Therapist

Nature therapy for stress relief

Young woman in raincoat enjoys nature in the rain

Keep Outside in Mind for Less Stress

Spending time in nature can help relieve stress and anxiety, improve your mood, and boost feelings of happiness and wellbeing. Whatever you call it – forest bathing, ecotherapy, mindfulness in nature, green time or the wilderness cure — humans evolved in the great outdoors, and your brain benefits from a journey back to nature.

Get Out

Have you been feeling down lately? A little sluggish, stressed out, or maybe wondering, “What’s life all about?” 

Here’s another question: How much time have you spent in nature lately?

The answer to these two questions might be more closely related than you’d think.

The modern way we live has changed radically from life in the savanna, but our brains have mostly stayed the same. We still have a deep connection with nature, and research shows that if we don’t nourish that bond despite our technological advancements, we may suffer in many ways.1

Feel Better

If you’re able to, get back to nature to energize your mind and body.
 
Depressed: If you’re feeling blue, try going outside to green, natural spaces. A stroll in the woods has been shown to help combat depression, and even just the view of the forest from a hospital room helps patients who are feeling down.2 Head for the hills if you need a boost to your mood.

Stressed: Nature presents scenes that gently capture your attention instead of suddenly snatching it, calming your nerves instead of frazzling them.3 
 
Anxious: You probably know that exercise is good for your state of mind. But did you know that working out in nature helps to reduce anxiety,4 among other benefits, even more than going to an indoor gym?5 Consider hitting some trails to get the best mental bang for your buck.

Self-Involved: If you dwell on your problems and just can’t stop, a walk through a meadow might put the brakes on the thought train circling through your head. Research shows that a 90-minute walk in nature lowers activity in the part of the brain linked to negative rumination.6

Fatigued: Are you constantly multitasking at work as you switch between customers and phone calls, or click from spreadsheets to presentations? Even at home, you might face a combination of kids, chores and devices vying for your attention. Your prefrontal cortex can only take so much distraction before it needs a recharge. Luckily, time in nature has been shown to restore mental abilities like short term memory and processing 3D images based on drawings.7

Uninspired: Changing the scenery is a great way to get the creative juices flowing, and nature offers stimuli that you won’t find while staring at a screen. In one example, spending four days in nature improved problem-solving skills by 50%. If you haven’t found a way to tackle that next big project at work, or an obstacle that’s impeding your personal goals, try noodling on it in the great outdoors.7

Antisocial: Time in nature can help with your personal relationships, too. Natural beauty results in more prosocial behaviors, like generosity and empathy.8

Disconnected: One of the most basic human needs is to feel that you belong and you’re part of a larger tribe. But studies show that this concept goes beyond human relationships alone. Time in nature results in a sense of belonging to the wider world that is vital for mental health.9

Angsty: At times, you might feel lost, and begin to wonder what life is all about. A dose of awe might remind you just how wondrous the world is. Nature provides trees that were hundreds of years old before you were even born, towering mountains that touch the clouds and a sky full of uncountable stars. When it comes to awe-inspiring awesomeness, nature leaves our jaws dropping and spines tingling, and rekindles the realization that we’re a tiny part of an incredible universe. What’s more powerful than that?

Consider seeing a mental health professional if your symptoms are serious, but if you’re feeling a tinge of any of the blues listed above, try something like:

  • Add a daily walk on a local hiking trail to your regimen.
  • Go on a bike ride around your neighborhood.

Have you been feeling down lately? A little sluggish, stressed out, or maybe wondering, “What’s life all about?”Here’s another question: How much time have you spent in nature lately?The answer to these two questions might be more closely related than you’d think.The modern way we live has changed radically from life in the savanna, but our brains have mostly stayed the same. We still have a deep connection with nature, and research shows that if we don’t nourish that bond despite our technological advancements, we may suffer in many ways.If you’re able to, get back to nature to energize your mind and body.If you’re feeling blue, try going outside to green, natural spaces. A stroll in the woods has been shown to help combat depression, and even just the view of the forest from a hospital room helps patients who are feeling down.Head for the hills if you need a boost to your mood.Nature presents scenes that gently capture your attention instead of suddenly snatching it, calming your nerves instead of frazzling them.You probably know that exercise is good for your state of mind. But did you know that working out in nature helps to reduce anxiety,among other benefits, even more than going to an indoor gym?Consider hitting some trails to get the best mental bang for your buck.If you dwell on your problems and just can’t stop, a walk through a meadow might put the brakes on the thought train circling through your head. Research shows that a 90-minute walk in nature lowers activity in the part of the brain linked to negative rumination.Are you constantly multitasking at work as you switch between customers and phone calls, or click from spreadsheets to presentations? Even at home, you might face a combination of kids, chores and devices vying for your attention. Your prefrontal cortex can only take so much distraction before it needs a recharge. Luckily, time in nature has been shown to restore mental abilities like short term memory and processing 3D images based on drawings.Changing the scenery is a great way to get the creative juices flowing, and nature offers stimuli that you won’t find while staring at a screen. In one example, spending four days in nature improved problem-solving skills by 50%. If you haven’t found a way to tackle that next big project at work, or an obstacle that’s impeding your personal goals, try noodling on it in the great outdoors.Time in nature can help with your personal relationships, too. Natural beauty results in more prosocial behaviors, like generosity and empathy.One of the most basic human needs is to feel that you belong and you’re part of a larger tribe. But studies show that this concept goes beyond human relationships alone. Time in nature results in a sense of belonging to the wider world that is vital for mental health.At times, you might feel lost, and begin to wonder what life is all about. A dose of awe might remind you just how wondrous the world is. Nature provides trees that were hundreds of years old before you were even born, towering mountains that touch the clouds and a sky full of uncountable stars. When it comes to awe-inspiring awesomeness, nature leaves our jaws dropping and spines tingling, and rekindles the realization that we’re a tiny part of an incredible universe. What’s more powerful than that?

Sources
1 Capaldi C, Dopko RL, Zelenski J. The relationship between nature connectedness and happiness: a meta-analysis. Frontiers in Psychology. 2014. doi: 10.3389/fpsyg.2014.00976.
2 Morita E, Fukuda S, Nagano J, et al. Psychological effects of forest environments on healthy adults: Shinrin-yoku (forest-air bathing, walking) as a possible method of stress reduction. Public Health. 2007;121:54–63. doi: 10.1016/j.puhe.2006.05.024.
3 Pearson DG, Craig T. The great outdoors? Exploring the mental health benefits of natural environments. Frontiers in Psychology. 2014;5:1178. doi:10.3389/fpsyg.2014.01178.
4 Mackay J, James G&N. The effect of “green exercise” on state anxiety and the role of exercise duration, intensity, and greenness: A quasi-experimental study. Psychology of Sport and Exercise. 2010;11:238-245. doi: 10.1016/j.psychsport.2010.01.002.
5 Thompson Coon J,Boddy K, Stein K, et al. Does Participating in Physical Activity in Outdoor Natural Environments Have a Greater Effect on Physical and Mental Wellbeing than Physical Activity Indoors? A Systematic Review. Environmental Science & Technology. 2011(45);5:1761-1772. DOI: 10.1021/es102947t 
6 Bratman GN, Hamilton JP, Hahn KS, et al. Nature experience reduces rumination and subgenual prefrontal cortex activation. Proceedings of the National Academy of Sciences of the United States of America. 2015(112);28:8567-8572. doi: 10.1073/pnas.1510459112.
7 Atchley RA, Strayer DL, Atchley P. Creativity in the Wild: Improving Creative Reasoning through Immersion in Natural Settings. de Fockert J, ed. PLoS ONE. 2012;7(12):e51474. doi:10.1371/journal.pone.0051474.
8 Zhang JW, Piff PK, Iyer R, et al. An occasion for unselfing: Beautiful nature leads to prosociality. Journal of Environmental Psychology. 2014;37:61-72. doi: 10.1016/j.jenvp.2013.11.008
9 Mayer F, Frantz C, Bruehlman-Senecal E, Dolliver K. Why Is Nature Beneficial? The Role of Connectedness to Nature. 2009;41:607-643. Doi: 10.1177/0013916508319745  
10 Joye Y, Bolderdijk JW. An exploratory study into the effects of extraordinary nature on emotions, mood, and prosociality. Frontiers in Psychology. 2014;5:1577. doi:10.3389/fpsyg.2014.01577.

hands plantingResearch reveals that environments can increase or reduce our stress, which in turn impacts our bodies. What you are seeing, hearing, experiencing at any moment is changing not only your mood, but how your nervous, endocrine, and immune systems are working.

The stress of an unpleasant environment can cause you to feel anxious, or sad, or helpless. This in turn elevates your blood pressure, heart rate, and muscle tension and suppresses your immune system. A pleasing environment reverses that.

And regardless of age or culture, humans find nature pleasing. In one study cited in the book Healing Gardens, researchers found that more than two-thirds of people choose a natural setting to retreat to when stressed.   

According to the search results between 2013 and 2016 (four years), only two publications were made on the nature of forest therapy based on VR. These studies were solely in 2013 and 2014, while no studies were published in 2015 and 2016. This implies that the concept of using forest therapy based on VR was still in its infancy during these years. However, since 2017, articles have gradually increased, reaching three articles in 2019, six in 2020, and three in the first half of 2021. These statistics in Figure 3 are not unexpected, given that VR has lately been widely used in research, particularly in therapy. Additionally, more research is required to improve people’s well-being and mental health in the workplace and everyday situations.

3.2. Psychosocial and Physiological Effects of Forest Therapy

36,45,46,47,48,49,50,51,52,53,

Recent studies focused on investigating the combined effect of psychological or physiological variables and the external environment on physical and mental health. Earlier studies on forest therapy concentrated on psychosocial and physiological factors, often enhancing an individual’s moods ( Table 1 ). Most studies on the psychosocial impacts of forest therapy used self-report surveys to assess participants’ mood states and overall mental health. Among the most employed methods were the Profile of Mood States (POMS), positive and negative affect scale (PANAS), visual analogue scales (VAS), standard stress scale (SSS), perceived stress scale (PSS), and state and trait anxiety inventory (STAI-S). Along with psychosocial impacts assessment, twelve studies [ 35 54 ] examined the effects of forest therapy on physiological health by evaluating heart rate (HR), heart rate variability (HRV), systolic blood pressure (SBP), diastolic blood pressure (DBP), salivary amylase (SA), the standard deviation of R-R intervals (SDRR), blood volume pulse (BVP), and skin conductance levels (SCL).

47,48,

Four of these studies used POMS and HR/HRV to evaluate the psychological and physiological responses [ 46 49 ]. Tsutsumi, Nogaki, Shimizu, Stone, and Kobayashi [ 46 ] conducted a study to see if stimulation from watching one’s favorite video of the sea or the forest affected relaxing. Participants were instructed to watch DVDs for sea and forest with natural sounds for 90 min. The POMS scores were collected on every session, and Bispectral Index System value and HRV were monitored by the Bispectral Index System and MemCalc system. Each indication was compared between the two groups of six participants based on their sea or forest scenery choice. The heart rate, persistent arousal, and high frequency changed significantly as watching the favorite video. These findings suggested that the viewer’s favorite movie of the sea or forest had a calming impact. Yu, Lee, and Luo [ 47 ] investigated the physiological and psychological reactions to virtual reality forests and urban environments. This study used a cross-over and pretest-posttest approach to assess the VR environment’s impact on forests and urban restoration. The researchers gathered both physiological and psychological responses (POMS). The findings revealed that the subjects’ systolic blood pressure and heart rate reduced over time, regardless of contextual variables. In simulated urban contexts, an increased degree of weariness and a decreased level of self-esteem was observed as psychological responses. However, in simulated forest conditions, vigor levels increased, and negative feelings, such as perplexity, tiredness, anger-hostility, tension, and despair, decreased. Overall, the benefits of immersing in a forest environment have proved to be more significant. Another study was carried out by Hong, Joung, Lee, Kim, Kim, and Park [ 48 ] to examine the influence of VR forest video on adult stress relief using POMS, HRV, and HR measurements. Arithmetic tasks (1-digit by 2-digit numbers multiplication) were used to induce stress in participants before giving them five minutes to watch a virtual reality forests (VRF) video. This study revealed that stress index and HR decreased, confirming that VRF reduces stress in adults, stabilizes physiological state, and improves psychological state. Wang, Shi, Zhang, and Chiang [ 49 ] presented seven exemplary forest rest areas discovered during fieldwork in Beijing to participants using VR. Blood pressure, heart rate, salivary amylase, and the Brief POMS were physiological and psychological indicators, with stress level as the dependent variable. Each environment type was randomly allocated to 96 participants, and only a kind of forest resting setting was observed. According to this study, all seven forest rest environments may reduce stress effects to some level. The impact of different types of forest resting environments on stress relief is distinct, with the most natural settings having the greatest impact on stress relief.

Two studies [ 35 36 ] used STAI-S as a psychological indicator and HR/HRV or SCL as physiological indicators. For example, [ 35 ] studied the effect of natural noises and stress recovery in natural surroundings. The study investigated subjective stress (STAI-S) and physiological recovery (HR) in two virtual natural environments—(1) with exposure to natural sounds and (2) without exposure to natural sounds—and one control condition after producing stress with a virtual stress test. The results revealed parasympathetic activation in the group exposed to natural sounds in a simulated natural environment, implying increased stress recovery in such settings. The control group and the group that recovered in virtual nature without sound showed neither autonomic activation nor inactivation. The findings imply a possible mechanistic relationship between nature, natural sounds, and stress recovery, indicating the potential use of VR as a viable method to manage stress. Li, Sun, Sun, Yuan, and Li [ 36 ] investigated the influence of brightness levels on stress retrieval when watching VRF with simulated natural light. This study used pre-test and post-test strategies to examine the effect of different brightness levels on stress recovery using a virtual forest environment. A total of 120 participants were recruited to watch stimuli from six immersive virtual environments (IVEs) through a head-mounted display. The physiological and psychological responses, as well as perceived environmental characteristics, were assessed. This study showed that VRF scenes of bright sunlight reduced stress more effectively than scenes from the dark night.

In two more studies, HR was used with VAS [ 54 ] and PANAS [ 50 ] to evaluate the effectiveness of VR in reducing stress. Schebella, Weber, Schultz, and Weinstein [ 54 ] use IVEs comprised of visual, auditory, and olfactory stimuli to examine the impacts of biodiversity on stress recovery. Their study employed three natural and one urban environment (none, low, moderate, and high). A further IVE with high biodiversity was also added, but no auditory or olfactory stimulation. The study reported consistent reactions to well-being using physiological and self-reported measurements. However, biodiversity has been shown to have a non-linear effect on stress recovery, and is most effective in urban settings and most influential in moderately diverse environments. It was stated that multisensory (visual, auditory, and olfactory) stimulation improved stress recovery and did not impact the immersion sense of the participants when compared to visual-only encounters. In [ 50 ], the impact of VR technology on reducing stress and enhancing individuals’ moods was investigated using a pulse-oximeter and the PANAS. This study was conducted on 36 women with substance use disorder (SUD) for the first 10 min of their daily programs in a residential treatment program for four weeks, including two activities. A cross-over design was employed to compare seeing natural environments and performing mindfulness-based activities. As a result, there were statistically significant reductions in mean negative affect ratings and heart rate after seeing a nature scene and conducting mindfulness-based exercises. Additionally, general mood significantly improved for participants in both circumstances.

The other four studies used other psychological and physiological indicators, such as EDA and MRJPQ in [ 45 ]; GHQ12 and GSR in [ 51 ]; POMS, PSS, and GSR in [ 52 ]; and PANAS and SDRR in [ 53 ]. For instance, Anderson, Mayer, Fellows, Cowan, Hegel, and Buckey [ 45 ] used VR technology with immersive natural scenery to reduce stress levels and improve participants’ moods. They recruited 18 participants (9 men and 9 women), aged 32 to 44. The participants were required to watch three 360° views of an indoor control, rural Ireland, and remote beaches for 15 min. Before the scenes, the subjects were psychologically stressed with arithmetic tasks. Psychophysiological arousal was measured using EDA and heart rate variability. The mood and scene qualities were assessed using the positive and negative affect schedule and the 15-question MRJPQ. When comparing the natural sceneries to the control scenario, the reductions in EDA from baseline were larger at the end of the natural scenes. The natural settings reduced negative influence from baseline, whereas the control scene did not. The control scene had lower scores of MRJPQ than natural situations. The preferred scene in the two natural sceneries reduced the negative effect and increased MRJPQ scores than the second-choice scene. Their study revealed that natural VR could produce relaxation with the right selection of scenery, owing to its impact on assessing the mood and quality of the scenery. In [ 51 ], VR was integrated with bilateral stimulation for stress relief to evaluate EMDR. The authors conducted three relaxation training sessions on 28 healthy office workers who recorded their subjective stress (GHQ12), HR, mood, GSR, and muscle response prior to the session. The study revealed a significant reduction in stress levels and improved participant mood using VR based on their findings. Mostajeran, Krzikawski, Steinicke, and Kühn [ 52 ] studied the effects of exposure to a forest and an urban virtual environment on mood, stress, physiological responses, and cognition. The environments were shown as either traditional photo slideshows or 360-degree films on a head-mounted display. Their findings revealed that the forest environment had a favorable effect on cognition while the urban environment disrupted mood. Furthermore, images of an urban or forest setting could lower physiological stimulation than immersive 360-degree movies. A more recent study by [ 53 ], with 111 subjects recruited, highlighted the impact of buildings with vertical greenery on negative psychophysiological stress responses using VR technology. The vertical greenery covered the balconies, walls, and pillars of buildings in the plant state. The plants were replaced with equivalent hues of green in the color condition. The study suggested that vertical greenery prevented stress from increasing, as indicated by heart rate variability.

Two studies measured only physiological responses, such as SCL in [ 55 ], and NIRS, HRV, and SD in [ 56 ]. The effects of visual stimuli (virtual 360-degree images of forests, urban areas, and parks) on recovery from physiological stress have been compared by [ 55 ] to the effect of congruent olfactory stimuli (natural and urban smells) and acoustic stimuli (birdsong and noise). In their study, a total of 154 participants were randomly assigned to one of the three situations, urban area, forest, or park, and were then exposed to stress (operationalized by skin conductance levels). This study showed a significant reduction in stress in parks and forests but not in cities. Igarashi, Yamamoto, Lee, Song, Ikei, and Miyazaki [ 56 ] investigated the physiological effects on relaxation of 3D floral pictures compared to 2D images upon prefrontal cortex and autonomic nerve activity. Ninety male university students, aged 22 to 23, were given 90 s to see the water lily picture in 3D and 2D images. Their study detected prefrontal cortex (PFC) activity using near-infrared spectroscopy, whereas autonomic nerve activity was quantified using HRV. Besides, a modified SD approach was used to determine psychological impacts. The 3D visual stimulation, compared to 2D visual stimulation, resulted in significantly decreased hemoglobin concentration in the right PFC. Additionally, it caused lower sympathetic activity as measured by the low- and high-frequency ratio of the HRV component and substantially more realistic feeling, as evidenced by higher SD ratings.

The four final research used psychological indicators based on questionnaires and observations. Moyle, Jones, Dwan, and Petrovich [ 34 ] used the observed emotion rating scale (OERS) to assess the impacts of VRF on dementia patients’ engagement, apathy, and mood states, and learn more about staff, patients, and their families’ perspectives. Their study was conducted by the mixed method, consisting of ten individuals with dementia, ten family members, and nine care professionals from two residential aged care facilities by one care provider. Residents took part in a VRF session that was facilitated. The results showed that residents, family members, and staff agreed that the VRF had a favorable impact. Residents reported significantly higher levels of pleasure and attentiveness during the VRF session. They also felt more fear and anxiety during the forest encounter than the comparative normative sample. The VRF was considered to have a favorable impact on dementia patients, although a larger level of fear and anxiety has been observed during the VRF than the normative sample. Besides, Reese, et al. [ 57 ] used SSS and PANAS to evaluate participants’ condition following the VR experience irrespective of the control. This study recruited 64 participants who navigated by an experimenter or navigated across a VR environment. They claimed that lower stress could be experienced through a VR environment than actively navigating through it.

Scates et al. [ 58 ] used a Likert-type scale questionnaire to observe whether a VR nature could alleviate stress and discomfort in cancer patients in a treatment center. The authors recruited 50 patients having their regular chemotherapy treatment sessions. These patients were evaluated for two visits for stress and pain during their intravenous (IV). They watched a naturally inspired VR simulation during the second visit while getting their IV. The study found that cancer patients viewing naturally inspired VR were significantly less frustrated, more relaxed, and had peaceful feelings and positive distractions. Besides, Rozmi, et al. [ 59 ] highlighted several design aspects in terms of visual realism, navigation methods, and aids for users to be fully immersed in the virtual forest environment, thus reducing their stress levels. The design was based on a game concept and received positive feedback from users, and the study suggested using elements of nature, such as vegetation, natural habitat, and forests.

Table 1.Characteristics of included studies.

Table 1.Characteristics of included studies.

ReferencesCountryGroup InterventionsSex (M:F), AgeRecovery
DurationAimOutcomeMeasurement TechniqueResults[35]SwedenEG: VR with nature sounds
CG: VR without nature sounds or No VR treatmentEG: 10 (10:0), age 28.2 ± 10.3.
CG: 10 (10:0), age 28.1 ± 4.4; 10 (10:0), age 26.7 ± 3.4.40 minExplore physiological recovery in two distinct virtual natural settings, with and without interaction with natural sounds.The findings imply a possible mechanistic relationship between nature, natural sounds, and stress recovery.STAI-S, HRV, HR, TWAAfter the intervention, significant differences were discovered between groups (HR,

p

= 0.007; TWA,

p

< 0.001).[56]JapanEG: 3D flower images
CG: 2D flower imageEG & CG: 19 (19:0), age 22.2 ± 0.6.90 sEvaluate physiological relaxation effects on autonomic nerve activity by viewing 3D versus 3D flower images.The study found that realistic 3D floral images boost physiological relaxation more effectively than 2D floral images.NIRS, HRV, SDSignificant differences were found (NIRS,

p

< 0.01; HRV,

p

< 0.05; SD,

p

< 0.01) between the two groups.[45]LebanonEG: natural scenes (rural Ireland and remote beaches), and indoor control.
CG: -18 (9:9), age 32 ± 12.15 minPromote nature exposure for those living in isolated, restricted settings.VR nature produced relaxation, and scene selection had a substantial impact on both mood and visual perception.EDA,
MRJPQSignificant differences were found (EDA,

p

= 0.002; MRJPQ,

p

< 0.014) between the natural scenes and indoor control.[46]JapanEG: nature scence of sea or forest, and baseline
CG: -12 (12:0), age 22.2 ± 1.7.90 minEvaluate the influence on people’s relaxation while viewing a video of the sea or a forest.The viewer’s favorite movie of the sea or forest had a calming impact. The findings also imply that watching a favorite scene of a natural setting could help to relieve stress and exhaustion.POMS, HR, low frequency, high frequency, BISSignificant stress reduction was found (POMS,

p

< 0.05) between the nature scenes (sea and forest) and their baselines.[34]AustraliaEG: virtual reality forest
CG: -Residents with dementia: 10 (3:7), age = 89 ± 4.7; Family members: 10; Care staff: 9.15 minAssess the apathy, engagement, and mood of dementia patients and to examine employees, dementia patients, and family experiences.The VRF positively affected dementia patients despite a higher level of fear/anxiety during the VRF compared to the normative group.OERSResidents reported higher levels of happiness (

p

= 0.008), attentiveness (

p

= 0.001), and anxiety/fear (

p

= 0.16).[47]TaiwanCross-over study: forest and urban VR environments.30 (13:17), age 20–29.9 min and 30 sEvaluate the effects of virtual forests on boosting people’s psychological well-being.Immersing in forests could provide benefits such as reduced negative emotions and enhanced vigor as compared to urban environments that lower self-esteem and raise fatigue levels.PASAT, POMS, BP, HRVSignificant decrease in negative emotions (tension,

p

= 0, depression,

p

< 0.017) observed in forest environments.[55]SwedenPseudo-randomised study: VR forest, park and urban environments.Forest: 52 (24:28), age 27; park: 52 (26:22), age 28; park: 50 (22:28), age 27.3 minAssess the potential for stress recovery using three different environments: urban areas, parks, and forests.According to the study, residing in an urban environment with no green space, traffic noise, and tar and diesel odors can expose people to a certain amount of stress compared to natural environments such as gardens and forests.SCLSignificant differences were found between urban areas and both forest (

p

= 0.003) and park (

p

< 0.001), while no significant differences (

p

= 0.39) between forest and park.[48]KoreaEG: VR forest, baseline
CG: -40 (23:17), age 24.4 ± 2.8.5 minEvaluate viewing forest videos in reducing stress in adults.The study revealed that watching videos of VR forests could affect individuals’ stress levels, regulate physiological conditions, and positively affect their mental conditions.HRV, HR, SI, POMS, SD, PANASSignificant decrease in stress was found (SI,

p

< 0.01; HRV,

p

< 0.05; HR,

p

< 0.01; SD,

p

< 0.01; POMS-TMD,

p

< 0.01).[49]ChinaIndependent group design: Pre and post-VR forests.96 (33:63), age 24.03 ± 5.29.5 minEvaluate stress recovery after viewing VR videos of seven forest environments: (1) structure, (2) wood, (3) wood with bench, (4) wood with platform and bench, (5) platform with trees, (6) waterfall with trees, and (7) pool with plants.The study investigated seven forest resting environments. These environments showed a distinct impact on stress relief and proved to reduce stress to some level.SBP, DBP, HR, SA, POMSSignificant differences were found in various environments with greatest impact in type 6: (SBP,

p

< 0.01; DBP,

p

< 0.05; HR,

p

< 0.05; SA,

p

< 0.05; POMS-TMD,

p

< 0.01)[36]ChinaIndependent group design: six immersive virtual environments (IVE) (lightest to darkest).120 (27:93), age 19.79 ± 1.90; 20 for each scene.6 minInvestigate how varied natural light brightness levels affect people’s stress recovery effects in the forest and provide some proof for stress reduction’s mental well-being benefits.This study confirmed that bright sunlight scenes (i.e., the lightest, lightest, lightest) in the virtual forest ease tension more effectively than the darkest night sceneries. Another discovery indicated that dark settings, such as sunrise without sunlight but with a hint of brightness, had the same effect.SCL, BVP, STAI-SSignificant differences were found in natural light brightness (

p

< 0.001; SCL,

p

< 0.001; BVP,

p

< 0.001; STAI-S,

p

< 0.01).[54]AustraliaIndependent group design: four levels of biodiversity (urban IVE, none; natural IVE, low, moderate, and high).52 (24:28), age 37.6 ± 10.6. Not stated the number of participants for each scene.5 minEvaluate the effects of biodiversity IVEs on recovery from induced stress.The findings revealed similar well-being responses across self-reported and physiological measurements, implying that biodiversity had an impact on human happiness. In the urban IVE, stress recovery was the least effective for most well-being metrics.VAS, HRSignificant differences in stress recovery for subjective stress, anxiety, and happiness were found between urban and low biodiversity IVEs (

p

< 0.05). For HR, no significant differences were found between the urban and either biodiversity IVEs.[58]USARepeated measures design: cancer patients with/without viewing VR during the intravenous procedure (IV).50 (15:35), age > 65 (n = 29).During IV procedure for 30 consecutive daysInvestigate VR during IV procedures on reducing stress and pain among cancer patients.The participants felt significantly less frustrated and more relaxed while watching VR nature scenes throughout intravenous chemotherapy.Likert-type scale questionnaireSignificant increases were found in positive distractions (

p

< 0.0001), relaxation(

p

< 0.05), feelings of peace (

p

< 0.01).[50]USACross-over study: nature scene versus practicing mindfulness-based activities.36 (0:36), age ≥ 18.4 Weeks, 10 min dailyEvaluate the effectiveness of VR in reducing stress among people with SUD.This study provided preliminary evidence that nature-viewing had similar benefits as a mindfulness therapy for treating stress and low mood associated with recovery from SUD.PANAS, HRSignificant decreases in mean negative affect scores (

p

= 0.001) and heart rate (

p

≤ 0.001) were found while viewing nature scenes and practicing mindfulness-based activities.[59]MalaysiaObservational study.Public respondents.-Use VR nature therapy as an alternative tool for stress relief.An early study found that VR had potential as an aid in therapy, with positive outcomes from users.Users’ feedback-[51]PolandCross-over study: VR immersion with visual, auditory, and tactile conditions.23 (10:13), age 37.2 ± 9.7.6.3 minVR combined with bilateral stimulation in EMDR as a stress-relieving tool.According to the study’s preliminary findings, VR-based bilateral stimulation may boost mood and reduce stress.GHQ12, GSRNo significant differences were found between groups. For GSR, visual was most effective in subjective assessment ofstress level (pre, 80%; post, 100%).[52]GermanyCross-over study: forest and urban VR environments.34 (23:11), age 27.26 > 2.14.6 minDemonstrate the health and well-being advantages of natural environments.The forest environment had a beneficial influence on cognition, while the urban setting had a negative effect on mood. Photos of an urban or forest scene succeeded better than 360 videos to reduce physiological arousals.POMS, PSS,
GSRSignificant differences in participants’ mood (POMS,

p

< 0.05; PSS, no significant effects; GSR,

p

< 0.001)[57]GermanyEG: VR with active control and 30-s familiarization
CG: VR with no control.EG: 32 (8:24), age 23.31 ± 4.7.
CG: 32 (9:23), age 22.7 ± 2.85.5 minIdentify the impact of control on the positive effects elicited by virtual nature environments.The study showed that participants reported reduced stress, and their positive affective states were raised following the VR experience.PANAS, SSSSignificant positive effect was found after VR (PANAS,

p

< 0.001; SSS,

p

< 0.001)[53]SingaporeIndependent group design: VR based plant or color conditions.111 (40:71), age 21.63 > 1.81.5 minDemonstrate the influence emotion and stress-buffering of vertical greenery outside buildings.The study suggested that vertical greenery on city buildings could help to mitigate the negative psychophysiological effects of stress.PANAS, SDRRSignificant decreases were observed in SDRR (

p

= 0.01)and positive affect (

p

< 0.00) in color conditions. No significant main effect of the condition was found.

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