To stress the importance of nature : nature-based therapy for the rehabilitation and prevention of stress-related disorders

Sammanfattning: As a consequence of drastic labour market changes in the late 1990s, many employees experienced more stress in the workplace. Prolonged exposure to stress can lead to physical and mental health problems, and rehabilitation takes a long time. The lack of established rehabilitation programmes for patients with stress-related mental disorders has opened up for the use of garden/nature in a multimodal rehabilitation context (Nature- Based Therapy, NBT). The aim of Study I was to explore how participants in an Nature-Based Rehabilitation (NBR) experienced their rehabilitation. Study II aimed to explore effects on burnout, work ability, stress-related health symptoms, and sick leave from participation in a nature-based stress management course (NBSC) and to investigate how the nature/garden content was experienced. Study III aimed to explore the effects of NBR in individuals with long sick leave due to stress-related mental disorders and to explore the development of sick leave and health care utilization. Study IV aimed to examine potential environmental effects on directed attention and physiological measures of relaxation in nature and indoors. Validated self-assessment instruments, data from regional and national registers and semi-structured interviews were used. Education about nature opened up for new perspectives on life; thus, nature triggered existential reflection, which enhanced the recovery process. Nature and garden were experienced as supportive environments. Results for participants in the NBSC showed decreased burnout-scores and long-term sick leaves, and increased work ability; furthermore less stress-related symptoms were reported. The same pattern was seen for the NBR participants concerning burnout and also for depression, anxiety and wellbeing, reduced health care utilization, and a movement from ordinary sickness benefit to rehabilitation benefit was seen. Improved directed attention after relaxation in nature was seen. No environmental effects were seen for blood pressure or heart rate. The results indicate that the NBT in this thesis was successful in both prevention and rehabilitation, and in restarting a stalled rehabilitation process.

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