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How forest bathing affects our psyche & mental health

Richard Staudner
Richard Staudner

The Optimizer

In the last chapter, we looked at the effect of forest bathing and stress. It is easy to understand that the forest relaxes us and can thus reduce stress. But can forest bathing also demonstrably strengthen our mental health or help with or even cure mental illness? Let's take a closer look. 

What is mental health, anyway?

Since this is probably a bit difficult to define, let's help ourselves with the words of the World Health Organization. "Mental health is a state of well-being in which a person exhausts his or her abilities to cope with the normal stresses of life, work productively, and contribute to his or her community." 

As mental disorder on the other hand, are characterized by "a combination of stressful thoughts, emotions, behaviors, and relationships with others," according to WHO. 

So mental health is not black or white, but rather a spectrum of shades of gray. (WHO Europe, 2019)

The burden of mental illness

Even though we cannot see mental illnesses like a broken leg or a cut, they are real and often have devastating consequences for sufferers, their environment and also for the healthcare system. About 40% of those with mental illness suffer from additional secondary illnesses that prevent them from leading a regular workday. This is comparatively much higher than the 12% of the mentally healthy population. This also results in people with mental illness earning 15% less on average and being unemployed far more often. For men, this statistic is even more serious. It is estimated that the costs (social and medical) of mental illness account for about 4% of our GDP (OECD, 2015).

It is also alarming that, due to secondary illnesses, people with mental illness die about 20 years earlier than healthy people. Mental illnesses are the most common cause of disability and the third most common cause of overall disease burden (after cardiovascular disease and cancer) (WHO Europe, 2019). In Austria, the proportion of people receiving therapy is relatively high by international standards.

"Go outside for a while, you'll feel better".

Before we get into this topic, it is important to say a few words about mental illness and how to deal with it.

We now know from OECD studies how common mental illness is: about 1 in 5 people are experiencing a mental illness right now and 30% of all people, almost 1 in 3, have experienced a mental illness within the last year (OECD, 2021) During the pandemic and the lockdown, these numbers continued to climb. Despite this, mental illnesses are still stigmatized (i.e., associated with negative prejudice) and trivialized (Robinson et al., 2019). For example, people with depression are said to be lazy and effeminate, and people with anxiety disorders are said to be antisocial. 

On the other hand, there is the trivialization: a tidy workplace is jokingly titled "OCD" ("Obsessive Compulsive Disorder" or OCD), people with depression are told: get some fresh air, move around, then you will surely feel better. People with anxiety disorders are told to "just stop worrying your head about unnecessary things." Both behaviors are problematic for affected individuals and make open communication and dealing with the issue difficult.

Accordingly, I would not like to recommend to anyone with mental illness to "go to the forest and everything will be fine". Rather, I am interested in the extent to which forest bathing or forest therapy can be a useful complement to conventional therapy and whether this is also clinically measurable, as it may be useful preventively or in early stages.  

In addition, forest bathing offers the potential to have an effect on secondary diseases, such as cardiovascular diseases or cancer. We will also take a closer look at this in the next articles. 

Forest bathing vs forest therapy?

The results of recent review studies agree: forest bathing and forest therapy have a significant positive effect on mental health and psychological well-being. (Antonelli et al, 2021; Hossain et al, 2020; Rosa et al, 2021; Stier-Jarmer et al, 2021; Timko Olson et al, 2020).

People looking at a forest landscape experience fewer depressive feelings than people looking at an urban landscape. (Park et al., 2010)

These are enormously simple means that can be used in everyday life. Not only at home, but also in hospitals or retirement homes, for example. 

But what is the difference between forest bathing and forest therapy? Forest therapy involves a combination of activities in the forest to improve the health and well-being of the participants. This may include meditation, games with forest elements, psychotherapy or group activities. There are no standardized forest therapy programs yet. (Rosa et al., 2021) Unlike forest bathing, forest therapy is led by a trained person. For participants with mental illnesses, this is ideally a psychotherapist. This is probably the most important aspect. With a certain basic knowledge, we can integrate forest bathing into our daily lives on our own.  

Forest therapy and mental illness

Depression and anxiety are considered the most common form of mental illness worldwide (WHO Europe, 2019) and are therefore also the best researched in relation to forest bathing. Other diseases, such as schizophrenia, on the other hand, are less studied. 

An outstanding research group (Rosa et al., 2021) deals with previous results on the effect of forest therapy on the Depression and found very impressive trends: In the studies, the effect of forest therapy was better than the effect of any other intervention. In general, forest therapy was able to reduce symptoms by about 60%. Compared to conventional therapy, participants were 17 times more likely to experience improvement in symptoms! 

That's 17000%! 

Compared to hospital treatment, it is twice as likely to achieve remission. "Urban Therapy", exactly the same in an urban setting, is 13 times more likely to respond to treatment in combination with forest. Forest therapy is also more effective here than "simple" forest bathing.
All in all, forest therapy was able to alleviate depression better than all alternative approaches. These include similar therapies in hospitals or urban settings, no treatment, or forest bathing without therapy. 

Several studies show that simple forest bathing can also reduce symptoms and perceptions of anxiety disorder. (Farrow and Washburn, 2019; Hansen et al., 2017; Hossain et al., 2020; Lackey et al., 2019; Stier-Jarmer et al., 2021).

However, one research group suspects that the psychological effect of forest bathing works better in healthy individuals than in people with a clinically diagnosed mental illness (Lackey et al., 2019). Here, guided forest therapy might be more effective than simple forest bathing. 

Forest bathing and mood

Forest bathing can improve mood and emotional state, both in healthy populations and in people with mild depression, anxiety disorder, post-traumatic stress disorder, or alcoholism (Antonelli et al., 2021)

People who feel more connected to nature are happier and feel good about themselves, the effect is roughly comparable to the effect of income, education or volunteering (Capaldi et al., 2014; Pritchard et al., 2019; Timko Olson et al., 2020).

Looking at a forest also reduces feelings of anxiety, tension, or confusion compared to urban scenes. (Park et al., 2010)
Natural environment also strengthens the general well-being (Hansen et al., 2017; Houlden et al., 2018). and positive affect (Corazon et al., 2019; Hossain et al., 2020; Lackey et al., 2019; McMahan and Estes, 2015; Trøstrup et al., 2019)..

Positive affect can be thought of as a "glass is half full" attitude. People thus perceive situations, moods and their own emotional state as more positive. 

Can a recommendation now be formulated from this?

The psychological effects of forest bathing do not last as long as the physiological ones. Therefore, it is better to go to the forest more often to take advantage of this effect. Then it does not have to be so long, already after 15 minutes positive effects on mental health are noticeable (Kotera et al., 2020)., but the effect becomes stronger if you stay longer (Kotera et al., 2020).. The effect is also stronger in the forest than in parks or gardens. (Djernis et al., 2019). 

As mentioned above, for people with mental illness, forest therapy has a better effect than forest bathing alone. Nevertheless, you can do forest bathing and feel positive effects from it, but even better would be to participate in forest therapy. In some regions of Austria there are already forest therapy paths, where you are guided through a forest therapy session. You can also try these out for yourself, especially if you have never done forest bathing before and don't quite know where to start. 

It is not surprising that forest bathing probably has a stronger effect on people with a nature-oriented cultural background (Antonelli et al., 2019). The effect is also much clearer in older people (McMahan and Estes, 2015)

Whether natural accents in the city, such as the number of parks around the apartment block, or the view out the window of a park, has an impact on mental health cannot be answered unequivocally. (Gascon et al., 2015). In my opinion, every tree and every green spot counts for the inhabitants of cities. Be it for physical and also mental health.  

Here are my thoughts on study quality: 

Measuring subjective well-being is far more difficult than measuring measurable physical factors. As a result, the quality of studies also suffers. Researchers would like to see studies that also investigate the long-term effects on the psyche. (Lee et al., 2017; Rajoo et al., 2020). Yes and blinding, as for example with the swallowing of active and placebo pills, you can also not do. But then again, I think to myself... whether the forest has a placebo effect or a clinical effect, it doesn't matter, does it? The main thing is that we feel better!

This episode is also available spoken on my podcast RICH HEADROOM!
Have a woodsy week!

Richard Staudner
The Optimizer

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