Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15–2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120–179 mins: ORs [95%CIs]: Health = 1.59 [1.31–1.92]; Well-being = 1.23 [1.08–1.40]). Positive associations peaked between 200–300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity.

White, M.P., Alcock, I., Grellier, J., Wheeler, B.W., Hartig, T., Warber, S.L., Bone, A., Depledge, M.H., & Fleming, L.E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Nature Scientific Reports, 9, 9-11.  

Importance There is a gap in the evidence regarding nature-based interventions (NBIs) for children with autism spectrum disorder (ASD). Objective To systematically review and meta-analyze available evidence on the health-related outcomes in NBIs for children with ASD. Data Sources The Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Education Resources Information Center, Global Health, MEDLINE, PsycInfo, SPORTDiscus, and Web of Science were searched from inception until May 2023. Google Scholar and references from included studies were searched for additional studies. Study Selection Included studies were randomized clinical trials (RCTs), controlled studies, and single-group before-and-after studies that reported health-related outcomes. Data Extraction and Synthesis This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Random-effects meta-analyses were used to synthesize the data. The findings of studies that were ineligible for meta-analysis were summarized according to the Synthesis Without Meta-analysis (SWIM) reporting guidelines. Main Outcomes and Measures The outcomes of interest were health-related outcomes (ie, social functioning, behavioral functioning, emotional functioning, sensory functioning) and the self-reported well-being of children with ASD. Results A total of 24 studies with 717 participants (mean age range, 5.3 to 17.8 years; 141 [21.9%] female) were included. A meta-analysis from 13 studies indicated a significant negative moderate association between NBIs and social communication (standardized mean difference [SMD], −0.59; 95% CI, −0.85 to −0.34). For behavioral functioning outcomes, NBIs showed a significant moderate association with reduced hyperactivity (SMD, −0.56; 95% CI, −0.86 to −0.26) and a small to moderate association with reduced irritability (SMD, −0.49; 95% CI, −0.79 to −0.19). For sensory functioning, NBIs were significantly associated with improved inattention and distractibility (SMD, 1.13; 95% CI, 0.67 to 1.60). Significant moderate associations were observed in sensory seeking (SMD, 0.77; 95% CI, 0.33 to 1.22; P < .001; I2 = 0%) and sensory sensitivity (SMD, 0.56; 95% CI, 0.12 to 1.00; P = .01; I2 = 0%). Heterogeneity of the intervention effects was not high, and I2 ranged from 0% to 67%. Conclusions and Relevance The findings of this systematic review and meta-analysis suggested an association of NBIs in group-based recreational therapy with experiential learning with positive short-term outcomes on sensory, social, and behavioral functioning for children with ASD. Future evidence using robust study design to aid the health and functional trajectories of children with ASD is recommended.

Fan, M. S. N., Li, W. H. C., Ho, L. L. K., Phiri, L., & Choi, K. C. (2023). Nature-based interventions for autistic children: A systematic review and meta-analysis. JAMA Network Open, 6(12). doi.org/10.1001/jamanetworkopen.2023.46715  

Research suggests that contact with nature can be beneficial, for example leading to improvements in mood, cognition, and health. A distinct but related idea is the personality construct of subjective nature connectedness, a stable individual difference in cognitive, affective, and experiential connection with the natural environment. Subjective nature connectedness is a strong predictor of pro-environmental attitudes and behaviors that may also be positively associated with subjective well-being. This meta-analysis was conducted to examine the relationship between nature connectedness and happiness. Based on 30 samples (n = 8523), a fixed-effect meta-analysis found a small but significant effect size (r = 0.19). Those who are more connected to nature tended to experience more positive affect, vitality, and life satisfaction compared to those less connected to nature. Publication status, year, average age, and percentage of females in the sample were not significant moderators. Vitality had the strongest relationship with nature connectedness (r = 0.24), followed by positive affect (r = 0.22) and life satisfaction (r = 0.17). In terms of specific nature connectedness measures, associations were the strongest between happiness and inclusion of nature in self (r = 0.27), compared to nature relatedness (r = 0.18) and connectedness to nature (r = 0.18). This research highlights the importance of considering personality when examining the psychological benefits of nature. The results suggest that closer human-nature relationships do not have to come at the expense of happiness. Rather, this meta-analysis shows that being connected to nature and feeling happy are, in fact, connected.

Capaldi, C. A., Dopko L. R., & Zelenski, J. M. (2014). The relationship between nature connectedness and happiness: A meta-analysis. Frontiers in Psychology, 5. doi.org/10.3389/fpsyg.2014.00976 

In this influential work about the staggering divide between children and the outdoors, child advocacy expert Richard Louv directly links the lack of nature in the lives of today's wired generation—he calls it nature-deficit—to some of the most disturbing childhood trends, such as the rises in obesity, attention disorders, and depression. Last Child in the Woods is the first book to bring together a new and growing body of research indicating that direct exposure to nature is essential for healthy childhood development and for the physical and emotional health of children and adults. More than just raising an alarm, Louv offers practical solutions and simple ways to heal the broken bond—and many are right in our own backyard. This new edition reflects the enormous changes that have taken place since the book was originally published. It includes: 100 actions you can take to create change in your community, school, and family. 35 discussion points to inspire people of all ages to talk about the importance of nature in their lives. A new progress report by the author about the growing Leave No Child Inside movement. New and updated research confirming that direct exposure to nature is essential for the physical and emotional health of children and adults. Last Child in the Woods: Saving our Children from Nature Deficit Disorder has spurred an international movement to connect children, families and communities to the natural world. This is a book that will change the way you think about your future and the future of your children.

Louv, R. (2008). Last child in the woods: Saving our children from nature-deficit disorder. Algonquin Books. 

From the author of the New York Times bestseller that launched the international children-and-nature movement, Vitamin N (for “nature”) is a complete prescription for connecting with the power and joy of the natural world right now, with: five hundred activities, scores of informational websites, an abundance of down-to-earth advice, and dozens of thought-provoking essays. In his landmark work Last Child in the Woods, Richard Louv was the first to bring widespread attention to the alienation of children from the natural world, coining the term nature-deficit disorder and outlining the benefits of a strong nature connection—from boosting mental acuity and creativity to reducing obesity and depression, from promoting health and wellness to simply having fun. That book “rivaled Rachel Carson’s Silent Spring” (the Cincinnati Enquirer), was “an absolute must-read for parents” (the Boston Globe), and “an inch-thick caution against raising the fully automated child” (the New York Times). His follow-up book, The Nature Principle, addressed the needs of adults and outlined a “new nature movement and its potential to improve the lives of all people no matter where they live” (McClatchy Newspapers). Vitamin N is a one-of-a-kind, comprehensive, and practical guidebook for the whole family and the wider community, including tips not only for parents eager to share nature with their kids but also for those seeking nature-smart schools, medical professionals, and even careers. It is a dose of pure inspiration, reminding us that looking up at the stars or taking a walk in the woods is as exhilarating as it is essential, at any age.

Louv, R. (2016). Vitamin N: The essential guide to a nature-rich life: 500 ways to enrich your family’s health & happiness. Algonquin Books. 

Autism spectrum disorder (ASD) is the fastest growing developmental disorder in countries across the world. Although recent studies have demonstrated the health benefits of nature for typically developing children and children with attention deficit hyperactivity disorder, it is unclear whether these benefits extend to children with ASD. In this study, we investigated whether benefits associated with exposure to nature could be observed by parents of children diagnosed with ASD. We conducted semi-structured interviews with 22 parents and caregivers of children on the spectrum from two cities in China. Results showed that exposure to nature provided motor-sensory, emotional and social benefits to children with ASD, although some of the identified benefits also come with concerns. Participants identified a wide range of barriers that make exposing their children to nature difficult. Among them, inappropriate behaviors, safety concerns, phobias and issues with the public realm emerged as critical hurdles. These findings suggest that practitioners should consider nature exposure as an intervention strategy, and planners and designers should create places that better accommodate the needs of children with ASD.

Li, D., Larsen, L., Yang, Y., Wang, L., Zhai, Y., & Sullivan, W. C. (2019). Exposure to nature for children with autism spectrum disorder: Benefits, caveats, and barriers. Health & Place, 55, 71–79. https://doi.org/10.1016/j.healthplace.2018.11.005 

As a self-transcendent emotion, awe can enhance one's sense of connection; however, this has not been extensively studied to date. Although existing research on awe and well-being have identified some mechanisms in this relationship, there is no evidence of connectedness (e.g., nature connectedness) as a possible mechanism. Moreover, threatening awe, a subtype of awe, has been insufficiently examined. The present research focused on awe of nature and nature connectedness to examine whether and how different subtypes of awe can improve well-being. The results showed that positive awe improves well-being mainly by increasing nature connectedness. Threatening awe has no significant impact on well-being, mostly because there are two indirect and opposing effects between threatening awe and well-being: the positive indirect effect of nature connectedness and negative indirect effect of powerlessness. These results suggest that different subtypes of awe have different effects on well-being through different mechanisms. In particular, nature connectedness is an important mechanism in the process of awe enhancing one's well-being.

Liu, J., Huo, Y., Wang, J., Bai, Y., Meng, Z., & Di, M. (2023). Awe of nature and well-being: Roles of nature connectedness and powerlessness. Personality and Individual Differences, 201.  

Background The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes. Objective To quantify evidence of the impact of greenspace on a wide range of health outcomes. Methods We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors. Results We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol −0.05 (95% CI −0.07, −0.04), heart rate −2.57 (95% CI −4.30, −0.83), diastolic blood pressure −1.97 (95% CI −3.45, −0.19), HDL cholesterol −0.03 (95% CI −0.05, <-0.01), low frequency heart rate variability (HRV) −0.06 (95% CI −0.08, −0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality. Conclusions Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.

Twohig-Bennett, C., & Jones,A., (2018). The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environmental Research, 166. 628-637. https://doi.org/10.1016/j.envres.2018.06.030. 

Background/Study Context Attention Restoration Theory (Kaplan, 1995) suggests that exposure to nature improves attention. Berman, Jonides and Kaplan (2008) showed that simply viewing nature pictures improves executive attention in young adults. The present study is the first to investigate this Nature Effect in older adults. We investigated whether executive attention could be improved in healthy older adults following brief exposure to nature pictures. Methods Thirty healthy older adults (64–79 years old) and 26 young university students (18–25 years old) participated. They completed the Attention Network Test before and after six minutes of viewing either nature or urban pictures, with random assignment into a picture type. Attention immediately before (most fatigued) and after (most restored) picture viewing was measured, and change in attention was compared between age groups and picture types. Results Results showed that viewing nature, but not urban, pictures significantly improved executive attention in both older and young adults as measured by the Attention Network Test, with similar effects seen in the two age groups. Alerting and orienting attention scores were not affected by picture-viewing. Conclusion This was the first study to show that viewing nature pictures improves attention in older adults, and to show that it is executive attention, specifically, that is improved. Among a growing number of interventions, nature exposure offers a quick, inexpensive, and enjoyable means to provide a temporary boost in executive attention.

Gamble, K. R., Howard, J. H., Jr, & Howard, D. V. (2014). Not just scenery: viewing nature pictures improves executive attention in older adults. Experimental Aging Research, 40(5), 513–530. https://doi.org/10.1080/0361073X.2014.956618 

Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to the quantity of empirical evidence that supports this. A systematic review regarding the impact of exposure to natural environments on attention was conducted. Seven electronic databases were searched. Studies were included if (1) they were natural experiments, randomized investigations, or recorded “before and after” measurements; (2) compared natural and nonnatural/other settings; and (3) used objective measures of attention. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by another. Where possible, random effects meta-analysis was used to pool effect sizes. Thirty-one studies were included. Meta-analyses provided some support for ART, with significant positive effects of exposure to natural environments for three measures (Digit Span Forward, Digit Span Backward, and Trail Making Test B). The remaining 10 meta-analyses did not show marked beneficial effects. Meta-analysis was limited by small numbers of investigations, small samples, heterogeneity in reporting of study quality indicators, and heterogeneity of outcomes. This review highlights the diversity of evidence around ART in terms of populations, study design, and outcomes. There is uncertainty regarding which aspects of attention may be affected by exposure to natural environments.

Ohly, H., White, M. P., Wheeler, B. W., Bethel, A., Ukoumunne, O. C., Nikolaou, V., & Garside, R. (2016). Attention restoration theory: A systematic review of the attention restoration potential of exposure to natural environments. Journal of Toxicology and Environmental Health, Part B, 19(7), 305–343. https://doi.org/10.1080/10937404.2016.1196155 

Background: With the global burden of disease increasing, particularly in relation to often preventable chronic diseases, researchers and clinicians are keen to identify interventions that can mitigate ill health and enhance the psychological wellbeing of people living with long-term conditions (LTCs). It is long established that engagement with nature can support human health and wellbeing, and in recent years, nature-based interventions (NBIs) have been advanced as of potential benefit. This review thus sought to systematically appraise published evidence of the application of NBIs to address psychological wellbeing for those living with LTCs. Methods: A systematic search of three databases, PsycINFO, MEDLINE and SCOPUS, was undertaken, and the BestBETs quality assessment checklist was used to appraise methodological quality of elicited studies. Results: Of 913 studies identified, 13 studies (12 using quantitative methods, one qualitative) were used. Included papers reported use of a variety of psychological outcomes alongside more circumscribed physiological outcomes. Quality appraisal showed modest robustness, some methodological weaknesses and a dominance of application in developed countries, yet synthesis of studies suggested that reported psychological and physiological outcomes present a strong argument for NBIs having a promising and positive impact on psychological wellbeing. Conclusions: NBIs have positive psychological and physiological impacts on people with LTCs, suggesting they may be a suitable addition to current maintenance treatment. Future research should focus on minimising study bias and increasing the potential for cross-cultural applications.

Taylor, E. M., Robertson, N., Lightfoot, C. J., Smith, A. C., & Jones, C. R. (2022). Nature-based interventions for psychological wellbeing in long-term conditions: A systematic review. International Journal of Environmental Research and Public Health, 19(6). https://doi.org/10.3390/ijerph19063214 

A growing body of empirical research suggests that brief contact with natural environments improves emotional well-being. The current study synthesizes this body of research using meta-analytic techniques and assesses the mean effect size of exposure to natural environments on both positive and negative affect. Thirty-two studies with a total of 2356 participants were included. Across these studies, exposure to natural environments was associated with a moderate increase in positive affect and a smaller, yet consistent, decrease in negative affect relative to comparison conditions. Significant heterogeneity was found for the effect of nature on positive affect, and type of emotion assessment, type of exposure to nature, location of study, and mean age of sample were found to moderate this effect. The implications of these findings for existing theory and research are discussed, with particular emphasis placed on potential avenues for fruitful future research examining the effects of nature on well-being.

McMahan, E. A., & Estes, D. (2015). The effect of contact with natural environments on positive and negative affect: A meta-analysis. The Journal of Positive Psychology, 10(6), 507–519. 

Direct and indirect well-being benefits of children and adolescent's nature connectedness are a growing societal interest. Accordingly, they are increasingly studied and the field of research is evolving rapidly. However, the conceptualization and operationalization of nature connectedness, well-being and their interaction, as well as the empirical methods that are used to analyze them, vary remarkably. We conducted a systematic literature review on how children's nature connectedness and its well-being impacts have been studied during the past two decades and what are the key findings regarding the connection. Our analysis covered qualitative and quantitative studies, which all showed the positive effects of nature connectedness on well-being. Qualitative studies gave a voice to children in defining nature and its well-being impacts, while quantitative studies measured the connection using various nature connectedness scales. We conclude with recommendations for developing the research field in the future to fulfil current research gaps and to guide societal development to support children's well-being.

Arola, T., Aulake, M., Ott, A., Lindholm, M., Kouvonen, P., Virtanen, P., & Paloniemi, R. (2023). The impacts of nature connectedness on childrens wellbeing: Systematic literature review. Journal of Environmental Psychology, 85. doi.org/10.10016/j.jenvp.2022.101913. 

Nature-based interventions hold promise for vulnerable youth experiencing mental, emotional, developmental, behavioral, or social difficulties. This scoping review examined wilderness therapy, animal assisted therapy, care farming, and gardening and horticultural therapy programs to raise awareness and guide future development of research and treatment options. Studies included in this review were identified through a systematic search of the literature informed by a scoping review framework. Studies were examined by design, sample, intervention, and key findings. The majority of studies were quantitative using repeated measures designs and were conducted primarily in the United States. Sample sizes were generally small. Interventions were residential and community based with varying degrees of duration. Outcomes were largely positive across a wide range of psychosocial and behavioral measures and often maintained post-treatment. We emphasize the importance of robust empirical designs, comprehensive description of the interventions and surrounding therapies, and identification of target groups.

Overbey, T. A., Diekmann, F., & Lekies, K. S. (2021). Nature-based interventions for vulnerable youth: a scoping review. International Journal of Environmental Health Research, 33(1), 15–53. https://doi.org/10.1080/09603123.2021.1998390 

Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood −0.64 (95% CI: 1.05 to −0.23), reducing anxiety −0.94 (95% CI: 0.94 to −0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect −0.52 (95% CI: 0.77 to −0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.

Coventry, P. A., Brown, J.E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. C. L. (2021). Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM Popul Health,16. doi: 10.1016/j.ssmph.2021.100934 

The demand for mental health services around the world has risen dramatically. Many researchers and practitioners are looking for alternative mental health treatments, including nature-based recreation. However, reviews examining nature-based recreation’s therapeutic effectiveness are limited. The purpose of this study was to conduct a systematic review of available research regarding the potential mental-health benefits of nature-based recreation. Following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines, a global standard established to ensure consistency and quality in literature reviews, a systematic search generated 51 articles for review. Most articles (n = 46, 90%) observed at least one positive association between nature-based recreation and mental health, including improvements in affect, cognition, restoration, and well-being, and decreases in anxiety and depression symptoms. Trends regarding the setting, population, methodology, and theoretical orientation of existing research, as well as recommendations for future research, are discussed in this review.

Lackey, N. Q., Tysor, D. A., McNay, G. D., Joyner, L., Baker, K. H., & Hodge, C. (2019). Mental health benefits of nature-based recreation: A systematic review. Annals of Leisure Research, 24(3), 379–393. https://doi.org/10.1080/11745398.2019.1655459 

The time children spend in nature has severely decreased. While nature-based learning at school is considered an important strategy in addressing this, numerous knowledge gaps continue to remain. To address these, a systematic review was undertaken. Nine commonly used health and education databases were searched from inception to January 2019. To be included, study participants were required to be children aged 4 to 12 without health or developmental conditions with a focus on nature-based learning. The methodological quality of the included studies was assessed, followed by a descriptive synthesis. Out of 4703 results, 20 quantitative studies were included. There was a lack of universal definition of nature-based learning. This resulted in heterogeneity in how interventions were delivered, and outcomes measured. Overall, nature-based learning had varying levels of positive impacts across a range of outcomes. Despite these positive findings, the evidence base is constrained by some methodological issues.

Miller, N. C., Kumar, S., Pearce, K. L., & Baldock, K. L. (2021). The outcomes of nature-based learning for primary school aged children: A systematic review of quantitative research. Environmental Education Research, 27(8), 1115–1140. https://doi.org/10.1080/13504622.2021.1921117 

Spending time in nature has many psychological benefits for people, including stress reduction and improved mood. Using behavioral measures and field study settings, we demonstrate that exposure to nature also leads to prosocial behaviors, such as increasing charitable donations. We show these prosocial effects are explained by an increased sense of self-transcendence, whereby a person feels connected to something greater than oneself or the social groups one belongs to. When self-transcendence is not experienced, such as when people feel separate or distinct from others, these effects are no longer observed. The theoretical and practical implications of the research are discussed.

Castelo, N., White, K., & Goode, M. (2021). Nature promotes self-transcendence and prosocial behavior. Journal of Environmental Psychology, 76. doi.org/10.1016/j.jenvp.2021.101639. 

This paper provides an integrative review of evidence from different research areas showing that exposure to nature influences social health by evoking more prosocial judgments, decisions, and actions. Nature exposure increases prosocial behavior, decreases antisocial behavior, and increases ratings of social connection and satisfaction. Prosocial and antisocial behavior effects are observed with brief nature exposure, both actual and virtual. Social connection effects are observed with long-term nature exposure, such as neighbourhood greenspace. Several mechanisms are proposed for these effects including self-transcendent emotions, motivation, social ties, place attachment, trust, and self-regulation. This overview of the impact of nature on various factors of social health and consideration of possible causal mechanisms provides a coherent framework for designing future research and practical interventions to improve social health.

Arbuthnott, K. D. (2023). Nature exposure and social health: Prosocial behavior, social cohesion, and effect pathways. Journal of Environmental Psychology, 90. doi.org/10.1016/j.jenvp.2023.102109. 

Given the drastic changes in our lifestyles and ecosystems worldwide, the potential health effects of natural environments have grown into a highly pervasive topic. Recent scientific findings suggest beneficial effects from nature exposure on human immune responses. This review aims at providing a comprehensive overview of literature published on immunomodulatory effects of nature exposure by inhalation of natural substances. A systematic database search was performed in SCOPUS and PubMed. The quality and potential bias of included studies (n = 33) were assessed by applying the EPHPP (Effective Public Health Practice Project) tool for human studies and the ARRIVE (Animal Research: Reporting of In Vivo Experiments) and SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) tools for animal studies. The synthesis of reviewed studies points to positive effects of nature exposure on immunological health parameters; such as anti-inflammatory, anti-allergic, anti-asthmatic effects or increased NK (natural killer) cell activity. Decreased expression of pro-inflammatory molecules, infiltration of leukocytes and release of cytotoxic mediators are outcomes that may serve as a baseline for further studies. However, partially weak study designs evoked uncertainties about outcome reproducibility and key questions remain open concerning effect sizes, duration of exposure and contributions of specific vegetation or ecosystem types.

Andersen, L., Corazon, S. S., & Stigsdotter, U. K. (2021). Nature exposure and its effects on immune system functioning: A systematic review. International Journal of Environmental Research and Public Health, 18(4), 1416. https://doi.org/10.3390/ijerph18041416 

The aim of the study is to examine whether and to what extent nature connectivity directly impacts an individual’s level of empathy. The results may suggest a positive correlation, potentially serving as a humanitarian tool in the future. The compiled information regarding the beneficial impact of the natural world on an individual’s degree of mental awareness may be relevant in the field of social work due to the increased global demand for adjustments and presence on an emotional level to improve the well-being of society.

Matthews, Mesa & Jávor, Rebeka. (2023). Nature’s influence on the development of empathy: An exploratory study. Szociális Szemle. 16. 1-13. 10.15170/SocRev.2023.16.01.01.  

Three studies examine the effects of exposure to nature on positive affect and ability to reflect on a life problem. Participants spent 15 min walking in a natural setting (Studies 1, 2, & 3), an urban setting (Study 1), or watching videos of natural and urban settings (Studies 2 & 3). In all three studies, exposure to nature increased connectedness to nature, attentional capacity, positive emotions, and ability to reflect on a life problem; these effects are more dramatic for actual nature than for virtual nature. Mediational analyses indicate that the positive effects of exposure to nature are partially mediated by increases in connectedness to nature and are not mediated by increases in attentional capacity. The discussion focuses on the mechanisms that underlie the exposure to nature/well-being effects.

Mayer, F. S., Frantz, C. M., Bruehlman-Senecal, E., & Dolliver, K. (2008). Why is nature beneficial? The role of connectedness to nature. Environment and Behavior, 41(5), 607-643. https://doi.org/10.1177/0013916508319745  

Scientific research has widely examined the therapeutic and health benefits of being in contact with natural environments. Nature walk have been proposed as a cost-effective and inclusive method for successfully exploiting nature for the promotion of health and well-being. Depression and anxiety symptoms have been shown to benefit from nature walk. Despite recent empirical findings published in the scientific literature, a summary quantitative work on the effect of nature walk on depression and anxiety does not yet exist. The present systematic review and meta-analysis quantitatively analyze and qualitatively discuss the studies published on the effect of nature walk on depression and anxiety published during the past decade. A database search as well as snowballing methods were used to retrieve eligible articles. The research question and literature search were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Based on screening and retrieval processes, seven studies met the eligibility criteria and were then included in the quantitative meta-analysis. Risk of bias (RoB) analysis was used to evaluate the quality of the included studies using the Newcastle–Ottawa Scale. After a qualitative evaluation of the studies, data from six experiments were included in the meta-analysis. The meta-analysis show that nature walk effectively improve mental health. The findings were confirmed for the experiments reporting the quantitative data within groups (pre- and post-test) and between groups (experimental vs. control group).

Grassini S. (2022). A systematic review and meta-analysis of nature walk as an intervention for anxiety and depression. Journal of Clinical Medicine, 11(6). https://doi.org/10.3390/jcm11061731 

This research investigated the effects of a nature-based treatment on participants diagnosed with depression. Participants (N = 136) were randomized into nature-based (n = 59) or standard care-only (n = 77) groups. The participants in the nature-based group were offered 12 nature-based sessions once a week in addition to standard care. The participants in the nature-based group were on average 45.0 years (range 22–64 years) and participants in the standard-care only were on average 45.4 years (range 19–64 years). The nature-based groups took place in five towns across Finland. The observed effects of the intervention on participants in the nature-based group, when compared to the participants who received standard care only, included a greater decrease in psychological distress (p < .05) and an increase in restorative experiences (p < .01) as well as in the self-reported ability to work/study but only at post-measurement (p < .05). Nature sessions produced restorative experiences that mediated the decrease in depression. The depression scores of participants in both groups reduced significantly and no differences were observed between the groups. Thus, nature-based intervention can be a safe and beneficial form of short-term group treatment for depression in addition to standard care.

Hyvönen, K., Salonen, K., Paakkolanvaara, J.-V., Väkeväinen, P., & Korpela, K. (2023). Effects of nature-based intervention in the treatment of depression: A multi-center, randomized controlled trial, Journal of Environmental Psychology, 85. 101950, ISSN 0272-4944, https://doi.org/10.1016/j.jenvp.2022.101950. 

Aims Natural environments have been widely recognized to have many beneficial effects on emotions and emotion regulation processes. However, this mechanism is still largely overlooked in current research and practice, with only a few studies that specifically investigated these processes applying terminology and approaches grounded in the emotion regulation theories. This review explores the literature regarding how nature-related aspects impact on emotion regulation, considering studies based on relevant emotion regulation concepts and language. The aim is to bridge the nature-health literature with the emotion regulation field, enhancing theoretical development and understanding of the benefits of nature exposure by identifying common terminology and measurement approaches. Methods To inform future research with existing evidence, a rapid review of the literature on this topic was conducted in November 2022. In January 2024, an additional literature search was conducted to incorporate recent articles and update the review. Five databases (PsycInfo, PubMed, Google Scholar, Science Direct, PubPsych) were searched for relevant studies reporting effects of nature exposure and other nature-related aspects (e.g., nature connectedness) on emotion regulation processes. Results Following the application of inclusion and exclusion criteria, twenty-seven relevant articles were selected for the review. The assessment of emotion regulation and nature-related aspects used in the studies were diverse and the research was heterogeneous; therefore, a narrative synthesis of the results was conducted. Overall, nature exposure appears to have a positive impact on emotion regulation processes in general as well as on specific emotion regulation strategies, such as decreasing rumination and worry, and enhancing the use of adaptive emotion regulation strategies (i.e., mindfulness and cognitive reappraisal). Furthermore, the review indicated that there is an association between nature connectedness and affect regulatory processes, for example emotion regulation and dysregulation have been found to mediate the effects of nature connectedness on perceived stress and happiness. Conclusions Despite the variety in the methods adopted by the reviewed studies, most findings reported positive impacts of nature on affect regulatory processes in general, and more particularly on specific strategies of emotion regulation. These findings highlight the importance of further research on this topic and the need for enhanced methodological rigor in study designs and measurements tools to assess the association among individuals’ exposure to nature and the strategies they adopt to regulate their emotions. Achieving greater consistency in the terminology adopted across studies is also crucial for building a cohesive body of knowledge and facilitating evidence accumulation across diverse contexts.

Vitale, V. & Bonaiuto, M. (2024). The role of nature in emotion regulation process: An evidence-based rapid review. Journal of Environmental Psychology, 96. doi.org/10.1016/j.jenvp.2024.102325 

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

Jimenez, M. P., DeVille, N. V., Elliott, E. G., Schiff, J. E., Wilt, G. E., Hart, J. E., & James, P. (2021). Associations between nature exposure and health: A review of the evidence. International Journal of Environmental Research and Public Health, 18(9), 4790. https://doi.org/10.3390/ijerph18094790 

In this systematic review, we summarised and evaluated the evidence for benefits of immersive nature-experience on children and adolescents' mental, physical and social health. An electronic search was performed for English language articles published between January 2004 and May 2017. Data were extracted from 84 publications that met the inclusion criteria. Study quality was assessed for a subset of the studies, i.e. controlled between- and within-subject studies, using a systematic assessment scheme, and the quality of the evidence was reviewed at an outcome level. Across heterogeneous types of immersive nature-experience, there was conditional support for benefits on self-esteem, self-efficacy, resilience and academic and cognitive performance. Correlational research evidenced higher levels of physical activity in natural environments than comparison conditions. Benefits for outcomes such as self-concept, problem solving, and mood were more inconclusive. In addition, social skill-oriented and behavioural indicators were improved, although the categories comprised different outcomes. Risk of bias, insufficient sampling methods and unsuited comparison groups were common study limitations.

Mygind, L., Kjeldsted, E., Hartmeyer, R., Mygind, E., Bølling, M., & Bentsen, P. (2019). Mental, physical and social health benefits of immersive nature-experience for children and adolescents: A systematic review and quality assessment of the evidence. Health & Place,58. https://doi.org/10.1016/j.healthplace.2019.05.014. 

A wealth of literature has evidenced the important role that the greater-than-human natural environment plays in our mental health and wellbeing (reviews by Bratman et al., 2019; Capaldi et al., 2014, 2015; Pritchard et al., 2019). Spending time in nature, engaging with nature directly and indirectly, and a strong sense of nature connectedness (a psychological/emotional connection with nature) have each been shown to positively impact wellbeing. Few studies, however, have examined the importance that various nature-related factors have on our wellbeing when examined in concert with each other, with none including factors of nature connection and engagement. In the current study, using a national United Kingdom sample of 2,096 adults, we provide new insights into this gap in the literature. Our primary focus was on examining, when considered simultaneously, the patterns and relative predictive importance to hedonic wellbeing (i.e., happiness), eudaimonic wellbeing (i.e., worthwhile life), illbeing (i.e., depression and anxiety), and general physical health of five nature-related factors: (1) nature connectedness, (2) time in nature, (3) engagement with nature through simple everyday activities, (4) indirect engagement with nature, and (5) knowledge and study of nature. A consistent pattern of results emerged across multiple analytical approaches (i.e., correlations, linear regression, dominance analyses, commonality analysis), wherein time in nature was not the main (or significant) predictive nature-related factor for wellbeing. Rather, nature connectedness and engaging with nature through simple activities (e.g., smelling flowers) consistently emerged as being the significant and prominent factors in predicting and explaining variance in mental health and wellbeing. Implications for practical application and policy/programme planning are discussed.

Richardson, M., Passmore, H-A., Lumber, R., Thomas, R., & Hunt, A.(2021). Moments, not minutes: The nature-wellbeing relationship. International Journal of Wellbeing, 11(1), 8-33. https://doi.org/10.5502/ijw.v11i1.1267