Effects of Mobile-Based Forest-Therapy Programs Using Urban Forests for Symptoms of Depressed Patients.

This study investigated the effect of mobile-based forest therapy programs on relieving depression to advance non-pharmaceutical treatments for patients with depression. The effects of depression, sleep quality, and physical symptoms were analyzed as measurement indicators to determine the effectiveness of symptom relief in patients with depression. This study used a randomized controlled experiment design. Participants were randomly assigned, and a total of 44 people participated, including 23 in the experimental group and 21 in the control group. The experimental group participated in a mobile-based forest therapy program (participating once a week) for six sessions. As a result of this study, depression patients who participated in the mobile-based forest therapy program conducted in urban forests showed a significant reduction in MADRS (from 21.48 ± 4.05 to 7.13 ± 7.00). In addition, PSQI (from 19.78 ± 7.69 to 14.48 ± 8.11) and PHQ-15 (from 9.87 ± 5.08 to 7.57 ± 5.03) were also found to significantly improve symptoms. This suggests that forest-therapy programs using mobile applications can be applied as non-pharmaceutical interventions to relieve symptoms in patients with depression.

Benefits of Urban Forest Healing Program on Depression and Anxiety Symptoms in Depressive Patients.

Depression is considered a widespread mental health problem worldwide. Moreover, anxiety symptoms are very closely related to depression in patients, and it is known that the coexistence rate of depression and anxiety diagnosed simultaneously is high. Treatment and preventive management of depression and anxiety are essential for public health. Forest healing is attracting attention as a form of low-cost preventive medicine that is safe and has no side effects. However, although the physiological and psychological effects have been scientifically proven, it is insufficient to reveal a direct relationship between forest healing and depression. This study investigated the benefits of an urban forest healing program on depression and anxiety symptoms in depressive disorders. We employed a randomized controlled trial design. Forty-seven depressive patients were randomly divided into an urban forest healing program group and a control group. Measures included the Montgomery-Asberg depression rating scale (MADRS), the Hamilton Anxiety Rating Scale (HARS), and the State-Trait Anxiety Inventory (STAI) questionnaires. Our results revealed that the combination of general treatment and forest healing programs for patients with depression is more effective in improving depression and anxiety than routine treatment alone. We expect our work to serve as a starting point for more sophisticated research discussing the availability of non-pharmacological treatments in forest healing.

The Influence of Urban Gardening Activities on Participants' Perceived Restorativeness, Resilience, Sense of Community and Stress.

This study aimed to investigate the influence of urban garden activities on participants' perceived restorativeness, resilience, sense of community, and stress reduction. A total of ninety individuals who agreed to participate in the experiment were divided into experimental and control groups. To collect data, 16 sessions of urban garden activities were conducted every two weeks from May to November 2022. Perceived Restorativeness Scale, Connor-Davidson Resilience Scale, Sense of Community Index, and Brief Encounter Psychosocial Instrument were employed to measure participants' psychological effects. To evaluate physiological effects, salivary cortisol tests were performed. The results of the study revealed that urban gardening activities influenced on participants' physiological and psychological reactions in positive ways.

Effects of Forest Therapy on Psychological Improvement in Middle-aged Women in Korea.

OBJECTIVES: Women experience more stress in middle age than in other periods of their lives. Therefore, health management programs that enable middle-aged women to cope with and manage stress are needed. This study investigated the psychological effects of a meditation-focused forest therapy program among 53 middle-aged women living in urban areas in Korea. METHODS: Participants were divided into 2 groups: one group underwent the program for 3 days in a forest, followed by 3 days in an urban environment, and the other group underwent the program for 3 days in the urban environment, followed by 3 days in the forest. The psychological effects of the forest therapy program were evaluated using the Profile of Mood States-Brief (POMS-B). Differences in mood state before and after the program conducted in the forest (experimental group) and in the urban environment (control group) were evaluated using the paired-samples t-test. RESULTS: The program in the forest significantly reduced tension, depression, anger, fatigue, and confusion among the domains of the POMS-B. The program in the urban area significantly reduced tension, but not depression, anger, fatigue, or confusion. CONCLUSIONS: Meditation-focused forest therapy programs are expected to contribute to promoting psychological health and enhancing the quality of life of middle-aged women.

Effect of Forest Users' Stress on Perceived Restorativeness, Forest Recreation Motivation, and Mental Well-Being during COVID-19 Pandemic.

Even though the COVID-19 pandemic has discouraged travel and people's movements, the number of visitors to forests near cities which are easily accessible by private vehicle is increasing in Korea. This study aims to investigate the relationship between stress, perceived restorativeness, forest recreation motivation, and the mental well-being of forest users. A survey of forest users was conducted at three recreational forests near Seoul in the summer of 2020. A total of 1196 forest users (613 males and 583 females) participated in the study. As a result of the data analysis, it was found that stress had a negative correlation with perceived restorativeness, forest recreation motivation, and mental well-being; perceived restorativeness had a positive correlation with mental well-being, and forest recreation motivation had a positive correlation with mental well-being. For the relationship between stress and mental well-being, the fitness index that was mediated by the perceived restorativeness and the forest recreation motivation found that the model was statistically suitable. Through this study, a research model was derived that, if the stress of forest users is reduced, direct or indirect effects on perceived restorativeness, forest recreation motivation, and mental well-being are increased. Further, a multi-group analysis found that the effect of perceived restorativeness and forest recreation motivation on the mental well-being of the male group was higher than the effect on the female group. Using this research model to find ways to promote health in forests can be utilized for forest management or forest healing.

Effects of Urban Forest Therapy Program on Depression Patients.

Depression is a common serious mental health condition that can have negative personal and social consequences, and managing it is critical for treating depression patients. Forest therapy is emerging as a promising non-pharmacological intervention to improve mental health. However, although the effectiveness of forest therapy programs using forests far from the city has been proven, it is not well known that urban forests can be easily accessed in daily life. Therefore, this study aimed to examine the effects of an urban forest therapy program on depression symptoms, sleep quality, and somatization symptoms of depression patients. To evaluate this, a randomized controlled trial (RCT) design was employed. A total of 47 depression patients participated in this study (22 in the urban forest therapy program group and 25 in the control group). The Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were administered to each participant to assess the effects of the urban forest therapy program. The results of this study revealed that depression patients in the urban forest therapy program had significantly alleviated depression symptoms and improved sleep quality and somatization symptoms compared to the control group. In conclusion, this study demonstrates the possibility that the urban forest therapy program could be used as an effective non-pharmacological treatment to alleviate depression disorder.

Effect of Forest Therapy on Depression and Anxiety: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to summarize the effects of forest therapy on depression and anxiety using data obtained from randomized controlled trials (RCTs) and quasi-experimental studies. We searched SCOPUS, PubMed, MEDLINE(EBSCO), Web of science, Embase, Korean Studies Information Service System, Research Information Sharing Service, and DBpia to identify relevant studies published from January 1990 to December 2020 and identified 20 relevant studies for the synthesis. The methodological quality of eligible primary studies was assessed by ROB 2.0 and ROBINS-I. Most primary studies were conducted in the Republic of Korea except for one study in Poland. Overall, forest therapy significantly improved depression (Hedges's g = 1.133; 95% confidence interval (CI): -1.491 to -0.775) and anxiety (Hedges's g = 1.715; 95% CI: -2.519 to -0.912). The quality assessment resulted in five RCTs that raised potential concerns in three and high risk in two. Fifteen quasi-experimental studies raised high for nine quasi-experimental studies and moderate for six studies. In conclusion, forest therapy is preventive management and non-pharmacologic treatment to improve depression and anxiety. However, the included studies lacked methodological rigor and required more comprehensive geographic application. Future research needs to determine optimal forest characteristics and systematic activities that can maximize the improvement of depression and anxiety.

Forest Therapy Alone or with a Guide: Is There a Difference between Self-Guided Forest Therapy and Guided Forest Therapy Programs?

There are generally two types of forest therapy. One is to walk or view the forest alone without a guide, and the other is to be accompanied by a guide. This study aimed to investigate the healing factors and health benefits of self-guided forest therapy and guided forest therapy programs and examine the differences in characteristics between interventions. Thirty-seven undergraduate students participated in a randomized experiment (19 in the self-guided forest therapy and 18 in the guided forest therapy program). Data were collected from 111 self-reported essays after each intervention (three essays per person). Results revealed that the forest healing factors contained four categories in common: auditory element, visual element, tactile element, and olfaction element. Forest therapy's health benefits included five categories in common: change of mind and body, introspection, change of emotion, cognitive change, and social interaction. Among the typical differences, the self-guided forest therapy group mentioned more keywords related to introspection than the guided forest therapy program group. On the other hand, the guided forest therapy program group mentioned more keywords associated with the change of emotion and social interaction than the self-guided forest therapy. Our findings show that self-guided forest therapy provides an opportunity for self-reflection to focus on and think about one's inner self. On the other hand, guided forest therapy programs provide positive emotional changes and promoting social bonds through interaction with others. Therefore, because the effects that can be obtained vary depending on the type of forest therapy, participants can utilize forest healing to suit the desired outcomes.

Influence of Forest Visitors' Perceived Restorativeness on Social-Psychological Stress.

This study was conducted to verify the perceived restorativeness of citizens visiting forests on social-psychological stress and psychological resilience according to forest space type. The study involved a questionnaire survey conducted on citizens who visited forests between 1 May and 15 July 2020, when social distancing in daily life was being implemented. Three types of forest spaces (urban forest, national park, and natural recreation forest) were selected for the survey. They used the survey results of 1196 people as analysis data for this study. In this study, the PRS (Perceived Restorativeness Scale) and the PWI-SF (Psychosocial Well-being Index Short Form) were used to evaluate perceived restorativeness and social-psychological stress of citizens visiting forests. In the study, the average score of visitors' perceived restorativeness was 5.31 ± 0.77. Social-psychological stress was found in the healthy group, potential stress group, and high-risk group. These groups made up 8.0%, 82.5%, and 9.5% of the respondents, respectively. Pearson's correlation analysis between perceived restorativeness and social-psychological stress revealed that the higher the perceived restorativeness, the lower the social-psychological stress. "Diversion Mood", "Not bored", and "Coherence", which are the sub-factors of perceived restorativeness according to the forest space type, were found to have meaningful results for psychological resilience. However, there was no significant difference in the forest space type between "Compatibility" and social-psychological stress, which are sub-factors of perceived restorativeness. In conclusion, the forest space type affects the psychological resilience of those who visit the forest. Urban forests, national parks, and natural recreation forests are places to reduce stress.

The Physio-Psychological Effect of Forest Therapy Programs on Juvenile Probationers.

The study aimed to investigate the psychological and physiological effects of forest therapy programs on adolescents under probation. Fifty probationary teenagers from the Ministry of Gyeonggi Justice Compliance Support Center participated in the study. The study explored the effectiveness of a nonrandomized control group pretest-posttest design forest therapy program. The forest therapy program was conducted for two days and one night for the experimental groups (N = 33), who participated in the forest therapy program, and the control group (N = 17), who received two days of attendance center orders program in the lecture room of the Ministry of Gyeonggi Justice Compliance Support Center. As a result, adolescents under probation who participated in forest therapy programs had a beneficial effect on psychological well-being (K-WBMMS) and HRV's HF (high frequency) and LF/HF (A ratio of Low Frequency to High Frequency) compared to those who received the general attendance center orders program. These results support that forest therapy programs play a positive role in the psychological and physiological effects of probationary adolescents and can affect the diversity of rehabilitation programs for probationary adolescents.

The Influence of Forest Activities in a University Campus Forest on Student's Psychological Effects.

This study aimed to examine the psychological effects of forest activities in a campus forest. A pre-test and post-test control group design was employed to evaluate the psychological effect of forest activities in a campus forest. A total of 38 participants participated in this study (19 in the forest activities group; 19 in the control group). The Profile of Mood State (POMS) questionnaire, the Concise Measure of Subjective Well-Being (COMOSWB), and the modified form of the Stress Response Inventory (SRI-MF) were administered to each participant to assess psychological effects. This study revealed that participants in the forest activities intervention group had significantly positive increases in their mood, stress response, and subjective well-being, comparing with those of control group participants who did not partake in any forest activities. In conclusion, the implementation of forest activities in a campus forest is an efficient strategy to provide psychological well-being benefits to college students.

Effects of Forest Therapy on Health Promotion among Middle-Aged Women: Focusing on Physiological Indicators.

Women experience more stress in middle age than in other life stages, and health in middle age is vital, because it influences the quality of life in old age. In this study, the effects of a forest therapy program on physiological changes in 53 middle-aged women (divided into two groups) who lived in the city were examined. One group participated in a three-day program in the forest, followed by three days in the city; the other group participated in a three-day program in the city, followed by three days in the forest. Forest experiments were conducted in a "healing forest," and urban experiments were conducted near a university campus. Blood tests were performed to evaluate the physiological effects of forest therapy. Differences in serotonin levels and vitamin D levels were verified before and after the forest (experimental group) and urban (control group) programs through paired t-tests. Statistically significant increases in serotonin levels were noted for participants in the forest program; vitamin D levels also increased, but not by statistically significant values. The findings of this study verify that forest therapy programs promote health among middle-aged women, and may prevent disease and improve quality of life.

The Psychological Effects of a Campus Forest Therapy Program.

This study aimed to examine the psychological effects of a campus forest therapy program. To evaluate these, pre-test and post-test control group design was employed. A total of 38 participants participated in this study (19 in the campus forest therapy program group, and 19 in control). The Profile of Mood State (POMS) questionnaire and Modified form of the Stress Response Inventory (SRI-MF) were administered to each participant to assess psychological effects. The results of this study revealed that participants in the campus forest therapy program group had significantly positive increases in their mood and stress response compared with those of control group participants. In conclusion, the campus forest therapy program is an efficient strategy to provide psychological health benefits to university students and our study can inform decision-makers on the priority of the campus forest program in societal efforts to promote psychological well-being among university students.

Six-Step Model of Nature-Based Therapy Process.

Several studies have confirmed that the natural environment has psychophysiological healing effects. However, few studies have investigated the healing process involved in the effect of the natural environment. To date, no theoretical model on the nature-based therapy process has been clearly established. Thus, the aim of this study was to develop a theoretical model of the nature-based therapy process by analyzing individual empirical data. Research materials were 180 self-reported essays on "Forest Therapy Experiences" submitted to the Korea Forest Service. This study was conducted based on grounded theory. Data were analyzed through open coding. A total of 82 concepts, 21 subcategories, and six categories were derived. Results revealed that the nature-based therapy process contained six categories: Stimulation, acceptance, purification, insight, recharging, and change. When in the natural environment, participants first experienced positive emotional change, followed by cognitive and behavioral changes. Based on these results, a nature-based therapy process model was derived. This study revealed that the nature-based therapy process did not consist of just a single element or step, but involved an integrated way of healing with emotional and cognitive changes. This study is significant in that it derives a theoretical model of the nature-based therapy process with comprehensive mechanisms. Further research is needed to establish more systematic theoretical model.

The influence of forest therapy camp on depression in alcoholics.

OBJECTIVES: To evaluate the effect of a forest experience on the levels of depression of alcoholics. METHODS: Prior to the study, 92 alcoholics were divided into treatment and control groups. During the summer of 2009, the treatment group participated in a series of forest therapy programs, while the control group followed their normal daily routines. Both groups were re-tested upon completion of the program by the treatment group and the depression levels compared. RESULTS: There was a significant improvement in the depression level of alcoholics who had participated in the forest camp program (treatment group). Those participants in their 40s who had severe levels of depression at the beginning of the program showed the most significant improvement during the program experience. CONCLUSION: The forest therapy camp experience can considerably reduce and ameliorate the depression levels of alcoholics.

Forest experience and psychological health benefits: the state of the art and future prospect in Korea.

The aims of this study were twofold: to examine the empirical evidence supporting the positive contribution that a forest environment can make on human psychological health and well-being and to describe the theoretical framework within which the forest environment has this effect. Our review of the literature provides empirical evidence that a forest experience can contribute to improved emotional and cognitive health.This experience can be through a forest activity program and by experiencing the social and physical conditions of the forest environment and the therapeutic elements of the forest. Visiting or viewing a forest scene has been documented to have a positive effect on psychological healing and well-being in terms of recovering from stress, improving concentration and productivity, improving the psychological state, particularly for people from urban environments. Wilderness and related studies clearly demonstrate that being in a forest environment has a positive effect on people, while results from other studies indicate that contacts with forest environments provide multiple positive physiological and psychological effects on human health that included decreasing the blood pressure and heart rate and reducing anxiety and stress. There are several theories explaining the healing effects of the forest on human beings. Most hypothesize that restorative environments are settings in which recovery is associated with the reduction of stress and that the benefits of contact with natures include a wide range of positive physiological and psychological responses. These theories are based on an evolutionary perspective and share a number of similarities and differences. This article summarizes a number of these theories of restorative environments as well as addresses the current status of forest therapy and the challenges and opportunities for therapeutic effects of the forest in Korea.