Elsevier

Health & Place

Volume 17, Issue 1, January 2011, Pages 103-113
Health & Place

The restorative benefits of walking in urban and rural settings in adults with good and poor mental health

https://doi.org/10.1016/j.healthplace.2010.09.003Get rights and content

Abstract

People differ in their potential for psychological restoration but there is little evidence on the role of varying mental health state or settings in the process. This paper reports two quasi-experiments which compare the restorative benefits of walking in urban and rural settings in two groups of adults with good and poor mental health. Two aspects of restoration are examined, firstly mood, the other using personal project techniques (Little, 1983) to capture an under-explored aspect of cognitive restoration through reflection on everyday life tasks. Results are consistent with a restorative effect of landscape: the rural walk was advantageous to affective and cognitive restoration in both health groups when compared to an urban walk. However, beneficial change took place to a greater extent in the poor health group. Differential outcomes between health groups were found in the urban setting, which was most advantageous to restoration in the poor mental health group. This study extends restorative environments research by showing that the amount of change and context for restoration can differ amongst adults with variable mental health.

Introduction

This paper focuses on psychological restoration and the ability of different settings to promote recovery of cognitive and emotional resources in people with varying mental health. Restoration has been defined as the process of recovery from a depleted psychological, physiological or social resource (Hartig, 2007). In order for restoration to take place, the possibility for restoration must exist in the first place, i.e. there must be a depleted resource. Two theories currently dominate the literature on restorative environments, each one dealing with different forms of resource depletion. Firstly, we briefly overview these two theories before presenting some of the empirical research they have generated, focusing on research most relevant to the experiments in this study, i.e. restorative outcomes in different environmental settings. Secondly, we set out the mental health framework for this study and explore concepts of coping and how they are related to emotional health. Thirdly, we introduce the framework for this particular study and introduce the concept of personal project analysis, a method for capturing aspects of reflection on personal goals.

Firstly, we outline attention restoration theory (ART) which deals with attention fatigue, or the depleted capacity to direct attention (Kaplan and Kaplan, 1989). In the ART model, Kaplan and Kaplan posit that natural settings, inherently rich in fascinating stimuli, invoke involuntary attention which supports restoration from mental fatigue. These settings, high in ‘soft’ fascination, have just sufficient enough interest in the surroundings to hold attention but not so much to as to exclude room for reflection. By contrast, urban environments (built, entertainment and sport settings, for instance) are rich in ‘hard’ fascination which grabs the attention dramatically, leaving no room for reflective thought and requiring directed attention to overcome the stimulation. In addition to fascination, natural settings are believed to promote restoration, owing to their ability to promote a sense of being away (psychological and/or geographical distance from routines that impose demands on directed attention), extent (a setting ‘rich enough and coherent enough so that it constitutes a whole other world’ with sufficient scope to engage the mind (Kaplan, 1995, p. 173) and compatibility (a good fit between an individual's purposes or inclinations and the kinds of activities, supported, encouraged or demanded by the setting). Whilst settings other than nature can promote restoration, ART proposes that natural settings have a greater proportion of these four qualities than urban environments.

The ART model proposes four successive stages in a restorative experience (Kaplan and Kaplan, 1989, pp. 196–197): firstly, ‘clearing the head’ of distracting thoughts; secondly, recovery of directed attention capacity; thirdly, a process of contemplation or ‘cognitive quiet’; fourthly, a deeper state of restoration, reflection on one's life, priorities, possibilities, actions and goals. This latter process of reflection is defined as ‘the most demanding of all in terms of both quality of the environment and duration required’ (Kaplan and Kaplan, 1989, p. 197). Subsequently, Herzog et al. (1997) have grouped these processes into two stages: attentional recovery and reflection.

The second theory, psychoevolutionary theory (Ulrich et al., 1991, Ulrich, 1983) focuses on stress reduction rather than attention restoration. Parsons (1991) defines this model as “first and foremost an attempt to deal with affective responses” (p. 5) in that stress reduction arises from an affective and aesthetic response to the environment. The affective response is evoked immediately by the visual stimulus array and involves like–dislike affect accompanied by change in psycho-physiological activation. For a person already experiencing stress, this might help promote a degree of recovery from stress. According to Ulrich, the initial perception of an environment is of its ‘preferenda’, a term coined by Zajonc (1980) to describe the features of the visual stimulus array which promote affective reactions in people. In natural environments, the ‘preferenda’ believed to promote positive affective responses are moderate depth, moderate complexity, and the presence of a focal point. The restorative effects of such settings are proposed to have an innate, evolutionary basis, i.e. we are drawn to settings that have been significant for survival in the past (e.g. water bodies). Ulrich conceives restoration in a broader context than ART arguing it is potentially feasible in any stressful situation and in people not just attentionally fatigued.

Now we turn to the empirical evidence supporting these two theoretical frameworks. Firstly, in healthy adults, experimental research has shown that some natural settings are advantageous over urban settings to restoration including cognitive, affective and physiological restoration (Ulrich et al., 1991, Van denBerg et al., 2003, Hartig et al., 1996, Tennesson and Cimprich, 1995). This research has shown that restoration is a multi-faceted process and that different aspects of restoration can accompany each other (for example, affective restoration and stress reduction, Ulrich et al., 1991). But evidence of a relationship between attention restoration and reflection, or evidence that the processes operate sequentially, is limited. Herzog et al. (1997) has shown, using attentional recovery and reflection goal scenarios, how settings impact on these two processes differently: settings high on hard fascination (sports settings) were found to promote attentional recovery but not reflection; natural settings offering soft fascination were higher in overall restorative effectiveness, including reflection. Exploring the actual effects of nearby green space in residential settings, Kuo (2001) found a link between reflection on life tasks (using personal project analysis) and attention restoration with higher levels of nearby green space. Mediation tests and tests for confounding variables supported the notion that green space could enhance residents’ reflection on life goals by reducing mental fatigue. But other research using scenario methodology has shown contrary patterns, i.e. reflection outcomes were more positive in people who assumed an absence of attentional fatigue (Staats and Hartig, 2004, Staats et al., 2003). It is suggested in the literature that reflection can either be an aspect of restoration or an activity which is enabled by restoration of directed attention capacity. This distinction seems to be reinforced with Herzog et al. (1997) supporting the former and Staats and colleagues supporting the latter view. We are aware, however, that a limitation of the studies of both Herzog et al. and Staats and colleagues is the use of a scenario method rather than measured effects on reflection from different actual settings. In addition, Kuo's discovered link between attentional capacity and reflection on life tasks is compatible with both views on the role of reflection. To summarise, evidence that reflection is part of the restoration process is limited but we have held with the Kaplan and Kaplan (1989) concept that restoration is a phenomenon that includes reflection.

Research conducted in the field (as opposed to the laboratory) has shown a walk in a natural setting is advantageous to aspects of restoration when compared to an urban walk (Hartig et al., 2003, Berman et al., 2008); and when compared to a control day (i.e. no walk) (Morita et al., 2007). Time spent outdoors (in a garden context) has also been shown to be advantageous to restoration in older adults when compared to time spent indoors (Ottosson and Grahn, 2005). Secondly, in adults with mental health problems, a rural walk has been found to be advantageous to mood and self-esteem when compared to walking in an indoor shopping centre (Peacock et al., 2007); and in adults with psychosis, an urban walk was disadvantageous to mood compared to an indoor relaxation task (Ellett et al., 2008). Elsewhere research points to the substantial therapeutic benefits of green activity in people with mental health problems, particularly in relation to building coping resources and as a buffer to stress (Ottosson, 2007, Ottosson and Grahn, 2008), in improving belonging and self-identity (Parr, 2005) and in improving social cohesion and meaningful occupation (Townsend, 2006).

It is generally recognised people's needs for restoration can vary (Hartig, 2007) but a significant gap in the research field is in empirical evidence showing how the experience varies in sub-sections of the population. Scopelliti and Giuliani (2004) have shown how the potential for restoration varies across the age span, both in relation to social context and the amount of time available for restoration. The potential for differential capacities for restoration has been explored in several experimental studies in healthy student populations (Hartig et al., 1996, Hartig et al., 2003). In Hartig et al.'s (2003) study, to ensure a potential for restoration prior to an environmental ‘treatment’, a series of psychological demands were imposed on subjects (e.g. tasks requiring focused attention, such as driving) in varying degrees of intensity. Following these demands, natural settings were found to have more positive effects on restoration. Subjects with seemingly differently psychological points of departure showed similar patterns of change (i.e. outcomes converged between groups subjected to a pre-task stressor and those unexposed to a pre-task stressor). These experiments generated a transient state of attention deficiency; but it is not known if the same patterns would hold in a variety of daily living situations.

In the mental health context, it has been suggested the intensity of a restorative experience may be influenced by the degree of stress or crisis a person experiences (Korpela et al., 2008, Ottosson and Grahn, 2008). However, as far as we are aware, no studies to date have explored differential capacities for restoration in people with varying mental health states in different settings. Would, for instance, a depressed individual experience similar levels of restoration to a non-depressed person, and how would the setting interact with such individual differences? Or again, would the process be more, or less, intense? These are some of the questions this paper explores, using the activity of a walk in urban versus rural settings to explore restorative outcomes between two groups with different mental health status. There were two reasons for the inclusion of subjects with good and poor mental health. Firstly, little evidence is currently available on possible benefits to those with poor mental health. Secondly, it is possible that a poor mental health group would already suffer from depleted resources in coping prior to any experimental intervention. This would be a natural equivalent to introducing a pre-walk stressor and would give greater opportunity for any recovery to show itself from a different and lower starting point on the mood scales, in this case the anticipated change following forest intervention would be greater. (We were also aware of the counter argument that people with major problems of whatever kind might be so internally focused that there would be little likelihood of external (i.e. environmental) benefits.)

For the purpose of this study a simple division is made between good and poor mental health. Poor mental health is defined as having a clinically diagnosed mental health problem (depression, anxiety, bi-polar disorder or psychotic illness); conversely, good mental health is defined as having no clinically defined disorder. However, we recognise concepts of mental health are significantly more complex than this, i.e. health is more than the absence of disease, and may have something to do with day-to-day level of functional ability (WHO, 2007). Definitions of mental illness in the UK are shifting away from categorizing mental health by type of illness, towards defining mental health as a spectrum of coping abilities, ranging from coping well to coping poorly. Within this spectrum, a person suffering from schizophrenia, say, and managing well on medication, may be coping better than an individual, as yet undiagnosed, with anxiety. However, following advice from clinicians at the time, our split of good and poor mental health based on clinical diagnoses was considered appropriate.

In the past, mental health promotion has focused on strategies that aid psychological relaxation and reduce tension, taking the view that excessive arousal (physiological or psychological) is harmful to health. Recently, the focus has shifted towards strategies that can help build coping resources for dealing with life's day-to-day challenges. This notion of coping and resource building is integral to the theoretical framework directing this study and, in particular, ideas linking mood with coping and manageability of life tasks. Folkman and Lazarus (1988) have shown how coping can mediate emotions during stressful encounters. For instance, coping with life tasks (‘planful problem-solving’) was associated with more positive emotion. This idea is also reflected in Fredrickson's (2004) ‘broaden and build’ hypothesis, which posits that positive emotion broadens cognition (defined as ‘mindset’), widening thought-action repertoires and in turn helping to build personal resources for coping in the future. The theory suggests an upward spiral in which positive emotions and subsequent broadened thinking influence one another reciprocally, a process that leads to improved mental well-being. In this way positive emotion produces good mental health as opposed to simply signalling or marking it, the traditional perspective. Empirical support for this proposition is provided by Isen et al., 1987, Folkman and Lazarus, 1988, Fredrickson and Branigan, 2005.

Using the above framework, this study focuses on two dependent variables linked in the literature with coping: mood and reflection of life-tasks. Using similar methods to Kuo (2001) we have explored reflection using personal project techniques (Little, 1983) as a framework for capturing aspects of reflection in relation to project planning. This is a technique whereby participants list their personal projects and assess or characterize them according to 18 dimensions exploring what they think and feel about them in relation to their goals. The dimensions have been subject to factor analysis which has identified five core dimensions from the original framework (Little, 2007, Chambers, 1997, Meyer et al., 2004). Firstly, affective dimensions of project appraisal: (1) positive affect (enjoyment from the domain of meaning) and (2) negative affect (stress). Secondly, cognitive aspects of project appraisal including (3) project mastery (efficacy, i.e. the anticipated success of achieving the project goal); (4) project manageability (degree of individual control over a project); and (5) degree of difficulty in perceived implementation of a project (challenge) which also factors with negative affect dimensions such as stress. In discussion with Little (2006) we selected the italicised dimensions from each of these domains as appropriate measures for this study. Our aim was to relate aspects of reflection on project planning to positive well-being, as well as affective (rather than attention) restoration. In the literature, positive well-being is associated with projects that are enjoyable, manageable, controllable, and neither too difficult nor too stressful (Little, 2007).

Previous research supported the hypothesis that interactions with nature could improve mood and reflection. The present study aimed to extend this research by asking whether outcomes would vary between two mental health groups, firstly, when walking within a rural setting and, secondly, when directly compared with a walk in an urban setting. Two studies are presented here. In the first (n=123), a combined data set of adults with good mental health (GMH) (n=83) and poor mental health (PMH) (n=40) walked in a rural setting. The purpose was to assess the effect of the walk and possible differences between the two health groups. A second study explored the differential effects of rural versus urban settings in a smaller mixed health group (n=24).

Section snippets

Study 1, restorative outcomes of rural settings in adults with good and poor mental health

This study explored the outcomes of walking in a rural setting within two different mental health groups. Two hypotheses were proposed. Firstly, that a walk in a rural setting would result in a positive shift in mood and mindset in relation to personal projects. Secondly, that the poor mental health group would show a greater positive shift in mood and in mindset from pre to post walk than the good mental health group (at the time of the data collection there was no evidence based information

Study 2: restorative outcomes of rural versus urban settings in adults with good and poor mental health

This study aimed to explore differences in restorative outcomes between two mental health groups in two different settings, urban vs. rural. Firstly, we hypothesised that a walk in a rural setting would result in greater positive shift in mood and in mindset to personal projects than a walk in an urban setting. Secondly, we hypothesised that this effect would be greater for the poor mental health group.

Limitations

The study of two mental health groups walking in different settings (urban vs. rural) was in a small sample only and requires replication in a larger sample of the population. Our definition of poor and good mental health (based on having – or not having – a clinically diagnosed mental health problem) has limitations since mental health is increasingly being defined in the UK across a coping spectrum (see Section 1.2). Paradoxically therefore, the ‘healthy’ sample in this study may have

Policy implications

It is known that exercise can help treat depression (Donaghy, 2007) and increasingly doctors in the UK are prescribing exercise for patients with mild to moderate depression (Mental Health Foundation, 2008). However, there is little evidence to guide doctors on what types of locations might maximize the mental health benefits of exercise. The study indicates that walking in green spaces is beneficial to mood in healthy adults, and extends that research by showing it is more advantageous over

Conclusions

Firstly, we have shown that brief interactions with nature can positively improve mood and reflection on project planning, potentially impacting on personal development and coping resources. Secondly, we have shown that whilst these benefits are advantageous in adults with good and poor mental health, the restorative experience from walking in rural settings is potentially greater in adults with poor mental health. Thirdly, we have shown the potential of an urban walk to promote restoration in

Acknowledgements

This research was part of a Ph.D. study funded by the Economic and Social Research Council (ESRC) and Forestry Commission (FC) and supervised by Prof. P.A. Aspinall, Heriot Watt University and Prof. C. Ward Thompson, Edinburgh College of Art.

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