeks to investigate the feasibility of a nature-based mind- body intervention (NMI) designed to reduce test anxiety among adolescents by integrating elements of NBIs and mind-body therapies (MBTs).

Results

The findings suggest that NMI can significantly diminish excessive test anxiety and academic stress, along with alleviating symptoms of general anxiety and depression.

Discussion

This approach presents a low-stigma, low-cost strategy for managing test anxiety in adolescents and offers valuable insights for mental health policymakers. Furthermore, it may enhance academic performance and broaden educational access for disadvantaged populations in developing countries.

A generational relational model of nature and mental wellbeing: results of a qualitative analysis

Introduction

There is a developing evidence base for the benefits of natural environments for health and mental wellbeing. However, given the increasing urbanisation of our planet and subsequent disconnection from our natural world, there is a danger that we may ultimately suffer from a nature 'generational amnesia'. The facets and mechanisms underpinning these relationships are poorly understood and theoretical frameworks are needed to aid further research. There is a paucity of research into the lived experiences of people with good wellbeing and their nature experiences, which has the potential to elucidate key elements of the nature-wellbeing relationship.

Methods

The current study used a qualitative design to explore themes concerning the lived experiences with nature, of 12 people with self-reported good wellbeing. Semi-structured interviews were carried out and data were analysed using thematic analysis.

Results

Two overarching themes of human-nature relationship and self-regulation encapsulated the data. Within the first, there were two superordinate themes of developmental and nature interconnectedness. Self-regulation consisted of managing health and flourishing.

Discussion

A theoretical model is proposed to help better understand these relational themes in a generational context. The model is informed by Cognitive Analytic Therapy and attachment theory and generates testable hypotheses for future research.

Is forest bathing a panacea for mental health problems? A narrative review

Background

The fast pace of modem life brings great pressure, which lead to physical and mental health issues. Researches have demonstrated that forest bathing can considerably alleviate symptoms of depression and anxiety, eliminate negative emotions and promote mental wellbeing. We presented evidences of the positive impact of forest bathing on mental health in the context rapid urbanization and surging health needs in the post-pandemic era, and outlined the current insights into the related factors affecting the effect of forest bathing, as to provide directions for future interventions or research.

Method

The electronic databases PubMed, Cochrane Library, Embase, Web of Science Core Collections and the China Academic Journals (CAJ) offered through the Full-text Database (CNKI) were searched for relevant studies published from the inception of the databases to December 2024. The initial search strategy was performed using keywords, MeSH terms, and free text words such as "forest bathing", "forest medicine", "mental health pressure", "anxiety", "depression", "cortisol", etc.

Results

The synthesis of the findings in the included studies revealed that forest bathing interventions might improve mental and physical health, reduce blood pressure, improve sleep quality and boost immunity, as well as alleviate depression, anxiety, and stress. Furthermore, the effect of forest bathing on mental health indicators and the differences in these results among different populations varied. Forest environment, tree species, exposure duration, season, composition and concentration of volatile organic compounds have an impact on the effect of forest bathing.

Conclusions

Forest bathing were effective in lowering cortisol levels, reducing sympathetic nerve activity, as well as improving negative mood, which could serve as a non-pharmacological treatment for mental health in the general population.

Contributing Factors to the Rise in Adolescent Anxiety and Associated Mental Health Disorders: A Narrative Review of Current Literature

BACKGROUND

The prevalence of anxiety among adolescents has seen a notable increase in recent years, becoming a significant public health concern. In fact, anxiety is substantially more prevalent in Generation Z (individuals born between 1997 and 2012) than in any of the past three generations. We aimed to examine what factors contribute to the increased prevalence in teen anxiety and identify points of intervention.

METHODS

This study employed a narrative review method. We performed a literature search of the PubMed, ScienceDirect, and Medline databases and identified original research and review articles discussing increased anxiety and other mental health disorders in Generation Z.

RESULTS

We provide a comprehensive overview of the factors contributing to the increased rates of adolescent anxiety, including academic pressures, social media influence, family dynamics, and broader societal stressors.

CONCLUSIONS

In this narrative review, we examine the multifaceted nature of adolescent anxiety, identifying contributing factors. Additionally, we discuss potential clinical, educational, and community-based interventions to prevent and treat adolescent anxiety. By understanding and addressing the underlying causes of anxiety, it is possible to mitigate its impact and promote healthier developmental trajectories for young individuals.

Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: An umbrella review

Several systematic reviews support nature-based interventions (NBIs) as a mechanism of enhancing mental health and wellbeing. However, the available evidence for the effectiveness of these interventions is fragmentary and mixed. The heterogeneity of existing evidence and significant fragmentation of knowledge within the field make it difficult to draw firm conclusions regarding the effectiveness of NBIs. This can only limit the development of interventions to support personal and planetary wellbeing, potentially resulting in ineffective and ill-targeted investment decisions. These concerns have hindered the translation of research evidence into practice and guidelines are urgently required to assist researchers, practitioners and policymakers in developing interventions to promote environmental stewardship and meet the health needs of diverse communities. A higher-order or meta-level synthesis is required to make sense of this evidence. This umbrella review synthesises evidence on the barriers and enablers to nature-based interventions through a summative review of existing published systematic reviews and meta-analyses. A systematic search in PsycINFO, PubMed, Greenfile, Web of Science, Embase, Scopus, Academic Search Complete (EBSCO), Environment Complete (EBSCO), Cochrane Library, CINAHL, Health Policy Reference Centre and Google Scholar was performed. This is a mixed method review, and systematic reviews with both quantitative and qualitative data synthesis were included. 64 systematic reviews were included in the synthesis. The descriptive data, extracted from each study, forms an overview of the characteristics of available evidence on nature-based interventions. A narrative synthesis is used to present the potential factors influencing the outcomes of NBIs. The risk of bias of the systematic reviews was assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. Directions for future research, potential quality needs and recommendations for future research, policymaking, and practice are discusssed.

Efficacy of a multicomponent nature-based intervention on well-being and environmental engagement: A randomized clinical trial

BACKGROUND

Nature-based interventions (NBIs) benefit human well-being, but clinical trials comparing different NBIs in various natural environments are scarce.

OBJECTIVE

To evaluate the efficacy of a multicomponent nature-based intervention (MNBI) in comparison to control group (classical forest bathing).

PRIMARY OUTCOME

well-being; Secondary outcomes: vitality, happiness, connection, and engagement with nature across urban, peri-urban, and rural areas.

METHODS

Randomized clinical trial with 486 participants between October/2022 and June/2023, from five natural areas in Southeast and Southern/Brazil. Well-being was assessed immediately before the activity and 30 days after, and secondary outcomes immediately before, immediately after and 30 days after. The data analyses considered a 95 % confidence interval and p-values < 0.05.

RESULTS

The main hypothesis was confirmed, well-being levels of MNBI group were significantly improved, especially in peri-urban areas (p = 0.036). Both groups increased vitality (p < 0.001), but MNBI was more effective overall (p = 0.038), especially in urban areas (p = 0.020). Happiness increased in both groups (p = 0.001), but MNBI participants maintained higher levels 30 days post-intervention (p = 0.010). Nature connection increased significantly in both groups (p < 0.001) but remained higher in MNBI after 30 days (p = 0.021), especially in peri-urban areas (p = 0.034). While both groups reported calm and relaxation, MNBI uniquely fostered learning, knowledge, and contemplation.

CONCLUSIONS

MNBI was more effective than classical forest bathing in improving well-being, nature connection and pro-environmental behaviors, particularly in peri-urban settings, expanding the potential of NBIs for well-being promotion.

CLINICALTRIALS REGISTRATION

NCT05486156.

Nature's Touch: The Experience of Using Nature for Health Improvements in Patients with Mental Illness. A Qualitative Study

This study aims to describe staff experiences of nature as a tool for working with people with mental illnesses. A qualitative study consisting of nine interviews with staff working with nature as a tool was conducted. The data were analysed using qualitative content analysis. Two themes with six subthemes emerged. The first theme, making the invisible visible with subthemes, getting in touch with nature, getting in touch with feelings and acceptance of time and lack of demands, and the second theme, working with what we have with subthemes, nature becomes a tool for resiliency, the surrounding environment becomes a safe setting and important relationships for good treatment. The healthcare staffs' experiences of incorporating nature as a caring tool for patients with mental illness showed that nature could contribute to a patient's recovery. For psychiatric nursing, this study observed that having the knowledge and awareness of nature's effect on patients, and using it as complementary care and treatment-tool may inspire both staff, and their patients to further include nature-assisted care and therapy in their treatment of mental illnesses on the road to improved mental health.

Randomized controlled trial on the efficacy of forest walking compared to urban walking in enhancing mucosal immunity

Scientific research on forest therapy's preventive medical and mental health effects has advanced, but the need for clear evidence for practical applications remains. We conducted an unblinded randomized controlled trial involving healthy men aged 40-70 to compare the physiological and psychological effects of forest and urban walking. Eighty-four participants were randomly assigned to either the forest or urban group, with 78 completing 90-min walks and analysis. The primary outcome measured was the change in saliva-secreted immunoglobulin A (sIgA) levels. Evaluating researchers were blinded to the groups, but participants and on-site staff were not. Here, we demonstrate a significant increase in saliva-secreted immunoglobulin A (sIgA) levels in the forest group. Furthermore, forest walking resulted in improved mood, including a reduction in stress hormone levels. In conclusion, mindful forest walking has the potential to enhance immunity and promote health. Clinical trial registration: University Hospital Medical Information Network. Trail registration number: UMIN000045851. Approval date: 25/10/2021.

Stressful but Not Unhappy: A Review of the Positive Aspects of Parenting a Child with Autism Spectrum Disorder

This review aimed to identify and synthesise the evidence for the positive aspects of parenting a child with autism spectrum disorder (ASD). To date, ASD parental research has predominantly focused on the negative aspects; parents and carers are left uninformed of how to strengthen their positive mental wellbeing. Three electronic databases-PubMed, Scopus, and Web of Science -were searched for literature reporting positive aspects of parenting a child with ASD, published between January 2013 and December 2023. The PRISMA 2020 checklist was used for reporting. Two hundred and fifty-four articles were retrieved from the databases. After title/abstract screening (n = 213) and full-text reviews (n = 32), six papers were included (n = 6). Sixteen positive aspects of parenting a child with ASD were identified and grouped into three themes: joyful moments, journey to resilience, and social connection. These three themes are eudaimonic wellbeing constructs and often under-represented in ASD parental studies. Focusing on joyful moments, building resilience through the parenting journey, and finding support and connection with others in similar situations can support the mental wellbeing of parents and carers of children with ASD. Future research is needed to further evaluate the positive aspects of parenting a child with ASD.

The Psychometric Performance of State Mindfulness Scales Around Sitting and Walking on Desert Trails: A Pilot Study

State mindfulness is a dynamic construct reflecting current mindfulness, or purposeful attention to the present moment with openness, non-judgment, non-reactivity, and acceptance. Despite its popularity and research in psychology and medicine, measuring state mindfulness remains a challenge. Validity and reliability of the State Mindfulness Scale (SMS) and State Mindfulness Scale for Physical Activity (SMS-PA) in applied settings like nature require more data to be established. This pilot study aimed to evaluate these scales and introduce a new, one-item scale, the Visual Analog Scale-Mindfulness (VAS-M), for quicker mindfulness assessment. Participants completed the SMS, SMS-PA, and VAS-M upon arrival at a desert trail, after 10 minutes of sitting, and after 10 minutes of walking. A subset repeated the intervention 24 hours later. The study found that the SMS and SMS-PA could be given before, during, and after nature immersion. The SMS-PA showed evidence of concurrent validity with the SMS (ρ = .89, p < .001). However, the VAS-M did not meet the criteria for concurrent validity with the other scales. None of the scales met the criteria for test-retest reliability. This study underscores the need to validate state mindfulness scales, especially in non-laboratory settings. While the SMS-PA shows promise, further validation and refinement of the VAS-M are needed. The findings enhance our understanding of measuring state mindfulness, particularly in natural environments. While the scales are already in use, our study helps address gaps in evidence and informs future decisions about their application.

From space to street: A systematic review of the associations between visible greenery and bluespace in street view imagery and mental health

A large body of literature shows that living near greenery supports healthy lifestyles and improves mental health. Much of this research has used greenery measured from a bird's eye perspective. Street view images (SVI) are an important alternative data source that could assess visible greenery experienced by residents in daily life. The current review is the first to systematically critique and synthesize the evidence relating to greenery and bluespace in SVI and its associations with mental health outcomes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct this review. First, we identified relevant articles published as of April 2023 in PubMed, Web of Science, Scopus, and CINAHL. Articles meeting inclusion criteria were narratively synthesized. Quality assessments were conducted with the Newcastle-Ottawa Scale (NOS). Based on our search, we identified 35 articles on greenery and bluespace measured with SVI and mental health outcomes. Two-thirds of the included papers found positive associations between greenery in SVI and mental health. The average score for risk of bias was good. Association between visible greenery in SVI and all 10 of the mental health outcomes studied were low or very low quality of evidence and showed limited or inadequate strength of evidence. SVI is likely to be an increasingly used and a validated instrument for estimating health-promoting exposure to greenery. Future research would benefit from the standardization of SVI datasets and computational processes, and studies conducted outside of China and high-income countries. Such advancements would improve the generalizability and robustness of associations between visible greenery and mental health outcomes.

A Breath of Fresh Air: Perspectives on Inhaled Nutrients and Bacteria to Improve Human Health

We propose that the human respiratory system and olfactory pathways sequester airborne nutrients (vitamins, fatty acids, and trace minerals) that are beneficial for health, which we term "aeronutrients." In addition, airborne bacteria, termed "aeromicrobes," have the potential for positive health effects by improving species diversity in the microbiotas of the respiratory and gastrointestinal tracts. These concepts have implications for people living in urban areas or those who have limited access to nature, such as astronauts exposed for long periods to highly filtered air that may be depleted of aeronutrients and aeromicrobes. The possibility that fresh air contributes to human nutrition and health may stimulate a re-evaluation of guidelines pertaining to nutrition and access to natural environments, and will open new avenues of scientific enquiry.

How taking pictures of landscapes affects the mental stress of young adults

In today's fast-paced society, escalating work and academic pressures have led to rising stress levels. While numerous studies have explored adolescent mental health, there has been a lack of focus on "educational stress" among Chinese students. This study sought to understand the psychological and physiological effects of educational stress in Chinese university students. We studied the impact of a 5-min nature photography session on campus compared with a control activity of photographing urban settings near campus. Data were collected using blood pressure measurements, electroencephalography (EEG), the Semantic Differential Method (SDM), and the State-Trait Anxiety Inventory (STAI) in order to understand psychophysiological reactions. The findings from the SDM and STAI assessments indicated that students felt slightly more at ease and considerably more relaxed, had a heightened sense of naturalness, and experienced reduced anxiety after engaging in nature photography compared with urban photography. Notably, we observed that both systolic and diastolic blood pressure dropped by many values and there were noticeable EEG changes among participants. The results suggest that a brief 5-min nature photography activity can effectively reduce mental stress in Chinese university students.

Principal sensory experiences of forest visitors in four countries, for evidence‐based nature therapy

Read the free Plain Language Summary for this article on the Journal blog.

A Nature-Based Intervention and Mental Health of Schoolchildren: A Cluster Randomized Clinical Trial

Importance

Nature-based therapeutic or preventive interventions for mental health are increasingly popular, but their effectiveness for improving mental health is not well documented.

Objective

To investigate the effectiveness of the Open Sky School Program (École à Ciel Ouvert), a 12-week nature-based intervention for elementary schoolchildren in grades 5 and 6, for reducing mental health symptoms.

Design, Setting, and Participants

This 2-arm, cluster randomized clinical trial was conducted from February 27 to June 16, 2023, in French-language elementary schools in Quebec, Canada, with green space within 1 km. Participants were teachers and students in grades 5 and 6.

Intervention

In the intervention group, for 2 hours per week for 12 weeks, classes were taught outdoors in a nearby park or wooded area. Teachers were encouraged to engage students in basic subjects and in 10 or more mental health activities (mindfulness, philosophy, and/or art therapy). Control group schools conducted classes as usual.

Main Outcomes and Measures

The primary outcome was change in student mental health (internalizing and externalizing symptoms, social problems) based on teacher- and student-reported 30-item Social Behavior Questionnaire (SBQ) scores (3-point scale) from baseline to the immediate postintervention follow-up, assessed in per-protocol and intent-to-treat mixed-model analyses. Secondary outcomes were student self-reported changes in depressive symptoms, positive or negative affect, pro-environmental efforts and/or attitudes, and nature connectedness.

Results

A total of 33 schools participated (53 teachers, 1015 students), including 16 schools (25 teachers, 515 students) in the intervention group and 17 schools (28 teachers, 500 students) in the control group. Student mean (SD) age was 10.9 (0.75) years; 507 (50.7%) were girls. Per-protocol and intent-to-treat mixed-model analyses showed no differences in mental health symptom change between groups; for example, the adjusted mean difference in SBQ scores between the intervention and control groups for externalizing symptoms was -0.04 (95% CI, -0.13 to 0.04) in the intent-to-treat analysis and -0.06 (95% CI, -0.16 to 0.04) in the per-protocol analysis. Post hoc analyses revealed low mental health symptoms at baseline, with low variability. Slightly greater reductions in symptoms were observed in the intervention group, but only for children with higher mental health symptoms at baseline (P < .05 for interaction). For example, for children with internalizing symptoms 1 SD above the mean at baseline, internalizing symptoms decreased by 0.38 SD (mean change, -0.15; P < .001) in the intervention group vs the control group.

Conclusions and Relevance

In this large cluster randomized clinical trial in daily-life elementary school settings, 12 weeks of classes in green space for 2 hours per week did not reduce mental health symptoms in students aged 10 to 12 years in either the per-protocol or the intent-to-treat analysis. However, this low-cost, safe outdoor intervention may provide unmeasured or longer-term benefits for children with higher risk of mental health symptoms.

Trial Registration

ClinicalTrials.gov Identifier: NCT05662436.

The role of torso stiffness and prediction in the biomechanics of anxiety: a narrative review

Although anxiety is a common psychological condition, its symptoms are related to a cardiopulmonary strain which can cause palpitation, dyspnea, dizziness, and syncope. Severe anxiety can be disabling and lead to cardiac events such as those seen in Takotsubo cardiomyopathy. Since torso stiffness is a stress response to unpredictable situations or unexpected outcomes, studying the biomechanics behind it may provide a better understanding of the pathophysiology of anxiety on circulation, especially on venous impedance. Any degree of torso stiffness related to anxiety would limit venous return, which in turn drops cardiac output because the heart can pump only what it receives. Various methods and habits used to relieve stress seem to reduce torso stiffness. Humans are large obligatory bipedal upright primates and thus need to use the torso carefully for smooth upright activities with an accurate prediction. The upright nature of human activity itself seems to contribute to anxiety due to the needed torso stiffness using the very unstable spine. Proper planning of actions with an accurate prediction of outcomes of self and non-self would be critical to achieving motor control and ventilation in bipedal activities. Many conditions linked to prediction errors are likely to cause various degrees of torso stiffness due to incomplete learning and unsatisfactory execution of actions, which will ultimately contribute to anxiety. Modifying environmental factors to improve predictability seems to be an important step in treating anxiety. The benefit of playful aerobic activity and proper breathing on anxiety may be from the modulation of torso stiffness and enhancement of central circulation resulting in prevention of the negative effect on the cardiopulmonary system.

Embodied earth kinship: interoceptive awareness and relational attachment personal factors predict nature connectedness in a structural model of nature connection

Previous research has found that nature connectedness, an experiential close connection to nature with cognitive, affective and physical benefits, profoundly impacts individual wellbeing and subsequently increases pro-environmental behaviors. However, little is known about the personal and contextual factors that predict nature connectedness. Testing theory derived from a qualitative interpretative phenomenological analysis study, this research addresses the lacuna in the literature. A structural equation model analysis finds that interoceptive awareness significantly predicts nature connection, that secure attachment to nature significantly explains this relationship, and that these inter-related constructs predict both pro-environmental behavior and wellbeing. This revised model of nature connection indicates important antecedents for the human-nature bond, illuminating in particular that the interpersonal relational processes foundational for close bonding with humans also occur in bonding with nature. Structural equation modeling indicates that emotional awareness is the dimension of interoceptive awareness that most significantly predicts nature connection, suggesting that the more aware a person is of the connection between inner bodily sensations and emotions, the more likely they can bond with nature. Given that interoceptive awareness indicates a coherent relationship with the self, including effective communication between body, mind and feelings, this process is therefore implicated in the capacity for humans to bond with nature. In sum, this present research points to the efficacy of an embodied, secure attachment with nature to help close both the human-nature disconnection chasm, and the environmental value-action gap. Theoretical and methodological implications for research and policy are discussed.

Credibility of the evidence on green space and human health: an overview of meta-analyses using evidence grading approaches

BACKGROUND

Green space is an important part of the human living environment, with many epidemiological studies estimating its impact on human health. However, no study has quantitatively assessed the credibility of the existing evidence, impeding their translations into policy decisions and hindering researchers from identifying new research gaps. This overview aims to evaluate and rank such evidence credibility.

METHODS

Following the PRISMA guideline, we systematically searched PubMed, Web of Science, and Embase databases for systematic reviews with meta-analyses concerning green spaces and health outcomes published up to January 15, 2024. We categorized the credibility of meta-analytical evidence from interventional studies into four levels (i.e., high, moderate, low, and very low) using the Grading of Recommendation, Assessment, Development and Evaluations framework, based on five domains including risk of bias, inconsistency, indirectness, imprecision, and publication bias. Further, we recalculated all the meta-analyses from observational studies and classified evidence into five levels (i.e., convincing, highly suggestive, suggestive, weak, and non-significant) by considering stringent thresholds for P-values, sample size, robustness, heterogeneity, and testing for biases.

FINDINGS

In total, 154 meta-analysed associations (interventional = 44, observational = 110) between green spaces and health outcomes were graded. Among meta-analyses from interventional studies, zero, four (wellbeing, systolic blood pressure, negative affect, and positive affect), 20, and 20 associations between green spaces and health outcomes were graded as high, moderate, low, and very low credibility evidence, respectively. Among meta-analyses from observational studies, one (cardiovascular disease mortality), four (prevalence/incidence of diabetes mellitus, preterm birth, and small for gestational age infant, and all-cause mortality), 12, 22, and 71 associations were categorized as convincing, highly suggestive, suggestive, weak, and non-significant evidence, respectively.

INTERPRETATION

The current evidence largely confirms beneficial associations between green spaces and human health. However, only a small subset of these associations can be deemed to have a high or convincing credibility. Hence, future better designed primary studies and meta-analyses are still needed to provide higher quality evidence for informing health promotion strategies.

FUNDING

The National Natural Science Foundation of China of China; the Guangzhou Science and Technology Program; the Guangdong Medical Science and Technology Research Fund; the Research Grant Council of the Hong Kong SAR; and Sino-German mobility program.

Effects of different natural soundscapes on human psychophysiology in national forest park

Most of the current soundscape research content is limited to the discussion of the restoration effect of single-element soundscapes, but it is the combination of sounds that is common in outdoor activities, and there is no evidence that the restoration of natural soundscapes is better with multi-element combinations. In this study, the Zhangjiajie National Forest Park in China was used as the research object, and the physiological indices of the subjects were collected through electroencephalogram signals, and the POMS short-form psychological scale was used to understand the subjective psychological responses of the subjects to the soundscape. The results showed that (1) The psychophysiological restorative ability of the natural soundscape of the National Forest Park was confirmed, and the subjects' psychological and physiological indices changed significantly and positively after listening to each section of the natural soundscape (p = 0.001). (2) The restorative effect of the multi-natural sound combination was ranked first in the overall ranking of the five natural soundscapes, and the multi-natural sound combination did indeed provide better restorative effects than the single-element sounds. (3) Gender does not usually have a significant effect on the restoration effect, and only Windy Sound among the four single-element nature sound landscapes and one multi-element combination of nature sound landscapes showed a significant gender difference, so in general, the effect of gender on the restoration effect of nature sound landscapes is not significant. In terms of research methodology, this study used cluster analysis to cluster the five types of natural soundscapes according to psychological and physiological recovery ability, and used ridge regression to construct mathematical models of the psychological and physiological recovery of each of the four natural soundscapes. The study of human physiological and psychological recovery from different types of natural soundscapes in China's national forest parks will provide a basis for soundscape planning, design, and policy formulation in national forest parks.

The effect of forest composition on outdoor recreation

Climate change will shift the composition of northern Minnesota forests from boreal to temperate by the end of the century. This shift in forest composition will likely affect outdoor recreation, a valuable ecosystem service and a key economic driver for the region. In this context, the objective of our paper is to empirically examine the relationship between forest composition and recreation. We analyze the effect of changes in forest composition for seven forest types on seven types of recreation using a lognormal pooled panel regression model for Minnesota's Laurentian Mixed Forest Province. Earlier research showed forest composition affected recreation at the level of broad groups of broadleaved or coniferous species. We find a statistically significant empirical association between forest composition and recreation at the forest type level (forest types within those broad groups). This relationship varies across forest types and recreation categories. For example, big game hunting is positively related to elm-ash-cottonwood and white-red-jack pine and negatively associated with aspen-birch. We find individual forest types within broad groups of broadleaved or coniferous forests, have different relationships with recreation, so that these broad groups are not sufficient in capturing the effect of forest composition on recreation. Our results are of interest in the context of current shifts in forest composition caused by climate change, which could also affect recreation. Our findings suggest adding a forest composition lens to existing policies could facilitate strategies for more effective recreation management and climate change adaptation.

Nature-based experience in Venetian lagoon: Effects on craving and wellbeing in addict residential inpatients

Introduction

It is known that exposure to the natural environment may positively modulate mental processes and behaviors; in particular, it can reduce stress, anxiety, and depressive symptoms. This suggests a potential integration of "nature experience" into the treatment for substance use disorder (SUD) since various types of addiction are associated with anxiety and depression. Considering that only one study has been reported to date in patients with alcohol use disorder, the effect of nature experience in SUD patients' needs to be further investigated. This study aimed to test the effects of exposure to a natural lagoon environment on craving and measures of wellbeing in SUD patients in comparison to exposure to an urban environment.

Methods

Twenty-four SUD patients were divided into three groups of eight participants and exposed to two walking sessions (interspersed with a 1-week wash-out period) in a natural environment typical of the Venetian lagoon, an Urban walk, or staying at the residential center based on a Latin-square design. Before and after each session, drug craving, mood, wellbeing, agency, openness to the future, and restorativeness were assessed.

Results

The Nature walk significantly decreased craving in participants compared to their pre-walk values, and compared to craving after the Urban walk, with the latter significantly increased vs. pre-walk values. The Nature walk significantly decreased negative mood and increased wellbeing and agency. Openness to the future and restorativeness measures showed significant improvement after the Nature walk compared to the Urban walk. On the other hand, craving scores after the Urban Walk positively correlated with negative mood and a Sense of Negative Agency values and negatively correlated with wellbeing scores.

Discussion

Our results confirm that "nature experience" may improve mood, wellbeing, attention, stress relief, openness, and sense of being active in SUD patients. Moreover, we also showed a specific effect on drug craving-a key symptom of SUD.

Construction of the "Full Path" of restorative effects on older adults' mental health in parks under seasonal differences: taking Changchun as an example

With the aging and older adults' mental health problems in China, more attention has been paid to the restorative environment. As an important restorative environment in the city, the mental health restorative effect of park environment has been confirmed. However, further exploration is needed to determine whether winter parks have positive effects, their differences from non-winter parks, and the specific pathways of these effects. Therefore, this study constructed a "full path" for the restorative effects of older adults' mental health in parks under seasonal differences, including four components: perceived environment, affective feedback, behavioral feedback, and restorative effect, forming four pathways. Based on this, this study obtained 211 and 240 sample data in winter and non-winter parks, and verified the validity of various hypotheses and mediation paths using structural equation models. It found that: (1) overall restorative effects existed in different seasons; (2) in winter, perceived environmental assessment was not a direct antecedent of restorative effects, and affective feedback and Moderate and Vigorous Physical Activity (MVPA) feedback were important mediating factors, and the chain mediated pathway existed; (3) in non-winter, both direct, indirect and chain mediated effects existed, and affective feedback and Low Physical Activity (LPA) feedback were important mediating factors. Based on this, this study divided parks into "affective inducing" and "behavioral promoting" types, and proposed corresponding planning priorities to positively intervene in planning and design practices.

A scoping review of human health co-benefits of forest-based climate change mitigation in Europe

Climate change is a pressing global challenge with profound implications for human health. Forest-based climate change mitigation strategies, such as afforestation, reforestation, and sustainable forest management, offer promising solutions to mitigate climate change and simultaneously yield substantial co-benefits for human health. The objective of this scoping review was to examine research trends related to the interdisciplinary nexus between forests as carbon sinks and human health co-benefits. We developed a conceptual framework model, supporting the inclusion of exposure pathways, such as recreational opportunities or aesthetic experiences, in the co-benefit context. We used a scoping review methodology to identify the proportion of European research on forest-based mitigation strategies that acknowledge the interconnection between mitigation strategies and human impacts. We also aimed to assess whether synergies and trade-offs between forest-based carbon sink capacity and human co-benefits has been analysed and quantified. From the initial 4,062 records retrieved, 349 reports analysed European forest management principles and factors related to climate change mitigation capacity. Of those, 97 studies acknowledged human co-benefits and 13 studies quantified the impacts on exposure pathways or health co-benefits and were included for full review. Our analysis demonstrates that there is potential for synergies related to optimising carbon sink capacity together with human co-benefits, but there is currently a lack of holistic research approaches assessing these interrelationships. We suggest enhanced interdisciplinary efforts, using for example multideterminant modelling approaches, to advance evidence and understanding of the forest and health nexus in the context of climate change mitigation.

The Inverse Association between the Frequency of Forest Walking (Shinrin-yoku) and the Prevalence of Insomnia Symptoms in the General Japanese Population: A Japan Multi-Institutional Collaborative Cohort Daiko Study

Since a single forest walk (Shinrin-yoku or forest bathing) session is reported to improve sleep temporarily, occasional forest walks may have a positive effect on daily sleep. Therefore, this study aimed to examine whether more frequent forest walking is associated with better daily sleep conditions. Data from the second survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko Study conducted among residents of Nagoya City, Japan, were used. The study design was a cross-sectional study. In total, 2044 participants (529 men and 1515 women; age, mean ± standard deviation: 58.8 ± 9.9 years) were included in the analysis. Frequent forest walks were associated with a low percentage of insomnia symptoms (Insomnia Severity Index ≥10) in women, but not in men. The adjusted odds ratio for the group that rarely took forest walks with reference to the group that engaged in the activity once a month or more often was 2.04 (95% confidence interval: 1.29-3.23) in women. Forest walk frequency was not significantly associated with sleep duration or sleep efficiency as measured by actigraphy in either men or women. In conclusion, the results suggested that increasing the frequency of forest walks or Shinrin-yoku may be effective in preventing insomnia in women.

How do women feel cold water swimming affects their menstrual and perimenopausal symptoms?

OBJECTIVE

This study aimed to determine how women felt cold water swimming affected their menstrual and perimenopausal symptoms.

STUDY DESIGN

An online survey that asked women who regularly swim in cold water about their experiences. The survey was advertised for 2 months on social media. Questions related to cold water swimming habits and menstrual and perimenopausal symptoms were analysed.

MAIN OUTCOME MEASURES

Quantitative and qualitative data including; frequency of menstrual and menopause symptoms, the effect of cold water swimming on these symptoms.

RESULTS

1114 women completed the survey. Women reported that cold water swimming reduced their menstrual symptoms, notably psychological symptoms such as anxiety (46.7%), mood swings (37.7%) and irritability (37.6%). Perimenopausal women reported a significant improvement in anxiety (46.9%), mood swings (34.5%), low mood (31.1%) and hot flushes (30.3%). The majority of women with symptoms swam specifically to reduce these symptoms (56.4% for period and 63.3% for perimenopause symptoms). Women said they felt it was the physical and mental effects of the cold water that helped their symptoms. For the free text question, five themes were identified: the calming and mood-boosting effect of the water, companionship and community, period improvements, an improvement in hot flushes and an overall health improvement.

CONCLUSION

Women felt that cold water swimming had a positive overall effect on menstrual and perimenopause symptoms. Studies on other forms of exercise to relieve menstrual and perimenopause symptoms may show similar findings.

The swimming habits of women who cold water swim

BACKGROUND

Cold water swimming is growing in popularity, especially among women. We have previously reported that women felt that cold water swimming helps with their menstrual and menopause symptoms. But little is known about the habits of women who cold water swim.

OBJECTIVES

To determine the habits of women who cold water swim.

DESIGN

This was a mixed-methods study.

METHODS

An online survey asked women who cold water swim about their experience of swimming and how this affected their menstrual and menopause symptoms. The survey was advertised for 2 months on social media, with a focus on advertising in cold water swimming Facebook groups. In this article, only the questions on the women's swimming habits were analyzed.

RESULTS

The analysis of 1114 women, mainly from the United Kingdom, revealed that most had been swimming for 1-5 years (79.5%). Most swim in the sea (64.4%), and only 15.5% swim alone. The majority (89.0%) swim all year around, swimming for mainly 30-60 min in the summer and 5-15 min in the winter. The women mostly swim wearing swimming costumes (skins) throughout the year. The majority of the free-text responses showed women found mental and physical benefits from cold water swimming.

CONCLUSION

It was not surprising to learn that women swim for longer in the summer than the winter, but hearing how they feel cold water swimming helps their physical and mental health is important. With the limitations on access and safety of many wild swimming sites in the United Kingdom, it is time to ensure that cold water swimming is safer and more supported.

The mechanisms of nature-based therapy on depression, anxiety, stress, and life satisfaction: examining mindfulness in a two-wave mediation model

Background

Nature-based therapy (NBT), which centers around engaging in activities within natural surroundings, has consistently demonstrated therapeutic benefits for mental health. While NBT highlights the potential of nature as a therapeutic resource for promoting mental health, there is limited knowledge regarding its underlying mechanisms.

Methods

Two hundred seventy-six Korean participants (204 women, mean age = 54.99 ± 23.25 years) participated in a 30-session gardening program held twice weekly for 15 weeks. Structural equation modeling with a two-wave autoregressive cross-lagged model was used to investigate the mediating effects of mindfulness.

Results

NBT significantly improved the mean scores of all psychological variables. The mediation model was partially confirmed, with mindfulness at post-intervention (T2) mediating the relationship between baseline (T1) depression and anxiety and post-intervention (T2) life satisfaction. However, no significant indirect effect was observed between the path from stress (T1) to life satisfaction (T2).

Conclusion

Mindfulness is a crucial component for improving mental health outcomes. This study underscores the need to prioritize and emphasize mindfulness practices in NBT.

Spending time in the forest or the field: qualitative semi-structured interviews in a randomized controlled cross-over trial with highly sensitive persons

Introduction

The effects of spending time in forests have been subject to investigations in various countries around the world. Qualitative comparisons have been rarely done so far.

Methods

Sixteen healthy highly sensitive persons (SV12 score ≥ 18) aged between 18 and 70 years were randomly assigned to groups spending 1 h in the forest and in the field at intervals of one week. Semi-structured interviews were conducted after each intervention and analyzed using a mixed-methods approach of content analysis and grounded theory.

Results

Both natural environments induced feelings of inner calmness, inner cleansing, joy, freedom, connectedness, strengthening qualities, and heightened body awareness. The forest environment additionally offered emotional shelter, and showed advantages in promoting inner strength and self-concentration.

Discussion

People with previous negative experiences in the forest may feel safer in fields because of the wider view and better overview. Important preconditions are enough time and the absence of a judgmental authority. The two environments induced in part different but also similar emotions which might be useful to promote psychological well-being differentially.

Benefits of Urban Forest Healing Program on Depression and Anxiety Symptoms in Depressive Patients

Depression is considered a widespread mental health problem worldwide. Moreover, anxiety symptoms are very closely related to depression in patients, and it is known that the coexistence rate of depression and anxiety diagnosed simultaneously is high. Treatment and preventive management of depression and anxiety are essential for public health. Forest healing is attracting attention as a form of low-cost preventive medicine that is safe and has no side effects. However, although the physiological and psychological effects have been scientifically proven, it is insufficient to reveal a direct relationship between forest healing and depression. This study investigated the benefits of an urban forest healing program on depression and anxiety symptoms in depressive disorders. We employed a randomized controlled trial design. Forty-seven depressive patients were randomly divided into an urban forest healing program group and a control group. Measures included the Montgomery-Asberg depression rating scale (MADRS), the Hamilton Anxiety Rating Scale (HARS), and the State-Trait Anxiety Inventory (STAI) questionnaires. Our results revealed that the combination of general treatment and forest healing programs for patients with depression is more effective in improving depression and anxiety than routine treatment alone. We expect our work to serve as a starting point for more sophisticated research discussing the availability of non-pharmacological treatments in forest healing.

Nature-Based Interventions in the UK: A Mixed Methods Study Exploring Green Prescribing for Promoting the Mental Wellbeing of Young Pregnant Women

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups (n = 6) were conducted with nature activity providers and young mothers (n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women's engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.

Nature As Medicine: The 7th (Unofficial) Pillar of Lifestyle Medicine

There are 6 Official Pillars of Lifestyle Medicine, and now mounting evidence supports daily exposure to nature and fresh air as vital to optimizing overall physical and mental health. Time spent in nature has been shown to help lower blood pressure, reduce nervous system arousal, enhance immune system function, reduce anxiety and increase self-esteem. The positive effects of time spent in nature span different occupations, ethnic groups, financial status and individuals with a variety of chronic illnesses and disabilities. "Forest Bathing" is the term coined by Japanese researchers for walking in the woods. It is suspected that aerosols from trees, when inhaled during a forest walk, are one factor responsible for elevated immune system Natural Killer (NK) cells, which help fight off infections and tumor growth. In a culture of ever-increasing technology and screen time, now more than ever it is crucial to educate and empower individuals to incorporate nature into therapeutic treatment regimens. This article will demonstrate the potential benefits of nature, share evidence supporting nature as medicine and provide tools to help engage individuals to spend more time outdoors.

Do Mental Health Changes in Nature Co-occur with Changes in Heartrate Variability and Executive Functioning? A Systematic Review

PURPOSE OF REVIEW

Given the global burden of mental health issues, new solutions are needed to promote mental health. Nature exposure represents a promising option to promote mental health, but the mechanisms are poorly understood. Recent frameworks have argued that changes in mental health in nature are caused by activity changes in the vagus nerve, which connects the heart and the brain, and that these changes also improve executive functioning (EF) abilities. This suggests that changes in mental health symptomology in nature should be accompanied by changes in vagus nerve activity, as well as changes in executive functioning. Yet, little work has systematically examined co-variation of these outcomes in empirical studies. The present manuscript systematically examines whether changes in mental health in nature are accompanied by changes in vagus nerve activity (approximated by heartrate variability) and changes in executive functioning.

RECENT FINDINGS

There is compelling evidence that spending time in nature can increase heartrate variability, improve mental health, and improve executive functioning. However, despite strong theoretical claims that these three outcomes should be linked after spending time in nature settings, few studies directly examine such co-occurrence. The study systematically examines whether studies that considered both mental health and executive functioning (n = 6) showed co-occurring effects in response to nature exposure. Similarly, the study also considers if studies examining mental health and heartrate variability (n = 6) showed similarly directional effects following nature exposure. This systematic review concludes with discussion about the limited number of studies (n =1) that include all three measures. We find mixed results of co-occurrence with these variables, suggesting that the relationship between these three constructs in nature may be more nuanced than current theory suggests. Perhaps more importantly, our results demonstrate that there is very little existing work linking changes in mental health to changes in EF and vagal tone. We conclude with justification for why it may be beneficial for researchers to include all three metrics as well as guidance on how to do so.

Demographic, Psychosocial, and Lifestyle-Related Characteristics of Forest Therapy Participants in Italy: A Multicenter Cross-Sectional Survey

This research aims to provide a comprehensive overview of the key demographic, psychosocial, and lifestyle-related characteristics of forest therapy participants in Italy. A survey was conducted among 1070 adults who had engaged in standardized forest therapy experiences between June 2021 and October 2022. The findings indicate that most forest therapy participants in Italy share certain distinctive traits. They are primarily female, aged between 45 and 54 years, employed, and unmarried. Moreover, they possess a high level of education, predominantly reside in urban areas, demonstrate a strong environmental awareness, maintain a nature-oriented attitude, and typically exhibit moderate levels of trait anxiety. Additionally, they tend to be nonsmokers, possess a healthy BMI within the normal range, and consume an adequate quantity of fruits and vegetables on a daily basis. However, it should be noted that their male counterparts tend to be overweight and exhibit poorer dietary habits. Irrespective of gender, approximately 40% of forest therapy participants in Italy live with a chronic disease that requires daily medicinal treatment. Subsequent research should investigate whether these characteristics hold true in different countries. Furthermore, exploring the potential effectiveness of health-promoting interventions integrated with forest therapy sessions could prove beneficial in addressing these specific issues among forest therapy participants. By doing so, such interventions have the potential to contribute significantly to public health promotion and overall community well-being.

Bibliometric Analysis of Nature-Based Therapy Research

Unrestrained urbanisation and natural space loss are reducing contact with nature in today's society, producing negative consequences for people's mental and physical health and wellbeing. Nature-based therapies, such as physical activity in natural settings, forest bathing, therapeutic hiking, or experiential learning, reduce anxiety and depressive symptoms and improve the quality of life in both general and specific populations. A bibliometric analysis of research on nature-based therapies was performed by applying the traditional laws of bibliometrics (exponential growth law, Bradford's concentration law, Lotka's law, Zipf's law, etc.) to documents published in journals indexed in the Core Collection of the Web of Science (WoS). Graphical visualisation was performed using the VOSviewer software. Annual publications between 2006 and 2021 presented an exponential growth trend (R² = 91%). The International Journal of Environmental Research and Public Health (MDPI) and Urban Forestry & Urban Greening (Elsevier) were the most productive and cited journals. Ikei, Miyazaki, and Song are the most cited prolific authors. The USA and South Korea were the countries with the highest scientific production. In recent years, there has been a growing interest in adventure, nature, and forest therapies among researchers. Nature-based therapies have experienced a growing interest in recent years. Positive effects on mental, physical, and emotional health have been found in different populations and research lines, although more studies with different designs and populations are needed.

Effects of soothing images and soothing sounds on mood and well-being

OBJECTIVES

Mental health problems are increasing at an alarming rate, calling for the need for more cost-effective and easily accessible interventions. Visual images and sounds depicting nature have been found to have positive effects on individuals' mood and well-being; however, the combined effects of images and sounds have been scarcely investigated. This study therefore aimed to compare the mood effects of viewing nature-related soothing images versus listening to soothing sounds versus a combination of both.

METHODS

In this study, 149 participants aged 18-83 years old (M = 35.88, SD = 15.63; 72.5% female, male 26.8%, .7% transgender) were randomised into three intervention conditions: images only, sounds only or combined (images and sounds). Baseline depressive and anxiety symptoms were indexed, and four outcome variables (positive affect, negative affect, serenity affect and depressive mood states) were measured pre- and post-intervention.

RESULTS

Findings showed that all participants, regardless of group, reported a decrease in negative affect, positive affect and depressive mood as well as an increase in serenity affect (including feelings of soothe). However, there were no group differences. Exploratory analyses found that individuals with higher levels of depressive and anxiety symptoms at baseline experienced greater reduction in negative affect and depressive mood state, as well as a larger increase in serenity affect.

CONCLUSIONS

These findings therefore provide preliminary evidence that, upon further research and development, images and sounds depicting nature can potentially be developed for use as an effective tool to improve mood and well-being.

Effects of Plant-Emitted Monoterpenes on Anxiety Symptoms: A Propensity-Matched Observational Cohort Study

Immersive experiences in green areas, particularly in forests, have long been known to produce beneficial effects for human health. However, the exact determinants and mechanisms leading to healthy outcomes remain to be elucidated. The purpose of this observational cohort study was to investigate whether inhaling plant-emitted biogenic volatile compounds, namely monoterpenes (MTs), can produce specific effects on anxiety symptoms. Data from 505 subjects participating in 39 structured forest therapy sessions at different Italian sites were collected. The air concentration of monoterpenes was measured at each site. STAI state questionnaires were administered before and after the sessions as a measure of anxiety. A propensity score matching analysis was then performed, considering an above-average exposure to inhalable air MTs as the treatment. The estimated effect was -1.28 STAI-S points (95% C.I. -2.51 to -0.06, p = 0.04), indicating that the average effect of exposure to high MT air concentrations during forest therapy sessions was to decrease anxiety symptoms.

The Value of Mind-Body Connection in Physical Activity for Older People

Exercise that targets balance and strength is proven to prevent falls in older age. The Successful AGEing yoga trial is the first large randomized controlled trial to assess the impact of yoga on falls in people aged ≥60 years. We conducted a realist process evaluation to explain the strong participant engagement observed using interviews (21 participants and three yoga instructors) and focus groups (12 participants and four yoga instructors). Results showed that relaxation, breathing, and yoga's mind-body connection created a satisfying internal focus on bodily sensation which was valued by participants. The mechanisms of mindfulness and embodiment appeared to facilitate this. Mindfulness and embodiment are also linked to, and enhance engagement with, other forms of physical activity. By focusing creatively on these mechanisms, we can develop a range of programs that target improvements in physical and mental health (including reducing falls and fear of falls) and appeal to older people.

Group Nature-Based Mindfulness Interventions: Nature-Based Mindfulness Training for College Students with Anxiety

The mental health crisis across college campuses is accelerating, with anxiety listed as the top mental health issue for undergraduate college students. Although evidence suggests the COVID-19 pandemic escalated the mental health crisis on college campuses, pre-COVID-19 anxiety among college students was on the rise. Research supports Mindfulness Based Interventions (MBIs) to reduce anxiety among college students. Additionally, exposure to natural environments, which are accessible to students on college campuses, is effective in reducing anxiety. While brief nature-based mindfulness interventions appear effective in reducing anxiety among college students, these interventions are often offered in isolation without social interaction among group members and lack intentional integration of mindfulness and nature-related theories. The purpose of this work is to describe a framework for integrating the use of Mindfulness and Attention Restoration Theory (ART) in an innovative psychoeducational group intervention, Nature-Based Mindfulness Training © (NBMT), for college students with anxiety. In conclusion, we argue for the need to intentionally integrate mindfulness and nature into nature-based mindfulness interventions as an effective and sustainable means to reduce anxiety. Limitations and areas for future research are described.

Brief repeated virtual nature contact for three weeks boosts university students' nature connectedness and psychological and physiological health during the COVID-19 pandemic: A pilot study

The COVID-19 pandemic and its associated uncertainties and restrictions have adverse impacts on university students' mental wellbeing. Evidence shows that virtual nature contact has mental health benefits. However, little is known about the potential beneficial health impacts of virtual nature contact during times of social distancing, when access to the natural environment is restricted. This pilot study aimed to examine the effectiveness of a 3-week virtual nature contact in improving nature connectedness and reducing psychophysiological stress. A sample of 56 university students in Hong Kong was randomly assigned to control and nature interventions using 2-D video played for 15 min three times a week for 3 weeks. Nature connectedness, perceived restorativeness and psycho-physiological wellbeing were measured. Our findings show significant changes in psychological stress levels after nature interventions compared with the baseline, including increased happiness and stronger emotions of comfort and relaxation. When compared with the control group, the results show the nature intervention group has significantly higher levels of nature connectedness, happiness, and positive affect, but no significant effects on other psychological and physiological variables (e.g., cardiovascular responses). Our preliminary findings highlight the potential use of virtual nature contacts in bolstering university students' wellbeing at times of pandemic or when in-person visit to the natural environment is not feasible.

Effectiveness of a natural wellness group program using interactive real-time video for unmarried mothers: A quasi-experimental study

BACKGROUND

Unmarried mothers who raise their children alone in South Korea experience various difficulties in maintaining their health. Improving the health of unmarried mothers, who are socioeconomically vulnerable, is important not only for them but also for the healthy growth and development of their children. We aimed to implement a natural wellness group program using an interactive real-time video platform for unmarried mothers and to verify its effects.

METHODS

This quasi-experimental study utilized a sequential explanatory mixed-methods design. The participants were unmarried mothers raising children aged 0-6 years. The quantitative data collection occurred from August to November 2021. For the qualitative data collection, semi-structured interviews were conducted with seven participants from the experimental group. The experimental group received eight 90-minute weekly online sessions, whereas the control group received no intervention. The outcome variables were physical and mental health, depression, anxiety, self-esteem, and parenting stress.

RESULTS

A total of 42 unmarried mothers (21 experimental, 21 control) participated. The Wilcoxon signed-rank test revealed significant post-intervention differences in mental health, depression, and self-esteem in the experimental group. Moreover, a generalized estimating equation analysis revealed significant differences in self-esteem levels between the experimental and control groups. Four themes identified through qualitative analysis revealed that the natural wellness group program using interactive real-time video not only increased mothers' vitality and relaxation but also improved depression and anxiety, and had a positive effect on parenting stress.

CONCLUSIONS

Natural wellness group programs using interactive real-time videos can help improve the psychological health of unmarried mothers with young children, a group that tends to be socially and psychologically marginalized.

Green spaces for mental disorders

PURPOSE OF REVIEW

Mental illness is a global challenge, exacerbated by the coronavirus pandemic. Research suggests access to local green spaces is associated with better mental health, yet access is not always equitable. Evaluation of how nature-based interventions protect and support mental health is therefore required.

RECENT FINDINGS

Accessible local green spaces are associated with better mental health. They encourage active behaviours and social interaction, reduce loneliness and stress. Green views from the home are associated with increased self-esteem, life satisfaction and happiness and reduced depression, anxiety and loneliness. Nature-based interventions and green social prescriptions effectively target vulnerable groups, resulting in significant reductions in depression, anxiety and anger alongside positive mental health outcomes.

SUMMARY

Although existing evidence is encouraging, robust, high-quality research that strengthens the evidence base and informs future clinical practice and policy decision making is needed. Evidence of the long-term effectiveness in individuals with diagnosed mental illness is also required to ascertain the potential social and wider returns on investment. Barriers to use of green social prescriptions like mental health symptoms and geographical accessibility need to be overcome to increase accessibility and uptake of green social prescriptions for the prevention and treatment of mental illness.

Effects of Urban Forest Therapy Program on Depression Patients

Depression is a common serious mental health condition that can have negative personal and social consequences, and managing it is critical for treating depression patients. Forest therapy is emerging as a promising non-pharmacological intervention to improve mental health. However, although the effectiveness of forest therapy programs using forests far from the city has been proven, it is not well known that urban forests can be easily accessed in daily life. Therefore, this study aimed to examine the effects of an urban forest therapy program on depression symptoms, sleep quality, and somatization symptoms of depression patients. To evaluate this, a randomized controlled trial (RCT) design was employed. A total of 47 depression patients participated in this study (22 in the urban forest therapy program group and 25 in the control group). The Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were administered to each participant to assess the effects of the urban forest therapy program. The results of this study revealed that depression patients in the urban forest therapy program had significantly alleviated depression symptoms and improved sleep quality and somatization symptoms compared to the control group. In conclusion, this study demonstrates the possibility that the urban forest therapy program could be used as an effective non-pharmacological treatment to alleviate depression disorder.

The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis

Urban residents have a higher risk of hypertension and psychological stress than rural residents. Aside from medical interventions, understanding how to control hypertension and alleviate the stress of urban populations has become a public concern. As an alternative medical measure, forest therapy has shown the effects of normalizing blood pressure (BP) and reducing stress increasingly in recent literature, but this is still inconclusive. In order to systematically verify forest therapy’s effects on the BP and mental stress of urban residents, we conducted meta-analyses to assess the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group and urban control group. We searched 4 online databases, and 21 studies on BP involving 2270 participants and 13 studies on SCC involving 1786 participants were included. Through the meta-analysis, the mean difference and confidence interval (CI) estimates indicated that forest therapy significantly reduced participants’ SBP −3.44 (95% CI −5.74, −1.14), DBP −3.07 (95% CI −5.59, −0.54), and SCC −0.07 (95% CI −0.10, −0.04), as compared with urban control. Yet, there was substantial heterogeneity (I2 = 72.87−88.59%) among these studies. We also found that each prediction interval (PI) for SBP (95% PI −13.30, 6.42), DBP (95% PI −15.54, 9.41), and SCC (95% PI −0.18, 0.05) were all much wider than the CIs and contained values above 0. This means that forest therapy may reduce SBP, DBP, and SCC on average, but may not exclude adverse results. Meta-regression analyses showed that participants’ age and baseline SBP levels determined the heterogeneity among SBP studies. After forest therapy, older participants and those with higher baseline SBP levels had greater SBP-lowering effects. Among DBP studies, the primary source of heterogeneity was participants’ baseline DBP levels; participants with higher baseline DBP levels had greater DBP reduction. In subgroup analyses, we discovered that longer-term forest therapy programs (≥20 min) resulted in a greater reduction in BP and SCC than shorter-term forest therapy programs (<20 min). Additionally, seated viewing, walking, or multi-session programs in forests were observed to have similar effects on reducing BP and SCC. Despite extensive analyses, the study did not identify any sources of heterogeneity among forest therapy programs for lowering SCC levels. Overall, we conclude that forest therapy programs have beneficial therapeutic effects on urban residents’ physio-psychological health through lowering BP and relieving stress (reducing SCC). This finding provides solid evidence of the contribution of forest therapy to urban residents’ health and wellbeing.

Social prescribing of nature therapy for adults with mental illness living in the community: A scoping review of peer-reviewed international evidence

Social prescribing of nature therapy "green social prescribing" facilitates access to local nature-based activities that improve biopsychosocial wellbeing outcomes, are affordable, accessible, and can be adapted to context. These are becoming increasingly popular and gray literature is emerging, however, peer-reviewed scientific evidence is exiguous. This scoping review aimed to identify and critique peer-reviewed evidence for green social prescribing interventions and develop recommendations for research and clinical practice. Included studies were published in peer-reviewed journals in English on/after 1 January 2000. Participants were community-living adults with mental illness; Intervention was any green social prescribing program; Comparator was not restricted/required; Outcomes were any biopsychosocial measures; and any/all Study Designs were included. Twelve databases were searched on 15 October 2022; these were Academic Search Premier, APA PsycArticles, APA PsycINFO, CINAHL, Cochrane Library, Google Scholar, JSTOR, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Mixed Methods Appraisal Tool was used to assess quality. Seven publications describing 6 unique studies (5 UK, 1 Australia) were identified including 3 mixed-methods, 2 qualitative, and 1 RCT. Participants included 334 adults (45% female, aged 35-70 years); sample sizes ranged from 9 to 164. All studies showed improvements in biopsychosocial wellbeing, and participants from most studies (n = 5) reported increased connection to the earth and intention to further access nature. Participant demographics and diagnoses were poorly reported, and intervention activities and assessments varied considerably. However, MMAT scores were good overall suggesting these studies may reliably demonstrate intervention outcomes. We conclude that socially prescribed nature therapy can improve biopsychosocial wellbeing and is a potentially important intervention for mental illness. Recommendations for research and clinical practice are provided.

Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysis

Introduction

Nature exposure is a widely accepted option for promoting public health owing to the recent surge of scientific evidence. However, the actual settings to facilitate this initiative is yet to be extensively reviewed. In this systematic review, we have aimed to provide an up-to-date summary of interventional studies investigating the psycho-physiological effects of forests and urban forests, including details on their physical settings, and investigate an effect-modifying role of altitude and summarize data on the magnitude and shape of the association.

Methods

A keyword search using five electronic academic databases (PubMed, Embase, PsycINFO, Web of Science, and Scopus) was conducted to identify relevant articles published in English from the inception year to the end of February 2022. The methodological quality was evaluated using the ROBINS-I or ROB2 tool, depending on the study design. Meta-regression and random effects model were jointly used to examine the relationship between altitude and health outcomes.

Results

We included 27 eligible studies and 31 cases extracted from 19 studies were used for the meta-analysis. In the meta-regression, we observed a non-linear association between altitude and psycho-physiological effects. Altitude had a positive quadratic association with anxiety (p < 0.000, adjusted R ² = 96.79%), depression (p < 0.000, adjusted R ² = 98.78%), and fatigue (p < 0.000, adjusted R ² = 64.74%) alleviating effects. Conversely, altitude demonstrated a negative non-linear association with the blood pressure-lowering effect (p = 0.009, adjusted R ² = 32.83%). Additionally, the thermal index (THI) and illuminance (lx) levels were significantly associated with effect sizes of psychological restoration.

Discussion

This review provides moderate-certainty evidence for an effect-modifying role of altitude. The meta-regression results suggested the optimal and minimal altitude ranges for psychological restoration and physiological relaxation, respectively. Despite some limitations, the study findings provide a significant basis for utilizing altitude, which is easily accessible and simple, to promote the health benefits of nature-based initiatives.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310894, identifier: CRD42022310894.

How Nature Benefits Mental Health

Abstract. We present an overview of the evidence of how nature benefits mental health, popular theories used to explain the effects, and the development potential of these theories. A large body of evidence highlights the beneficial effects of nature on mental health, with observed outcomes ranging from alleviating the symptoms of psychiatric disorders to improvements in cognitive abilities. The theoretical backbone for these salutary effects of nature consists of a set of models, mainly the attention restoration theory (ART), the stress reduction theory (SRT), and the Biophilia hypothesis. However, these high-level models are only loosely related and lack a pronounced biopsychological basis. While biopsychological measurements have been used widely in recent years, these efforts have not sufficiently been reflected in theories aiming to explain the benefits of nature contact for mental health. This paper seeks to encourage interdisciplinary work and further theory development to guide both research and practice toward strategically green and healthy living conditions.