The evidence for stress recovery in forest therapy programs: investigating whether forest walking and guided forest therapy activities have the same potential?

Abstract

In recent years, forest therapy has become a popular method for improving human health. However, guided forest therapy is not always easily accessible, and forest walking is a more convenient and feasible alternative. Therefore, it is important to determine whether forest walking has the same effect as guided forest therapy. To investigate this, we conducted a campus forest-based study in which 247 university students were randomly assigned to participate in either forest walking or guided forest therapy activities. The study measured physical and psychological interventions in participants, while controlling for the intensity of physical activity. The findings indicated that both approaches were effective in promoting stress relief and physical and mental recovery among university students. No significant difference in effectiveness was observed between the two approaches. Furthermore, we constructed a mediation model that combines the biophilia hypothesis, stress reduction theory, and attention restoration theory to investigate the psychological mechanisms underlying the restorative effects of forest activities. Our findings indicate that an increase in nature connectedness significantly predicts a reduction in state anxiety. This effect is mediated by perceived restorativeness and a combination chain of mediators from perceived restorativeness to mood. This study presents a justification for selecting forest walking as a means of stress relief when guided forest therapy is unavailable. Additionally, it enhances our comprehension of how forests contribute to the restorative effects experienced by individuals.

Keywords

Urban forestry / Campus forest / Anxiety reduction / Nature connectedness / Perceived restorativeness / Mediation

References

[1] Baceviciene M, Jankauskiene R. The mediating effect of nature restorativeness, stress level, and nature connectedness in the association between nature exposure and quality of life. Int J Environ Res Public Health, 2022, 19(4): 2098

[2] Bakir-Demir T, Berument SK, Akkaya S. Nature connectedness boosts the bright side of emotion regulation, which in turn reduces stress. J Environ Psychol, 2021, 76 101642

[3] Berto R. Exposure to restorative environments helps restore attentional capacity. J Environ Psychol, 2005, 25(3249-259

[4] Berto R. The role of nature in coping with psycho-physiological stress: a literature review on restorativeness. Behav Sci, 2014, 4(4): 394-409

[5] Bossenbroek R, Wols A, Weerdmeester J, Lichtwarck-Aschoff A, Granic I, van Rooij MMJW. Efficacy of a virtual reality biofeedback game (DEEP) to reduce anxiety and disruptive classroom behavior: single-case study. JMIR Ment Health, 2020, 7(3 e16066

[6] Brambilla E, Petersen E, Stendal K, Sundling V, MacIntyre TE, Calogiuri G. Effects of immersive virtual nature on nature connectedness: a systematic review and meta-analysis. Digit Health, 2022, 10: 20552076241234639

[7] Browning MHEM, Saeidi-Rizi F, McAnirlin O, Yoon H, Pei Y. The role of methodological choices in the effects of experimental exposure to simulated natural landscapes on human health and cognitive performance: a systematic review. Environ Behav, 2021, 53(7): 687-731

[8] Chan SHM, Qiu L, Esposito G, Mai KP, Tam KP, Cui J. Nature in virtual reality improves mood and reduces stress: evidence from young adults and senior citizens. Virtual Real, 2021

[9] Chang WY, Wang X, Guo DS, Nguyen LHP, Tran NH, Yang SJ, Lin HZ, Wu HC, Huang CF. Explore the effects of forest travel activities on university students' stress affection. Front Psychol, 2024, 14: 1240499

[10] Chen HT, Yu CP, Lee HY. The effects of forest bathing on stress recovery: evidence from middle-aged females of Taiwan. Forests, 2018, 9(7403

[11] Chun HR, Choi YY, Cho I, Nam HK, Kim G, Park S, Cho SI. Indicators of the psychosocial and physiological effects of forest therapy: a systematic review. Forests, 2023, 14(71407

[12] Colley K, Irvine K, Currie M. Who benefits from nature? A quantitative intersectional perspective on inequalities in contact with nature and the gender gap outdoors. Landscape Urban Plann, 2022, 223: 104420

[13] Coughlan A, Ross E, Nikles D, De Cesare E, Tran C, Pensini P. Nature guided imagery: an intervention to increase connectedness to nature. J Environ Psychol, 2022, 80 101759

[14] Cvikl D, Avguštin C, Kreft S. The physiological and psychological effects benefits of forest therapy (FT) on tourists in the kranjska Gora destination. Forests, 2022, 13(101670

[15] Du QY, Liu HW, Yang CJ, Chen XY, Zhang XY. The development of a short Chinese version of the state-trait anxiety inventory. Front Psychiatry, 2022, 13 854547

[16] Eleftheriades R, Fiala C, Pasic MD. The challenges and mental health issues of academic trainees. F1000Res, 2020, 9: 104

[17] Fu X-L, Zhang K, Chen X-F, Chen Z-Y (2023) Report on national mental health development in China (2021–2022). Social Sciences Academic Press (China), Beijing, China

[18] Gobster PH, Kruger LE, Schultz CL, Henderson JR. Key characteristics of forest therapy trails: a guided, integrative approach. Forests, 2023, 14(2186

[19] Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 2010, 10: 113

[20] Gullone E. The biophilia hypothesis and life in the 21st century: increasing mental health or increasing pathology?. J Happiness Stud, 2000, 1(3293-322

[21] Han KT. A review of self-report scales on restoration and/or restorativeness in the natural environment. J Leis Res, 2018, 49(3–5151-176

[22] Hartig T, Evans GW, Jamner LD, Davis DS, Gärling T. Tracking restoration in natural and urban field settings. J Environ Psychol, 2003, 23(2): 109-123

[23] Hartig T, Korpela K, Evans G (1996) Validation of a measure of perceived environmental restorativeness.

[24] Hassan A, Jiang T, Guo L, Jiang MY, Aii L, Jiang ZH, Liu ZF, Chen QB. Effects of walking in bamboo forest and city environments on brainwave activity in young adults. Evid Based Complement Alternat Med, 2018, 2018: 9653857

[25] Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, 20223London, The Guilford Press, New York

[26] Hermans L, Van den Broucke S, Gisle L, Demarest S, Charafeddine R. Mental health, compliance with measures and health prospects during the COVID-19 epidemic: the role of health literacy. BMC Public Health, 2021, 21(1): 1365

[27] Huang X, Luo LY, Li XY, Lin YX, Chen ZQ, Jin C. How do nature-based activities benefit essential workers during the COVID-19 pandemic? The mediating effect of nature connectedness. Int J Environ Res Public Health, 2022, 19(2416501

[28] Huberty J, Green J, Glissmann C, Larkey L, Puzia M, Lee C. Efficacy of the mindfulness meditation mobile app “calm” to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth, 2019, 7(6 e14273

[29] Ideno Y, Hayashi K, Abe Y, Ueda K, Iso H, Noda M, Lee JS, Suzuki S. Blood pressure-lowering effect of shinrin-yoku (forest bathing): a systematic review and meta-analysis. BMC Complement Altern Med, 2017, 17(1409

[30] Igawahara K, Kagawa T, Takayama N, Park BJ. Research on the effect which a guide brings about in a forest walk. J Jpn Inst Landsc Archit, 2007, 70(5597-600

[31] Immich G, Robl E. Development of structural criteria for the certification and designation of recreational and therapeutic forests in Bavaria. Germany Forests, 2023, 14(61273

[32] Jadad AR, O’Grady L. How should health be defined?. BMJ, 2008, 337 a2900

[33] Janeczko E, Górski J, Woźnicka M, Czyżyk K, Kędziora W, Korcz N. Physical activity in forest and psychological health benefits: a field experiment with young Polish adults. Forests, 2023, 14(91904

[34] Jung WH, Woo JM, Ryu JS. Effect of a forest therapy program and the forest environment on female workers’ stress. Urban Urban Green, 2015, 14(2274-281

[35] Kaplan R, Kaplan S. The experience of nature: a psychological perspective, 1989, New York, NY, US, Cambridge University Press

[36] Kaplan S. The restorative benefits of nature: toward an integrative framework. J Environ Psychol, 1995, 15(3): 169-182

[37] Kaplan S, Kaplan R. Cognition and environment: functioning in an uncertain world, 1983, New York, Praeger

[38] Kellert S, Mcvay S, Katcher A, Mccarthy C. The biophilia hypothesis. Bioscience, 1993

[39] Kim JG, Shin WS. Forest therapy alone or with a guide: is there a difference between self-guided forest therapy and guided forest therapy programs?. Int J Environ Res Public Health, 2021, 18(13): 6957

[40] Konijnendijk CC. Evidence-based guidelines for greener, healthier, more resilient neighbourhoods: introducing the 3–30-300 rule. J for Res, 2023, 34(3821-830

[41] Kotera Y, Richardson M, Sheffield D. Effects of Shinrin-Yoku (forest bathing) and nature therapy on mental health: a systematic review and meta-analysis. Int J Ment Health Addict, 2020, 20(1): 337-361

[42] Kotte D, Li Q, Shin WS, Michalsen A. International handbook of forest therapy, 2019, Newcastle upon Tyne, UK, Cambridge Scholars Publishing

[43] Lee HJ, Son YH, Kim S, Lee DK. Healing experiences of middle-aged women through an urban forest therapy program. Urban Urban Green, 2019, 38: 383-391

[44] Leonardi F. The definition of health: towards new perspectives. Int J Health Serv, 2018, 48(4): 735-748

[45] Li H, Xu MR, Li JZ, Li ZY, Wang ZY, Zhuang WJ, Li CY. Spatial distribution characteristics of Japan’s forest therapy bases and their influencing factors. Sustainability, 2022, 14(22): 15156

[46] Li HS, Zhang X, Bi SL, Cao Y, Zhang GD. Psychological benefits of green exercise in wild or urban greenspaces: a meta-analysis of controlled trials. Urban for Urban Green, 2022, 68 127458

[47] Lim PY, Dillon D, Chew PKH. A guide to nature immersion: psychological and physiological benefits. Int J Environ Res Public Health, 2020, 17(165989

[48] Qiu L, Zheng X, Wang Y-F. Revision of the Positive affect negative affect scale (PANAS). Chinese J Appl Psychol, 2008, 14: 249-254+268

[49] Liu H, Xu XX, Tam VW, Mao P. Exploring the ‘dark’ side of forest therapy and recreation: a critical review and future directions. Renew Sustain Energy Rev, 2023, 183 113480

[50] Liu QH, Wang XP, Liu JL, An CY, Liu YQ, Fan XL, Hu YS. Physiological and psychological effects of nature experiences in different forests on young people. Forests, 2021, 12(101391

[51] Lui JC, Sagar-Ouriaghli I, Brown JSL. Barriers and facilitators to help-seeking for common mental disorders among university students: a systematic review. J Am Coll Health, 2022, 72(82605-2613

[52] Luo L, Jiang B. From oppressiveness to stress: a development of stress reduction theory in the context of contemporary high-density city. J Environ Psychol, 2022, 84 101883

[53] Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-trait anxiety inventory (STAI). Br J Clin Psychol, 1992, 31(3): 301-306

[54] Martin C, Czellar S. The extended Inclusion of nature in self scale. J Environ Psychol, 2016, 47: 181-194

[55] Martyn P, Brymer E. The relationship between nature relatedness and anxiety. J Health Psychol, 2016, 21(7): 1436-1445

[56] Matthews KA, Katholi CR, McCreath H, Whooley MA, Williams DR, Zhu S, Markovitz JH. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation, 2004, 110(1): 74-78

[57] Mayer FS, Frantz CM, Bruehlman-Senecal E, Dolliver K. Why is nature beneficial? The role of connectedness to nature. Environ Behav, 2009, 41: 607-643

[58] Munakata M. Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings. Hypertens Res, 2018, 41(8): 553-569

[59] Nghiem TPL, Wong KL, Jeevanandam L, Chang CC, Tan LYC, Goh Y, Carrasco LR. Biodiverse urban forests, happy people: experimental evidence linking perceived biodiversity, restoration, and emotional wellbeing. Urban for Urban Green, 2021, 59 127030

[60] Nguyen PY, Astell-Burt T, Rahimi-Ardabili H, Feng XQ. Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review. Lancet Planet Health, 2023, 7(4): e313-e328

[61] Nieto I, Vazquez C. Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program. J Anxiety Disord, 2021, 83 102459

[62] Nisbet EK, Zelenski JM. Underestimating nearby nature: affective forecasting errors obscure the happy path to sustainability. Psychol Sci, 2011, 22(9): 1101-1106

[63] Ohly H, White MP, Wheeler BW, Bethel A, Ukoumunne OC, Nikolaou V, Garside R. Attention restoration theory: a systematic review of the attention restoration potential of exposure to natural environments. J Toxicol Environ Health B Crit Rev, 2016, 19(7): 305-343

[64] Ottosson J, Grahn P. Nature archetypes - concepts related to objects and phenomena in natural environments. A Swedish Case Front Psychol, 2021, 11 612672

[65] Piva G, Caruso L, Gómez AC, Calzolari M, Visintin EP, Davoli P, Manfredini F, Storari A, Spinozzi P, Lamberti N. Effects of forest walking on physical and mental health in elderly populations: a systematic review. Rev Environ Health, 2022, 39(1): 121-136

[66] Pouso S, Borja Á, Fleming LE, Gómez-Baggethun E, White MP, Uyarra MC. Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health. Sci Total Environ, 2021, 756 143984

[67] Pritchard A, Richardson M, Sheffield D, McEwan K. The relationship between nature connectedness and eudaimonic well-being: a meta-analysis. J Happiness Stud, 2020, 21(3): 1145-1167

[68] Rajoo KS, Karam DS, Abdul Aziz NA. Developing an effective forest therapy program to manage academic stress in conservative societies: a multi-disciplinary approach. Urban Urban Green, 2019, 43 126353

[69] Ruiz C, Hernández B. Emotions and coping strategies during an episode of volcanic activity and their relations to place attachment. J Environ Psychol, 2014, 38: 279-287

[70] Salehi S, Ballen CJ, Bolander Laksov K, Ismayilova K, Poronnik P, Ross PM, Tzioumis V, Wieman C. Global perspectives of the impact of the COVID-19 pandemic on learning science in higher education. PLoS ONE, 2023, 18(12 e0294821

[71] Schultz PW (2002) Inclusion with nature: the psychology of human-nature relations. In: Psychology of sustainable development. Springer US, pp 61–78. https://doi.org/10.1007/978-1-4615-0995-0_4

[72] Shim SR, Chang J, Lee J, Byeon W, Lee J, Lee KJ. Perspectives on the psychological and physiological effects of forest therapy: a systematic review with a meta-analysis and meta-regression. Forests, 2022, 13(12): 2029

[73] Shin WS, Seong IK, Kim JG. Psychological benefits of self-guided forest healing program using campus forests. Forests, 2023, 14(2336

[74] Simkin J, Ojala A, Tyrväinen L. Restorative effects of mature and young commercial forests, pristine old-growth forest and urban recreation forest - a field experiment. Urban Urban Green, 2020, 48 126567

[75] Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual for the state-trait anxiety inventory. Self Evaluation Questionnaire

[76] Staats H, Hartig T. Alone or with a friend: a social context for psychological restoration and environmental preferences. J Environ Psychol, 2004, 24(2199-211

[77] Stier-Jarmer M, Throner V, Kirschneck M, Immich G, Frisch D, Schuh A. The psychological and physical effects of forests on human health: a systematic review of systematic reviews and meta-analyses. Int J Environ Res Public Health, 2021, 18(4): 1770

[78] Stigsdotter UK, Corazon SS, Sidenius U, Kristiansen J, Grahn P. It is not all bad for the grey city–a crossover study on physiological and psychological restoration in a forest and an urban environment. Health Place, 2017, 46: 145-154

[79] Subiza-Pérez M, Vozmediano L, San Juan C. Green and blue settings as providers of mental health ecosystem services: comparing urban beaches and parks and building a predictive model of psychological restoration. Landsc Urban Plan, 2020, 204 103926

[80] Sudimac S, Kühn S. Can a nature walk change your brain? Investigating hippocampal brain plasticity after one hour in a forest. Environ Res, 2024, 262(Pt 1 119813

[81] Sudimac S, Sale V, Kühn S. How nature nurtures: amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry, 2022, 27(114446-4452

[82] Sung J, Woo JM, Kim W, Lim SK, Chung EJ. The effect of cognitive behavior therapy-based “forest therapy” program on blood pressure, salivary cortisol level, and quality of life in elderly hypertensive patients. Clin Exp Hypertens, 2012, 34(1): 1-7

[83] Tang IC, Sullivan WC, Chang CY. Perceptual evaluation of natural landscapes. Environ Behav, 2015, 47(6): 595-617

[84] Ulrich RS (1983) Aesthetic and affective response to natural environment. In: Altman I, Wohlwill JF (eds) Behavior and the natural environment. Springer US, pp 85–125. https://doi.org/10.1007/978-1-4613-3539-9_4

[85] Ulrich RS. View through a window may influence recovery from surgery. Science, 1984, 224(4647): 420-421

[86] Ulrich RS, Simons RF, Losito BD, Fiorito E, Miles MA, Zelson M. Stress recovery during exposure to natural and urban environments. J Environ Psychol, 1991, 11(3): 201-230

[87] Wang X, Gong XF, Xiong KX, Guo DS, Liu LJ, Lin CM, Chang WY. Mapping of research in the field of forest therapy-related issues: a bibliometric analysis for 2007–2021. Front Psychol, 2022, 13 930713

[88] Wang XX, Rodiek S, Wu CZ, Chen Y, Li YX. Stress recovery and restorative effects of viewing different urban park scenes in Shanghai, China. Urban Urban Green, 2016, 15: 112-122

[89] Watkins-Martin K, Bolanis D, Richard-Devantoy S, Pennestri MH, Malboeuf-Hurtubise C, Philippe F, Guindon J, Gouin JP, Ouellet-Morin I, Geoffroy MC. The effects of walking in nature on negative and positive affect in adult psychiatric outpatients with major depressive disorder: a randomized-controlled study. J Affect Disord, 2022, 318: 291-298

[90] Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol, 1988, 54(6): 1063-1070

[91] Wright CJ, Wilson SA, Hammer JH, Hargis LE, Miller ME, Usher EL. Mental health in undergraduate engineering students: identifying facilitators and barriers to seeking help. J Eng Edu, 2023, 112(4): 963-986

[92] Xin MY, Yang CX, Zhang LJ, Gao CZ, Wang SS. The impact of perceived life stress and online social support on university students' mental health during the post-COVID era in Northwestern China: gender-specific analysis. BMC Public Health, 2024, 24(1): 467

[93] Yang Y, Sedikides C, Wang YQ, Cai HJ. Nature nurtures authenticity: Mechanisms and consequences. J Pers Soc Psychol, 2024, 126(179-104

[94] Yau KKY, Loke AY. Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature. Environ Health Prev Med, 2020, 25(1): 23

[95] Yeo NL, White MP, Alcock I, Garside R, Dean SG, Smalley AJ, Gatersleben B. What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality. J Environ Psychol, 2020, 72 101500

[96] Yu CP, Chen HT, Chao PH, Yin J, Tsai MJ. The role of social context in physiological and psychological restoration in a forest: case study of a guided forest therapy program in Taiwan. Int J Environ Res Public Health, 2021, 18(1910076

[97] Zhang ZY, Wang P, Gao Y, Ye B. Current development status of forest therapy in China. Healthcare (Basel), 2020, 8(161

[98] Zhang ZY, Ye B. Forest therapy in Germany, Japan, and China: proposal, development status, and future prospects. Forests, 2022, 13(81289

[99] Zhang ZY, Ye B, Yang WJ, Gao Y. Effect of nature space on enhancing humans’ health and well-being: an integrative narrative review. Forests, 2024, 15(1100

[100] Zuckerman M. Development of a situation-specific trait-state test for the prediction and measurement of affective responses. J Consult Clin Psychol, 1977, 45(4513-523

RIGHTS & PERMISSIONS

Northeast Forestry University