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Can the boreal forest be used for rehabilitation and recovery from stress-related exhaustion? A pilot study.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
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2011 (English)In: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 26, no 3, 245-256 p.Article in journal (Refereed) Published
Abstract [en]

It has been suggested that humans suffering from mental exhaustion recover better in environments that do not demand directed attention. Hence, we hypothesized that forests have restorative effects and examined whether the boreal forest in northern Sweden can be used for rehabilitation from stress-related exhaustion in a pilot study. Six participants suffering from stress-related exhaustion were offered visits twice a week, for 11 weeks, in six different forest settings: pine forest, mixed forest, spruce forest, forest by the lake, the forest with a small stream and rock outcrops. The participants chose one forest setting prior to each visit, and the mental state of each participant was evaluated before and after each visit. Interviews focusing on the experience of the forest were conducted after the 22 visits. Solitude and forest settings with light were identified as positive factors for recovery. Despite the limited amount of data, the results showed that the forest visits had significant positive effects on the participants' mental state. The interviews also indicated that the concept is suitable for use in larger randomized studies and that it is important to provide various forest settings to meet individual preferences of the participants and to offer the possibility of solitude.

Place, publisher, year, edition, pages
Taylor & Francis, 2011. Vol. 26, no 3, 245-256 p.
Keyword [en]
Attention, burnout, environment, human health, nature, restoration, well-being
National Category
Forest Science Environmental Health and Occupational Health
Research subject
medicinsk beteendevetenskap
URN: urn:nbn:se:umu:diva-41227DOI: 10.1080/02827581.2011.558521ISI: 000289773800006OAI: diva2:405065
Available from: 2011-03-21 Created: 2011-03-21 Last updated: 2016-05-25Bibliographically approved
In thesis
1. Forest for rest: recovery from exhaustion disorder
Open this publication in new window or tab >>Forest for rest: recovery from exhaustion disorder
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Exhaustion disorder (ED) is a common mental and behavioural disorder which often leads to severe negative consequences for the individual and the society. Natural environments have positive effects on mental, physiological and attentional recovery in stressed persons, which encouraged us to test if forest visits could improve recovery from ED. The main objective of the thesis was to study if visits to different kinds of forest environments have positive health effects on patients suffering from ED, and if forest visits can be utilized for rehabilitation.

Methods Participants in the MiniRest study (n=20) and the Pilot study (n=6) (Papers I and II) were recruited from the Stress Rehabilitation Clinic (SRC) at the University Hospital in Umeå.  Participants in the randomised controlled study, ForRest (n=99) and the Interview study (n=19) (Papers III and IV) were recruited from both the SRC and the Swedish Social Insurance Agency in Umeå. The MiniRest study involved only female ED patients and focused on immediate mental, physiological and attention capacity effects in one urban and three forest environments. The Pilot study investigated the practical arrangements for the forthcoming ForRest study. Participants in the ForRest study were randomised into either a three-month forest rehabilitation group; A (forest visits twice a week/4 hours per day) or to a control condition; B. Both groups received Cognitive Behavioural Rehabilitation (CBR) at 24 occasions/once a week after the three-month study period. Preferences for forest environments, mental state and attention capacity were studied for group A only. Psychological health measurements and sick leave data were compared between the groups after (i) the forest rehabilitation and (ii) the CBR. The Interview study was conducted according to grounded theory methodology and consisted of 19 participants from group A to explore personal experiences from the forest rehabilitation. Data collection was implemented through questionnaires, medical records, physiological measurements, and interviews.

Results Exposure to forest environments was associated with higher preference, more favourable mental state and physiological responses, and increased attention capacity compared to an urban environment (Paper I). Open and accessible forest environments were preferred (Papers I, II and III). Recovery from ED was found in both groups in the ForRest study, but there were no differences between the groups over time. In group A, positive effects on mental state and attention capacity were found during the forest visits. An interaction effect was found with more positive effects on mental state during spring compared to autumn (Paper III). Solitude, feelings of freedom and no demands were important for finding peace of mind during the forest visits. Moreover, easier access to peace of mind, reflective thinking and positive feelings were reported as the forest rehabilitation progressed (Papers II and IV).

Conclusions Forest visits have restorative effects for ED patients through enhanced mental well-being, easier access to peace of mind, beneficial physiological reactions and increased attention capacity which support the use of forest environments in rehabilitation. However, forest rehabilitation tested in a randomised controlled trial did not improve recovery from ED. Potentially rehabilitation with CBR and forest visits integrated could be more effective and should be further investigated in nature-assisted rehabilitation for ED patients.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 47 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1667
Burnout, nature-assisted therapy, rehabilitation, forestry, stress disorders, environmental medicine, restoration, human health, well-being
National Category
Environmental Health and Occupational Health
Research subject
Public health
urn:nbn:se:umu:diva-92589 (URN)978-91-7601-083-9 (ISBN)
Public defence
2014-09-30, Hörsal Betula, byggnad 6M, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Available from: 2014-09-09 Created: 2014-08-29 Last updated: 2014-09-30Bibliographically approved

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Sonntag-Öström, ElisabetNordin, MariaSlunga Järvholm, LisbethBrännström, Rigmor
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