The Impact of Virtual Nature Therapy on Stress Responses: A Systematic Qualitative Review
Abstract
:1. Introduction
- Is VR effective enough to be employed for mental illness therapy?
- Are VR environments, including nature and forests, able to mitigate stress levels in patients? Is there an advantage of using VR technology over nature walks methods?
2. Methods
2.1. Protocol and Registration
2.2. Data Sources and Search Strategy
2.3. Eligibility Criteria
2.4. Study Selection
2.5. Data Extraction
3. Results
3.1. Search Results
3.2. Psychosocial and Physiological Effects of Forest Therapy
References | Country | Group Interventions | Sex (M:F), Age | Recovery Duration | Aim | Outcome | Measurement Technique | Results |
---|---|---|---|---|---|---|---|---|
[35] | Sweden | EG: VR with nature sounds CG: VR without nature sounds or No VR treatment | EG: 10 (10:0), age 28.2 ± 10.3. CG: 10 (10:0), age 28.1 ± 4.4; 10 (10:0), age 26.7 ± 3.4. | 40 min | Explore physiological recovery in two distinct virtual natural settings, with and without interaction with natural sounds. | The findings imply a possible mechanistic relationship between nature, natural sounds, and stress recovery. | STAI-S, HRV, HR, TWA | After the intervention, significant differences were discovered between groups (HR, p = 0.007; TWA, p < 0.001). |
[56] | Japan | EG: 3D flower images CG: 2D flower image | EG & CG: 19 (19:0), age 22.2 ± 0.6. | 90 s | Evaluate physiological relaxation effects on autonomic nerve activity by viewing 3D versus 3D flower images. | The study found that realistic 3D floral images boost physiological relaxation more effectively than 2D floral images. | NIRS, HRV, SD | Significant differences were found (NIRS, p < 0.01; HRV, p < 0.05; SD, p < 0.01) between the two groups. |
[45] | Lebanon | EG: natural scenes (rural Ireland and remote beaches), and indoor control. CG: - | 18 (9:9), age 32 ± 12. | 15 min | Promote nature exposure for those living in isolated, restricted settings. | VR nature produced relaxation, and scene selection had a substantial impact on both mood and visual perception. | EDA, MRJPQ | Significant differences were found (EDA, p = 0.002; MRJPQ, p < 0.014) between the natural scenes and indoor control. |
[46] | Japan | EG: nature scence of sea or forest, and baseline CG: - | 12 (12:0), age 22.2 ± 1.7. | 90 min | Evaluate the influence on people’s relaxation while viewing a video of the sea or a forest. | The viewer’s favorite movie of the sea or forest had a calming impact. The findings also imply that watching a favorite scene of a natural setting could help to relieve stress and exhaustion. | POMS, HR, low frequency, high frequency, BIS | Significant stress reduction was found (POMS, p < 0.05) between the nature scenes (sea and forest) and their baselines. |
[34] | Australia | EG: virtual reality forest CG: - | Residents with dementia: 10 (3:7), age = 89 ± 4.7; Family members: 10; Care staff: 9. | 15 min | Assess the apathy, engagement, and mood of dementia patients and to examine employees, dementia patients, and family experiences. | The VRF positively affected dementia patients despite a higher level of fear/anxiety during the VRF compared to the normative group. | OERS | Residents reported higher levels of happiness (p = 0.008), attentiveness (p = 0.001), and anxiety/fear (p = 0.16). |
[47] | Taiwan | Cross-over study: forest and urban VR environments. | 30 (13:17), age 20–29. | 9 min and 30 s | Evaluate the effects of virtual forests on boosting people’s psychological well-being. | Immersing in forests could provide benefits such as reduced negative emotions and enhanced vigor as compared to urban environments that lower self-esteem and raise fatigue levels. | PASAT, POMS, BP, HRV | Significant decrease in negative emotions (tension, p = 0, depression, p < 0.017) observed in forest environments. |
[55] | Sweden | Pseudo-randomised study: VR forest, park and urban environments. | Forest: 52 (24:28), age 27; park: 52 (26:22), age 28; park: 50 (22:28), age 27. | 3 min | Assess the potential for stress recovery using three different environments: urban areas, parks, and forests. | According to the study, residing in an urban environment with no green space, traffic noise, and tar and diesel odors can expose people to a certain amount of stress compared to natural environments such as gardens and forests. | SCL | Significant differences were found between urban areas and both forest (p = 0.003) and park (p < 0.001), while no significant differences (p = 0.39) between forest and park. |
[48] | Korea | EG: VR forest, baseline CG: - | 40 (23:17), age 24.4 ± 2.8. | 5 min | Evaluate viewing forest videos in reducing stress in adults. | The study revealed that watching videos of VR forests could affect individuals’ stress levels, regulate physiological conditions, and positively affect their mental conditions. | HRV, HR, SI, POMS, SD, PANAS | Significant decrease in stress was found (SI, p < 0.01; HRV, p < 0.05; HR, p < 0.01; SD, p < 0.01; POMS-TMD, p < 0.01). |
[49] | China | Independent group design: Pre and post-VR forests. | 96 (33:63), age 24.03 ± 5.29. | 5 min | Evaluate stress recovery after viewing VR videos of seven forest environments: (1) structure, (2) wood, (3) wood with bench, (4) wood with platform and bench, (5) platform with trees, (6) waterfall with trees, and (7) pool with plants. | The study investigated seven forest resting environments. These environments showed a distinct impact on stress relief and proved to reduce stress to some level. | SBP, DBP, HR, SA, POMS | Significant differences were found in various environments with greatest impact in type 6: (SBP, p < 0.01; DBP, p < 0.05; HR, p < 0.05; SA, p < 0.05; POMS-TMD, p < 0.01) |
[36] | China | Independent group design: six immersive virtual environments (IVE) (lightest to darkest). | 120 (27:93), age 19.79 ± 1.90; 20 for each scene. | 6 min | Investigate how varied natural light brightness levels affect people’s stress recovery effects in the forest and provide some proof for stress reduction’s mental well-being benefits. | This study confirmed that bright sunlight scenes (i.e., the lightest, lightest, lightest) in the virtual forest ease tension more effectively than the darkest night sceneries. Another discovery indicated that dark settings, such as sunrise without sunlight but with a hint of brightness, had the same effect. | SCL, BVP, STAI-S | Significant differences were found in natural light brightness (p < 0.001; SCL, p < 0.001; BVP, p < 0.001; STAI-S, p < 0.01). |
[54] | Australia | Independent group design: four levels of biodiversity (urban IVE, none; natural IVE, low, moderate, and high). | 52 (24:28), age 37.6 ± 10.6. Not stated the number of participants for each scene. | 5 min | Evaluate the effects of biodiversity IVEs on recovery from induced stress. | The findings revealed similar well-being responses across self-reported and physiological measurements, implying that biodiversity had an impact on human happiness. In the urban IVE, stress recovery was the least effective for most well-being metrics. | VAS, HR | Significant differences in stress recovery for subjective stress, anxiety, and happiness were found between urban and low biodiversity IVEs (p < 0.05). For HR, no significant differences were found between the urban and either biodiversity IVEs. |
[58] | USA | Repeated measures design: cancer patients with/without viewing VR during the intravenous procedure (IV). | 50 (15:35), age > 65 (n = 29). | During IV procedure for 30 consecutive days | Investigate VR during IV procedures on reducing stress and pain among cancer patients. | The participants felt significantly less frustrated and more relaxed while watching VR nature scenes throughout intravenous chemotherapy. | Likert-type scale questionnaire | Significant increases were found in positive distractions (p < 0.0001), relaxation(p < 0.05), feelings of peace (p < 0.01). |
[50] | USA | Cross-over study: nature scene versus practicing mindfulness-based activities. | 36 (0:36), age ≥ 18. | 4 Weeks, 10 min daily | Evaluate the effectiveness of VR in reducing stress among people with SUD. | This study provided preliminary evidence that nature-viewing had similar benefits as a mindfulness therapy for treating stress and low mood associated with recovery from SUD. | PANAS, HR | Significant decreases in mean negative affect scores (p = 0.001) and heart rate (p ≤ 0.001) were found while viewing nature scenes and practicing mindfulness-based activities. |
[59] | Malaysia | Observational study. | Public respondents. | - | Use VR nature therapy as an alternative tool for stress relief. | An early study found that VR had potential as an aid in therapy, with positive outcomes from users. | Users’ feedback | - |
[51] | Poland | Cross-over study: VR immersion with visual, auditory, and tactile conditions. | 23 (10:13), age 37.2 ± 9.7. | 6.3 min | VR combined with bilateral stimulation in EMDR as a stress-relieving tool. | According to the study’s preliminary findings, VR-based bilateral stimulation may boost mood and reduce stress. | GHQ12, GSR | No significant differences were found between groups. For GSR, visual was most effective in subjective assessment ofstress level (pre, 80%; post, 100%). |
[52] | Germany | Cross-over study: forest and urban VR environments. | 34 (23:11), age 27.26 > 2.14. | 6 min | Demonstrate the health and well-being advantages of natural environments. | The forest environment had a beneficial influence on cognition, while the urban setting had a negative effect on mood. Photos of an urban or forest scene succeeded better than 360 videos to reduce physiological arousals. | POMS, PSS, GSR | Significant differences in participants’ mood (POMS, p < 0.05; PSS, no significant effects; GSR, p < 0.001) |
[57] | Germany | EG: VR with active control and 30-s familiarization CG: VR with no control. | EG: 32 (8:24), age 23.31 ± 4.7. CG: 32 (9:23), age 22.7 ± 2.85. | 5 min | Identify the impact of control on the positive effects elicited by virtual nature environments. | The study showed that participants reported reduced stress, and their positive affective states were raised following the VR experience. | PANAS, SSS | Significant positive effect was found after VR (PANAS, p < 0.001; SSS, p < 0.001) |
[53] | Singapore | Independent group design: VR based plant or color conditions. | 111 (40:71), age 21.63 > 1.81. | 5 min | Demonstrate the influence emotion and stress-buffering of vertical greenery outside buildings. | The study suggested that vertical greenery on city buildings could help to mitigate the negative psychophysiological effects of stress. | PANAS, SDRR | Significant decreases were observed in SDRR (p = 0.01)and positive affect (p < 0.00) in color conditions. No significant main effect of the condition was found. |
3.3. Effectiveness of VR Intervention to Relieve Stress
4. Discussion
4.1. Direction of Future Studies
4.2. Strengths and Limitations of the Current Review
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Syed Abdullah, S.S.; Awang Rambli, D.R.; Sulaiman, S.; Alyan, E.; Merienne, F.; Mohd Muhaiyuddin, N.D. The Impact of Virtual Nature Therapy on Stress Responses: A Systematic Qualitative Review. Forests 2021, 12, 1776. https://0-doi-org.brum.beds.ac.uk/10.3390/f12121776
Syed Abdullah SS, Awang Rambli DR, Sulaiman S, Alyan E, Merienne F, Mohd Muhaiyuddin ND. The Impact of Virtual Nature Therapy on Stress Responses: A Systematic Qualitative Review. Forests. 2021; 12(12):1776. https://0-doi-org.brum.beds.ac.uk/10.3390/f12121776
Chicago/Turabian StyleSyed Abdullah, Sharifah Shuthairah, Dayang Rohaya Awang Rambli, Suziah Sulaiman, Emad Alyan, Frederic Merienne, and Nadia Diyana Mohd Muhaiyuddin. 2021. "The Impact of Virtual Nature Therapy on Stress Responses: A Systematic Qualitative Review" Forests 12, no. 12: 1776. https://0-doi-org.brum.beds.ac.uk/10.3390/f12121776