Restorative effects of visits to urban and forest environments in patients with exhaustion disorder

Sonntag-Öström, Elisabet; Nordin, Maria; Lundell, Ylva; Dolling, Ann; Wiklund, Urban; Karlsson, Marcus; Carlberg, Bo; Järvholm, Lisbeth Slunga

doi:10.1016/j.ufug.2013.12.007

Cited by 100 publications

(69 citation statements)

References 45 publications

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“…Mood enhancement has also been found to be linked to visits of natural environments [16,17], especially forests [20,46,47]. In this case study, we found an increase in positive mood and a decrease in negative mood.…”

Section: Discussionsupporting

confidence: 65%

“…A comprehensive body of literature shows that forests contribute to human health and well-being [1,3,10,11]. Forest visits provide restoration, decrease stress [12,13] and blood pressure [14], and improve reflection [15], mood [16][17][18][19][20], cognitive capacity [20], and vitality [21,22]. Restorative places in a forest increase connectedness with nature and the forest and mindfulness [5].…”

Section: Introductionmentioning

confidence: 99%

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Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study

Cervinka

Schwab

Haluza

2020

IJERPH

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Prior research shows that forests contribute to human health and well-being. In this sense, this cross-sectional case study, adopting the principles of citizen science, assessed the restorative potential of places in the Hallerwald, an Austrian community forest. A convenience sample of adult forest visitors (n = 99, 64% females) completed a survey during a guided 2.5 h forest tour. The German questionnaire assessed the qualities of defined places in the forest. We also investigated changes in mood states, perceived stress, restoration, connectedness, and mindfulness before and after visiting the forest. In cooperation with a local working group, we developed the new Widen One’s Mind (WOM) scale, which showed good scale characteristics. All places received high scores in their potential to increase restoration and vitality and to widen one’s mind. Positive affect, restoration, connectedness with nature and the forest, and mindfulness increased pre- versus post-visits, whereas negative affect and perceived stress decreased. The findings of this study suggest that in recreational forests, visitors experience beneficial mental effects such as stress reduction in addition to physical exercise. To facilitate regional development goals, we recommend evaluating places in forests regarding the potential effects on the health and well-being as well as citizen participation before initiating extensive remodeling.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study

Cervinka

Schwab

Haluza

2020

IJERPH

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“…blue space, passive lab setting were not included in meta-analysis. Two studies had multiple 'green' environments: Sonntag-Öström et al (2014) examined differences across a spruce forest, a forest with a lake, and a forest with a rocky outcrop, and Tyrväinen et al (2014) considered both a park and a forest. The first environment listed was selected for both studies.…”

Section: Meta-analysismentioning

confidence: 99%

The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis

Roberts¹,

Lissa²

2019

Preprint

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Background: Research suggests that exposure to the natural environment can improve mood, however, current reviews are limited in scope and there is little understanding of moderators.Objective: To conduct a comprehensive systematic review and meta-analysis of the evidence for the effect of short-term exposure to the natural environment on depressive mood. Methods: Five databases were systematically searched for relevant studies published up to March 2018. Risk of bias was evaluated using the Cochrane Risk of Bias (ROB) tool 1.0 and the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool where appropriate. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence overall. A random-effects meta-analysis was performed. 20 potential moderators of the effect size were coded and the machine learning-based MetaForest algorithm was used to identify relevant moderators. These were then entered into a meta-regression.Results: 33 studies met the inclusion criteria. Effect sizes ranged from -2.30 to 0.84, with an unweighted mean effect size of = −0.29, = 0.60. However, there was significant residual heterogeneity between studies and risk of bias was high. Type of natural environment, type of built environment, gender mix of the sample, and region of study origin, among others, were identified as relevant moderators but were not significant when entered in a meta-regression. The quality of evidence was rated very low to low. An assessment of publication bias was inconclusive. Conclusions:A small effect was found for reduction in depressive mood following exposure to the natural environment. However, the high risk of bias and low quality of studies limits confidence in the results. The variation in effect size also remains largely unexplained. It is recommended that future studies make use of reporting guidelines and aim to reduce the potential for bias where possible.Keywords: systematic review, meta-analysis, natural environment, built environment, green space, depression Highlights:• A systematic review and meta-analysis is conducted of depressive mood following natural environment exposure• Studies published up until March 2018 were searched; 33 studies met the eligibility criteria• A small effect size for reduction in depressive mood following exposure is found• Studies are found to be highly biased and of low or very low quality• No significant moderators of the effect size are identified ABSTRACT Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.

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“…In nature-based rehabilitation (NBR), it has been found that sensory stimuli of outdoor nature experiences can play an important role in treatment of stress-related mental conditions such as exhaustion disorder [35,38,39,40]. Caregivers in NBR claim that the connection to nature through sensory impressions can help patients “open up” to treatment [38].…”

Section: Introductionmentioning

confidence: 99%

The Role of Soundscape in Nature-Based Rehabilitation: A Patient Perspective

Cerwén

Pedersen

Pálsdóttir

2016

IJERPH

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Nature-based rehabilitation (NBR) has convincing support in research, yet the underlying mechanisms are not fully understood. The present study sought to increase understanding of the role of soundscapes in NBR, an aspect paid little attention thus far. Transcribed interviews with 59 patients suffering from stress-related mental disorders and undergoing a 12-week therapy programme in the rehabilitation garden in Alnarp, Sweden, were analysed using Interpretative Phenomenology Analysis (IPA). Described sounds were categorised as natural, technological or human. The results showed that patients frequently referred to natural sounds as being part of a pleasant and “quiet” experience that supported recovery and induced “soft fascination”. Technological sounds were experienced as disturbing, while perception of human sounds varied depending on loudness and the social context. The study further uncovered how sound influenced patients’ behaviour and experiences in the garden, through examination of three cross-theme dimensions that materialised in the study; sound in relation to overall perception, sound in relation to garden usage, and increased susceptibility to sound. The findings are discussed in relation to NBR; the need for a more nuanced understanding of susceptibility to sound among people suffering from mental fatigue was identified and design considerations for future rehabilitation gardens were formulated.

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Restorative effects of visits to urban and forest environments in patients with exhaustion disorder

Cited by 100 publications

References 45 publications

Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study

Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study

The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis

The Role of Soundscape in Nature-Based Rehabilitation: A Patient Perspective

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