A Review of Field Experiments on the Effect of Forest Bathing on Anxiety and Heart Rate Variability

Can pre-visit exposure to virtual tours of healthcare facilities help reduce child and parent anxiety during outpatient surgical procedures?

AIM

The study aims to evaluate the impact of exposure to a highly realistic virtual facility tour prior to the on-site visit on patients and their parent/care partner's self-reported anxiety and physiological measures on the day of the procedure.

BACKGROUND

Preoperative anxiety impacts pediatric surgical outcomes; therefore, it is important for healthcare providers to address and manage preoperative anxiety in pediatric patients to promote better outcomes and overall wellbeing. Providing patients with a preview of the care setting before the actual procedure can be highly beneficial in mitigating preoperative anxiety.

METHODOLOGY

In this pilot randomized experimental study, sixteen patient-care partner dyads scheduled to undergo a gastrointestinal procedure either received a virtual tour identical to the places experienced on the day of the procedure (experimental group) or received no virtual tour (control group). Self-reported measures of anxiety were collected from participants before and on the day of the procedure. Physiological measures of heart rate variability and skin conductance were collected on the day of the procedure from both groups.

RESULTS

There were no significant differences between the self-reported and physiological measures of anxiety between the child groups. However, parents in the control group reported lower levels of anxiety and demonstrated lower levels of stress based on their physiological measures.

CONCLUSION

Exposure to virtual facility tours days before the surgery was not helpful in positively impacting the psychological measures related to preoperative anxiety levels for the participants.

Scenting serenity: influence of essential-oil vaporization on dental anxiety - a cluster-randomized, controlled, single-blinded study (AROMA_dent)

Dental fear and anxiety (DFA) is known as an immense challenge in oral healthcare, which can result in compromised oral health, pain, and uncomfortable treatment. The objective of this study was to analyze the effect of essential-oil vaporization on acute anxiety of patients in dental practices. Four dental practices used five weekly cycles of vaporization with each scent: Orange (Citrus sinensis), Swiss Pine (Pinus cembra), Good Mood (blended essential oils: Citrus sinensis, Citrus aurantifolia, Citrus limon, Osmanthus fragrance (5%)), Forest Walk (blended essential oils: Abies grandis, Pinus cembra, Myrtus communis c. t. 1,8-cineol, Abies alba, Citrus paradisi, Abies sibirica, Pseudotsuga menziesii, Vetiveria zizanoides), and water. Acute anxiety was the primary outcome (state-trait-anxiety inventory (STAI-S)). Secondary outcomes were trait anxiety (STAI-T), dental anxiety (Kleinknecht dental fear survey), and pain perception in treatment (numeric rating scale). Across all patients (n = 486), STAI-S was slightly higher in the control group (40.7 ± 11.6) than in the intervention groups (38.4 ± 10.5). Post-hoc analyses revealed that the effect is only robust for the subgroup of female patients (n = 296, p = 0.044). We also conducted a post-hoc additional analysis on a subpopulation with an increased level of STAI-T ≥ 42 (n = 131 patients). For this group the difference in acute anxiety between the control group (51.1 ± 11.9, n = 30) vs. the intervention groups (46.8 ± 9.6, n = 118) was significant (T = 4.39, p = 0.0379). The results of the study indicate a promising potential of essential-oil vaporization to alleviate dental anxiety, particularly in the subgroups of patients with a high level of trait anxiety, and particularly in female patients. The calming effects of the essential-oil vaporization were also highlighted by the anecdotical statements of the dental-practice staff. The anxiety-reducing role of essential-oil vaporization alone and as one part of combined techniques to counter DFA should be further explored using multi-perspective methodological approaches in research.

Interplay among Anxiety, Digital Environmental Exposure, and Cognitive Control: Implications of Natural Settings

Inhibitory control performance may differ greatly as a function of individual differences such as anxiety. Nonetheless, how cognitive control proficiency might be influenced by exposure to various environments and how anxiety traits might impact these effects remain unexplored. A cohort of thirty healthy volunteers participated in the study. Participants performed a Go/No-Go task before exposure to a 'forest' and 'urban' virtual environment, in a counterbalanced design, before repeating the GNG task. The State-Trait Anxiety Inventory (STAI) was finally filled-in. Our findings unveiled an initial negative correlation between anxiety trait levels and GNG task performance, consistent with the established literature attributing difficulties in inhibitory functionality to anxiety. Additionally, different environmental exposures reported opposite trends. Exposure to the 'forest' environment distinctly improved the GNG performance in relation to anxiety traits, while the 'urban' setting demonstrated adverse effects on task performance. These results underscore the intricate relationship among cognitive control, environmental exposure, and trait anxiety. In particular, our findings highlight the potential of natural settings, such as forests, to mitigate the impact of anxiety on inhibition. This might have implications for interventions aimed at improving cognitive control.

ON-SITE monitoring OF BVOCS emission in Tremiti island, Italy

A measurement campaign was conducted on San Domino Island, part of the Tremiti Islands archipelago, located in Foggia, Italy. The area is almost entirely covered by vegetation, dominated by the following main species: Juniperus turbinata, Helichrysum italicum, Myrtus communis, Rosmarinus officinalis, Pistacia lentiscus and Pinus halepensis.This study focused on the BVOCs emitted by plants and the ground, employing a simple, economical, and efficient sampling and analysis method. The main known BVOC species emitted by Mediterranean plant species as α-pinene, β-pinene, camphene and limonene were detected. The measurements highlighted a daily complementarity between plant and soil emissions. The daily variations in BVOCs emitted by both plants and the soil are differ, ensuring an almost constant concentration throughout the day. At the same time, the composition of sea spray aerosol (SSA) was also measured. The measurement sites were selected based on botanical characterization to account for the predominant species on San Domino Island, and the sampling was conducted at human height to accurately identify the species for potential use. The combination of beneficial effects of the substances emitted by plant species and soil, along with the simultaneous presence of SSA, are factors that could enhance the effectiveness of forest therapy in a previously unexplored location.

An exploratory investigation of human biofield responses to encountering a sacred object

CONTEXT

While advances in the Western sciences have increased our understanding of the human biofield, few studies have examined the potential effects of sacred objects on its functioning.

DESIGN AND STUDY PARTICIPANTS

This exploratory study examined the effects of a sacred object called the Sri Yantra / Durga Stone on the human biofield. Twelve women and five men were studied on three separate occasions using the Bio-Well device, which purportedly measures aspects of the biofield: baseline (the day before exposure to the sacred object), pre-exposure (immediately prior to exposure to the sacred object), and post-exposure (immediately following exposure to the sacred object). A set of a priori hypotheses examined outcome effects on a set of variables, including multiple physiological systems.

RESULTS

The overall Bio-Well energy state (Bio-Well variables are in units of joules) was significantly changed following exposure to the sacred object (p = 0.001). In addition, the cardiovascular, endocrine, musculoskeletal, digestive, urinogenital, and immune system readings showed significant changes (p's<0.003) while the nervous and respiratory system assessments were unchanged. Chakra (defined as a center of vital prana) energy was changed following exposure to the stone (p = 0.001), while chakra alignment was not (p = 0.145).

CONCLUSIONS

The findings from this exploratory study suggest that short-term human exposure to this particular sacred object had significant effects on aspects of the human biofield.

The relationship between perceived restorativeness and place attachment for hikers at Jeju Gotjawal Provincial Park in South Korea: the moderating effect of environmental sensitivity

Objectives

Jeju Gotjawal Provincial Park provides visitors with opportunities for outdoor recreation and informs visitors of the environmental significance of the park's ecosystem. This study attempted to examine how the perceived restorativeness of park visitors influenced their place attachment. In addition, the moderating effect of environmental sensitivity on the hypothesized relationship was explored.

Methods

Using the purposive sampling method, 408 surveys were collected at Jeju Gotjawal Provincial Park. The hypotheses were tested by confirmatory factor analysis, path analysis, and invariance tests using Lisrel 8.70.

Results

The results indicated that perceived restorativeness had a positive influence on place attachment (place identity and place dependence). Further, the hypothesized relationship was stronger for the visitors with higher environmental sensitivity, compared to those with weaker environmental sensitivity.

Conclusion

Park managers should consider ways to increase the perceived restorativeness of visitors as they experience the natural environment at the park. Also, since environmental sensitivity played an important role in shaping the perceived restorativeness-place attachment relationship, there is a need for educational programs that can inform visitors of the significance of the natural environment to increase their affection for nature.

A systematic review of the anxiety-alleviation benefits of exposure to the natural environment

Research suggests that exposure to natural environments can be beneficial for health, such as reducing physical illness and improving mood and cognitive ability. The potential benefits of nature have come into focus at a time when mental health issues are growing globally. Here, we have selected 24 studies from four databases for meta-analysis to explore the effects of exposure to the natural environment on the anxiety of the human body and summarize the influencing factors on the anxiety relief effect. A random-effect meta-analysis of anxiety state changes before and after exposure to natural environment shows that natural exposure effectively alleviated human anxiety (SMD -1.28, 95% CI: -1.65 to -0.92). The overall quality of the included papers, assessed using the PEDro scale, is considered to vary considerably, but most of the papers are rated between 4 and 7 which is considered fair or good. In addition, we have also investigated the potential moderators of anxiety-relieving effects of the nature. Our results shows that the age and exposure time of the subjects are related to the effect of anxiety relief. The results of the subgroup analysis of moderators prove that compared with the middle-aged people (SMD -0.63, 95% CI: -1.13 to -0.12), young people (SMD -1.50, 95% CI: -1.90 to -1.10) get better anxiety alleviation effect in the natural environment. In terms of exposure time, compared with 0.5-2 h (SMD -0.18, 95% CI: -0.59 to -0.23) and >2 h (SMD -0.84, 95% CI: -1.40 to -0.27) exposure periods, subjects get the maximum anxiety relief benefit when they spent <0.5 h (SMD -1.60, 95% CI: -1.93 to -1.27) in the natural environment. However, the quality of the included studies varies greatly and there is a significant heterogeneity in the meta-analysis. Study location, natural environment type and other moderator factors have no obvious correlation with anxiety-alleviation effect of the nature. A higher quality and more comprehensive study needs to be carried out to find out more moderators about the effects of the natural environment on anxiety alleviation. Further experimental studies should also be conducted to determine the mechanism by which natural exposure reduces anxiety so as to provide strong support for the construction and improvement of healthy natural environment.

Effects of Plant-Emitted Monoterpenes on Anxiety Symptoms: A Propensity-Matched Observational Cohort Study

Immersive experiences in green areas, particularly in forests, have long been known to produce beneficial effects for human health. However, the exact determinants and mechanisms leading to healthy outcomes remain to be elucidated. The purpose of this observational cohort study was to investigate whether inhaling plant-emitted biogenic volatile compounds, namely monoterpenes (MTs), can produce specific effects on anxiety symptoms. Data from 505 subjects participating in 39 structured forest therapy sessions at different Italian sites were collected. The air concentration of monoterpenes was measured at each site. STAI state questionnaires were administered before and after the sessions as a measure of anxiety. A propensity score matching analysis was then performed, considering an above-average exposure to inhalable air MTs as the treatment. The estimated effect was -1.28 STAI-S points (95% C.I. -2.51 to -0.06, p = 0.04), indicating that the average effect of exposure to high MT air concentrations during forest therapy sessions was to decrease anxiety symptoms.

Spending Time in the Forest or the Field: Investigations on Stress Perception and Psychological Well-Being-A Randomized Cross-Over Trial in Highly Sensitive Persons

Research suggests that stays in a forest promote relaxation and reduce stress compared to spending time in a city. The aim of this study was to compare stays in a forest with another natural environment, a cultivated field. Healthy, highly sensitive persons (HSP, SV12 score > 18) aged between 18 and 70 years spent one hour in the forest and in the field at intervals of one week. The primary outcome was measured using the Change in Subjective Self-Perception (CSP-14) questionnaire. Secondary outcomes were measured using the Profile Of Mood States (POMS) questionnaire and by analyzing salivary cortisol. We randomized 43 participants. Thirty-nine were allocated and included in the intention-to-treat analysis (90% female, mean age 45 years). CSP-14 in part showed significant differences-total score (p = 0.054, Cohen's d = 0.319), item "integration" (p = 0.028, Cohen's d = 0.365)-favoring the effects of the forest. These effects were more pronounced in summer (August). In October, during rainfall, we detected no relevant differences. POMS only showed a significant difference in the subcategory "depression/anxiety" in favor of the field. The amount of cortisol in saliva was not different between the groups. A short-term stay in a forest in summer caused a greater improvement in mood and well-being in HSP than in a field. This effect was not detectable during bad weather in the fall.

A Forest Bathing Intervention in Adults with Intellectual Disabilities: A Feasibility Study Protocol

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.

Effects of forest bathing (shinrin-yoku) on individual well-being: an umbrella review

The aim of this review was to outline the most relevant benefits of forest bathing for well-being promotion. This study was designed as an umbrella literature review. Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, Google Scholar, Scopus, PsycINFO, CINAHL and the DOAJ were systematically searched for relevant reviews up to February 2021. After article selection, 16 systematic reviews met inclusion criteria. Overall, the best available evidence supports the use of forest bathing as a complementary practice for the promotion of psychophysical well-being, whereas evidence for its use as a therapeutic practice for the improvement of organic diseases needs to grow before clear and specific clinical indications can be formulated. The positive impact of forest bathing on individual quality of life, along with its favorable cost-effectiveness profile, may justify its possible adoption for public health strategies of well-being promotion. Further investigations on the topic are advised.

Changes in the Abundance of Monoterpenes from Breathable Air of a Mediterranean Conifer Forest: When Is the Best Time for a Human Healthy Leisure Activity?

The exposure to monoterpenes emitted by plants to the air might provide human health benefits during forest-based leisure activities. However, forests, especially Mediterranean ones, lack studies to relate forest production and the emission of monoterpenes, considering potential human forest exposure. Thus, the aim of this study was to analyze the variation in the abundance of monoterpenes in the human breathable air under the canopy of a Mediterranean conifer forest, evaluating the influence of different factors. For this purpose, from March to November 2018, we monitored the abundance of monoterpenes in the air at nose height, leaf development, air temperature and soil water potential in a mountain Mediterranean forest of Pinus pinaster located in Sierra de Albarracín (Teruel, Spain). We detected six monoterpenes, with α-pinene, β-pinene and limonene being the three most abundant. Temperature was the main environmental factor driving the abundance of monoterpenes in air, with a maxima of abundance found during summer. Leaf development in spring decreased the abundance, while after a drought period, the abundance increased. Thus, people enjoying forest-based activities in Mediterranean conifer areas would be more exposed to air monoterpenes when the temperature increases during the period after leaf development, as long as the trees are not severely water-stressed. If that is the case, the abundance of monoterpenes in the air would increase after the drought period.

Perceived Benefits and Forest Tourists Consumption Intention: Environmental Protection Attitude and Resource Utilization Attitude as Mediators

Establishing a relationship model between environmental protection and resource utilization attitude and consumption intention is the key to promoting the sustainable development of forest tourism. From the standpoint of the Stimulus–Organism–Response (SOR) framework, the purpose of this study is to explore the complex causal relationships between perceived benefits, attitudes toward environmental protection, resource utilization attitudes, and consumption intentions in the context of forest tourism. The research data have been collected using a questionnaire survey of 436 tourists at Siming Mountain in the suburbs of Ningbo city, China. Furthermore, it is analyzed by structural equation modeling. The results indicate a positive correlation between the perceived benefits and tourists’ consumption intention that is mediated by the tourists’ attitude toward resource utilization. Although the independent mediating effect of environmental protection attitude is not supported in this study, both attitudes have played a chain-mediating role between perceived benefit and consumption intention. This study contributes to the existing knowledge by measuring the impact of perceived benefits and environmental attitudes of forest tourists on consumption intentions.

Tourists’ Safety Perception Clues in the Urban Forest Environment: Visual Quality, Facility Completeness, Accessibility—A Case Study of Urban Forests in Fuzhou, China

The service quality and safety perception of urban forests are important factors that influence tourists to choose them as recreation destinations. This study aims to propose a theoretical model of multivariate relationships to explore the relationship between service quality (including visual quality, facility completeness, and accessibility) and safety perception to examine whether visual quality, facility completeness, and accessibility on tourists’ safety perception in the urban forest and to explain the specific reasons for the impact. We collected sample data from many urban forest green spaces in Fuzhou through a two-stage field survey (N = 891), and controlling for potential confounders, a structural equation model was used to estimate relationships. Safety perception was divided into safety environment perception, control perception, and safety emotion. Visual quality of an urban forest positively affected safety emotion. Traffic accessibility positively affected control perception. Facility completeness had a positive impact on safety emotion and control perception. Both safety emotion and control perception played an important intermediary role in improving the perception of a safe environment in the multivariate model. Visual quality, facility completeness, and accessibility all had a positive impact on tourists’ safety perception of urban forests. The findings suggest that improving the service quality of a green space can effectively improve tourists’ evaluation of the safety of the urban forest environment. Specifically, tourists’ psychological tolerance to threats and their self-confidence in survival can be enhanced by improving the service quality of a green space.

The Relationship between Internet Addiction, Internet Gaming and Anxiety among Medical Students in a Malaysian Public University during COVID-19 Pandemic

The internet has become an important medium for learning and communication during the COVID-19 pandemic, particularly for university students. Nevertheless, an increase in internet usage could predispose people to internet addiction (IA) and internet gaming (IG). Equally, there is concern that anxiety levels have increased during the pandemic. The aim of this study is to determine the prevalence of IA and IG, and their associations with anxiety among medical students during the pandemic. Data were collected during the second wave of the “Conditional Movement Control Order” (CMCO) in Malaysia between 12 November and 10 December 2020. A total of 237 students participated through proportionate stratified random sampling in this cross-sectional study. They completed a set of online questionnaires which consisted of a sociodemographic profile, the Malay version of the internet addiction test (MVIAT), the Malay version of the internet gaming disorder-short form (IGDS9-SF) and the Malay version of the depression, anxiety and stress scale (DASS-21). The prevalence of IA and internet gaming disorder (IGD) were 83.5% and 2.5%, respectively. A multiple logistic regression showed that those in pre-clinical years had a greater risk of anxiety than those in clinical years [(AOR) = 2.49, p-value 0.01, 95% CI = 1.22–5.07]. In contrast, those who scored high on IA were protected against anxiety [AOR = 0.100, p-value 0.03, 95% CI = 0.01–0.76)]. In conclusion, IA was highly prevalent during the COVID-19 pandemic and its high usage might serve as a protective factor against anxiety among the medical students in this study sample.

Recreation and Therapy in Urban Forests—The Potential Use of Sensory Garden Solutions

Urban forests are not only woodlands or groups of trees, but also individual trees, street trees, trees in parks, trees in derelict corners, and gardens. All of which are located in urban and peri-urban areas and diversify the landscape and provide a wide range of social benefits. Sensory gardens play a specific therapeutic and preventive role. Designing such gardens as a recreational infrastructure element can successfully enrich urban forests. Following the principles of universal design may provide enjoyment for all city-dwellers, with special attention given to the needs of individuals with disabilities. We studied 15 gardens and one sensory path located in various regions in Poland. The inventory was carried out on the basis of the features considered important in spatial orientation by blind and partially sighted people. The results showed that the solutions used were only partly adequate for the needs of selected users. We found neither tactile walking surface indicators (e.g., communication lines and terrain), spatial models, nor applications in mobile devices. However, these could be useful for all visitors. We confirmed that although problems with the use of forest tourist space are dependent on the type of disability, by implementing the idea of universal design for all elements of recreational infrastructure, forests may be accessible for all users.

Short-Term Effects of Forest Therapy on Mood States: A Pilot Study

Immersion in forest environments was shown to produce beneficial effects to human health, in particular psychophysical relaxation, leading to its growing recognition as a form of integrative medicine. However, limited evidence exists about the statistical significance of the effects and their association with external and environmental variables and personal characteristics. This experimental study aimed to substantiate the very concept of forest therapy by means of the analysis of the significance of its effects on the mood states of anxiety, depression, anger and confusion. Seven forest therapy sessions were performed in remote areas and a control one in an urban park, with participants allowed to attend only one session, resulting in 162 psychological self-assessment questionnaires administered before and after each session. Meteorological comfort, the concentration of volatile organic compounds in the forest atmosphere and environmental coherence were identified as likely important external and environmental variables. Under certain conditions, forest therapy sessions performed in remote sites were shown to outperform the control session, at least for anxiety, anger and confusion. A quantitative analysis of the association of the outcomes with personal sociodemographic characteristics revealed that only sporting habits and age were significantly associated with the outcomes for certain psychological domains.

Physiological and Psychological Assessments for the Establishment of Evidence-Based Forest Healing Programs

This study aimed to establish a health and medical foundation for forest healing programs and provide a basis for developing an evaluation system for such programs. While the number of visitors to forests and interest in forest healing effects are increasing, few studies have examined the various indicators of the persistent changes in forest healing effects. Therefore, this study conducted pre-, post-, and follow-up experiments on 87 health and clinical indicators in a sample of 88 adolescent participants. The relationships between pre-, post-, and follow-up experiment results for each indicator were analyzed. Of the 87 indicators, 46 showed significant changes, including systolic blood pressure, diastolic blood pressure, cholesterol, serotonin, vitamin D, CD16+CD56 count, interferon-γ, resilience, and self-esteem. The findings are significant for studying diverse participants and indicators and lay the foundation for developing forest healing programs by clarifying aspects such as the indicators suitable for short-term observation versus the indicators requiring long-term observation. Based on these analyses, the results of this study are expected to be useful when conducting research to establish an evidence-based forest healing program in the future.

A Qualitative Study Comparing Mindfulness and Shinrin-Yoku (Forest Bathing): Practitioners’ Perspectives

The boundary between mindfulness and forest bathing, two conceptually related therapies, is unclear. Accordingly, this study reports the strengths and challenges, similarities and differences, and barriers and facilitators for both. Semi-structured interviews were conducted with seven trained and experienced practitioners of both mindfulness and forest bathing. Reflexive thematic analysis revealed four main themes: (i) differences between the approaches; (ii) the benefits of forest bathing; (iii) biophilia through forest bathing; and (iv) inward versus outward attentional focus as a distinction between the approaches. Both practices were found to benefit well-being, but practitioners revealed key barriers to mindfulness. For vulnerable groups experiencing mental health challenges or difficulties achieving a meditative state, mindfulness may introduce well-being risks. By offering a gentler, more intuitive approach that encourages outward attentional focus, forest bathing was found to overcome this barrier. Forest bathing is suitable for all groups, but adaptations are recommended for those expressing fear or discomfort in forested environments. The findings inform how to position both approaches in practice, as a first step towards social prescribing recommendations. Wider implications concern forest bathing’s potential to impact environmental well-being. Future research must garner comparative data, involve young people, and explore the feasibility of a forest bathing social prescription.

Evaluation of a Positive Psychology Group Intervention in Nature for Young Cancer Survivors to Promote Well-Being and Post-Cancer Identity Development

Purpose: Adolescent and young adult (AYA) cancer survivors (15-39 years) often struggle with their post-cancer identity. We developed an age-appropriate positive psychology group intervention with fellow AYA cancer survivors in a nature-rich environment. The aim of this study was to examine the needs and expectations of participants of this new, 1-week post-cancer identity intervention, and to evaluate their experiences to identify factors that contribute to the quality and impact of post-cancer mental health care interventions. Methods: This was a mixed-method exploratory pilot study evaluating a new, 1-week post-cancer identity intervention. The participants (n = 13) completed questionnaires at baseline measuring needs and expectations, and on the last day of the intervention and at 1-month follow-up, measuring experiences. Results: Participants' expectations to be supported in finding their post-cancer identity and receiving acknowledgment and recognition of their suffering in fellow AYAs were met. The intervention was perceived as positively contributing to post-cancer identity development (n = 11) and several aspects of well-being. Most appreciated elements of the intervention were peer support and the nature-rich environment on perceived well-being. Conclusion: The group-based positive psychology after care intervention in nature for AYA oncology was well received by participants and provided useful feedback for improvement of future editions. The intervention could offer support to AYA's in the promotion of their well-being and post-cancer identity development, but more research is needed to confirm this.

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

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.

Disentangling the Diversity of Forest Care Initiatives: A Novel Research Framework Applied to the Italian Context

In the effort to advance the knowledge of and disentangle the diversity of emerging forest-based initiatives for wellbeing, we propose (1) an umbrella definition (i.e., forest care initiatives (FCIs)), (2) a custom-made repository to collect and systematize information on FCIs in Italy, and (3) discuss a categorization scheme to cluster initiatives into three main categories according to target users, substitutability of the forest ecosystem, and the specificity of the health contributions to which they are aimed. We analyzed 232 initiatives, showing a lively panorama of Italian FCIs, mainly provided by private entities and civil society. FCI developments appear to be occasions for, but are not restricted to, rural and marginal areas delivering inclusive wellbeing services to a wide target user group and business opportunities. However, due to the novelty of this area of investigation, further research is needed to account for benefits and opportunities and to increase knowledge on enabling forest environments.

Comparative Study of the Restorative Effects of Forest and Urban Videos during COVID-19 Lockdown: Intrinsic and Benchmark Values

The prolonged lockdown imposed to contain the COrona VIrus Disease 19 COVID-19 pandemic prevented many people from direct contact with nature and greenspaces, raising alarms for a possible worsening of mental health. This study investigated the effectiveness of a simple and affordable remedy for improving psychological well-being, based on audio-visual stimuli brought by a short computer video showing forest environments, with an urban video as a control. Randomly selected participants were assigned the forest or urban video, to look at and listen to early in the morning, and questionnaires to fill out. In particular, the State-Trait Anxiety Inventory (STAI) Form Y collected in baseline condition and at the end of the study and the Part II of the Sheehan Patient Rated Anxiety Scale (SPRAS) collected every day immediately before and after watching the video. The virtual exposure to forest environments showed effective to reduce perceived anxiety levels in people forced by lockdown in limited spaces and environmental deprivation. Although significant, the effects were observed only in the short term, highlighting the limitation of the virtual experiences. The reported effects might also represent a benchmark to disentangle the determinants of health effects due to real forest experiences, for example, the inhalation of biogenic volatile organic compounds (BVOC).

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

Shinrin-yoku, immersing oneself in nature using one’s senses, has been receiving increased attention internationally. While most of the existing studies have focused on physical health, this systematic review and meta-analysis examined the mental health impacts of shinrin-yoku, using the PRISMA guidelines (PROSPERO registry: BLINDED). Of 497 articles retrieved on databases including PubMed/MEDLINE, PsycINFO, Science Direct and Google Scholar, twenty met the inclusion criteria. All studies were conducted in Asia and Europe, and used a variety of different bathing approaches (e.g. breathing, walking, yoga). While noting a need for more rigorous research and extensive follow-up assessments, the findings indicate that shinrin-yoku can be effective in reducing mental health symptoms in the short term, particularly anxiety. More careful examination of shinrin-yoku practices is needed; longer follow-up with participants from a range of countries along with greater examination of potential mechanisms is needed for shinrin-yoku to be accepted into mainstream interventions.

Forest and Wellbeing: Bridging Medical and Forest Research for Effective Forest-Based Initiatives

Research Highlights: This review gives an overview of existing literature on the emerging topic of human wellbeing-forest contact nexus and provides a preliminary framework linking forests to wellbeing by highlighting key variables affecting this relationship. Background and Objectives: Existing literature reveals the psychological, physiological and social wellbeing benefits of contact with forest ecosystems; however, the role of forests in this relationship remains largely unexplored. The objectives of this review are twofold: (i) to provide an overview of the contributions of forest experiences to human wellbeing and the related interplay with forest ecosystems and (ii) to identify knowledge gaps to inform future research and systematize information available for forest managers and planners to support the development of effective forest-based initiatives. Materials and Methods: A scoping review was performed with a five-phase method integrating a systematic approach on Scopus, Web of Science and PubMed databases and snowball search. Studies were analyzed using a descriptive-analytical method. Results: Overall, 93 papers were included in the review. These are mainly from health-related sciences providing limited information for forest managers, planners and practitioners. Four main underlying variables of the forest-wellbeing relationship are identified: interaction, forest features, sensorial dimension of the forest and individual traits and reactions. Conclusions: Forest-based initiatives provide good opportunities for supporting public health and time spent in contact with forests seems to have a “health-bonus”. Whether and to what extent forest management can contribute to this is still poorly investigated. There is the need to better study causal relationships between specific forest features, type of interactions, frequency and “dose” of experiences, individual reactions and needs and wellbeing effects to maximize benefits from forest-based initiatives.

Temporal and Spatial Variability of Volatile Organic Compounds in the Forest Atmosphere

The healing effects of the forest are increasingly being valued for their contribution to human psychological and physiological health, motivating further advances aimed at improving knowledge of relevant forest resources. Biogenic volatile organic compounds, emitted by the plants and accumulating in the forest atmosphere, are essential contributors to the healing effects of the forest, and represent the focus of this study. Using a photoionization detector, we investigated the high frequency variability, in time and space, of the concentration of total volatile organic compounds on a hilly site as well as along forest paths and long hiking trails in the Italian northern Apennines. The scale of concentration variability was found to be comparable to absolute concentration levels within time scales of less than one hour and spatial scales of several hundred meters. During daylight hours, on clear and calm days, the concentration peaked from noon to early afternoon, followed by early morning, with the lowest levels in the late afternoon. These results were related to meteorological variables including the atmospheric vertical stability profile. Moreover, preliminary evidence pointed to higher concentrations of volatile organic compounds in forests dominated by conifer trees in comparison to pure beech forests.

The Influence of Forest Resting Environments on Stress Using Virtual Reality

To explore the effects of different types of forest environments for forest therapy, this study focused on forest resting environments. Seven representative forest resting environments found in field research in Beijing were used as independent variables and were shown to subjects by a virtual reality (VR) video. Stress level was used as the dependent variable, and blood pressure, heart rate, salivary amylase, and the Brief Profile of Mood States (BPOMS) were used as physiological and psychological indicators. A between-subjects design was used in the experiment. A total of 96 subjects were randomly assigned to each environment type, and only one type of forest resting environment was observed. Through the relevant sample t-test and one-way analysis of variance, the pre- and post-test data of the indicators were analyzed. This study found that all the seven different types of forest resting environments can produce stress relief effects to some extent. Different types of forest resting environments have different effects on relieving stress. The most natural environment does not have the most significant effect on stress relief. A water landscape has a positive effect on the relief of stress. The conclusions of this study are conducive to the better use of the forest environment for forest therapy services.