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Objective: The purpose of this study is to investigate if there is a physiological stress response to the visual and auditory characteristics of waterscapes. Background: Biophilic research suggests that the presence of water can reduce stress, reduce blood pressure, and increase circulation. However, water has largely been omitted from healthcare design due to concerns of cost, maintenance, waterborne pathogens, and contamination. Existing research has not yet provided a design methodology to incorporate the healing effects of water without the potential diseases, contamination, and maintenance issues associated with physical water. Given the current technological capabilities, the isolation of the auditory and visual sensory stimuli has potential to re-introduce the healing benefits of water into healthcare design. Methods: Participants were either exposed to a slow-moving or fast-moving waterscape for 20 minutes. Pre- and post-anxiety were measured using the State Trait Anxiety Scale in an online Qualtrics survey (118 participants) and through a salivary cortisol biomarker (in which 26 participants also partook). Results: The overall results demonstrate that the utilization of digital blue space was effective in reducing stress. There was no significant difference between the lake or waterfall environment in both salivary cortisol and state-trait anxiety measures. However, it is suggested that the slow and fast-moving waterscapes may be beneficial in different settings. Conclusion: Design recommendations are made regarding potential biophilic design in healthcare facilities. The utilization of sensory waterscapes can also provide a cost affordable, non-pharmacological, alternative for anxiety mitigation for patients and staff undergoing high-stress situations.

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Background: A vital element to understanding the the health and wellbeing of both humans and the environment is human-nature interactions. The biophilia hypothesis is referred to when discussing these interactions. This hypothesis suggests that due to evolution, humans have an innate urge to seek out nature. The concept of nature connectedness was developed from this hypothesis and is rooted in the belief that human identity and nature can be intertwined. This research aims to explore the intricate details of how an individual builds this connection in a meaningful way. Methods: This is done using a modified Delphi method. A Delphi study in its typical form aims to gather the consensus of a group of experts in a specific area of interest. This modified Delphi aims to break down the barrier between the public and the experts by creating a second category of participants referred to as our 'expanded experts.' Expand experts are described as individuals with lived experience of being connected to nature in the everyday. This category comprises of artists, city planners, activists and many more. This allows for a much more inclusive and real-world exploration of experiences. The participants will first take part in a semi-structured interview process to investigate their experiences of connecting with nature. Following a hybrid thematic analysis with both deductive and indictive coding will be applied to the interviews. These themes will be shared with participants for them to weigh the importance of the theme to the construct to allow a deeper understanding of our interactions with nature. Results: The results of this project will contribute to and shape the development of a state-of-the-art nature-connectedness scale. Furthermore, understanding how nature connectedness fits into our modern world will allow for more appropriate nature-based interventions for urban residents and beyond.

This interview-based study looks at the interaction's individuals have with the nature around them and how those interactions help them to feel connected to the natural world. Interviews are taking place with fellow researchers, as well as individuals who work with nature in their everyday. Some examples are nature-based therapists and practitioners, poets, artists, farmers and city planners to name a few. By undertaking this research, it is hoped that we will better understand what nature resources urban residents require in their areas to improve their overall health and wellbeing as well as how individuals interact with the resources the already have access to. The end goal is to produce a method to measure these interactions for future research and practical use.

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AIM: To summarize the existing literature surrounding the influence of natural elements on course in hospital and to introduce clinicians to the concept of biophilic design and the potential for incorporation of nature into the hospital environment as a component of a therapeutic hospitalization. BACKGROUND: For decades, architects and designers have espoused the benefits of incorporating natural elements into the healthcare environment for therapeutic purposes. The benefits of this "biophilic" design philosophy has been investigated predominantly in long-term care or rehabilitation settings; however, some of the most appealing opportunities lie in the acute care setting. METHODS: This scoping review surveyed the literature surrounding the influence of exposure to nature on course in acute hospitalizations. After screening 12,979 citations, 41 articles were included. Exposures were divided into seven categories, the most common of which were the presence of a window/natural light, a natural scene through a window, and nature soundscapes. These articles were reviewed in a narrative fashion and thematic analysis was conducted. RESULTS: Studies were extremely heterogeneous in their design, research questions, and reported outcomes. Types of exposure to nature studied were exposure to a real natural scene through a window, presence of a window/nature light, nature in the healthcare environment, art depicting nature, direct contact with nature, nature soundscapes, and nature experienced through virtual reality (VR). CONCLUSIONS: Exposure to nature during an acute hospital admission appears to have a real but small therapeutic effect, predominantly on psychological metrics like anxiety/depression, pain, and patient satisfaction. Greater beneficial effects are seen with greater durations of exposure to nature and greater degrees of immersion into nature (e.g., creating multisensory experiences using emerging technology like VR).

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OBJECTIVES, PURPOSES, AND AIMS: Principles of behavioral economics are now being used across fields in changing human behavior toward perceived benefit. We studied the effectiveness of simple, cost-effective design cues based on these principles, in encouraging use of a neglected outdoor space in a hospital. BACKGROUND: Benefits of access to nature and green spaces are established in healthcare; however, we found utilization of an outdoor space to be suboptimal. Presenting choices in different ways is known to influence user choice. METHODS: We designed four design interventions based to nudge relative-caregivers waiting outside the operation theater toward utilizing an adjoining outdoor balcony. These included making the terrace prominent, reducing indoor sensory stimulation, adding stereotypical elements, and improving usability. We measured usage via video camera data and satisfaction using questionnaires. RESULTS: The number of users and average time per person spent on the balcony increased over the consecutive intervention periods as compared to baseline (trend p < .01 for both), mainly driven by the addition of stereotypical elements. There were no adverse events in the balcony. There was no difference in the satisfaction related outcomes on questionnaire; a larger percentage of positive comments tended to be related to the balcony in the final intervention. CONCLUSIONS: Cost-effective design cues nudged patient-caregivers toward spending more time with nature, thus changing behavior toward that with perceived benefits.

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Concern about humanity's detachment from nature has spawned a global push to increase the availability of green spaces within cities. One impetus for this movement is a growing collection of studies documenting an association between improved human well-being and exposure to nature. The challenge lies in translating this research into pragmatic recommendations for cities. The usefulness of the existing research portfolio is diminished by the limitations of prevailing research designs. For example, most nature exposure studies (>80%) are observational. The rare randomized manipulative experiments tend to be indoors or virtual and rely on nature exposures on the order of ten to fifteen minutes. "Nature" and "biodiversity" are commonly invoked together as benefiting human well-being despite little evidence that biodiversity has particular importance for human psychological and emotional health. The most glaring gap in nature exposure research is the neglect of differences among cultures and ethnic groups with respect to the nature they prefer. In the few cases where researchers looked for differences among groups, they often found heterogeneous responses. Finally, few studies have compared greening interventions to other possible efforts to improve urban life. Thus, the utopian city of the future might be resplendent with urban parks on every block, but it is not clear whether those parks should offer basketball and pickleball courts, or small woodlands with a cornucopia of birds. We advocate for the next generation of nature exposure research that better informs the envisioning of our future sustainable cities with enhanced and equitable access to nature.

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Introducing plants in the design of biophilic indoor environments is fundamental for improving human health, well-being, and performance. Previous studies showed that the phenotype of the model plant Arabidopsis thaliana grown under LED-sourced CoeLux® lighting systems was characterized by low biomass production rates, a small leaf area, and a low lamina-to-petiole length ratio, suggesting the onset of a strong shade avoidance syndrome. Therefore, it is essential to identify new strategies to improve plant growth under these peculiar light conditions. In the present work, we investigated the effects of two growing media (i.e., low-fertility soil and soil-less substrate), solid and liquid fertilizers, manure, biochar, perlite, mirror reflection of light, and a 24 h photoperiod on A. thaliana plants growing under CoeLux® lighting systems at a light intensity of 30 µmol m-2s-1. We found that the biochar soil amendment to low-fertility soil increases both the above-ground plant biomass and leaf area. Furthermore, the application of a mirror behind the plants and a continuous photoperiod improves not only the biomass and the leaf area but also the lamina-to-petiole length ratio. The combination of different beneficial treatments can further boost plant growth in the low-intensity light environment characterizing the CoeLux® biophilic lighting systems.

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There are 6 Official Pillars of Lifestyle Medicine, and now mounting evidence supports daily exposure to nature and fresh air as vital to optimizing overall physical and mental health. Time spent in nature has been shown to help lower blood pressure, reduce nervous system arousal, enhance immune system function, reduce anxiety and increase self-esteem. The positive effects of time spent in nature span different occupations, ethnic groups, financial status and individuals with a variety of chronic illnesses and disabilities. "Forest Bathing" is the term coined by Japanese researchers for walking in the woods. It is suspected that aerosols from trees, when inhaled during a forest walk, are one factor responsible for elevated immune system Natural Killer (NK) cells, which help fight off infections and tumor growth. In a culture of ever-increasing technology and screen time, now more than ever it is crucial to educate and empower individuals to incorporate nature into therapeutic treatment regimens. This article will demonstrate the potential benefits of nature, share evidence supporting nature as medicine and provide tools to help engage individuals to spend more time outdoors.

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The high incidence of psychopathologies recorded in today's human society, correlated with the high percentages of biodiversity loss, point to the need for an interdisciplinary approach of the scientific fields under study-neuroscience and biodiversity conservation. Thus, our approach here presents, in a synergistic manner, the significant correlation between mental health and the increased values of biodiversity in the ecosystems located in the immediate vicinity, especially those located in the middle of cities. Our approach aims to emphasize the importance of biodiversity conservation in the context of preserving mental health and general well-being. There are a series of recent experimental demonstrations that outline the influence of natural elements on the human psyche and, implicitly, the effects of nature in the prevention and reduction of stress, anxiety, and depression. And beyond the cognitive barriers of humanity in relating to the surrounding biodiversity must lie the desire to know the values of biodiversity and the absolute importance of its conservation. The sustainable relationship between humans and living nature, seen as a complex of biodiversity, is dealt with by a branch of science called human ecology. Therefore, this study emphasizes the crucial need to know and respect the connection between man and nature, based, since time immemorial, on biophilia. And with the regression of ignorance and the correlated approach of several scientific fields, some at the intersection of the humanities and natural sciences, one can observe the progress of preserving the dynamic balance within ecosystems and, implicitly, the preservation of mental health and human well-being.

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This paper applies the Free Energy Principle (FEP) to propose that the lack of action in response to the global ecological crisis should be considered a maladaptive symptom of human activity that we refer to as biophilia deficiency syndrome. The paper is organised into four parts: the characterisation of the natural world under the Gaia Hypothesis, the employment of the FEP as a description of the behavior of self-organising systems, the application of the FEP to Gaia to understand coupling dynamics between living systems and purportedly non-living planetary processes, and the offering of positive interventions for addressing the current state of ecological crisis under this framework. For the latter, we emphasize the importance of perturbing stuck states for healthy development, and the necessary appreciation of life existing as nested systems at multiple levels in a hierarchy. We propose the development of human biophilia virtue in accordance with the FEP as a practical intervention for treating biophilia deficiency syndrome and helping to safeguard the balance of planetary processes and the integrity of living systems that depend on them, offering some examples of what this might look like in practice. Overall, this paper provides novel insights into how to catalyse meaningful ecological change, proposing a deliberate and disruptive approach to addressing the dysfunctional relationship between humans and the rest of the natural world.

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Humans have lived from equator to poles for millennia but are now increasingly intruding into the wild spaces of other species and steadily extruding ourselves from our own wild spaces, with a profound impact on: our relationship with the natural world; survival of other species; pollution; climate change; etc. We have yet to grasp how these changes directly impact our own health. The primary focus of this paper is on the beneficial influence of proximity to the natural environment. We summarize the evidence for associations between exposure to green space and blue space and improvements in health. In contrast, grey space - the urban landscape - largely presents hazards as well as reducing exposure to green and blue space and isolating us from the natural environment. We discuss various hypotheses that might explain why green, blue, and grey space affect health and focus particularly on the importance of the biodiversity hypothesis and the role of microbiota. We discuss possible mechanisms and exposure routes - air, soil, and water. We highlight the problem of exposure assessment, noting that many of our current tools are not fit for the purpose of understanding exposure to green and blue space, aerosols, soils, and water. We briefly discuss possible differences between indigenous perspectives on the nature of our relationship with the environment and the more dominant international-science view. Finally, we present research gaps and discuss future directions, particularly focusing on the ways in which we might - even in the absence of a full understanding of the mechanisms by which blue, green, and grey space affect our health - begin to implement policies to restore some balance to our environment of with the aim of reducing the large global burden of ill health.

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Cities, as places of social interactions and human relationships, face new challenges, problems, and threats, which are sources of stress for residents. An additional cause of stress in recent years has been the COVID-19 pandemic; it was urban dwellers who were most exposed to the virus and most affected by it. Chronic stress has led to the serious erosion of physical health and psychophysical well-being among urban dwellers, and so there is a need to seek new solutions in terms of building the resilience of cities and their residents to stress. This study aims to verify the hypothesis that greenery reduced the level of stress among urban dwellers during the pandemic. The verification of this hypothesis was achieved based on a literature analysis and the results of geo-questionnaire studies conducted involving 651 residents of Poznan-among the largest of Polish cities, where the share of green areas in the spatial structure is more than 30%. According to the analysis, the interviewees experienced above-average stress levels that went up during the pandemic, and the source was not so much the virus but the restrictions imposed. Green areas and outdoor activities helped in reducing this stress (being surrounded by and looking at greenery, garden work, or plant cultivation). Residents perceive a post-pandemic city as one that is more green, in which priority is given to unmanaged green areas. It has also been pointed out that a response to the reported need for urban re-construction towards stress resilience may be a biophilic city.

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Investigating morphological and molecular mechanisms that plants adopt in response to artificial biophilic lighting is crucial for implementing biophilic approaches in indoor environments. Also, studying the essential oils (EOs) composition in aromatic plants can help unveil the light influence on plant metabolism and open new investigative routes devoted to producing valuable molecules for human health and commercial applications. We assessed the growth performance and the EOs composition of Mentha x piperita and Ocimum basilicum grown under an innovative artificial biophilic lighting system (CoeLux®), that enables the simulation of natural sunlight with a realistic sun perception, and compared it to high-pressure sodium lamps (control) We found that plants grown under the CoeLux® light type experienced a general suppression of both above and belowground biomass, a high leaf area, and a lower leaf thickness, which might be related to the shade avoidance syndrome. The secondary metabolites composition in the plants' essential oils was scarcely affected by both light intensity and spectral composition of the CoeLux® light type, as similarities above 80% were observed with respect to the control light treatments and within both plant species. The major differences were detected with respect to the EOs extracted from plants grown under natural sunlight (52% similarity in M. piperita and 75% in O. basilicum). Overall, it can be speculated that the growth of these two aromatic plants under the CoeLux® lighting systems is a feasible strategy to improve biophilic approaches in closed environments that include both plants and artificial sunlight. Among the two plant species analyzed, O. basilicum showed an overall better performance in terms of both morphological traits and essential oil composition. To increase biomass production and enhance the EOs quality (e.g., higher menthol concentrations), further studies should focus on technical solutions to raise the light intensity irradiating plants during their growth under the CoeLux® lighting systems.

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People can express irrational fears and disgust responses towards certain wild organisms. This so-called 'biophobia' can be useful and indeed necessary in some circumstances. Biophobia can, however, also lead to excessive distress and anxiety which, in turn, can result in people avoiding interactions with nature. Here, we highlight concern that this reduction in interactions with nature might lead to progressive increases in biophobia, entrenching it more in individuals and across society. We propose the 'vicious cycle of biophobia', a concept that encapsulates how excessive aversion towards nature might emerge and grow in society. The vicious cycle of biophobia risks accelerating the extinction of experience, leading to long-term adverse consequences for the conservation of biodiversity.

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In 2020, COVID-19 mitigation measures, including lockdowns and travel bans to curtail disease transmission, inadvertently led to an "Anthropause" - a unique global pause to anthropogenic activities. While there was a spike in ecological studies measuring Anthropause effects on environmental indicators, people's experiences of the Anthropause or its potential to inspire change were hardly considered. Hence, we aimed to measure people's appreciation of the environmental outcomes of the Anthropause, ecophilosophical contemplations about the pandemic, and experiences of lockdown-triggered biophilia (human's innate love for and draw towards nature) and test the hypothesis that these experiences would be consistently more prominent among the already environmentally inclined. To that end, we developed and tested three measures on a representative sample of 993 New Zealanders. Anthropause Appreciation received the highest overall mean ratings, followed by Lockdown-Biophilia and Eco-Contemplation. Pre-existing pro-environmental dispositions and behaviours did not consistently influence our three measures as expected. Demographic variables had little influence, while experiences of financial and mental health impacts due to COVID-19 had no influence. We interpreted the limited influence of explanatory variables as indicative of a degree of uniformity in people's experiences. High appreciation of Anthropause benefits suggests that the public may be supportive of policies and ways of living that can lead to similar outcomes post-pandemic - offering environmental policymakers and communicators a basis for action. Ecophilosophical contemplations and biophilic draw among the public suggest an awareness of the significance of the human-nature relationship - offering a symbolic global keystone for communicating and advocating conservation and the many values of pauses in life to connect with nature. Building women's environmental leadership capabilities and the ongoing greening of Christianity may be essential steps for global post-pandemic environmental behaviour transformations.

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The interest in the response to contours has recently re-emerged, with various studies suggesting a universal preference for curved over angular stimuli. Although no consensus has yet been reached on the reasons for this preference, similar effects have been proposed in interior environments. However, the scarcely available research primarily depends on schematic or unmatched stimuli and faces heterogeneity in the reported results. In a within-subject design, we investigated the claimed contour effect in photo-realistic indoor environments using stimulus material previously tested in virtual reality (VR). A total of 198 online participants rated 20 living room images, exclusively manipulated on the contours (angular vs. curved) and style (modern vs. classic) levels. The scales represented aesthetic (beauty and liking) and stress (rest and stress) responses. Beyond our main focus on contours, we additionally examined style and sex effects to account for potential interactions. Results revealed a significant main effect of contours on both aesthetic (η2 g = 1-2%) and stress (η2 g = 8-12%) ratings. As expected, images of curved (vs. angular) contours scored higher on beauty, liking, and rest scales, and lower on stress. Regarding interactions with style, curvature was aesthetically preferred over angularity only within images depicting modern interiors, however, its positive effect on stress responses remained significant irrespective of style. Furthermore, we observed sex differences in aesthetic but not in stress evaluations, with curvature preference only found in participants who indicated female as their sex. In sum, our study primarily confirms positive effects of curvature, however, with multiple layers. First, the impact on aesthetic preference seems to be influenced by individual and contextual factors. Second, in terms of stress responses, which might be especially relevant for designs intended to promote mental-health, the consistent effects suggest a more generalizable, potentially biophilic characteristic of curves. To the best of our knowledge, this is the first study to demonstrate these effects in fully-matched, photo-realistic, and multi-perspective interior design stimuli. From the background of a previous VR trial from our research group, whereby the same rooms did not elicit any differences, our findings propose that static vs. immersive presentations might yield different results in the response to contours.

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Chronic pain results from a complex series of biomechanical, inflammatory, neurological, psychological, social, and environmental mechanisms. Pain and pain-related diseases are the leading causes of disability and disease burden globally. Employing nature-based interventions for the treatment of pain is an emerging field. Current theory driving the suggested mechanism(s) linking the pain reducing effects of nature-based interventions is lacking. A two-step approach was taken to complete a theoretical review and analysis. First, a literature review was completed to gather a substantive amount of research related to theoretical frameworks on the topic of nature-based interventions and pain. Secondly, a theoretical analysis as proposed by Walker and Avant was completed to explore current theoretical frameworks accepted in the literature on nature-based interventions and pain. Stress reduction theory and attention restoration theory were the most common theoretical frameworks identified. Neither theoretical framework explicitly identifies, describes, or intends to adequately measure the concept of pain, revealing a limitation for their application in research with nature-based interventions and pain. Theoretical development is needed, as it pertains to nature-based interventions and pain. Without this development, research on nature-based interventions and pain will continue to use proxy concepts for measurement and may result in misrepresented findings.

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Most people living with dementia in the early-to-middle stages live in the community or in their own homes and engagement in enjoyable activities is fundamental to maintaining quality of life and autonomy. Horticulture-based activities are beneficial for the health and well-being for people living with dementia ("PLWD") in residential care settings, yet evidence within community settings, where the majority live, has not been comprehensively synthesized. A mixed studies systematic review protocol was registered and a systematic search conducted to June 2022 across MEDLINE, COCHRANE, Web of Science, Embase, Psycnet, CINAHL, PsycINFO databases, using terms relating to dementia and horticulture. Original studies examining group or individual horticulture-based programs for community-dwelling PLWD were included. Forty-five articles were selected for full review, eight met inclusion criteria and were retained for data extraction. Evidence from three mixed methods, two quantitative, two qualitative, and one case study design, involving a total of 178 community dwelling PLWD, was narratively summarized. Findings revealed that involvement in horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical well-being in PLWD. No conclusive evidence was found from included studies for improvement in cognitive function. As most studies to date have concentrated on PLWD in long-term care settings, future research should evaluate the effect of these types of activities in a more rigorous intervention design in community settings.

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The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent "stay-at-home" restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.

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