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

Kotera, Yasuhiro; Richardson, Miles; Sheffield, David

doi:10.1007/s11469-020-00363-4

Cited by 176 publications

(182 citation statements)

References 61 publications

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“…This near-universal finding supports that natural environments are generally enjoyed more than urban ones. Our data are consistent with prior findings of nature's beneficial effects compared to urban environments (Bielinis et al, 2018;Doimo, Masiero & Gatto, 2020;Hansen & Jones, 2020;Kotera, Richardson & Sheffield, 2020;Park et al, 2011).…”

Section: Notessupporting

confidence: 93%

“…City living impacts mental health negatively and contributes to increased amygdala activity, negative affect, stress, mood and anxiety disorders (Diorio, Viau & Meaney, 1993;Lederbogen et al, 2011;Peen et al, 2010) whereas exposure to green spaces has been found to be protective (Tost et al, 2019). Extensive research into green spaces and forest bathing demonstrates their stress-reducing effects and their potential to foster physical and mental healing (Bielinis et al, 2018;Doimo, Masiero & Gatto, 2020;Hansen & Jones, 2020;Kotera, Richardson & Sheffield, 2020;Park et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

Ameli

Skeath²,

Abraham

et al. 2021

PeerJ

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We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

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Section: Notessupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

Ameli

Skeath²,

Abraham

et al. 2021

PeerJ

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“…Four of these were conducted in Korea and one each in Japan, Australia, Indonesia, Italy, the USA, China, and the UK. Three included papers were systematic reviews with additional meta-analyses [ 27 , 28 , 29 ]. Most of the reviews examined the effects of forest-based interventions for specific indications, such as stress or depression [ 27 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three included papers were systematic reviews with additional meta-analyses [ 27 , 28 , 29 ]. Most of the reviews examined the effects of forest-based interventions for specific indications, such as stress or depression [ 27 , 29 , 30 , 31 , 32 , 33 , 34 ]. Three studies are broader in scope and examined the health effects of forest-based interventions without focusing on specific conditions [ 19 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…The authors of seven reviews stated that there were no conflicts of interest [19,28,30,32,[34][35][36]. Four others did not provide conflict-of-interest statements [27,29,31,33]; one reported that no financial support was received for the preparation of the paper [29]. The 11 included SRs and MAs cover a total of 131 individual studies that examined the health effects of forest-based interventions.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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The Psychological and Physical Effects of Forests on Human Health: A Systematic Review of Systematic Reviews and Meta-Analyses

Stier-Jarmer

Throner

Kirschneck

et al. 2021

IJERPH

102

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Background: The aim of this systematic review of systematic reviews was to identify, summarise, and synthesise the available evidence of systematic reviews (SRs) and meta-analyses (MAs) on the preventative and therapeutic psychological and physical effects of forest-based interventions. Methods: Both bibliographic databases and grey literature sources were searched for SRs and MAs published until May 2020. Eight databases were searched for relevant articles: MEDLINE, Embase, Web of Science, Cochrane Library, PsycInfo, CiNii, EBSCO, and Scopus. Grey literature was sourced from Google Scholar and other web-based search tools. SRs and MAs that included randomised controlled (RCT), non-randomised controlled (NRCT), and non-controlled trials (NCT) on health-related effects of forest-based interventions were eligible if they had searched at least two databases. The methodological quality of eligible reviews was assessed by AMSTAR-2. Results: We evaluated 11 systematic reviews covering 131 different primary intervention studies, mostly from Asian countries, three of which included supplementary meta-analyses. The quality assessment resulted in moderate confidence in the results of two reviews, low confidence in six, and critically low confidence in three. The results of the eight moderate and low-rated reviews indicated that forest-based interventions are beneficial to the cardiovascular system, immune system, and mental health (in the areas of stress, depression, anxiety, and negative emotions). Evidence for the effectiveness of forest-based interventions on metabolic parameters in adults, the severity of atopic dermatitis in children and adolescents, and social skills and sociality in healthy primary school children was weak. Discussion/Conclusions: Evidence suggests beneficial therapeutic effects of forest-based interventions on hypertension, stress, and mental-health disorders, such as depression and anxiety. Changes in immunological and inflammatory parameters after forest therapy should be verified in bio-geographically native forests. In the future, more attention should be paid to careful planning, implementation, and reporting of primary studies and to systematic reviews on the effects of forest-based interventions.

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A Nature-Based Intervention and Mental Health of Schoolchildren

Loose,

Fuoco,

Malboeuf-Hurtubise

et al. 2024

JAMA Netw Open

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ImportanceNature-based therapeutic or preventive interventions for mental health are increasingly popular, but their effectiveness for improving mental health is not well documented.ObjectiveTo 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 ParticipantsThis 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.InterventionIn 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 MeasuresThe 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.ResultsA 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 &lt; .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 &lt; .001) in the intervention group vs the control group.Conclusions and RelevanceIn 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 RegistrationClinicalTrials.gov Identifier: NCT05662436

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

Cited by 176 publications

References 61 publications

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

The Psychological and Physical Effects of Forests on Human Health: A Systematic Review of Systematic Reviews and Meta-Analyses

A Nature-Based Intervention and Mental Health of Schoolchildren

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