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  • 1.
    Sonntag-Öström, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forest for rest: recovery from exhaustion disorder2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 2.
    Sonntag-Öström, Elisabet
    et al.
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Nilsson, Leif
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för matematik och matematisk statistik.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Can rehabilitation in boreal forests help recovery from exhaustion disorder?: the randomised clinical trial ForRest2015Ingår i: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 30, nr 8, s. 732-748Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Modern society is faced with increasing incidence of mental and behavioural disorders. The objective of this study was to evaluate whether visits to boreal forests can be utilised for rehabilitation from exhaustion disorder (ED). This randomised controlled trial comprised of a forest rehabilitation group (n = 35) and a waiting list group (control group) (n = 43) with subsequent cognitive behavioural rehabilitation (CBR) for all participants in both groups. The recovery from ED was compared between the forest rehabilitation and the control group at baseline, after the forest rehabilitation (3 months), and at the end of the CBR (1 year). Both groups had enhanced recovery from ED after the 3-month intervention period and at the end of the CBR (1 year), and there were no significant differences between the groups in terms of psychological health measures. Mental state, attention capacity and preferences for different forest environments were studied during the forest visits. Mental state was improved, but it showed some seasonal differences. A significant effect on attention capacity was found for single forest visits, but there was no effect found for the rehabilitation period as a whole. The most popular forest environments contained easily accessible, open and bright settings with visible water and/or shelter. Forest rehabilitation did not enhance the recovery from ED compared to the control group, but the participants’ well-being was improved after single forest visits.

  • 3.
    Sonntag-Öström, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lundell, Ylva
    Dolling, Ann
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Karlsson, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Restorative effects of visits to urban and forest environments in patients with exhaustion disorder2014Ingår i: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 13, nr 2, s. 344-354Artikel i tidskrift (Refereegranskat)
    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. 

  • 4.
    Sonntag-Öström, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundell, Ylva
    Brännström, Rigmor
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dolling, Ann
    Can the boreal forest be used for rehabilitation and recovery from stress-related exhaustion? A pilot study.2011Ingår i: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 26, nr 3, s. 245-256Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Sonntag-Öström, Elisabet
    et al.
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stenlund, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lundell, Ylva
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fjellman-Wiklund, Annchristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dolling, Ann
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    “Nature's effect on my mind”: patients’ qualitative experiences of a forest-based rehabilitation programme2015Ingår i: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, nr 3, s. 607-614Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to investigate the personal experiences and perceived effects on mind from visits to forest environments in a subset of patients with severe exhaustion disorder (ED), who participated in a randomized controlled trial for evaluation of forest-based rehabilitation.

    Participants: A subsample of 19 patients with diagnosed ED, who completed the three-month forest-based rehabilitation programme in the ForRest project, was interviewed. Method: The forest-based rehabilitation consisted of repeated forest visits with the main objective of spending time in rest and solitude in a chosen forest setting. Semi-structured interviews were carried out and analysed using Grounded Theory.

    Result: A core category and five subcategories were set up to describe the patients’ experiences and development during the forest-based rehabilitation. As patients mostly reported that they strove to achieve peace of mind during the forest visits, Striving for serenity was chosen to be the core category. At first the patients were frustrated when left alone with their own thoughts in an unfamiliar forest environment. They gradually became familiar with the forest environments and also found their favourite places where they experienced peace of mind. They were then able to rest and begin reflective thinking about their life situation, which led to ambitions to change it.The preferred forest environments were characterised by openness, light and a good view, and were felt to be undemanding, peaceful and stimulating.

    Conclusion: Visits to the forest provided favourite places for rest, were experienced as restorative, seemed to improved reflection and may have contributed to starting the coping process for these patients. However, forest visits, as the only treatment option, are not sufficient as rehabilitation from severe and long-term ED. We suggest that forest visits should be integrated with cognitive behavioural therapy to further improve the recovery and enhance coping in daily life for these patients.

  • 6.
    Sonntag-Öström, Elisabet
    et al.
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stenlund, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    "Nature's effect on my mind". Patients' experiences of nature based rehabilitation: a qualitative inquiry.2015Ingår i: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, nr 3, s. 607-14Artikel i tidskrift (Refereegranskat)
1 - 6 av 6
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