Healing through nature: A scoping review of eating disorders and nature-based interventions.

BackgroundNature-based interventions are emerging as an alternative to therapeutic approaches aimed to reduce and prevent mental and physical ailments. However, little is known of the types of interventions available to use by healthcare professionals. This systematic review of reviews aimed to classify and categorise different types of Nature-Based Interventions (NBIs) which currently exist under different names and approaches. The second aim of our review was to explore the mediating and moderating factors impacting NBI effectiveness.MethodsThe systematic review used the narrative synthesis approach following the PRISMA guidelines, using the following databases: Academic Search Complete, APA PsycInfo, CINAHL, MEDLINE, and included only peer-reviewed review articles in English which explored Nature Based Interventions (NBIs), excluding animal-based interventions. The quality review was conducted using AMSTAR-2.ResultsThe review included a total of 61 reviews of NBIs, covering 13 different categories of NBIs: nature-based interventions, horticulture, nature exposure, green exercise, wilderness and adventure therapy, forest therapy, blue space interventions, care farming, nature play, nature-based education, environmental volunteerism, immersive nature experiences, and caring for country. Furthermore, 11 moderating and mediating factors influencing NBI effectiveness were identified: social, physical activity, age, nature connectedness, duration and frequency, gender, symptom severity, environment type, participant motivation and preference, challenge confrontation, and autonomy, responsibility, and skill and knowledge acquisition.ConclusionThe current review found a wide variety of NBIs, showcasing the many different options available to individuals and healthcare professionals offering accessible and cost-effective NBIs. Moreover, the moderating and mediating factors identified in our review will help future researchers, healthcare professionals, and practitioners consider these factors when evaluating the effectiveness of NBIs.Systematic review registrationPROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42023491598), identifier (CRD42023491598).

Chronic pain results from a complex series of biomechanical, inflammatory, neurological, psychological, social, and environmental mechanisms. Pain and pain-related diseases are the leading causes of disability and disease burden globally. Employing nature-based interventions for the treatment of pain is an emerging field. Current theory driving the suggested mechanism(s) linking the pain reducing effects of nature-based interventions is lacking. A two-step approach was taken to complete a theoretical review and analysis. First, a literature review was completed to gather a substantive amount of research related to theoretical frameworks on the topic of nature-based interventions and pain. Secondly, a theoretical analysis as proposed by Walker and Avant was completed to explore current theoretical frameworks accepted in the literature on nature-based interventions and pain. Stress reduction theory and attention restoration theory were the most common theoretical frameworks identified. Neither theoretical framework explicitly identifies, describes, or intends to adequately measure the concept of pain, revealing a limitation for their application in research with nature-based interventions and pain. Theoretical development is needed, as it pertains to nature-based interventions and pain. Without this development, research on nature-based interventions and pain will continue to use proxy concepts for measurement and may result in misrepresented findings.

This article explores horticulture therapy as an innovative and emerging treatment modality for individuals with disabilities. Horticulture therapy involves engaging in gardening and related activities under the guidance of a trained therapist, aiming to achieve specific therapeutic goals. The practice has roots in ancient civilizations, such as Mesopotamia and Greece, and has evolved significantly over time, particularly gaining prominence post-World War II with the establishment of the American Horticulture Therapy Association (AHTA) in 1973.The mechanism of action behind horticulture therapy leverages natural elements to reduce stress and anxiety, promote cognitive function, and improve overall well-being. Theoretical frameworks such as Biophilia Theory, Attention Restoration Theory, and Overload and Arousal Theory provide insight into how nature and plant interactions foster healing and mental restoration. Horticulture therapy offers a range of benefits, including enhanced physical health, improved mental wellness, increased social interaction, and cognitive stimulation. The article highlights evidence supporting the effectiveness of horticulture therapy for various groups including individuals with autism spectrum disorder, physically challenged children, people with dementia, and those with learning disabilities. It underscores the importance of integrating horticulture therapy into rehabilitation and mental health care settings, advocating for its broader acceptance and application. Future prospects suggest that with increased research, government support, and integration into urban planning, horticulture therapy can play a crucial role in enhancing the quality of life for individuals with disabilities.

Background: Depression, a leading global cause of disability, continues to challenge mental health systems due to issues of treatment resistance, accessibility, and adverse effects associated with conventional therapies. Complementary and alternative approaches, such as forest therapy, have gained prominence as non-pharmacological interventions for enhancing mental well-being. Objectives: This review critically examines the effectiveness of forest therapy in alleviating depression, synthesizing findings from global randomized controlled trials, observational studies, and meta-analyses. Methods: A narrative review methodology was employed, integrating data from diverse disciplines. Empirical studies were selected based on predefined inclusion and exclusion criteria, focusing on interventions involving structured forest therapy and depression-related outcomes. Results: Evidence indicates that forest therapy significantly reduces depressive symptoms, cortisol levels, and improves psychosocial parameters such as self-esteem, emotional regulation, and social connectedness. Theoretical frameworks such as Attention Restoration Theory, Stress Reduction Theory, and the Biophilia Hypothesis support these findings. However, methodological heterogeneity, small sample sizes, and limited cross-cultural research pose challenges to generalizability. Conclusions: Forest therapy emerges as a promising, low-cost, and accessible intervention for depression, complementing traditional treatments. Future research must focus on standardizing protocols, conducting longitudinal and comparative effectiveness trials, and expanding cross-cultural investigations. Policy integration and technological innovations could further enhance its scalability and public health impact.

The COVID-19 pandemic has had a profound, negative impact on the lives and wellbeing of much of the population, and it can raise additional challenges for individuals with eating disorders (EDs). During early stages of the UK lockdown, individuals reported disruptions to many aspects of their lives, including reduced feelings of control and serious concerns over the impact of the pandemic on ED symptoms and/or recovery. This study applied a mixed methods online survey to collect responses from 58 individuals (age 16–65yrs) with lived experience of EDs. Data was collected across two time points (April 2020 and June 2020) to explore the ongoing impacts of the pandemic on this population. The results suggest that higher perceptions of general, external control may be associated with ED recovery. Quantitative results show that individuals who reported recovering from their ED since the first time point, also reported significant increases in perceived control (compared to individuals who had relapsed or whose ED status was unchanged). Thematic analysis generated two themes: ED behaviours as an ‘auxiliary control mechanism’, and loss of auxiliary control after lockdown. Individuals who experienced less perceived control reported a tendency to rely upon eating disorder behaviours as an auxiliary coping mechanism, i.e., diminished external control was directed inwards and replaced with controlling their own behaviour. The preliminary results suggest that perceived control may be a significant factor in ED recovery. Individuals with EDs may be at significant risk of detrimental impacts on their recovery and wellbeing because of the pandemic reducing peoples' sense of control. These preliminary findings highlight the need for further research in this area, including investigation around potential interventions based upon strengthening perceptions of control to promote ED recovery.

The accelerating rate of urbanisation correlates with an increase in mental health issues, including anxiety and depression. While pharmacological treatments remain common, they come with side effects and limited long-term efficacy. In recent years, nature-based interventions, particularly forest bathing (Shinrin-yoku), have received increasing attention for their potential psychological and physiological benefits. However, the application of such nature-based public health strategy remains limited, and more future research is needed. This paper evaluates several current research in the benefits and application of forest bathing, with a special focus on the integration of forest bathing into China’s public health framework. Based on empirical studies and theoretical models like Attention Restoration Theory and Stress Recovery Theory, this review examines how forest bathing contributes to emotional regulation, cortisol reduction, cardiovascular improvement, and immune system enhancement. It also analysis the efficacy of forest bathing in vulnerable populations including students, elders, and urban residents. By analyzing the research findings and cultural background of forest bathing in China through the traditional “Yang Sheng” practices, this paper argues for a broader application of this strategy in mental health improvement, elderly care, and urban planning. Future research s needed to develop standardized guidelines, address inequality in green space access, and long-term clinical outcomes in diverse populations.

This study explores the therapeutic value of nature-based intervention methods in psychiatry through an assessment of their practical applications, action mechanisms, and conceptual development. The conceptual framework is based on discussions of emerging psychological constructs such as eco-anxiety, ecological grief, and solastalgia, which have arisen as a result of climate change. The study reviews the psychiatric effects of horticultural therapy, forest bathing, community gardening, and mindfulness-based nature practices. The findings indicate that horticultural therapy helps patients with depression and anxiety and improves their attention, forest bathing decreases cortisol levels and boosts immunity and sleep quality, community gardening reduces social isolation and creates feelings of belonging, and mindfulness-based nature practices help people manage stress and develop self-awareness. They further demonstrate that nature-based practices support both personal mental health and the creation of enduring mental health policies. However, evidence on the long-term effects of these interventions and their adaptability to different cultural contexts is limited. Standardized assessment tools are lacking in this field, which creates challenges for the comparison of different research findings. To integrate nature-based interventions into clinical practice, structural policy changes and professional development training are both needed, together with the establishment of ecologically sensitive protocols and policy arrangements that encourage interdisciplinary collaboration.

Substance Use Disorders Are Deadly.

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark’s thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.

The role of outdoor adventure programmes as a recognised approach for the effective treatment of psychological issues has, in recent years, reflected the growing interest in the development of adventure therapy. Although there has been an increased awareness of the possibilities of such a therapeutic approach there is limited practice, and thus very little instruction for how to implement such approaches, especially from a UK perspective. The aim of this study was to develop adventure therapy practice in the UK by specifically developing an intervention for women with eating disorders. Given that this specific approach for working with eating disorders didn't exist at the time of this study, this thesis is based on the principles of action research -a key aspect of the research process was the development of adventure therapy practice itself. Given the gender considerations of working in an outdoor adventure setting and the fact that eating disorders are largely a female phenomenon this study also took a feminist approach to ensure that disordered eating was in fact not reinforced by any adventure therapy approach developed. The thesis itself describes in detail the processes of developing the adventure therapy intervention and the associated experience of the six women who were recruited and took part in the intervention. The dilemmas and decisions made with regard to a number of issues in implementing an adventure therapy approach are examined, for example, facilitating therapeutic processes in an outdoor setting, identifying issues related to eating disorders that might arise in an outdoor adventure context, and examining feminist principles in action (e. g. reflexivity). As well as the six women's experiences of the different aspects of the adventure therapy intervention, the overall impact of the intervention for each woman is also examined. Data collected from a range of tools completed by the women, including personal information sheets, the Eating Disorders Inventory (EDI), personal journals, individual interviews and a final focus group indicate changes in most, but not all of the women. The results suggests that for the women with less chronic eating disorder symptoms positive change across a range of clinical symptoms were evident, including reduced troubled eating behaviours, improved body image, and motivation for change, albeit to different degrees for each woman. And for the one woman with the most chronic symptoms, although the intervention was a positive experience there was no evidence to suggest the intervention had any sustained impact. Although, the results from this study are not representative of a large clinical population of women, there is an indication that the intervention did initiate therapeutic change for some of the women and thus suggests that adventure therapy has the potential to be an effective therapeutic treatment for eating disorders and is, therefore, worthy of further investigation. Inevitably, in continuing to develop work in this area many questions and issues are raised as result of the action research process and the thesis concludes with a consideration of some of the needs of developing future adventure therapy research and practice in the UK.

The current cross-sectional correlational study aimed to determine the relationship of medication adherence with functionality and quality of life in individuals with bipolar disorder (BD). The research was conducted with 141 individuals with BD followed as outpatients. Data were collected using an information form, Morisky Medication Adherence Scale (MMAS), Quality of Life in Bipolar Disorder Scale (QoL.BD), and Bipolar Disorder Functioning Questionnaire (BDFQ). A significant positive correlation was found between participants' MMAS total score and QoL.BD (p < 0.001) and BDFQ (p < 0.05) scores. A significant positive correlation was also found between QoL.BD and BDFQ scores (p < 0.001). Medication compliance positively affects quality of life and social functionality in individuals with BD. Thus, interventions to increase medication adherence are recommended. [Journal of Psychosocial Nursing and Mental Health Services, 63(3), 27-35.].

Anemia is highly prevalent, especially in older individuals. In selected populations, anemia has been reported to be associated with impaired survival and health-related quality of life. However, data on this impact in the general population are rare. Furthermore, discussions on the optimal definition of anemia have not been conclusive. We investigated these issues using survival data, scores from a health-related quality of life questionnaire (RAND-36), and hemoglobin concentration from 138670 subjects, aged 18-93 years, participating in the Lifelines cohort. Anemia was defined according to World Health Organization criteria and was further subclassified in participants over 60 years old. Anemia was present in 5510 (4.0%) of all 138670 subjects and 516 (2.8%) in the 18667 individuals older than 60 years. Anemia had no impact on overall survival and limited impact on health-related quality of life in individuals less than 60 years old. In contrast, in individuals over 60 years old anemia significantly impaired overall survival and health-related quality of life. The lower health-related quality of life was mainly observed in subscales representing physical functioning. Although consensus on the subclassification of anemia is lacking, our data suggest that particularly anemia of chronic inflammation was associated with worse overall survival and decreased health-related quality of life. Multivariate models confirmed that anemia was an independent risk factor for decreased health-related quality of life in older individuals. Finally, women with a hemoglobin concentration between 12.0-13.0 g/dL (considered anemia in men, but not in women) experienced a significantly lower health-related quality of life. This large, prospective, population-based study indicates that anemia is associated with worse overall survival and health-related quality of life in older individuals, but not in younger individuals. The findings of this study challenge the definition of anemia in women over 60 years old, and suggest that the optimal definition of anemia, in the perspective of health-related quality of life, in women over 60 years old should be altered to a hemoglobin concentration below 13.0 g/dL (8.0 mmol/L), which is comparable to that in men.

Objective: Little is known about the effects of SARS-CoV-2 coronavirus disease (COVID-19) on quality of life and social participation in individuals with traumatic brain injury. We aimed to compare social participation and health-related quality of life (HRQoL) in a sample of individuals with TBI before and during the second wave of COVID-19 and explored the relationships between the perceived impacts of COVID-19, social participation, and HRQoL.Patients and methods: Eighteen individuals with traumatic brain injury with a mean (standard deviation) age of 47.7 (17.0) years at 48.2 (10.5) months post-injury were administered a questionnaire on overall disability and participation (Mayo-Portland Adaptability Inventory-4th edition; MPAI-4), HRQoL (Quality of Life after Brain Injury Questionnaire; QOLIBRI), and the Coronavirus Impacts Questionnaire before and during the second wave of the COVID-19 pandemic at an interval of 6.4 (SD = 8.2) months. Results: Compared with pre-pandemic levels, individuals with traumatic brain injury reported a statistically significant decrease in the QOLI-BRI total score and its emotional subscale (with medium to large effect sizes), but without statistically significant differences in MPAI-4 scores. Increased difficulties with access to resources during COVID-19 were associated with increased adjustment problems on the MPAI-4, and with daily life and autonomy difficulties, emotional issues, and lower physical functioning on the QOLIBRI. Conclusion: The relationships identified in this exploratory correlational study suggest that COVID-19 had a negative impact on quality of life in individuals with traumatic brain injury, but not specifically on their social participation. LAY ABSTRACTLittle is known about the effects of SARS-CoV-2 coronavirus disease (COVID-19) on the lives of individuals with traumatic brain injury. This study compared social participation and health-related quality of life in individuals with TBI before and during the second wave of COVID-19 and explored relationships between the perceived impacts of COVID-19, social participation, and health-related quality of life, but not specifically on social participation in individuals with traumatic brain injury. Also, increased difficulties with access to resources during COVID-19 were associated with increased adjustment problems, daily life and autonomy difficulties, emotional issues, and lower physical functioning.

The aim of this study was to evaluate the effect of laughter yoga on the quality of life and sleep quality in individuals with fecal ostomies. This was randomized controlled trial. The sample comprised 55 individuals with an ostomy who received care at Ankara University's I˙bni Sina Hospital Stoma Therapy Unit in Ankara, Turkey. Data were collected over a 2-month period (January and February 2020). Participants were allocated into an intervention group (n = 27) who received a yoga therapy intervention and a control group (n = 28) who received no intervention via simple randomization. Demographic and pertinent clinical variables were obtained during a baseline visit in both groups, along with the Pittsburgh Sleep Quality Index (PSQI) and Stoma-Quality of Life (Stoma-QOL) instruments. The intervention group received laughter yoga weekly over a period of 8 weeks. Mean scores on the PSQI and the Stoma-QOL at baseline were compared. Participants in the intervention had a significant decline in mean PSQI scores (6.85 vs 5.48, P = .044) indicating improvement in sleep quality following the intervention. Analysis revealed no significant difference in mean Stoma-QOL scores (P = .077). Control group participants had no significant difference in either mean PSQI or Stoma-QOL scores following data collection at the end of 8 weeks. Laughter yoga had a positive effect on the sleep quality in individuals with fecal ostomies. Further research is recommended to evaluate the effect of the number of laughter yoga sessions on the sleep quality and quality of life in individuals with ostomies.

Systematic review and meta-analysis. The objective was to summarize the effectiveness of Inspiratory Muscle Training (IMT) on the quality of life in individuals with Spinal Cord Injury (SCI). An online systematic literature search was conducted in the following databases: PubMed/MEDLINE, PubMed CENTRAL, EMBASE, ISI Web of Science, SciELO, CINAHL/SPORTDiscus, and PsycINFO. Randomized and non-randomized clinical studies investigating the effectiveness of IMT in quality of life were included in the present study. The results used the mean difference and 95% confidence interval for maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), maximal expiratory pressure (MEP), and the standardized mean differences for the quality of life and maximum ventilation volume. The search found 232 papers, and after the screening, four studies met the inclusion criteria and were included in the meta-analytical procedures (n = 150 participants). No changes were demonstrated in the quality of life domains (general health, physical function, mental health, vitality, social function, emotional problem, and pain) after IMT. The IMT provided a considerable effect over the MIP but not on FEV1 and MEP. Conversely, it was not able to provide changes in any of the quality of life domains. None of the included studies evaluated the IMT effects on the expiratory muscle maximal expiratory pressure. Evidence from studies shows that inspiratory muscle training improves the MIP; however, this effect does not seem to translate to any change in the quality of life or respiratory function outcomes in individuals with SCI.