Change search
ReferencesLink to record
Permanent link

Direct link
Restorative effects of visits to urban and forest environments in patients with exhaustion disorder
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University. (Arcum)
Umeå University, Faculty of Social Sciences, Department of Psychology.
Show others and affiliations
2014 (English)In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 13, no 2, 344-354 p.Article in journal (Refereed) Published
Abstract [en]

This experimental study investigated differences in perceived restorativeness, mood, attention capacity and physiological reactions when visiting city and forest environments. Twenty female patients diagnosed with exhaustion disorder visited three different forest environments and one city environment in randomized order. They performed a standardized 90-min test procedure in each of these environments. Evaluation of the environments and psychological effects in mood were studied with self-administered questionnaires. Attention capacity was studied with Necker Cube Pattern Control task. Physiological responses were measured with regularly scheduled controls of heart rate and blood pressure, and a single test of heart rate recovery. Visits to the forest environments were perceived as significantly more restorative, enhancing mood and attention capacity compared to the city. This also applies to the results of heart rate and to some extent to the results of the diastolic blood pressure. The results from this experimental study support our hypothesis that short visits to forest environments enhance both psychological and physiological recovery and that visits to forest environments are likely to be beneficial when suffering from exhaustion disorder. 

Place, publisher, year, edition, pages
2014. Vol. 13, no 2, 344-354 p.
Keyword [en]
Burnout, City, Human health, Nature, Psychophysiology, Recovery
National Category
Environmental Health and Occupational Health
URN: urn:nbn:se:umu:diva-89305DOI: 10.1016/j.ufug.2013.12.007ISI: 000337018600017OAI: diva2:719769
Available from: 2014-05-27 Created: 2014-05-27 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

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Sonntag-Öström, ElisabetNordin, MariaWiklund, UrbanKarlsson, MarcusCarlberg, BoSlunga Järvholm, Lisbeth
By organisation
Occupational and Environmental MedicineArctic Research Centre at Umeå UniversityDepartment of PsychologyDepartment of Radiation SciencesMedicine
In the same journal
Urban Forestry & Urban Greening
Environmental Health and Occupational Health

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 644 hits
ReferencesLink to record
Permanent link

Direct link