Therapeutic Nature: An Exploration of Indoor Nature to Support Health and Wellbeing

While the benefits of outdoor natural environment exposure on health outcomes are well evidenced, outdoor natural spaces may not be accessible to all populations. Specific populations, such as vulnerable populations, or those who have limited capacity due to health or functional status, may be unable to access or engage with outdoor natural environments in the short or long term. The aim of this PhD was to explore the potential benefits of passive Indoor Nature Exposure (INE) as a viable alternative for harnessing the positive health benefits of nature, with a primary focus on clinical populations.

This body of work consisted of four studies. Study 1 aimed to replicate a seminal study of stress recovery through exposure to 2D virtual natural and urban environments in university students (n = 74). While viewing 2D digital nature did not result in faster recovery from acute stress, significant sex differences in stress reactivity were observed. The findings contribute to a more nuanced understanding of digital nature by highlighting the qualities of virtual environments needed for restoration, the role of sex differences, and key methodological considerations.

Study 2 mapped the existing evidence on passive INE using a scoping review to identify how passive INE has been conceptualised and characterised as a health and wellbeing intervention in adult clinical populations (n = 107). The review provides conceptual clarity and enhances understanding of how distinct forms of passive INE can promote therapeutic benefits.

The second half of this thesis focused on co-production as a collaborative process with people with a chronic pain condition – Fibromyalgia (FM). Study 3 and 4 employed co-production methodologies to inform the co-design of digital nature as an augmentative intervention for people with FM, and a future Ecological Momentary Assessment study to explore the inter-relationship between environmental context, stress, and pain in people with FM.

The body of work contributes to our understanding of how distinct types of passive INE can promote therapeutic benefit in adult clinical populations, with implications for the relevance of INE as a viable alternative to outdoor nature and as an intervention in both healthcare and community-based settings. Furthermore, methodological considerations are at the core of this thesis. Phenomena replications and co-production can strengthen the evidence base by addressing the limitations of a ‘one-size-fits-all’ approach and facilitate the development of contextually sensitive nature-based interventions and research designs which are relevant to the needs of the target population.