Nature Walks for Stress Management

Overseen By Leticia Marquez-Magana, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: Charlotte Tate

Disqualifiers: Pregnancy, Prisoners, Cognitive impairment

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

200 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Reclaiming Nature Intervention for stress management?

Research shows that nature-based therapies can help people with stress-related illnesses by promoting calmness, joy, and personal growth. Patients often report positive health effects from spending time in nature, which can aid in recovery from stress-related mental disorders. ^{1 2 3 4 5}

Is participating in nature walks generally safe for stress management?

Research on nature-based interventions, including nature walks, suggests they are generally safe for improving mental health and well-being. These activities are considered a low-risk way to help manage stress and related conditions. ^{1 6 7 8 9}

How is the Reclaiming Nature Intervention treatment different from other stress management treatments?

The Reclaiming Nature Intervention is unique because it involves community nature walks, which use the calming effects of natural environments to reduce stress, unlike traditional treatments that may rely on medication or therapy sessions indoors. This approach leverages the benefits of being in nature, similar to cognitive-behavioral therapy, but in a more natural and supportive setting. ^{7 8 10 11 12}

What is the purpose of this trial?

The investigators will test the efficacy of our proposed intervention to reduce embodied stress in four racial/ethnic groups (Black, Latinx, Pilipinx, and Pacific Islander) as a preventative intervention for health disparities found in these communities. The intervention is comprised of two phases. The first consists of community nature walks in a pristine redwood forest for six months. This is followed by chosen nature activities with family and/or friends for three months. The investigators will test the ability of these activities in nature to reduce chronic stress that underpins many health disparities using validated biological, behavioral, and sociocultural measures. The use of these measures is in alignment with the National Institute of Minority Health and Health Disparities (NIMHD) Research Framework, and will increase understanding of individual, interpersonal, community, and social level factors that lead to, and that can eliminate health disparities.

Eligibility Criteria

This trial is for adults over 18 who speak English, Spanish, or Tagalog and can walk. They must commit to a 9-month program involving nature walks and activities. It's not for pregnant individuals, prisoners, or those with cognitive impairments.

Inclusion Criteria

I can commit to a 9-month nature-based activity program.

You are fluent in English, Spanish or Tagalog.

I can walk on my own.

Exclusion Criteria

Prisoners

I am currently pregnant.

I have cognitive impairment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Community Nature Walks

Participants engage in community nature walks in a pristine redwood forest

6 months

Regular group walks

Chosen Nature Activities

Participants engage in chosen nature activities with family and/or friends

3 months

Self-directed activities

Follow-up

Participants are monitored for biological and behavioral outcomes post-intervention

3 months

Immediate post-intervention and 3 months after

Treatment Details

Interventions

• Reclaiming Nature Intervention

Trial Overview The study tests if community nature walks followed by chosen nature activities can reduce stress in Black, Latinx, Pilipinx, and Pacific Islander groups to prevent health disparities using biological and behavioral measures.

Participant Groups

Group I: Waitlist Control Experimental Treatment 1 Intervention

Waitlist control; all participants receive the treatment but are in a control condition prior to the treatment

Who Is Running the Clinical Trial?

Charlotte Tate

Lead Sponsor

Trials

1

Recruited

200+

University of California, San Francisco

Collaborator

Trials

2,636

Recruited

19,080,000+

Findings from Research

A randomized controlled trial involving 84 participants found that both nature-based therapy (NBT) and cognitive-behavioral therapy (STreSS) significantly improved psychological well-being and reduced burnout, with effects lasting for 12 months.

There was no significant difference in efficacy between NBT and STreSS, suggesting that both therapies are equally effective for treating stress-related illnesses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of nature-based therapy for individuals with stress-related illnesses: randomised controlled trial. Stigsdotter, UK., Corazon, SS., Sidenius, U., et al.[2019]

The nature-assisted rehabilitation program significantly reduced healthcare consumption among 118 patients with severe stress reactions and mild to moderate depression, particularly in outpatient and inpatient psychiatric visits.

While the program showed benefits in reducing healthcare needs, it did not result in significant changes in sick-leave status compared to a matched control group of 678 individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: long-term follow-up including comparisons with a matched population-based reference cohort. Währborg, P., Petersson, IF., Grahn, P.[2018]

A nine-month study using semi-structured surveys revealed that nature-based therapy groups in a psychiatric inpatient setting enhanced patients' sensory experiences, social interactions, and self-care practices.

Patients reported various benefits from engaging with nature, leading to a deeper understanding of how these activities positively impact mental health, which supports the development of a theoretical model for nature-based programming in mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-based Group Therapy Reflections: A Grounded Theory Study. Carlson, K., Kingsley, J., Strimaitis, C., et al.[2021]

Participants in a nature-based intervention program reported significant improvements in their well-being and reduced stress-related exhaustion, indicating the potential efficacy of such programs for stress-related illnesses.

The study highlighted that the calming environment of nature and the supportive community on the farm helped participants feel understood and confident, suggesting that nature-based interventions could be a valuable complement to traditional treatments for stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness. Johansson, G., Engström, Å., Juuso, P.[2022]

Nature-based rehabilitation (NBR) has been found to provide positive health effects for patients with long-standing stress-related mental disorders, based on a synthesis of 5 studies with moderate to high quality.

Patients reported benefits such as instilling calm and joy, meeting their needs, gaining new insights, and experiencing personal growth, indicating that spending time in nature can aid in their recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-Based Rehabilitation for Patients with Long-Standing Stress-Related Mental Disorders: A Qualitative Evidence Synthesis of Patients' Experiences. Bergenheim, A., Ahlborg, G., Bernhardsson, S.[2021]

Nature-based interventions (NBIs), such as gardening and green exercise, significantly improve mental health outcomes in adults, including reducing depressive mood and anxiety, based on a systematic review of 50 studies involving various formats and durations.

The most effective NBIs were conducted over 8 to 12 weeks, with sessions lasting between 20 to 90 minutes, indicating a structured approach is key to maximizing their benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. Coventry, PA., Brown, JE., Pervin, J., et al.[2021]

The SHINE intervention aims to reduce stress and promote health among low-income families by encouraging contact with nature, utilizing a randomized controlled trial design with caregiver-child dyads from a pediatric primary care center.

Participants in the intervention group receive additional support, including case management and group outings to parks, which will be evaluated for their impact on caregiver stress and other health-related outcomes over three months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Design and evaluation of a park prescription program for stress reduction and health promotion in low-income families: The Stay Healthy in Nature Everyday (SHINE) study protocol. Razani, N., Kohn, MA., Wells, NM., et al.[2018]

The study analyzed 406 individuals to identify three health clusters based on perceived stress and age: Low-stress Youth (ages 16-24), Low-stress Seniors (ages 65+), and High-stress Mid-Age (ages 25-44), highlighting how stress levels vary across different age groups.

Coping strategies for stress differ by age, with younger individuals benefiting from social interactions and outdoor activities in green spaces, while older adults and middle-aged individuals tend to prefer staying at home, indicating that local green space may not effectively support stress regulation for all age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping with Stress in Deprived Urban Neighborhoods: What Is the Role of Green Space According to Life Stage? Roe, JJ., Aspinall, PA., Ward Thompson, C.[2020]

A systematic review and meta-analysis of seven studies found that nature walks significantly improve mental health, particularly reducing symptoms of depression and anxiety.

The analysis included data from six experiments, confirming the effectiveness of nature walks through both pre- and post-test comparisons and between experimental and control groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review and Meta-Analysis of Nature Walk as an Intervention for Anxiety and Depression. Grassini, S.[2022]

Nature-based interventions (NBIs), such as garden and forest activities, have been shown to effectively reduce stress and improve health and well-being for individuals with stress-related illnesses, based on a review of 25 studies.

These interventions not only promote relaxation and restoration but also enhance self-efficacy and work ability, suggesting that spending time in nature can be a valuable alternative treatment for stress-related conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-based interventions to promote health for people with stress-related illness: An integrative review. Johansson, G., Juuso, P., Engström, Å.[2022]

Nature gardens can provide benefits comparable to cognitive-behavioral therapy for individuals on sick leave due to stress-related illnesses, suggesting a natural approach to mental health management.

Further pragmatic trials are needed to explore the specific processes and additional health and environmental benefits that nature gardens can offer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are we ready to use nature gardens to treat stress-related illnesses? Coventry, PA., White, PCL.[2019]

Group walks in natural environments, particularly farmland and green corridors, are linked to lower perceived stress and negative emotions, as well as improved mental well-being among participants (n = 708).

While walking in natural settings showed benefits for stress and emotional health, there were no significant differences in effects on depression or positive emotions compared to urban environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Walking for well-being: are group walks in certain types of natural environments better for well-being than group walks in urban environments? Marselle, MR., Irvine, KN., Warber, SL.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Efficacy of nature-based therapy for individuals with stress-related illnesses: randomised controlled trial. [2019]

2. Sweden pubmed.ncbi.nlm.nih.gov

Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: long-term follow-up including comparisons with a matched population-based reference cohort. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Nature-based Group Therapy Reflections: A Grounded Theory Study. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Nature-Based Rehabilitation for Patients with Long-Standing Stress-Related Mental Disorders: A Qualitative Evidence Synthesis of Patients' Experiences. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Design and evaluation of a park prescription program for stress reduction and health promotion in low-income families: The Stay Healthy in Nature Everyday (SHINE) study protocol. [2018]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Coping with Stress in Deprived Urban Neighborhoods: What Is the Role of Green Space According to Life Stage? [2020]

9. Switzerland pubmed.ncbi.nlm.nih.gov

A Systematic Review and Meta-Analysis of Nature Walk as an Intervention for Anxiety and Depression. [2022]

10. Sweden pubmed.ncbi.nlm.nih.gov

Nature-based interventions to promote health for people with stress-related illness: An integrative review. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Are we ready to use nature gardens to treat stress-related illnesses? [2019]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Walking for well-being: are group walks in certain types of natural environments better for well-being than group walks in urban environments? [2021]