Restoring attention in pregnancy: the natural environment

Adding virtual plants leads to higher cognitive performance and psychological well-being in virtual reality

Previous research has shown the positive effects of exposure to real and virtual nature. To investigate how such benefits might generalize to ever-more-prevalent virtual workplaces, we examined the effects of the absence or presence of virtual plants in an office environment in Virtual Reality (VR) on users' cognitive performance and psychological well-being. The results of our user study with 39 participants show that in the presence of virtual plants, participants performed significantly better in both short-term memory and creativity tasks. Furthermore, they reported higher psychological well-being scores, including positive affect and attentive coping, whilst reporting lower feelings of anger and aggression after exposure to virtual plants in VR. The virtual office with plants was also perceived as more restorative and induced a higher sense of presence. Overall, these results highlight how the presence of virtual plants in VR can have positive influences on users, and therefore, constitute important design considerations when developing future working and learning spaces.

Effects of exposure to immersive computer-generated virtual nature and control environments on affect and cognition

Previous research has shown that exposure to immersive virtual nature environments is able to induce positive affective and physiological effects. However, research on the effects on cognitive performance is scarce. Additionally, the effects of virtual nature exposure compared to a virtual control environment with a comparable amount of virtual objects have not been examined so far. Therefore, we conducted an experiment with 27 participants to study the psychological effects of such exposure. The virtual nature consisted of a 3D model of a typical forest environment, whereas the control environment was an abstract replication of the virtual forest environment. In both environments, a virtual wooden cart was used to transport the users from the start to the end of the virtual road. The typical background noise of moving such a cart was integrated into both environments as well. In addition, the virtual nature environment included typical forest sounds in the background, whereas the control condition did not have such background sounds. Both environments were compared with regard to their effects on cognitive performance (using trail making tests (TMTA, TMTB, and TMTB-A) as well as digit span forward and digit span backward tests), perceived restorativeness, mood, stress, sense of presence, and simulator sickness. The results showed that in comparison to the control environment, exposure to the virtual nature resulted in significantly higher cognitive performance, higher perceived restorativeness, higher positive affect, higher sense of presence, lower perceived stress, and lower simulator sickness.

Positive Effects of Nature on Cognitive Performance Across Multiple Experiments: Test Order but Not Affect Modulates the Cognitive Effects

Interactions with natural environments and nature-related stimuli have been found to be beneficial to cognitive performance, in particular on executive cognitive tasks with high demands on directed attention processes. However, results vary across different studies. The aim of the present paper was to evaluate the effects of nature vs. urban environments on cognitive performance across all of our published and new/unpublished studies testing the effects of different interactions with nature vs. urban/built control environments, on an executive-functioning test with high demands on directed attention—the backwards digit span (BDS) task. Specific aims in this study were to: (1) evaluate the effect of nature vs. urban environment interactions on BDS across different exposure types (e.g., real-world vs. artificial environments/stimuli); (2) disentangle the effects of testing order (i.e., effects caused by the order in which experimental conditions are administered) from the effects of the environment interactions, and (3) test the (mediating) role of affective changes on BDS performance. To this end, data from 13 experiments are presented, and pooled data-analyses are performed. Results from the pooled data-analyses (N = 528 participants) showed significant time-by-environment interactions with beneficial effects of nature compared to urban environments on BDS performance. There were also clear interactions with the order in which environment conditions were tested. Specifically, there were practice effects across environment conditions in first sessions. Importantly, after parceling out initial practice effects, the positive effects of nature compared to urban interactions on BDS performance were magnified. Changes in positive or negative affect did not mediate the beneficial effects of nature on BDS performance. These results are discussed in relation to the findings of other studies identified in the literature. Uncontrolled and confounding order effects (i.e., effects due to the order of experimental conditions, rather than the treatment conditions) may explain some of the inconsistent findings across studies in the literature on nature effects on cognitive performance. In all, these results highlight the robustness of the effects of natural environments on cognition, particularly when confounding order effects have been considered, and provide a more nuanced account of when a nature intervention will be most effective.

Cognitive Strategies and Natural Environments Interact in Influencing Executive Function

Exposure to natural environments and the adoption of specific cognitive strategies are each claimed to have a direct influence on executive mental functioning. Here we manipulate both factors to help determine whether they draw on common cognitive resources. Three experiments investigated links between environmental effects (nature vs. urban video tours) and strategic effects (active vs. passive instructional approaches to the task). Each experiment used a pretest-posttest design and assessed executive mental functioning using a backward digit span task and Raven's progressive matrices. Experiment 1 manipulated participants' cognitive strategy through explicit instructions in order to establish a link between cognitive strategy and executive mental functioning. Experiment 2 used a pair of 10-min video tours (urban, nature) to examine the relationship between environmental exposure and executive mental function on the same tasks, replicating previous findings with the backward digit span task and extended them to a new task (i.e., Raven's progressive matrices). In Experiment 3, these two manipulations were combined to explore the relations between them. The results showed that the nature video tour attenuated the influence of task instructions relative to the urban video tour. An interaction between environmental video exposure and cognitive strategy was found, in that effects of cognitive strategy on executive function were smaller in the nature video condition than in the urban video condition. This suggests that brief exposure to nature had a direct positive influence on executive mental functioning.

Attention Restoration Theory II: a systematic review to clarify attention processes affected by exposure to natural environments

Attention Restoration Theory (ART) predicts exposure to natural environments may lead to improved cognitive performance through restoration of a limited cognitive resource, directed attention. A recent review by Ohly and colleagues (2016) uncovered substantial ambiguity surrounding details of directed attention and how cognitive restoration was tested. Therefore, an updated systematic review was conducted to identify relevant cognitive domains from which to describe elements of directed attention sensitive to the restoration effect. Forty-two articles that tested natural environments or stimuli against a suitable control, and included an objective measure of cognitive performance, had been published since July 2013. Articles were subjected to screening procedures and quality appraisal. Random effects meta-analyses were performed to calculate pooled effect sizes across 8 cognitive domains using data from 49 individual outcome measures. Results showed that working memory, cognitive flexibility, and to a less-reliable degree, attentional control, are improved after exposure to natural environments, with low to moderate effect sizes. Moderator analyses revealed that actual exposures to real environments may enhance the restoration effect within these three domains, relative to virtual exposures; however, this may also be due to differences in the typical lengths of exposure. The effect of a participants' restoration potential, based upon diagnosis or fatigue-induction, was less clear. A new framework is presented to qualify the involvement of directed attention-related processes, using examples of tasks from the three cognitive domains found to be sensitive to the restoration effect. The review clarifies the description of cognitive processes sensitive to natural environments, using current evidence, while exploring aspects of protocol that appear influential to the strength of the restoration effect.

The effects of gardening on quality of life in people with stroke

BACKGROUND

Compared with traditional rehabilitation, gardening has been viewed as a more occupation-based intervention to help patients improve functional performance. However, there is still a need for evidence-based research into what factors interact to create the beneficial effects of gardening for people who have sustained a cerebral vascular accident (CVA).

OBJECTIVE

To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life of patients in a gardening program.

METHODS

One treatment of tending short-term plants, and another treatment of tending long-term plants were compared. Quality of life improvement was evaluated according to three factors: plant, gender, and the time after stroke onset. The data were analyzed with 2k replicated factorial designs.

RESULTS

The 2k factorial design with replication indicated significant effects on both the social role and the family role. For the social role, the interaction of plant and gender difference was significant. For the family role, the significant effects were found on interaction of plant with both gender and the time after stroke onset.

CONCLUSIONS

Tending plants with different life cycles has varied effects on the quality of life of people who have sustained a CVA. Factors related to gender and the time after stroke onset influenced role competency in this sample.

Attention Restoration Theory: A systematic review of the attention restoration potential of exposure to natural environments

Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to the quantity of empirical evidence that supports this. A systematic review regarding the impact of exposure to natural environments on attention was conducted. Seven electronic databases were searched. Studies were included if (1) they were natural experiments, randomized investigations, or recorded "before and after" measurements; (2) compared natural and nonnatural/other settings; and (3) used objective measures of attention. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by another. Where possible, random effects meta-analysis was used to pool effect sizes. Thirty-one studies were included. Meta-analyses provided some support for ART, with significant positive effects of exposure to natural environments for three measures (Digit Span Forward, Digit Span Backward, and Trail Making Test B). The remaining 10 meta-analyses did not show marked beneficial effects. Meta-analysis was limited by small numbers of investigations, small samples, heterogeneity in reporting of study quality indicators, and heterogeneity of outcomes. This review highlights the diversity of evidence around ART in terms of populations, study design, and outcomes. There is uncertainty regarding which aspects of attention may be affected by exposure to natural environments.

What is the evidence to support the use of therapeutic gardens for the elderly?

Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging.

Directed Attention in Normal and High‐Risk Pregnancy

OBJECTIVE

To compare the ability to direct attention in women having a high-risk pregnancy with those having an uncomplicated pregnancy.

DESIGN

Descriptive comparative.

SETTING

A tertiary-care hospital.

PARTICIPANTS

Women in the 3rd trimester of pregnancy receiving care from perinatologists were recruited for this study and comprised the high-risk group (n = 67). Women in their 3rd trimester of pregnancy with uncomplicated pregnancies and enrolled in prenatal classes were the comparison group (n = 57).

MAIN OUTCOME MEASURES

Objective measures of directed attention included digit span forward, digit span backward, Trailmaking A, and Trailmaking B. Subjective measures included the Attentional Function Index and Mental Effort in Tasks.

RESULTS

Women having a complicated pregnancy had significantly more difficulty directing attention on all measures than women having normal pregnancies. When all covariates were considered, women having a high-risk pregnancy had significantly more difficulty directing attention as measured by Trailmaking A, Trailmaking B, and Mental Effort in Tasks.

CONCLUSIONS

Women having high-risk pregnancies may have more difficulty with activities that require directed attention than women having normal pregnancies. Learning new information and skills, problem solving, and planning may require additional effort for women having complicated pregnancies.