Restorative Environments: Focus on Clinical Use

F. Beute; K. Tanja-Dijkstra; F. Lymeus; C. Campos Andrade. Location: A12

Symposium: Restorative Environments: Focus on Clinical Uses 

Organisers: H. Staats & T. Hartig

One of the landmark studies in restorative environment research, Ulrich’s 1984 hospital room study, was so influential because it focused on clinical use. Here we have 4 studies that continue this tradition by looking at different ways in which restorative environments can be applied for clinical purposes. Femke Beute and colleagues’ study looks at therapeutic use by stressed individuals in mainstream settings. Their focus is on long term effects created by everyday stressors and the degree to which these are affected by exposure to nature, both for healthy people and for those with mental health problems. Looking at  experiences in a specific instutional setting is the study by Karin Tania-Dijkstra and colleagues, as it takes place in dental practices. Exposure to virtual nature during treatment was compared to exposure to virtual urban scenery and a control group. Another approach to clinical application of restorative environment research is taken by Freddy Lymeus and colleagues: they report on the development of a specific kind of mindfulness training that combines the stress reducing, restorative quality of the natural environment with a non-taxing, simplified form of mindfulness training. The last contribution, by Campos Andrade and colleagues, goes back to the hospital room, the setting to  test Ulrich’s 1991 theory about three socio-physical dimensions as mediators of the environment-stress reduction relationship.

Hedonic nature: The relation between nature and stress in everyday life

F. Beute, Y. de Kort, & W. IJsselsteijn

Epidemiological studies have reported beneficial effects of nature on health and longevity, often hypothesized to be due to the stress-reducing effects of natural environments (e.g., Mitchell & Popham, 2008). Evidence for stress restoration comes from studies in which stress is experimentally induced, which has proven notoriously hard to achieve and results in relatively short-lived stress experiences. The actual detrimental effects of stress on health are caused by long-term stress exposure in everyday life (e.g., chronic stress, rumination). Hence, it makes sense to study the relation between daily stressors, nature exposure, and well-being (e.g., stress, mood, self-regulation) in ‘real life’. In a series of studies, we used Experience Sampling to investigate (1) cross-sectional relations between nature exposure and well-being, and (2)  the restorative effects of repeated short-term exposure to natural vs. urban images. Participants were both healthy volunteers and people experiencing mental health problems. Analyses of the first studies indicate a positive relation between nature exposure and hedonic tone - an important component of stress-reduction, which can also directly benefit health in and of itself (Pressman & Cohen, 2005). The outcomes suggest that affective responses to nature play a crucial role in the salutogenic effects of nature exposure in everyday life.

The restorative effects of virtual nature during dental treatment: A randomised controlled trial

K. Tanja-Dijkstra, S. Pahl, M. White, J. Andrade, R. Stone, M. Auvrey, & D. Moles

Distraction interventions are used in daily medical practice to help patients cope with unpleasant procedures. There is evidence that exposure to natural scenery is beneficial for patients and that the use of virtual reality (VR) distraction is more effective than other distraction interventions, such as watching television. The main aim of this randomised controlled trial was to determine whether the use of VR during dental treatment can improve the overall dental experience and recollections of treatment for patients. The second aim is to test whether the content of the VR distraction can make a difference for its effectiveness. Patients (n = 79) undergoing dental treatment (fillings, extractions) were randomised into three groups: 1) Nature VR; 2) Urban VR; 3) standard care control group. VR distraction resulted in lower stress, less experienced pain, less treatment unpleasantness, and lower future avoidance intentions. Effects on vividness of memories and remembered pain are only marginally significant. The nature VR was evaluated more positively and perceived as more restorative than the urban VR. At 1-week follow up patients in the nature VR group reported more pleasant memories than those distracted with an urban VR environment. We will discuss the implications of these results.

Development of a mindfulness-based Restoration Skills Training (ReST) program set in a natural environment

F. Lymeus, J. Apelman, C. de Mander Florin, M. Lundström, C. Östergren, P. Lindberg, & T. Hartig

People strained by everyday demands need restorative opportunities to sustain health. If such opportunities are limited, they may need an improved ability to draw benefits from those opportunities that exist. Restorative environments researchers study environments that support restoration, but rarely consider individual practices that may enhance restoration. Conversely, stress-management approaches like mindfulness training target skill development, but often neglect the contextualized, transactional nature of stress and restoration. Moreover, initiating conventional mindfulness training is too demanding for many already overloaded individuals. Drawing on attention restoration theory and mindfulness theory, we developed a 5-week Restoration Skills Training (ReST) program given in a greenhouse, with low-demand sensory mindfulness exercises tailored to enhance restorative person-environment transactions. With university students experiencing attentional problems (N ≈ 80), three iterations of ReST were compared to conventional mindfulness training given indoors. Participants rated their everyday mindfulness, attention failures, and perceived stress before and after the programs. They also completed attention tests and reported affective states before and after the classes at weeks 1, 3 and 5 and completed perceived restorativeness and state mindfulness scales after those classes. Preliminary analyses indicate enhanced acceptability and unique benefits of ReST. The presentation will cover the development process and final analyses.

Stress reduction in the hospital room: A field study applying Ulrich's theory of supportive design

C. C. Andrade, A. S. Devlin, & M. L. Lima

In Ulrich's (1991) theory of supportive design, the hospital environment is hypothesized to reduce stress if it fosters positive distraction (PD), perceptions of control (PC), and social support (SS). We tested and confirmed this theory using an experimental design (Andrade & Devlin, 2015); results showed that the number of elements in a hospital room affects expected stress especially through perceptions of how much PD and SS it is perceived to provide. The current study builds on these results by testing Ulrich’s theory in a multi-site field study. A total of 236 orthopedic patients participated in the study: 78 American and 158 Portuguese patients. In each room, the numbers of favorable elements for PD, PC, and SS were assessed with an objective coding scheme, and patients responded to a survey including questions about PD, PC, SS, stress, and overall satisfaction. Mediational analyses showed that perceived SS and PD predict satisfaction with the service and stress, whereas PC does not. Moreover, for US patients, it is SS and PC that mediate this relationship; for Portuguese patients, it is SS and PD. Evidence was found for Ulrich’s theoretical model. Implications for cross-cultural research and healthcare architecture are discussed.