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Advances in Nature-Based Therapies and Human Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 51075

Special Issue Editors


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Guest Editor
Department of People and Society, Swedish University of Agricultural Sciences, 234 22 Lomma, Alnarp, Sweden
Interests: nature-based interventions; lakes/sea shores; forest bathing; adventure therapy; nature- and animal-assisted interventions; landscape planning and architecture; evidence based health design; public health and nature; environmental psychology; urban agriculture; nature-based Integration; social interactions
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Geosciences and Natural Resource Management, Landscape Architecture, University of Copenhagen, 1165 København, Denmark
Interests: the relation between nature invironment and human health in health protion, prevention and as part of a rehabilitation; nature as a fundamental part of a therapeutic intervention; the benefit of designed or specially chosed nature environment

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Guest Editor
Department of Forest Ecology and Management, Forest and Health, Swedish University of Agricultural Sciences, SE-901 83 Umeå, Sweden
Interests: wilderness therapy and forest therapy; forest bathing; forest planning; human health; nature-based integration

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Guest Editor
1. Department of Systems Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
2. Department of Bio and Healing Convergence at Graduate School, Konkuk University, Seoul 05029, Republic of Korea
Interests: horticultural therapy; urban agriculture; green care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is increasing evidence that nature can be a valuable source for human health and well-being; in recent months, this has been more evident than ever. Nature-based interventions have been used for supporting different aspects of human health and have targeted ill health, different types of disability, and diseases. We have made a distinction between place-dependent interventions, such as nature-based interventions, where nature (outdoor environment) is the base for the intervention, and nature and animal-assisted interventions, where the focus is on activities and occupations rather than a place, i.e., place independent. Nature settings are outdoor spaces, e.g., gardens, parks, forests, meadow and coastlines, where natural elements such as plants, trees, animals, water, soil, sand and stones dominate over the manmade surroundings.

Nature-based therapies (NBT) can include both aspects and are always goal-orientated interventions, i.e., have a clear and well-defined clinical outcome for the client, the therapist and the client. NBT contains many parts, such as the choice of location, choice of team, choice of activities, etc. It is important for the continued development in the field that all these parts are carefully described. As interest increases, the demands for evidence-based development in the area also increase. This can be documented and described in study protocols, theoretical and/or conceptual papers, or in papers reporting on studies investigating the health benefits of NBT for different target groups. The study design may vary from randomized controlled trials, controlled trials, longitudinal studies, case studies and evaluation of best practices.

Dr. Anna Maria Palsdottir
Dr. Dorthe Varning Poulsen
Dr. Ann Dolling
Prof. Dr. Sin-Ae Park
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • evidence-based health design
  • forest therapy
  • animal-assisted therapy
  • equine-assisted therapy
  • rehabilitation
  • public health
  • green care, health interventions

Published Papers (11 papers)

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Research

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24 pages, 2346 KiB  
Article
Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature—A Pilot Study
by Lilly Joschko, Anna María Pálsdóttir, Patrik Grahn and Maximilian Hinse
Int. J. Environ. Res. Public Health 2023, 20(3), 2167; https://doi.org/10.3390/ijerph20032167 - 25 Jan 2023
Cited by 5 | Viewed by 6045
Abstract
In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between [...] Read more.
In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals’ connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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19 pages, 1192 KiB  
Article
Nature-Based Meditation, Rumination and Mental Wellbeing
by Matthew Owens and Hannah L. I. Bunce
Int. J. Environ. Res. Public Health 2022, 19(15), 9118; https://doi.org/10.3390/ijerph19159118 - 26 Jul 2022
Cited by 10 | Viewed by 5044
Abstract
Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and [...] Read more.
Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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9 pages, 311 KiB  
Article
Efficacy of a Horticultural Therapy Program Designed for Emotional Stability and Career Exploration among Adolescents in Juvenile Detention Centers
by Kyoung-Hee Park, Soo-Young Kim and Sin-Ae Park
Int. J. Environ. Res. Public Health 2022, 19(14), 8812; https://doi.org/10.3390/ijerph19148812 - 20 Jul 2022
Cited by 2 | Viewed by 2335
Abstract
We aimed to develop a horticultural therapy program to prepare adolescents at the Dae san juvenile detention center (D-JDC) for their return to society. The effects of the program on emotional stability and career exploration were investigated. Adolescents who wished to participate in [...] Read more.
We aimed to develop a horticultural therapy program to prepare adolescents at the Dae san juvenile detention center (D-JDC) for their return to society. The effects of the program on emotional stability and career exploration were investigated. Adolescents who wished to participate in the horticultural therapy program were recruited from the D-JDC. Data were collected using various questionnaires before and after the program was implemented. Thirty-five (mean age, 15.74 ± 1.65 years; 11 males, 24 females) students were enrolled. The program mainly consisted of plant cultivation activities, such as seeding, transplanting plants, cutting, harvesting, and post-harvest utilization. To evaluate emotional health, the ego-resiliency scale was used. To evaluate social behavior, the inventory of parent and peer attachment, peer attachment scale, and social skills scale were used. Career exploration was assessed using the career preparation behavior scale and the career decision-making self-efficacy-short form. Peer attachment, social skills, and career preparation behavior showed significant improvements after the program, with the students responding positively in the post-program surveys. Our horticultural therapy program helped improve the career exploration and social skills of D-JDC students and positively affected their emotional stability. Based on our findings, horticultural therapy can be used as a correctional program for adolescents in D-JDC to help them return to society. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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11 pages, 642 KiB  
Article
Mixing Job Training with Nature-Based Therapy Shows Promise for Increasing Labor Market Affiliation among Newly Arrived Refugees: Results from a Danish Case Series Study
by Sigurd Wiingaard Uldall, Dorthe Varning Poulsen, Sasja Iza Christensen, Lotta Wilson and Jessica Carlsson
Int. J. Environ. Res. Public Health 2022, 19(8), 4850; https://doi.org/10.3390/ijerph19084850 - 16 Apr 2022
Viewed by 2295
Abstract
The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture [...] Read more.
The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture activities, nature-based therapy, and traditional job training on job market affiliation and mental well-being. Fifty-two refugees met initial screening criteria and twenty-eight met all inclusion criteria and were enrolled. The program took place in a small community and consisted of informal therapeutic conversations, exercises aimed at reducing psychological stress, increasing mental awareness and physical wellbeing. At the end of the program traditional job market activities were led by social workers. Provisionary psychiatric interviews showed that at baseline 79% met criteria for either an anxiety, depression, or PTSD diagnosis. After the program, statistical analyses revealed an increase in the one-year incidence of job market affiliation (n = 28) and an increase in mental health according to two of four questionnaire measures (nrange = 15–16). The results strengthen the hypothesis that horticulture and nature-based therapy can help refugees enter the job market. However, the small sample size emphasizes the need for methodologically stronger studies to corroborate these preliminary findings. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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12 pages, 315 KiB  
Article
The Meaning of Social Support in Nature-Based Services for Young Adults with Mental Health Problems
by Anne Mari Steigen, Bengt G. Eriksson, Ragnfrid Eline Kogstad and Daniel Bergh
Int. J. Environ. Res. Public Health 2022, 19(3), 1638; https://doi.org/10.3390/ijerph19031638 - 31 Jan 2022
Cited by 2 | Viewed by 2402
Abstract
In previous studies, social context and social support have been found to be important in nature-based services. However, no studies have previously focused on the meaning of different dimensions of social support in these contexts. The aim of this study is therefore to [...] Read more.
In previous studies, social context and social support have been found to be important in nature-based services. However, no studies have previously focused on the meaning of different dimensions of social support in these contexts. The aim of this study is therefore to uncover dimensions of social support in relation to mental health among young adults with mental health problems participating in nature-based services in Norway. This study applies data from a survey of 93 young adults participating in nature-based services; in addition, qualitative interview data from 20 interviews are also used. The data are analysed using qualitative content analysis, descriptive statistics, and correlation analysis. The results indicate that participants in nature-based services experience emotional, esteem, informational, and instrumental support in addition to social integration and opportunities for nurturance in these services. The service leader, other participants, and the animals are important contributors to these dimensions of social support. Nature-based services may be a helpful intervention for young adults with mental health problems. The unique context of these services, including nature and animals, adds special qualities to mental health and social work practices. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
11 pages, 2651 KiB  
Article
The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate
by Rikuto Yamashita, Chong Chen, Toshio Matsubara, Kosuke Hagiwara, Masato Inamura, Kohei Aga, Masako Hirotsu, Tomoe Seki, Akiyo Takao, Erika Nakagawa, Ayumi Kobayashi, Yuko Fujii, Keiko Hirata, Harumi Ikei, Yoshifumi Miyazaki and Shin Nakagawa
Int. J. Environ. Res. Public Health 2021, 18(10), 5500; https://doi.org/10.3390/ijerph18105500 - 20 May 2021
Cited by 20 | Viewed by 6023
Abstract
It has been recently suggested that contact with nature improves mood via reducing the activity of the prefrontal cortex. However, the specific regions within the prefrontal cortex that underlie this effect remain unclear. In this study, we aimed to identify the specific regions [...] Read more.
It has been recently suggested that contact with nature improves mood via reducing the activity of the prefrontal cortex. However, the specific regions within the prefrontal cortex that underlie this effect remain unclear. In this study, we aimed to identify the specific regions involved in the mood-improving effect of viewing images of nature using a 52-channel functional near-infrared spectroscopy (fNIRS). Specifically, we focused on the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (dlPFC), two regions associated with affective processing and control. In a randomized controlled crossover experiment, we assigned thirty young adults to view images of nature and built environments for three minutes each in a counterbalanced order. During image viewing, participants wore a fNIRS probe cap and had their oxyhemoglobin (oxy-Hb) measured. Immediately following each image viewing, participants indicated their mood in terms of comfortableness, relaxation, and vigor. Results showed that viewing images of nature significantly increased comfortableness and relaxation but not vigor compared to viewing images of built environments, with a large effect size. Meanwhile, the concentration of oxy-Hb in only the right OFC and none of the other regions significantly decreased while viewing the images of nature compared to built environments, with a medium effect size. We speculate that viewing images of nature improves mood by reducing the activity of or calming the OFC. Since the OFC is hyperactive in patients with depression and anxiety at rest, contact with nature might have therapeutic effects for them. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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Review

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12 pages, 703 KiB  
Review
Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review
by Erica R. Timko Olson, Anthony A. Olson, Megan Driscoll and Amber L. Vermeesch
Int. J. Environ. Res. Public Health 2023, 20(3), 2376; https://doi.org/10.3390/ijerph20032376 - 29 Jan 2023
Cited by 5 | Viewed by 2954
Abstract
Background and purpose: nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction [...] Read more.
Background and purpose: nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction with the natural environment. Description/methods: this review was completed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research strategy included a combination of these terms: cancer, neoplasms, nature, and forest therapy. The articles were blinded and screened by four independent researchers. A total of twelve articles were selected. Outcome/results: a total of 2786 cancer survivors participated in the twelve studies with multiple types and stages of cancer represented. The studies used multiple designs and measures. Results showed improvements in anxiety, depression, sleep, connectedness, stress, tension, confusion, fatigue, and pain. Participants reported that nature was the most important resource in coping with their cancer. Conclusions and implications: nature is beneficial for cancer survivors while they experience cancer diagnosis and treatment. Nature opportunities can be feasibly delivered with this population and need to be explored further and safely implemented to support the overall health and well-being of cancer survivors. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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23 pages, 681 KiB  
Review
Nature-Based Interventions for Psychological Wellbeing in Long-Term Conditions: A Systematic Review
by Eleanor M. Taylor, Noelle Robertson, Courtney J. Lightfoot, Alice C. Smith and Ceri R. Jones
Int. J. Environ. Res. Public Health 2022, 19(6), 3214; https://doi.org/10.3390/ijerph19063214 - 9 Mar 2022
Cited by 15 | Viewed by 5956
Abstract
Background: With the global burden of disease increasing, particularly in relation to often preventable chronic diseases, researchers and clinicians are keen to identify interventions that can mitigate ill health and enhance the psychological wellbeing of people living with long-term conditions (LTCs). It is [...] Read more.
Background: With the global burden of disease increasing, particularly in relation to often preventable chronic diseases, researchers and clinicians are keen to identify interventions that can mitigate ill health and enhance the psychological wellbeing of people living with long-term conditions (LTCs). It is long established that engagement with nature can support human health and wellbeing, and in recent years, nature-based interventions (NBIs) have been advanced as of potential benefit. This review thus sought to systematically appraise published evidence of the application of NBIs to address psychological wellbeing for those living with LTCs. Methods: A systematic search of three databases, PsycINFO, MEDLINE and SCOPUS, was undertaken, and the BestBETs quality assessment checklist was used to appraise methodological quality of elicited studies. Results: Of 913 studies identified, 13 studies (12 using quantitative methods, one qualitative) were used. Included papers reported use of a variety of psychological outcomes alongside more circumscribed physiological outcomes. Quality appraisal showed modest robustness, some methodological weaknesses and a dominance of application in developed countries, yet synthesis of studies suggested that reported psychological and physiological outcomes present a strong argument for NBIs having a promising and positive impact on psychological wellbeing. Conclusions: NBIs have positive psychological and physiological impacts on people with LTCs, suggesting they may be a suitable addition to current maintenance treatment. Future research should focus on minimising study bias and increasing the potential for cross-cultural applications. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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Other

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18 pages, 791 KiB  
Perspective
Group Nature-Based Mindfulness Interventions: Nature-Based Mindfulness Training for College Students with Anxiety
by Luke A. Vitagliano, Kelly L. Wester, Connie T. Jones, David L. Wyrick and Amber L. Vermeesch
Int. J. Environ. Res. Public Health 2023, 20(2), 1451; https://doi.org/10.3390/ijerph20021451 - 13 Jan 2023
Cited by 4 | Viewed by 5466
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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25 pages, 444 KiB  
Case Report
COMSI®—A Form of Treatment That Offers an Opportunity to Play, Communicate and Become Socially Engaged through the Lens of Nature—A Single Case Study about an 8-Year-Old Boy with Autism and Intellectual Disability
by Kristina Byström, Björn Wrangsjö and Patrik Grahn
Int. J. Environ. Res. Public Health 2022, 19(24), 16399; https://doi.org/10.3390/ijerph192416399 - 7 Dec 2022
Viewed by 8471
Abstract
This case study shows how an 8-year-old boy with autism and mild intellectual disability underwent positive psychological development in terms of play, social communication, and mentalization during a year and a half of group-based therapy using COMSI®-(COMmunication and Social Interaction). This [...] Read more.
This case study shows how an 8-year-old boy with autism and mild intellectual disability underwent positive psychological development in terms of play, social communication, and mentalization during a year and a half of group-based therapy using COMSI®-(COMmunication and Social Interaction). This eclectic treatment has a relational approach and is based on developmental psychology, knowledge of autism, and the impact of nature and animals on human health. The change in the child was been studied using both quantitative and qualitative methods. His general intellectual capacity was measured using the Wechler Preschool and Primary Scale of Intelligence, and his Mentalization Ability/Theory of Mind was assessed using three tests: Eva and Anna, Hiding the fruit and Kiki and the cat. Throughout the study period, change was documented with the help of the therapists’ process notes and the parents’ descriptions. The results show that support for the child comes from three different sources: nature, animals, and the therapists. Animals and nature form the basis for episodes of coordinated attention in conversation and play with therapists. The therapists’ approach used sensitivity and compliance with the child’s needs and focus of interest. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
12 pages, 1028 KiB  
Protocol
A Forest Bathing Intervention in Adults with Intellectual Disabilities: A Feasibility Study Protocol
by Elena Bermejo-Martins, María Pueyo-Garrigues, María Casas, Raúl Bermejo-Orduna and Ana Villarroya
Int. J. Environ. Res. Public Health 2022, 19(20), 13589; https://doi.org/10.3390/ijerph192013589 - 20 Oct 2022
Cited by 3 | Viewed by 2544
Abstract
Forest bathing practices benefit individuals’ physical and mental health. A growing number of published studies provide evidence of such effects in diverse populations and contexts. However, no literature has been found that evaluates the effects of forest bathing on people with intellectual disabilities. [...] Read more.
Forest bathing practices benefit individuals’ physical and mental health. A growing number of published studies provide evidence of such effects in diverse populations and contexts. However, no literature has been found that evaluates the effects of forest bathing on people with intellectual disabilities. In this paper, we present a quasi-experimental pre–post protocol for assessing the preliminary efficacy and feasibility of a forest bathing intervention in a group of adults with intellectual disability. An 11-weekly session program will be applied in the forests of the Ollo Valley, Navarre (Spain). The preliminary efficacy outcomes will be blood pressure, psycho-physiological coherence parameters and quality of life. The feasibility of the intervention will be assessed through data on barriers and facilitators of the implementation process and indicators of environmental comfort (physiological equivalent temperature and thermic perception). This study offers an opportunity for people with intellectual disabilities to benefit from a forest bathing intervention and explore its effects not only on their quality of life, but also on the improvement in their physiological and psychological state. This feasibility study is an essential step to explore crucial aspects for a future full-scale trial. Full article
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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