Nature-Based Guided Imagery as an Intervention for State Anxiety

Effects of greenness in university campuses on test anxiety among Chinese university students during COVID-19 lockdowns: a correlational and mediation analysis

The purpose of this study is to investigate the correlations of greenness exposure with test anxiety among university students during COVID-19 lockdowns and to explore their mechanisms. We conducted a cross-sectional study with 2609 university students in Anhui and Shandong provinces, China. We assessed perceived campus greenness using a five-point Likert scale for quality, visibility, abundance, usage, and accessibility. Objective greenness was estimated via average normalised difference vegetation index (NDVI) in 1,000-, 1,500-, and 2,000-m radius zones around each of the campuses. A generalised linear mixed model examined the associations between greenness and test anxiety and to evaluate the mediation effects of physical activity, body mass index (BMI), and air pollution. Results showed that higher NDVI1500-m correlated with lower test anxiety (OR = 0.871; 95% CI: 0.851, 0.891), physical activity may partially mediate this association. Increased campus greenness may alleviate test anxiety among Chinese university students.

Comparison of the level of physical activity after the COVID-19 pandemic in Poland, Slovakia and the Czech Republic

BACKGROUND

The COVID-19 pandemic was associated with limited physical activity (PA) of most of the world's population. This cross-sectional prospective study aimed to assess the levels of PA of university students in Poland, Czech Republic and Slovakia after COVID-19 using the International Physical Activity Questionnaire Short Form (IPAQ-SF).

METHODS

A total of 2635 students completed questionnaires regarding their PA levels using the IPAQ-SF between September and December 2022.

RESULTS

PA measured by metabolic equivalent of task (MET) scores, varied between the three countries: Slovakia median MET-minutes/week score 4459.9; Czech Republic 3838.8 Poland 3567.1. The results of the post hoc analysis revealed there were significant differences in MET-minutes/week values between the Czech Republic and Poland (p < 0.035) as well as between the Czech Republic and Slovakia (p < 0.037). The analysis of energetic expenditure during walking revealed that students from the Czech Republic and Slovakia had higher median MET-min/weeks values (Czech 2284.1; Slovak 2467.1) compared to their Polish (1536.1) peers (p < 0.001). Polish cohort presented with significantly higher body mass index (BMI) (p < 0.001) than Czech and Slovak groups (BMI Czech: 22.3; Slovak 22.8; Polish 23.8).

CONCLUSIONS

Significant differences in PA levels between the Czech Republic, Poland, and Slovakia university students were identified. Slovakia showed the highest median PA measured as a MET score, and Poland showed the lowest. Compared to available pre-COVID studies it seems the total level of PA in the observed cohorts has not returned to the pre-COVID levels and students remain less active.

Identifying complementary and alternative medicine recommendations for anxiety treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines

Background

Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs.

Methods

Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively.

Results

Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind-body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John's wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as "unclear, unambiguous, or uncertain". No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism.

Conclusion

Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694.

Guided imagery for anxiety disorder: Therapeutic efficacy and changes in quality of life

Background

Patients with anxiety disorder were showing severity of anxiety symptoms as well as poor quality of life. Guided imagery (GI) provides immediate relaxation, and improves the severity of anxiety symptoms and the quality of life of patients with anxiety disorder. Anxiety is a basic emotion that is required as a motivation for everyday work of life. Anxiety presents a complex cognitive, affective, physiological, and behavioral response that is related to future harm (real or perceived).

Aim

To study the efficacy of GI intervention on patients with anxiety disorder and their quality of life.

Materials and Methods

This longitudinal, interventional study was done in a state institute of mental health, psychiatric unit on 20 patients (outpatients) with anxiety disorder, diagnosed according to diagnostic criteria of research ICD-10 DCR. Patients were assessed using a sociodemographic and clinical data sheet, Hamilton anxiety scale, and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi version.

Results

Patients with anxiety disorder in the experimental group improved as compared with the control group significantly. The mean QOL-BREF score was also improved after intervention in the intervention group.

Conclusion

GI intervention helps reduce the severity of anxiety symptoms and improve the quality of life in patients with anxiety disorder.

Investigating the Impact of Guided Imagery on Stress, Brain Functions, and Attention: A Randomized Trial

The aim of this study was to investigate the potential impact of guided imagery (GI) on attentional control and cognitive performance and to explore the relationship between guided imagery, stress reduction, alpha brainwave activity, and attentional control using common cognitive performance tests. Executive function was assessed through the use of attentional control tests, including the anti-saccade, Stroop, and Go/No-go tasks. Participants underwent a guided imagery session while their brainwave activity was measured, followed by attentional control tests. The study's outcomes provide fresh insights into the influence of guided imagery on brain wave activity, particularly in terms of attentional control. The findings suggest that guided imagery has the potential to enhance attentional control by augmenting the alpha power and reducing stress levels. Given the limited existing research on the specific impact of guided imagery on attention control, the study's findings carry notable significance.

Group Nature-Based Mindfulness Interventions: Nature-Based Mindfulness Training for College Students with Anxiety

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.

Mental imagery of nature induces positive psychological effects

Exposure to natural environments promotes positive psychological effects. Experimental studies on this issue typically have not been able to distinguish the contributions of top-down processes from stimulus-driven bottom-up processing. We tested in an online study whether mental imagery (top-down processing) of restorative natural environments would produce positive psychological effects, as compared with restorative built and non-restorative urban environments. The participants (n = 70) from two countries (Finland and Norway) imagined being present in different environments for 30 s, after which they rated their subjective experiences relating to vividness of imagery, relaxation, emotional arousal, valence (positivity vs. negativity) of emotions, and mental effort. In addition, a psychometric scale measuring vividness of imagination, a scale measuring nature connectedness, and a questionnaire measuring preference of the imagined environments were filled-in. Imagery of natural environments elicited stronger positive emotional valence and more relaxation than imagery of built and urban environments. Nature connectedness and preference moderated these effects, but they did not fully explain the affective benefits of nature. Scores in a psychometric imagery scale were associated in consistent way to the subjective ratings in the imagery task, suggesting that the participants performed attentively and honestly in reporting their subjective experiences. We conclude that top-down factors play a key role in the psychological effects of nature. A practical implication of the findings is that inclusion of natural elements in imagery-based interventions may help to increasing positive affective states.

The Impact of COVID-19 on Physical Activity Patterns of Dental Students: A Multinational Survey

BACKGROUND

The authorities of the world had to take extraordinary containment measures due to the coronavirus (COVID-19) pandemic spreading across the globe. The only way to stay active during the pandemic was at-home physical activity (PA). The current study evaluates how these preventative measures impacted the PA and well-being of students.

METHODS

This study is multicentral and was conducted in Malaysia, India, Cambodia, and Saudi Arabia; participants were recruited from four different regions to answer the online questionnaire provided via a link shared using their personal WhatsApp, Facebook Messenger, and Twitter social media.

RESULTS

The means of vigorous, moderate, and light PA (min/day) between the active and inactive groups were significantly different (p = 0.001, 0.007, and 0.001), respectively. In comparison with pre-COVID-19, the participants reported that it became more challenging to engage in regular exercise since the onset of social distance, associated with a lack of motivation followed by "less confidence", "less enjoyment", "less support, and fewer opportunities to engage in exercise"; moreover, it was "difficult to maintain close relationships" and "hard to voice their options on contentious matters" (p = 0.001). Public health measures affected the PA and well-being of active and inactive students; this demonstrates that health promotion strategies aimed at enhancing levels of PA in inactive students may be necessary to improve students' well-being.

Mindfulness and Relaxation-Based Interventions to Reduce Parental Stress, Anxiety and/or Depressive Symptoms in the Neonatal Intensive Care Unit: A Systematic Review

Parents with infants in the neonatal intensive care unit (NICU) experience high levels of stress, anxiety, and depression. Mindfulness and relaxation-based interventions are effective in reducing distress in the general postpartum population. The aim of this systematic review was to evaluate whether mindfulness and/or relaxation-based interventions reduce stress, anxiety, and depression in NICU parents. A total of five studies met the inclusion criteria and were assessed for quality using the Downs & Black Checklist. The most consistent results in this review suggest that mindfulness and/or relaxation-based interventions may be effective at reducing anxiety symptoms in NICU parents, with moderate to large effect sizes, and show promise in reducing depressive symptoms. The findings show limited potential benefits on parental stress. Methodological weaknesses, heterogeneous intervention factors (including format and length), and varying participant adherence hinder the ability to make strong conclusions. Directions for future research are discussed.

Coping and Resilience Among Endurance Athletes During the COVID-19 Pandemic

COVID-19 lockdowns constrained the training opportunities of athletes resulting in physical and mental hardship. In this study, athletes involved in the outdoor endurance sports of running, cycling or swimming were recruited through Facebook groups and using online mailing lists. The final sample (n = 3,551) consisted of 576 female respondents (16.2%), and 2,975 male respondents (83.8%). The mean age of participants was 44.13  years (min = 16, max = 83, and SD = 9.84). An online survey was designed to measure variables relevant to athletes' mental health; resilience and emotion regulation strategies; mobility restrictions; training routines; personal involvement in endurance sports; age; gender; and country of residence. Overall, the results of our study indicate that during lockdown, decreases in training volume, lower lockdown-specific resilience, and holding more negative perceptions about lockdown mobility restrictions (perceived strictness) all contributed to perceived barriers to training. In the analysis, athletes' relative observance of mobility restrictions was controlled for. Athletes exhibiting high personal commitment to their sports displayed: greater lockdown resilience, a greater use of adaptive coping strategies, and lower levels of perceived barriers to training.

The Relationship Between Climate Change Issue Engagement, Connection to Nature and Mental Wellbeing

As the threat of climate change becomes increasingly prevalent for people in both the developed and developing world, the impact of climate change on mental wellbeing has become a crucial area of research. In addition to the direct, indirect, and psychosocial impacts of climate change on mental wellbeing, there is also a question of how climate change driven changes to the environment will influence the well-established positive relationship between connection to nature and mental wellbeing. The aim of this study was to investigate the relationship between climate change issue engagement, connection to nature, and mental wellbeing in English speaking adults over 18 years of age. This study examined the average levels of connection to nature and mental wellbeing in people with different levels of climate change issue engagement, and evaluated whether a person's level of climate change issue engagement uniquely predicted mental wellbeing. The study corroborated positive relationships between wellbeing and various aspects of relatedness to nature in the overall sample. The strength of these relationships, however, depended on the level of climate change issue engagement. More specifically, the level of engagement is inversely linked to mental wellbeing, such that the lower the level of engagement, generally the higher is wellbeing.

Anthropomorphising nature in times of crisis: A serial mediation model from connectedness to nature via anthropomorphism on support for COVID-19 travel restrictions

The COVID-19 pandemic has resulted in widespread travel restrictions to reduce the spread of the virus. It is therefore necessary to understand factors that lead to support for these imposed travel restrictions. Given the reduced environmental impact (e.g., reduced pollution) resulting from travel restrictions, these restrictions can be viewed through a pro-environmental lens. This study aimed to examine the influence of the well-supported predictor of pro-environmental behaviour, connectedness to nature, on support for COVID-19 travel restrictions. To understand why connectedness to nature may predict support for travel restrictions, mediators of this relationship were examined. Anthropomorphism of nature is reasoned to accompany connectedness to nature, and can involve anthropomorphism in various forms (i.e., generalised, and context-specific anthropomorphism). This study (N=270) examined a mediation model whereby anthropomorphism of nature (general) and anthropomorphism of nature in COVID-19 (context-specific) were serial mediators of the relationship between connectedness to nature and support for travel restrictions. Individual pathways of the model were significant, as were the indirect effects, providing support for the serial mediation model, with these predictors accounting for 13% of the variance in support for COVID-19 travel restrictions. Implications of this research are discussed and include promotion of connectedness to nature as well as considering anthropomorphic message framing.

Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program

Objective:

The purpose of this pilot study was to evaluate the safety and use of a nature-based virtual reality (VR) experience among health care providers (HCP) during a pandemic.

Methods:

Twenty-four frontline HCP participated in this crossover pilot where the viewing order of the experiences were randomized. All participants attended in-person consent, baseline, and end-of-study visits. The intervention consisted of viewing 2 nature-based scenes (“walk in the woods” and “forest of focus”) through 3-D VR and with computer 4K graphic imagery. Randomization took place with regards to the viewing order (VR vs 4K computer video, scene 1 and 2). Outcomes measured were safety, acceptability and changes in intensity of anxiety feelings, resilience, emotional distress, cognitive function, and self-efficacy.

Results:

Among the 26 HCP expressing interest in the study, 24 enrolled in this study. The majority were male (58.3%), white (66.7%) and of an average age of 46.3 ± 10.5 years (standard deviation (SD)). End of the study survey showed that almost all participants (96%) would participate in the study again and recommend it to others. Twenty-three of the 24 participants also felt relaxed after seeing the imagery. With respect to anxiety (as measured by the STAI Y1), the VR “walk in the woods” had the greatest reduction from pre to post (6.4 points, SD = 5.98) followed by VR “forest of focus” (5.8 points, SD = 9.29), computer screen “forest of focus” (5.0 points, SD = 8.89), and computer screen “walk in the woods” (4.1 points, SD = 6.22). All 4 sessions had a significant decrease in score from pre to post (P-values ≤.005), but there was no significant difference in the change from pre- to post-session between the 4 groups (P-value = .5835).

Conclusion:

The use of the VR among HCP has promise for reducing stress among health care providers during a high stress period, such as a pandemic but much larger studies are needed.

Comparison of General-Social Health and Corona-Induced Anxiety Between Active and Inactive Students in the COVID-19 Pandemic

Background: General health includes physical and mental health and their interactions, and physical activity can improve people's mental and social health. The present study has compared general-social health and COVID-19-induced anxiety between active and inactive students during the COVID-19 pandemic. Methods: A causal-comparative research design was used in this study. The statistical population consisted of all students of the Farhangian University of Mashhad (2,500 students) in 2020, out of whom 752 students were randomly selected (323 men and 429 women). Subjects were assessed for general health, social health, and COVID-19-induced anxiety. Data normality was investigated by the Kolmogorov-Smirnov test and data were analyzed statistically using independent t-test and Pearson correlation coefficient test. Results: The results of the present study showed that there was a significant difference between general health and COVID-19-induced anxiety of active and inactive students (p = 0.001), but no significant difference was observed between these two groups in social health (p ≥ 0.05). Results obtained regarding the correlation indicated that there was a significant correlation between general and social health in both active and inactive students (p = 0.001). However, there was no significant correlation between COVID-19-induced anxiety and general-social health (p ≥ 0.05). Conclusion: According to the results of the present study, it can be said that an active lifestyle and physical activity are important factors to improve general health and reduce anxiety, especially in specific conditions of the COVID-19 outbreak. Therefore, it is recommended that students have a regular exercise program to reduce their anxiety and increase the level of their physical health.

Connectedness to nature: Mapping the role of protected areas

Connectedness to nature (CNT) is likely to be a strong influence on how local communities and stakeholders respond to designation and management of protected areas. This study explores relationships between CNT and location, using the Maltese Islands as a case study. The intensity of CNT, as expressed by a sample of household respondents across the islands (n = 401), was measured using the Nature Relatedness Scale (NRS). Respondents were also asked to indicate places that are significant for their own connection with nature. Results were mapped and analysed with respect to the location of two types of protected areas: Natura 2000 sites and Urban Conservation Areas. The bulk of special places of high CNT identified by respondents were located in or very close to Natura 2000 sites, regardless of respondents' place of residence and regardless of protected area size. Protected natural areas are therefore important loci of community attachment with nature. Managers of such sites can potentially leverage this attachment to enhance community engagement in conservation and to contribute to increased nature connectedness in the community. However, this study also noted a not-insignificant contribution to CNT from urban or non-protected sites, providing support for adoption of landscape approaches that focus holistically on spaces that provide a context for daily life.

Dog Tales: Mindful Dog Interactions Evoke Similar Experiences to Dog Assisted Mindfulness Meditations

Simple Summary

As humans went into lockdown in response to the global COVID-19 pandemic, so did their pets. The resulting loss of human freedoms can be an important reflection point for standard pet keeping practices. This study evaluated the feasibility and effectiveness of two six-week interventions that owners can complete with their pet dogs from the safety and comfort of their homes, designed to enhance the wellbeing of both parties. One was a dog-assisted mindfulness intervention, whereby participants would sit quietly with their dog and listen to a mindfulness recording, using a feature of their dog as their object of focus, e.g., their dog’s fur. The other was a dog interactions intervention, whereby participants spent at least 7 min of undivided attention interacting with their dog in different ways each week. Common experiences were reported across the two interventions including: enhanced owner–dog connection, and feelings of relaxation, happiness and engagement both during and after participating in the weekly activities. Additionally, ‘dog happiness’ was commonly reported in the dog interactions group. Using our own experiences of being “locked down” as a reference point, this study offers two novel ways in which owners can attempt to enrich the lives of their dogs at home.

Abstract

Stay-at-home regulations in response to COVID-19 have put humans at increased risk of loneliness. Some studies support dog ownership as a protection against loneliness, while other studies have suggested the lockdowns can be used to reflect upon the similar restrictions owners impose on their pets on a daily basis. This study evaluated two novel ways to enrich the lives of pet dogs in the home, while also providing benefits to owners. It was hypothesized that a six-week Dog Assisted Mindfulness (DAM) intervention and a Dog Interactions (DI) intervention would positively impact owner-rated loneliness, mindfulness, and owner–dog emotional attachment, compared to a control group. Seventy-three participants were randomly assigned to each group. Mixed methods ANOVAs found no significant main effects of group, nor any group × time interaction effects. Qualitative analyses revealed common experiences among participants in the two active interventions, including enhanced owner–dog connection, and feelings of relaxation, happiness and engagement both during and after participating in the weekly activities. There was also an added benefit of ‘dog happiness’ in the interactions group. Future studies should investigate this in a more objective manner and in the meantime, regular owner–dog interactions should be encouraged, especially during times of extended lockdown.

Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation

Research suggests that multiple forms of relaxation training (e.g., progressive muscle relaxation, meditation, breathing exercises, visualization, and autogenics) can help individuals reduce stress, enhance relaxation states, and improve overall well-being. We examined three different, commonly used approaches to stress relaxation-progressive muscle relaxation, deep breathing, and guided imagery-and evaluated them in a head-to-head comparison against each other and a control condition. Sixty healthy undergraduate participants were randomized to one of the four conditions and completed 20 minutes of progressive muscle relaxation, deep breathing, or guided imagery training that was delivered by recorded audio instruction. Baseline and follow-up assessment of psychological relaxation states were completed. Physiological relaxation was also assessed continuously using measures of electrodermal activity and heart rate. Results showed that progressive muscle relaxation, deep breathing, and guided imagery all increased the state of relaxation for participants in those groups, compared to participants in the control group. In each case, the increase was statistically significant and although the groups did not differ on relaxation before training, all groups were significantly higher on relaxation after training, as compared to the control group. Progressive muscle relaxation and guided imagery showed an immediate linear trend toward physiological relaxation, compared to the control group, and the deep breathing group showed an immediate increase in physiological arousal followed quickly by a return to initial levels. Our results lend support to the body of research showing that stress relaxation training can be effective in improving relaxation states at both the psychological and physiological level. Future research could examine stress relaxation techniques in a similar manner using designs where multiple techniques can be compared in the same samples.

Exploring the Use of Virtual Reality for the Delivery and Practice of Stress-Management Exercises

Background

Mindfulness-based interventions may benefit healthcare professionals with burnout symptoms. Virtual reality (VR) may reduce initial difficulty of engaging in mindfulness exercises and increase participants’ engagement through immersion and presence.

Aim

The aim was to investigate how VR affects participants’ experience of engagement with mindfulness practice, and its impact on quality of practice and negative mood states.

Methods

Fifty-one healthcare professionals were randomized to receive either a visualization or non-visualization mindfulness practice, to compare the quality of practice through the use of audio only vs. with a virtual reality interface. Selected self-reported measures were collected during the session (immersion, quality and difficulty of practice, mood states and likelihood for future practice).

Results

Results showed that order instead of type of modality administered made a difference in quality of mindfulness practice. A greater sense of presence was reported with VR if administered after audio (F = 4.810, p = 0.033, Partial η² = 0.093). Further, participants described difficulty practicing with audio if administered after VR (F = 4.136, p = 0.048, Partial η² = 0.081). Additionally, lower mood disturbance was reported with VR if administered after audio (F = 8.116, p = 0.006, Partial η² = 0.147). Qualitative responses echoed a preference for VR to engage better, in addition to improved mood states after practice.

Conclusion

Findings suggest that VR has the potential to provide healthcare professionals with an alternative or a supplement to conventional mindfulness practice.

Impact of the 2019 Coronavirus Disease Pandemic on Health-Related Quality of Life and Psychological Status: The Role of Physical Activity

This study investigated the impact of the 2019 coronavirus disease (COVID-19) pandemic on health-related quality of life (HRQoL) and psychological status among Saudi adults, and whether physical activity modifies this association. The participants were 518 adults aged ≥18 years (67.4% men). Using an online survey, data regarding demographic information, the impact of COVID-19 (assessed by the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5), HRQoL (Short Form-8), psychological distress (Depression, Anxiety and Stress Scale), and physical activity behavior (International Physical Activity Questionnaire-Short Form) were collected. The results demonstrate that adults reporting moderate or high levels of impact of COVID-19 had a lower HRQoL and higher psychological distress than adults reporting a low impact. HRQoL was higher for adults reporting any level impact (low, moderate, or high) of COVID-19 when they participated in recommended levels of physical activity (≥600 metabolic equivalent (MET)-min/week of total physical activity). Psychological distress was lower for adults reporting a high level of impact when they participated in recommended physical activity. Moderate or high levels of impact of COVID-19 were associated with a significantly lower HRQoL and higher psychological distress than the low impact of COVID-19. However, these associations were moderated by the recommended levels of physical activity.

A Thematic Analysis of Multiple Pathways Between Nature Engagement Activities and Well-Being

Research studies have identified various different mechanisms in the effects of nature engagement on well-being and mental health. However, rarely are multiple pathways examined in the same study and little use has been made of first-hand, experiential accounts through interviews. Therefore, a semi-structured interview was conducted with seven female students who identified the role of nature engagement in their well-being and mental health. After applying thematic analysis, 11 themes were extracted from the data set, which were: “enjoying the different sensory input,” “calm nature facilitates a calm mood,” “enhancing decision making and forming action plans,” “enhancing efficiency and productivity,” “alleviating pressure from society's expectations regarding education,” “formation of community relations,” “nature puts things into perspective,” “liking the contrast from the urban environment,” “feel freedom,” “coping mechanism,” and “anxious if prevented or restricted.” The results indicate complementary mechanisms for how nature-related activities benefit mental health and well-being that may occupy different levels of experience within a hierarchical framework informed by perceptual control theory.

Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study

Background

Increased exercise and physical activity levels are recommended throughout cancer therapy and survivorship. Nonetheless, the COVID-19 pandemic and consequent social distancing are likely to cause a decline in physical activity.

Objective

to evaluate the level of unsupervised physical activity of breast cancer survivors during the COVID-19 pandemic, and the factors associated with difficulties in engaging and maintaining recommended physical activity levels.

Methods

This is a cross-sectional epidemiological study with a sample of 37 breast cancer survivors. They participated in a canoeing training program (project Remama) at the University of São Paulo before the COVID-19 pandemic. Socioeconomic aspects, engagement in physical activity, motivation, and potential exposure to COVID-19 were investigated through an online survey, administered in September of 2020.

Results

During the pandemic, participants increased their body weight (5 ± 3.4 kg); 90% reported decreasing physical activity levels associated with increased sedentary time. Twenty-one (58%) participants exhibited some COVID-19-related symptoms, most used public transportation (59%), or returned to work during the period of a high incidence of COVID-19. The only factor associated with perceived difficulty in engaging in physical activities was having had more than three cancer treatments (RR: 2.14; 95% CI: 1.07–4.27).

Conclusion

The COVID-19 pandemic led to a group of previously active breast cancer survivors to decrease their physical activity, gain weight, and have sedentary behavior. Specific tailored-care interventions are needed to prevent these occurrences, as overweight and physical inactivity may impose an additional risk for breast cancer recurrence and a severe course of COVID-19 in cancer patients.

Adverse Childhood Experiences: The Protective and Therapeutic Potential of Nature

Adverse childhood experiences (ACEs) are prevalent in many western populations. Large studies have put the likelihood of having at least one ACE above 50% of the general population. ACEs and the associated experience of chronic stress, moreover, have been consistently linked with a variety of negative physical and psychological health outcomes across the lifespan from behavioral problems and cognitive difficulties early on, to greater chance of suffering from a mental health disorder and engaging in self destructing behaviors. The literature puts forward several protective factors, such as mother-child relations, parental health, and community engagement. In this perspective paper we put forward the potential of regular nature engagement as a possible additional protective factor. Nature's therapeutic potential has been well documented, for many psychopathologies and mental health difficulties. Yet studies looking at the protective and therapeutic potential of nature with people with ACEs are remarkably limited in numbers. In this perspective piece we conduct a search of the literature to find previous applications of nature as a protective or therapeutic intervention for people with ACEs. We highlight the gap in the current literature, and put forward various mechanisms of action that justify a closer exploration of this area in further research.

Virtual Reality Nature Exposure and Test Anxiety

The number of students affected by exam anxiety continues to rise. Therefore, it is becoming progressively relevant to explore innovative remediation strategies that will help mitigate the debilitating effects of exam anxiety. The study aimed to investigate whether green environment exposure, delivered by virtual reality (VR) technology, would serve as an effective intervention to mitigate participants’ test anxiety and therefore improve the experience of the exam, measured by positive and negative affect, and increase test scores in a pseudo exam. Twenty high and twenty low exam anxiety students completed a pseudo exam before and after being exposed to either a simulated green environment or urban environment. Only those who had high anxiety and were exposed to the nature VR intervention had significant reductions in negative affect (F(1, 31) = 5.86, p = 0.02, ηp2 = 0.15), supporting the idea that exposure to nature, even if simulated, may benefit students’ feelings about their academic performance. The findings are discussed in light of future developments in nature and educational research.

Physical Activity Changes and Its Risk Factors among Community-Dwelling Japanese Older Adults during the COVID-19 Epidemic: Associations with Subjective Well-Being and Health-Related Quality of Life

Psychological distress caused by decreased physical activity (PA) is a growing concern among the elderly due to public health measures since the coronavirus disease (COVID-19). We aimed to (1) assess how public health restrictions impact PA, subjective well-being (SWB), and health-related quality of life (HRQoL) of community-dwelling elderly, and (2) investigate risk factors that lead to a decline in PA. Self-administered questionnaires assessed the changes in PA, SWB, HRQoL. Multivariate logistic regression analysis was performed to identify significant associated risk factors for decreased PA. Of 165 participants (valid response rate, 41.3%; mean age, 78.5 ± 8.0 years), 47.3% became less active, 23.0% became more active, and 29.7% maintained PA levels. There was a significant decrease in SWB at baseline and follow-up after COVID-19 restrictions in the less active group (p < 0.01). Higher levels of moderate or strenuous exercise/sports activity at baseline (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01–1.24), and lower mental component HRQoL scores at baseline (OR, 0.96; 95% CI, 0.93–0.99) were associated with an increased risk of decreased PA. Public health restrictions impact the PA of the elderly, especially those who had higher levels of exercise/sports activity and lower HRQoL before COVID-19. Decreased PA was strongly associated with lower SWB.

Pain Management in Breast Surgery: Recommendations of a Multidisciplinary Expert Panel-The American Society of Breast Surgeons

Opioid overdose accounted for more than 47,000 deaths in the United States in 2018. The risk of new persistent opioid use following breast cancer surgery is significant, with up to 10% of patients continuing to fill opioid prescriptions one year after surgery. Over prescription of opioids is far too common. A recent study suggested that up to 80% of patients receiving a prescription for opioids post-operatively do not need them (either do not fill the prescription or do not use the medication). In order to address this important issue, The American Society of Breast Surgeons empaneled an inter-disciplinary committee to develop a consensus statement on pain control for patients undergoing breast surgery. Representatives were nominated by the American College of Surgeons, the Society of Surgical Oncology, The American Society of Plastic Surgeons, and The American Society of Anesthesiologists. A broad literature review followed by a more focused review was performed by the inter-disciplinary panel which was comprised of 14 experts in the fields of breast surgery, anesthesiology, plastic surgery, rehabilitation medicine, and addiction medicine. Through a process of multiple revisions, a consensus was developed, resulting in the outline for decreased opioid use in patients undergoing breast surgery presented in this manuscript. The final document was reviewed and approved by the Board of Directors of the American Society of Breast Surgeons.

The Impact of COVID-19 on Physical Activity Behavior and Well-Being of Canadians

A global pandemic caused by the novel coronavirus (COVID-19) resulted in restrictions to daily living for Canadians, including social distancing and closure of city and provincial recreation facilities, national parks and playgrounds. The objective of this study was to assess how these preemptive measures impacted physical activity behaviour and well-being of Canadians. An online survey was utilized to measure participant physical activity behavior, nature exposure, well-being and anxiety levels. Results indicate that while 40.5% of inactive individuals became less active, only 22.4% of active individuals became less active. Comparatively, 33% of inactive individuals became more active while 40.3% of active individuals became more active. There were significant differences in well-being outcomes in the inactive population between those who were more active, the same or less active (p < 0.001) but this was not seen in the active population. Inactive participants who spent more time engaged in outdoor physical activity had lower anxiety than those who spent less time in outdoor physical activity. Public health measures differentially affected Canadians who were active and inactive and physical activity was strongly associated with well-being outcomes in inactive individuals. This suggests that health promoting measures directed towards inactive individuals may be essential to improving well-being.