On this page, you’ll find a small sample of the research that has been done on the benefits of biophilia and biophilic Healing Art in particular and how incorporating Healing Art into a healthcare/senior care, palliative care facility can dramatically impact the patients, residents and their families as well as the hard working doctors, nurses and support staff of these facilities.
In what has become a landmark study conducted in 1984 on the benefits of nature in a healthcare environment, Dr. Robert Ulrich found that post-operative gall bladder surgery patients, whose rooms had windows with views of a park had better outcomes than those patients whose rooms had windows with views of a brick wall. Patients with the view of a park complained less to staff, experienced fewer post-surgical complications, needed analgesic pain medication of lesser strength and were discharged earlier.
(Ulrich R.S. View through a window may influence recovery from surgery. Science. 1984;224:420–421.doi: 10.1126/science.6143402.)
In another study, adult patients in a procedure room reported better pain control when exposed to a nature scene. Diette et al found that exposure to images of nature can reduce anxiety, improve pain control and patients’ satisfaction with the procedure. One study found that the exposure to images of nature effectively distracted patients from stressful or painful conditions.
(Diette G.B., Lechtzin E., Haponik E., Devrotes A., Rubin H.R. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy. Chest. 2003;123:941–948. doi: 10.1378/chest.123.3.941.)
The presence of nature-themed wall murals resulted in a significant decrease in reported pain intensity, pain quality and anxiety by burn patients
(Miller A.C., Hickman L.C., Lemasters G.K. A distraction technique for control of burn pain. J. Burn Care Rehabil. 1992;13:576–580. doi: 10.1097/00004630-199209000-00012.)
In another study, images of serene nature scenes mounted to the ceiling were shown to highly stressed pre-surgical patients on gurneys. This resulted in lower blood pressure and anxiety.
(Coss, 1990).
Installing restorative nature-themed art in a pediatric inpatient setting not only impacts positively the mental state and frame of mind of the young patients, the art also goes a long way towards de-stressing the parents and making them feel more comfortable in what can often be a very stressful environment.
(Monti, F., & Dellabartola, S., & Neri, E., & Bozicevic, M., & Agostini, F Journal of Environmental Psychology.)
The benefits of nature in a healthcare setting extend to family members and visitors as well. An overwhelming 95% of all people visiting inpatients, surveyed across 4 independent hospitals, reported feeling more relaxed, rejuvenated, and positive. They also reported feeling less stressed and more able to cope with the situation
(Marcus & Barnes, 1995).
The benefits that we’ve discussed in this section are both immediate and impactful. The evidence shows that all of the benefits that have been presented here can occur in as little as 5 to 20 minutes of exposure to nature-themed images.
(Brown, Barton & Gladwell, 2013; Barton & Pretty, 2010; Tsunetsugu & Miyazaki, 2005).
Healing Art has also shown to be very important for people who work in a healthcare environment – the doctors, nurses administrative and support staff. As expected, studies consistently find that people’s access to natural scenery is significantly correlated to their job satisfaction, health and productivity. In a recent study, research found that the quality of a person’s view from their workspace was the primary predictor of absenteeism.
(Bergs, 2002)
The presence of Healing Art in common areas as well as in staff-only sections of a healthcare facility provides hospital staff with a sense that their lives are not just full of endless hallways. When they enter a space, Healing Art helps them feel they are being welcomed to their workplace, that the institution itself has a sense of caring about the employees as well as the patients. Another study found that views of nature, including images of nature enable better focus, mental stamina and productivity – behaviors that benefit workers and employers alike.
(Kahn, 2008).
Parson et al found that when nature captures people’s attention, the executive system that regulates directed attention gets to rest, pessimistic thoughts are blocked, and negative emotions are replaced by positive ones.
(Parsons R. The potential influences on environmental perception on human health. J. Environ. Psychol. 1991;11:1–23. doi: 10.1016/S0272-4944(05)80002)
In particular, natural settings have restorative influences on three affective dimensions: positive affects, anger/aggression, and fear.
(Ulrich R.S., Simons R.F., Losito B.D., Fiorito E., Miles M.A., Zelson M. Stress recovery during exposure to natural and urban environments. J. Environ. Psychol. 1991;11:201–230. doi: 10.1016/S0272-4944(05)80184-7)
(Zuckerman M. Development of a situation-specific trait-state test for the prediction and measurement of affective responses. J. Consult. Clin. Psychol. 1977;45:513–523. doi: 10.1037/0022-006X.45.4.513)
(Ulrich R.S. Visual landscape and psychological well-being. Landsc. Res. 1979;4:17–23. doi: 10.1080/01426397908705892)
Moreover, people report more positive emotions (such as friendliness) and fewer negative emotions (such as sadness) when viewing urban scenes with trees than when viewing the same scenes with inanimate objects.
(Lohr I., Pearson-Mims C.H. Responses to scenes with spreading, rounded, and conical tree forms. Environ. Behav. 2006;38:667–688. doi: 10.1177/0013916506287355)
Another study found that heart-rates and self-reports of emotional state of patients in dental clinics improved with exposure to natural environments; patients felt calmer on days when a mural depicting a natural scene was on the wall than on days when the wall was blank.
(Heerwagen J.H. Affective functioning, light, hunger and room brightness preferences. Environ. Behav. 1990;22:608–635. doi: 10.1177/0013916590225003)
In a workplace environment, a view of natural elements was found to buffer the negative impact of job stress, intention to quit and it had a positive effect on general wellbeing and cognitive functioning.
(Leather P., Pyrgas M., Beale D., Lawrence C. Windows in the Workplace Sunlight, View, and Occupational Stress. Environ. Behav. 1998;30:739–762. doi: 10.1177/001391659803000601)
(Wells N.M. At home with nature: Effects of “greenness” on children’s cognitive functioning. Environ. Behav. 2000;32:775–795. doi: 10.1177/00139160021972793)
The most significant understanding of nature’s salutary effect on cognition comes through studies of attention. Research has shown that natural elements have restorative effects that include increased performance on task requiring attention and cognitive processing.
(Kaplan R., Kaplan S. The Experience of Nature: A Psychological Perspective. Cambridge University Press; Cambridge, UK: 1989)
(Berto R. Exposure to restorative environments helps restore the attentional capacity. J. Environ. Psychol. 2005;25:249–259. doi: 10.1016/j.jenvp.2005.07.001)
(Berman M.G., Jonides J., Kaplan S. The cognitive benefits of interacting with nature. Psychol. Sci. 2008;19:1207–1212. doi: 10.1111/j.1467-9280.2008.02225.x.)
(Felsten G. Where to take a study break on a collage campus: An attention restoration perspective. J. Environ. Psychol. 2009;29:160–167. doi: 10.1016/j.jenvp.2008.11.006)
(Tennessen C.M., Cimprich B. Views to nature: Effects on attention. J. Environ. Psychol. 1995;15:77–85. doi: 10.1016/0272-4944(95)90016-0)
Cognitive restoration following visual exposure to natural elements, as reflected in improved performance on attentional tasks, has been established in a variety of experimental studies involving the use of videos and/or images of nature.
(Van den Berg A.E., Koole S.L., van der Wulp N.Y. Environmental preference and restoration: (How) are they related? J. Environ. Psychol. 2003;23:135–146. doi: 10.1016/S0272-4944(02)00111-1)
(Hartig T., Evans G., Jamner L.D., Davis D.S., Garling T. Tracking restoration in natural and urban field settings. J. Environ. Psychol. 2003;23:109–123. doi: 10.1016/S0272-4944(02)00109-3)
(Hartig T., Mang M., Evans G. Restorative effects of natural environment experiences. Environ. Behav. 1991;23:3–26. doi: 10.1177/0013916591231001)
(Taylor A.F., Kuo F.E. Children with attention deficits concentrate better after walk in the park. J. Atten. Disord. 2009;12:402–409)
(Berto R. Exposure to restorative environments helps restore the attentional capacity. J. Environ. Psychol. 2005;25:249–259. doi: 10.1016/j.jenvp.2005.07.001)
(Berman M.G., Jonides J., Kaplan S. The cognitive benefits of interacting with nature. Psychol. Sci. 2008;19:1207–1212. doi: 10.1111/j.1467-9280.2008.02225.x)
A logical extension of attention restoration theory is that people deprived of nature will display behaviors caused by weary minds: inhibition is essential to delay and reflection, lacking this capability an individual behaves in a less adaptive and appropriate fashion. Moreover, without the patience and endurance necessary to carry out difficult or unpleasant tasks, performance becomes more oriented to the short term. In fact, directed attention fatigue not only leads to the inability to focus, but it has also several unfortunate consequences, including performance errors, inability to plan, social incivility and irritability.
(Kaplan S. The restorative benefits of nature: Toward and integrative framework. J. Environ. Psychol. 1995;15:169–182. doi: 10.1016/0272-4944(95)90001-2)
Furthermore, mental/attentional fatigue manifests itself in negative emotions, irritability, impulsiveness, impatience, reduced tolerance for frustration, insensitivity to interpersonal cues, decrease altruistic behaviors, reduced performance, increased likelihood of taking risks, generally speaking in reduced competence and/or decreased effectiveness in functioning. In practice, the inability to renew the attentional capacity aggravates the mental fatigue state and can also damage mood, work performance and interpersonal relationships.
(Hartig T., Mang M., Evans G. Restorative effects of natural environment experiences. Environ. Behav. 1991;23:3–26. doi: 10.1177/001391659123100)
(Hartig T., Korpela K., Evans G.W., Gärling T. Validation of a measure of perceived environmental restorativeness. Göteb. Psychol. Rep. 1996;26:1–64)
(Hartig T., Evans G.W. Psychological Foundations of Nature Experience. In: Garling T., Golledge R.G., editors. Behavior and Environment: Psychological and Geographical Approaches. Vol. 96. North Holland; Amsterdam, The Netherland: 1993. pp. 427–457)
(Kaplan R. The role of nature in the context of workplace. Landsc. Urban Plan. 1993;26:193–201. doi: 10.1016/0169-2046(93)90016-7)
(Kaplan R., Kaplan S., Ryan R.L. With People in Mind: Design and Management of Everyday Nature.Island Press; Washington, DC, USA: 1998)
Using a paradigm in which stressed individuals were exposed to simulations of either natural or urban environments, Ulrich encompassed the range of restorative effects of the natural environments on human beings. Research showed different rates of recovery from stress depending upon the type of environmental exposure. Physiological measures of stress (e.g., electromyography, skin conductance response, pulse transit time, cardiac response, partial thromboplastin time) indicated that recovery was quicker and more complete in the natural environment exposure conditions, even when recovery was measured over a 10-minute period only.
(Ulrich R.S., Simons R.F., Losito B.D., Fiorito E., Miles M.A., Zelson M. Stress recovery during exposure to natural and urban environments. J. Environ. Psychol. 1991;11:201–230. doi: 10.1016/S0272-4944(05)80184-7)
(Ulrich R.S. Aesthetic and Affective Response to Natural Environment. In: Altman I., Wohlwill J.F., editors. Behavior and the Natural Environment. Plenum; New York, NY, USA: 1983. pp. 85–125)
(Ulrich R.S. View through a window may influence recovery from surgery. Science. 1984;224:420–421. doi: 10.1126/science.6143402)
(Ulrich R.S. Natural versus Urban Scenes Some Psychological Effects. Environ. Behav. 1981;13:523–556. doi: 10.1177/0013916581135001)
Taylor, Kuo and Sullivan found a relationship between exposure to nature and self-control; in studying a group of girls living in the same housing complex, the researchers found that those with views of nature or images of nature scored higher than those deprived of nature on several tasks related to discipline, higher concentration, inhibited impulsivity and ability to delay gratification. Regarding social behavior, which also depends upon inhibition, it becomes less appropriate and there is also a greater inclination to be impulsive, to take unnecessary risks, and to act in an impatient and hasty manner. Kuo and Sullivan reported significantly lower levels of aggression and violence in residents with apartments near nature than in those who looked onto barren lands; the researchers suggested that if fatigued attention is related to irritability, and irritability leads to impulsivity and aggression, then perhaps people deprived of nature’s restorative qualities would be overly aggressive. In general, exposure to nature or natural elements enhances sense of attachment, social life, mental and physical health, quality of life and the occurrence of activities and events that enhance wellbeing.
(Taylor A.F., Kuo F.E., Sullivan W.C. Views of nature and self-discipline: Evidence from inner city children. J. Environ. Psychol. 2002;22:49–63. doi: 10.1006/jevp.2001.0241)
(Kuo F.E., Sullivan W.C. Aggression and violence in the inner city: Impacts of environment via mental fatigue. Environ. Behav. 2001;33:543–571. doi: 10.1177/00139160121973124)
(Kuo F.E., Sullivan W.C., Coley R.L., Brunson L. Fertile Ground for Community: Inner-City Neighborhood Common Spaces. Am. J. Community Psychol. 1998;26:823–851. doi: 10.1023/A:1022294028903)
Laboratory and clinical studies have shown that viewing images of nature produces stress recovery quickly evident in physiological changes, for instance, in blood pressure and heart activity. Stressful or negative emotions such as fear or anger diminish while levels of pleasant feelings increase.
(Ulrich, R. S. (1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Health Care Interior Design, 3(1), 97-109.)
A study in a Swedish hospital found that heart-surgery patients in ICUs who were assigned a picture with a landscape scene with trees and water reported less anxiety/stress and needed fewer strong doses of pain drugs than a control group assigned no pictures It should be noted that another group of patients assigned an abstract picture, however, had worsened outcomes compared to the control group. These investigations also support the interpretation that nature serves as a positive distraction that reduces stress and diverts patients from focusing on their pain or distress.
(R. Ulrich, 1991)
A randomized prospective investigation found that adult patients undergoing a painful bronchosopy procedure reported less pain if they were assigned to look at a ceiling mounted nature scene rather than a control condition consisting of a blank ceiling.
(Diette, G. B., Lechtzin, N., Haponik, E., Devrotes, A., & Rubin, H. R. (2003). Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: A complementary approach to routine analgesia. Chest, 123(3), 941-948)
Another controlled experiment that used volunteers in a hospital assessed the effect on pain of viewing a soundless nature videotape in contrast to a static blank screen. Subjects who watched the nature scenes evidenced a higher threshold for detecting pain and had substantially greater pain tolerance.
(Tse, M. M.Y., Ng, J. K.F., Chung, J. W. Y., & Wong, T.K. S.(2002). The effect of visual stimuli on pain threshold and tolerance. Journal of Clinical Nursing, 11(4), 462-469)
Research on patients suffering intense pain because of severe burns found that exposing patients to a videotape of scenic nature (forest, flowers, ocean, waterfalls) during burn dressing changes significantly reduced both anxiety and pain intensity.
(Miller, A. C., Hickman, L. C., & Lemasters, G. K. (1992). A distraction technique for control of burn pain. Journal of Burn Care and Rehabilitation, 13(5), 576-580)
The possibility that nature can improve outcomes even in patients with late-stage dementia, including Alzheimer’s disease, has received some support from a quasiexperimental study that found reduced levels of agitated aggressive behavior associated with a shower bath when color pictures were present.
(Whall, A. L., Black, M. E., Groh, C. J., Yankou, D. J., Kupferschmid, B. J., & Foster, N. L. (1997). The effect of natural environments upon agitation and aggression in late stage dementia patients. American Journal of Alzheimer’s Disease and Other Dementias, September-October, 216-220.)
A well-controlled study of blood donors in a waiting room found that blood pressure and pulse were lower on days when a wallmounted television displayed a series of nature scenes, compared to days with continuous daytime television programs.
(Ulrich, R. S., Simons, R. F., & Miles, M. A. (2003).
(Effects of environmental simulations and television on blood donor stress. Journal of Architectural & Planning Research, 20(1), 38-47)
In a study that examined the relationship between nature connectedness and psychological wellbeing it was found that that the more connected people feel to nature, the greater their levels of “flourishing”.
(Bowler, D. E., Buyung-Ali, L. M., Knight, T. M., & Pullin, A. S. (2010). A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health, 10, 456. doi:10.1186/1471-2458-10-456)
The evidence is clear and irrefutable that a visual connection to nature reduces stress as measured by lower blood pressure and heart rate, improves mental engagement and attentiveness and positively impacts attitude and overall happiness.
(Brown, D.K., J.L. Barton, & V.F. Gladwell (2013). Viewing Nature Scenes Positively Affects Recovery of Autonomic
Function Following Acute-Mental Stress. Environmental Science & Technology, 47, 5562-5569)
(van den Berg, A.E., T. Hartig, & H. Staats (2007). Preference for Nature in Urbanized Societies: Stress, Restoration, and the Pursuit of Sustainability. Journal of Social Issues, 63 (1), 79-96)
(Tsunetsugu, Y. & Y. Miyazaki (2005). Measurement of Absolute Hemoglobin Concentrations of Prefrontal Region by Near-Infrared Time-Resolved Spectroscopy: Examples of Experiments and Prospects. Journal of Physiological Anthropology and Applied Human Science, 24 (4), 469-72)
(Biederman, I. & E. Vessel (2006). Perceptual Pleasure & the Brain. American Scientist, 94(1), 249-255)
(Barton, J. & J. Pretty (2010). What Is the Best Dose of Nature and Green Exercise for Improving Mental Health. Environmental Science & Technology, 44, 3947–3955)
Laumann et al found that videos/images depicting natural environments had an involuntary relaxing effect on autonomous functions, inducing positive cardiac deceleration as well as beneficial physiological arousal.
(Laumann, K. et al. Selective attention and heart rate responses to natural and urban environments. Journal of Environmental Psychology 23:125–134. 2003)
The benefits of incorporating natural elements in a healthcare or senior care setting
extend to family members and visitors as well; an overwhelming 95% of all people visiting inpatients, surveyed across four independent institutions, reported feeling more relaxed, rejuvenated, and positive. They also reported feeling less stressed and more able to cope with the situation.
(Marcus, Clare C., and Marni Barnes. “Gardens in Healthcare Facilities: Uses, Therapeutic Benefits, and Design Recommendation.” University of California at Berkeley. The Center for Health Design. 1995)
The benefits of biophilia include improved stress recovery rates, lower blood pressure,improved cognitive functions, enhanced mental stamina and focus, decreased
violence and criminal activity, elevated moods, and increased learning rates.
(Joye, Yannick. 2007. Architectural Lessons From Environmental Psychology: The Case of Biophilic Architecture. Review of General Psychology. Vol. 11, No. 4, 305–328)
In a study with mental health patients, exposure to evidence-based art was found to decrease patient aggression and agitation.
(Nanda, Eisen, Zadeh, & Owen, 2011)
Becker and Douglas (2008) found that the physical attractiveness of a waiting room impacted anxiety levels and perception of quality of care to a larger degree than actual wait times.
(Becker, F., & Douglass, S. (2008). The ecology of the patient visit: Physical attractiveness, waiting time and perceived quality of care. Journal of Ambulatory Care. Management, 31, 128–141)
Hathorn & Nanda, 2008, found that visual art depicting realistic nature images were positively perceived by both patients and staff in an oncology outpatient waiting area.
(Hathorn, K., & Nanda, U. (2008). A guide to evidence-based art (a white paper for the Environmental Standards Council). Concord, CA: Center for Health Design)
ABSTRACT ART
Results suggest a consistent pattern wherein the great majority of patients respond positively to representational nature art, but many react negatively to chaotic abstract art (Ulrich & Gilpin, 2003). For example, Carpman & Grant (1993) studied the preferences of 300 randomly selected inpatients and concluded that the patients consistently preferred nature images but disliked abstract art. Although nature pictures and other emotionally appropriate art elicit positive reactions, there is also evidence that inappropriate art styles or image subject matter can increase stress and worsen other outcomes.
The pitfalls of displaying emotionally challenging art in healthcare environments are revealed by a study of psychiatric patients (Ulrich, 1991). The unit was extensively furnished with a diverse collection of wall-mounted paintings and prints. Interviews with patients indicated strongly negative reactions to artworks that were ambiguous, surreal, or could be interpreted in multiple ways. The same patients, however, reported having positive feelings and associations with respect to nature paintings and prints.
(Ulrich, R. S., & Gilpin, L. (2003). Healing arts: Nutrition for the soul. In S. B. Frampton, L. Gilpin & P. Charmel (Eds.), Putting patients first: Designing and practicing patient-centered care (pp. 117- 146). San Francisco: Jossey-Bass.)
(Carpman, J., & Grant, M. (1993). Design that cares: Planning health facilities for patients and visitors (2nd ed.). Chicago: American Hospital Publishing)