Ep 54 - Recent Research Review: Nature & Children's Psychological Well-Being
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Laura Park Figueroa: Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always 100 percent real, you'll hear it all on this podcast, Dr. Laura Park. My name is Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue.
I also host the free online community at therapyinthegreatoutdoors. com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in. Hi friends. Welcome to episode 54 of therapy in the great outdoors today. I'm going back to the basics. Y'all I have not done. A research review episode or an article review episode in so long, I've been doing lots of interviews, lots of business, live coaching calls, things like that. And so today we are going back to what I used to do a lot on this podcast in the very early days of looking at a very recent research article that relates to our work as nature-based therapists.
And the article I have chosen today is called. The effect of exposure to nature on children's psychological wellbeing, a systematic review of the literature.
It was published in urban forestry and urban greening in 2023. I will put the link to the article in the show notes that is open access. So you can read the whole thing. I will warn you. It is rather long. So I'm going to hopefully give you a summary here so that you don't have to go read it. So this was a systematic review. Of all of the literature around. Does nature impact children's psychological wellbeing. There are some caveats, however, they did exclude. And limit it in some ways that I wish they had not. Or actually, I wish they had limited in some ways that they didn't. But I'll talk about that in a bit.
For inclusion in this systematic review. The articles needed to be with six to 12 year olds. And they included 40 studies that met their inclusion criteria.
They do state that most of the studies employed cross sectional rather than longitudinal designs. That means they were observational rather than experimental. So about half of them were observational studies where they're looking at children at a specific point in time. There they're not really manipulating any variables.
They're not trying to change anything or comparing two groups to another, the way we commonly think about experiments in research. And those type of studies. Describe what is happening, but they do not explain cause and effect. They do not determine cause and effect. And they. I hope that you all have heard before correlation is not causation.
So things can be correlated, but that doesn't necessarily mean that one thing caused the other thing. So we have to be. Very careful in how we interpret research and remember that at all times. And they do say most of the studies, this is in the abstract and I'll get more into the study in a bit. Most of the studies identified positive psychological outcomes associated with children's exposure to nature with many yielding statistically significant yet weak to moderate outcomes.
They actually focused on looking at studies where the nature was within the built environment. And by that they mean like residential areas, schools. So it's kind of cool to think about. The nature in this study in all the studies that they were looking at they limited it to those types of studies.
So it's cool to think about that. It was actually accessible nature to a wide variety of children.. I do wish maybe one thing I do wish they had limited was I wish they'd limited it to active contact with nature because they did allow studies that. Assessed simulated nature environments, like visual exposure to nature on a screen or things like that.
So I wished that they had limited it only to like the direct experience with nature, but all in all they did. A fabulous job on this study. And. Yeah, let's get into the details of it. So the aim of the study was to provide a critical appraisal. Of the overall evidence-base evaluate the methods used and results obtained, identify gaps in knowledge and suggest directions and priorities for future research on the health and wellbeing associated with children's contact with nature. Within the context of predominantly built environmental settings.
So that's what I just talked about, what they meant by that. They had a. W a wide array of inclusion criteria. I won't read all of it to you, but one thing I did want to point out is that. This systematic review. Only looked at. The association between exposure to nature and psychological wellbeing involving children with mood and anxiety problems. It did not include studies that focused on children's physical health, like obesity, asthma, those type of studies were excluded. As well as they excluded studies with children that had known psychological disorders such as schizophrenia and autism. I thought it was a little weird that they define autism as a psychological disorder, because that's a direct quote from the article. And I wouldn't think of autism as a psychological disorder, but it's interesting because I would think that a study looking at. The psychological wellbeing of children would not need to exclude children who had diagnoses such as schizophrenia or autism, but for whatever reason, they chose to exclude those.
And really only focus on children that had mood or anxiety challenges. That is something to consider, because I know that many of us as nature based therapist do work with children with autism. And so those children were not included in this study, so that may be why there wasn't a wider number of studies because I do know there's a lot of literature coming out on autistic children and exposure to nature as well.
Right now. , but those were excluded.
I've mentioned that they categorize the studies by having either experimental or observational type research designs. So we will get into talking about. Those different categories shortly. They had 21 experimental and 19 observational studies. So it's a pretty even number of each. The studies were primarily from Europe and north America.
Europe had 19 of the 40 studies. North America had 15, Asia had four studies and Australia had two studies. So we do want to take into consideration the cultural. Context in which these studies were conducted because that does influence how the research is done right. In different cultural context. Let's talk about the observational studies.
The most frequently investigated environmental setting was residential areas followed by school. Areas and public areas. And they often in this paper talk about that blue spaces like water dominated areas were the least investigated area. So that may be an area for future research. I know that some of you who listened to this podcast do surf therapy. And I can think of a couple of you who work on beaches.
And so there is room for research there. This article is saying we need more studies about nature interventions that involve blue spaces water based spaces.
So they assessed. The outcomes of psychological wellbeing and these observational studies, they do say that they used well-developed and well verified, standardized tests and scales. Three of the observational studies do use bio monitoring, such as blood pressure hair, cortisol levels. 12 of the studies found statistically significant yet weak associations between nature exposure. And children's psychological wellbeing. Five found moderate association effects and none identified strong associations.
Man it's discouraging, right? Like you want to see that there's this, I think. Obviously as therapists, we want to see that there's this strong correlation and this research did not find it. It was, they state that. It was also interesting to note that two of the studies found no effects or even negative associations.
They say, for example, One study found that the presence of parks and additional playgrounds and sports fields and neighborhoods was associated with more depressive moods and negative feelings. But. Leisure time, physical activity, organized activities and social activity acted as a mediating counterbalance to some of the negative associations. So that's a weird finding, right?
Like it was associated with more depressed mood, but like maybe because they got outside more, it was a mediating effect to, to have the. The those playgrounds and sports fields near there. I don't know. That's a, it's a strange, sometimes research can be a little bit perplexing. I am a very black and white linear thinker and I. I want to just be able to look at research and go, okay, so this is what we should do.
And really the more research that you read, the more you realize that Gosh, we're always learning. We're always finding out new things. And sometimes what we find in research is a little bit perplexing and I think that's good in some ways it leads us to do more. Research and more investigation into why we're finding these things.
So that's it for the observational studies and then the same for the experimental study. So there were 19 papers that contained 21 experimental studies. So a couple of those contained two experiments, a couple of experienced mints in one paper. Again, school and public open space for the most frequently investigated. And schools represented the most frequently examined study sites for longitudinal studies.
So that kind of makes sense because you have a ready body of students at a school that you can assess over time. Now again, experimental studies. I'll just remind you all mean that they are manipulating variables. So for example, they might have, I'm not looking at the article right now. I'm just speaking as an example.
I'm not reading something from the article. That's an example. I want to clarify that for you all. But in an experimental study, you might have one group of children that is a control group, where you give like a. Intervention that, or maybe you do nothing. You might just do nothing for that group.
Right? They get like some sort of placebo thing. And then another group that you give an actual intervention to, and then you compare those. And sometimes you can have multiple groups, you could have a placebo, you could have one that received virtual nature and you could have one that received nature outside or something like that. So these are studies that. Actually are manipulating some type of variable in inside of the study design. So for the types of intervention. 14 of the 21 experimental studies looked at the effect of active and direct interaction with nature. And then. Seven studies examined the effect of passive involvement with nature.
Merely viewing nature. Four of the studies adopted more than one kind of intervention. So there were multiple studies inside of the main study. So the experimental studies were similar to the observational studies and that they used biomonitoring methods such as heart rate, variability, salivary, cortisol levels, electrodermal activity, and other methods to indicate psychological benefits. The overall magnitude of the effect of nature exposure on children's psychological wellbeing for the experimental studies was higher than that for the observational studies.
So that's good. That's actually. Great to hear for us nature-based therapy. We go yay. When we hear that. Nine studies found weak associations and 10 found moderate associations or effects, and none found strong associations. Once again.
Now let's talk about what this all means. This is a very extensive, there is a lot here to unpack. They have a lot of takeaways and I'm just going to quickly go through some of those here. The first being that. Simulated nature can help with attention. So they cited a few studies in their results section where they talk a little bit about some of the studies that they included. And they did find that simulated nature, like watching nature on a screen, which is crazy. Can help attention.
So I know that we all. I want to get kids out in nature and actually have the physical experience of being in nature. But it's cool that simulated nature can even help attention. They also talk about a longitudinal study. That was a 10 session health promotion program for children in an urban forest setting that was conducted by nursing student mentors. And they took data. Before. And after that study, using heart rate variability and standardized rating scales to detect changes in the children's perceived health status, psychological wellbeing self-esteem and peer relationships. So this was a pre and post testing with a 10 session program. And they found significant improvement in perceived and psychological health, as well as self esteem in comparison with the control group.
That is cool. That study, if you guys want to look that one up it's bang at all 2018, the effects of a health promotion program using urban forest and nursing student mentors on the perceived and psychological health of elementary school children in vulnerable populations. Whew. That's a long title, but that is bang B a N G.et all 2018 and I'll put that one in the show notes as well.
If you want to look at that one, but I like that they talked about. This article inside of the results of this larger systematic review, because it's for us, I think there's as nature-based therapists, I think there's a little bit more of a direct takeaway there because we're seeing that. 10 sessions, like it's a very clear. That was just 10 sessions and that it made a difference.
And so I think. This kind of gives me ideas and gets my wheels turning about wow, I think we could start doing as nature-based therapy start doing very accessible, meaningful research in as little as a 10 week session, measuring before and after for a 10 week sessions. They took away from this kind of, this area of the discussion that. The one of the findings from the systematic review was that we need to investigate more than necessary dose of nature exposure that is needed to elicit . Particular responses and children, but this example of the 10 sessions of a program is cool.
Now I think I'd want to look more into like how long were the sessions three hours long, or the sessions one hour long? There's some questions I would have there. Maybe I could look at that article on a future episode. That might be cool to do.. They also call for more longitudinal type studies, big surprise.
We need more longitudinal studies. Don't we always in research more research on. Blue spaces. So looking at spaces where water is involved in the nature based experience, and then also they made a comment that schools and residential areas that were mainly the focus of this study are really familiar settings for children. And they are more likely to have like daily access to those areas. And spend more time there, but also unfamiliar settings could be. They say challenging and more interesting to children and hence be more attractive, thus invoking a desirable sense of being away.
So they reference attention restoration theory in this. Article. And if you haven't heard of attention restoration theory, I think I'm going to do an episode on that because I thought I had done an episode on attention restoration theory. And I have not. So. A R T is a theory that was developed in the eighties by a husband and wife team, Rachel and Stephen Kaplan. And this idea of. Being away in nature is one of the concepts of that theory.
And they suggest that being away in nature actually restores our directed attention that we have these two systems of attention on our brain that are our directed attention, which is I always joke that it's like what you do when you do taxes. Like you have to stay very focused and like your brain, your frontal lobes just hurt because it's you're. You're forcing yourself to have to pay attention to some, something that you don't want to pay attention to, which I think is how a lot of children feel in today's world. So that's your director detention and that's finite that you can deplete that very quickly.
When you're doing something that's challenging to your executive function to your frontal lobes. And their suggestion in the theory, this is a very basic. Part of the theory, there's different elements to it. And a lot of other things I could talk about, but The one of the aspects of the theory is that when you go outside in an, in a nature area, that is a way where you feel away from the built environment, it allows your directed attention system to rest.
And you can. Feel that nature kind of elicits this soft fascination of your brain. Like your brain just becomes. Softly fascinated with the things around you when you're outdoors in nature. So that's a little. Attention restoration theory, mini lesson there. But but that's what they're referring to here when they say invoking that desirable sense of being away.
The last thing that they say here is that despite. Some of the studies using those biomonitoring methods that we need more studies that do that. I think a takeaway here for us is that. We in our nature-based therapy sessions can be incorporating more of the Types of things like measuring heart rate and doing the pulse oximeter on the finger to let kids see. What their own body is doing inside and connecting that to how they're feeling.
Right. So there are some things we can do. Those biomonitoring methods that are like basic kind of things like that, that we could do in our sessions to help children see that not necessarily to produce research, but to help children see. The connection to their own. Psychological wellbeing as well, but that is needed in research more.
They said. And finally they say that future studies could use other potentially more effective measurements to explore relationships between specific amounts, quantity of nature. And the quality of the nature of the children are experiencing methods of assessing the quality of nature in study environments also need to be further explored. So I am going to do an episode on art because that is something that I feel. Attention restoration theory actually gives us. A lot of things to think about when we're looking for a nature environment for children in therapy sessions.
And so that's something that I'm going to do. Maybe I'll do that next week. And do the episode on attention restoration theory, and just share a little more about that because it did come up in this article as well. So my takeaways from this article are that nature does have an impact on children's.
Remember, we were just looking at anxiety and mood, so I don't even want to say psychological wellbeing. I would say. It helps them with anxiety and it helps them to have better moods. However, the. The data does not show a strong correlation there it's not showing strong evidence. It's showing moderate to weak evidence.
That is statistically significant. So we have to be honest about the findings. Okay. I hope this episode wasn't too dry for you all. I feel like it was nerdy. My son told me the other day that he asked me, what was he was, he's almost 20. He'll be 20 in a few days. And he asked me the other day, what were you like when you were my age? And I was like um, and he was like, cause I imagine you as nerdy and shy.
What.
I don't feel I was nerdy and shy. Maybe. I know I wasn't shy. But I don't think I was nerdy and I was like,
kind of
Laura Park Figueroa: offended. Honestly. Y'all.
I had this,
I had this desire to go on Facebook and be like, Hey, if you knew me in high school, was I nerdy and shy? This is what my son thinks I was. But I think what he was referring to is just that I love to read, I'm obsessed with reading. Like I actually enjoy writing and so anyway, it was just so funny.
I thought I'd share that little funny bit with you all after this like researchy episode. Okay. That's it for this week. I will see you next week when I will do the episode on attention restoration theory. And we'll dive into that topic a bit. See y'all then bye.
Laura Park Figueroa: Wait a second, don't go yet. Do you want 120 ways that you can take your pediatric therapy work outdoors into nature? I wrote the free, big, huge list of nature based therapy activities just for you. The big, huge list will give you quick ideas for nature based sessions. In the big, huge list, there are activities for gross motor, fine motor, visual perceptual, executive function, balance, group collaboration, and team building.
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