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Review
. 2024 Mar 7;14(3):609-622.
doi: 10.3390/ejihpe14030040.

The Effects of Nature Exposure Therapies on Stress, Depression, and Anxiety Levels: A Systematic Review

Diana Marcela Paredes-Céspedes  1 , Norida Vélez  1 , Alejandra Parada-López  1 , Yesith Guillermo Toloza-Pérez  1 , Eliana M Téllez  1 , Claudia Portilla  1 , Carolina González  2 , Leany Blandón  2 , Juan Carlos Santacruz  2 , Jeadran Malagón-Rojas  1
Affiliations
Review

The Effects of Nature Exposure Therapies on Stress, Depression, and Anxiety Levels: A Systematic Review

Diana Marcela Paredes-Céspedes et al. Eur J Investig Health Psychol Educ. .

Abstract

Background: Mental well-being plays a pivotal role within the broader spectrum of health and illness, encompassing factors such as stress, depression, and anxiety. Nature-based therapeutic interventions have emerged as a promising approach to addressing these mental health challenges. This study seeks to assess the impact of these interventions on stress, depression, and anxiety levels.

Methods: We conducted an extensive search for randomized clinical trials that examined stress, anxiety, and depression levels. The selected studies underwent a rigorous risk-of-bias assessment following the guidelines outlined in the Cochrane Handbook for Systematic Reviews.

Results: Our review encompassed findings from eight publications. Among them, two studies measuring cortisol levels revealed significant differences between the pre-test and post-test measurements within the intervention groups. In two studies that employed the Stress Response Inventory, a significant decrease in stress levels was observed within the intervention groups in contrast to the control groups. However, no significant differences were noted in studies that utilized the Restorative Outcome Scale. In the assessment of anxiety and depression levels, three studies employed the Positive and Negative Affect Schedule, while four studies utilized The Profile of Mood States scale; none of these studies demonstrated significant differences.

Conclusions: The current body of evidence offers limited support for advocating nature-based therapeutic interventions as a primary approach to reducing stress, depression, and anxiety.

Keywords: blood pressure; forests; intervention; nature; stress; therapy cortisol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA diagram of articles selected for review.
Figure 2
Figure 2
Graph of methodological quality: reviewers’ evaluations on each item of methodological quality are presented as percentages for all included studies.
Figure 3
Figure 3
Evaluation of stress using SRI-MF and ROS scales [27,38,39,40,41].
Figure 4
Figure 4
Evaluation of stress anxiety and depression using PANAS scales [11,38,39,40,41].
Figure 5
Figure 5
Evaluation of effect of nature intervention using POMS [24,38,39,40,41]. (a) The initial subgroup consisted of the studies by Bielinis and Janeczko; (b) the second subgroup encompassed the studies by Kim.
See this image and copyright information in PMC

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