The role of nature in rehabilitation for individuals with stress-related mental disorders

Sammanfattning: Abstract The Alnarp Rehabilitation Garden was established in 2002 as a research and development project involving nature-based rehabilitation (NBR), based on empirical evidence that natural environments (nature) can have a positive effect on human health and well-being. The aim of this thesis was to investigate the Alnarp Rehabilitation Garden as a supportive environment in NBR with a special focus on the role of nature in relation to the rehabilitation process and essential qualities that might affect health outcome. Through trans-disciplinary joint co-operation, state-of-the-art NBR was described and research gaps for further studies were identified. The participants’ perspectives on the role of natural environments in NBR and the essential qualities that support rehabilitation processes were identified in a longitudinal prospective single-case study. In a prospective interventional study, the changes in participants’ experienced value of everyday occupations, self-rated health and function in everyday life were assessed after NBR. The results revealed a new quality of supportive environment was i.e. Social quietness, which refers to the participants’ urgent need for solitary encounters with nature. An explanatory model of a supportive environment is presented, illustrating how nature and nature-related occupations can facilitate and support the rehabilitation process in an NBR context. The most essential qualities of supportive environments in the rehabilitation garden were the Perceived Sensory Dimensions of: serene, nature, prospect, refuge and space as well as qualities of extent, being away, fascination and compatibility. Significant positive changes were measured regarding self-rated health, improved function in everyday life and perceived occupational values in daily life, especially the value of self-reward. Nature’s supported role seems to be extended to everyday life for restorative occupations. These findings are of importance both when designing outdoor environments and as a springboard in the future work of drawing up certification criteria for supportive environments in an NBR context. However, there is a great need to identify specific features of natural environments that may support health processes.