The influence of forest therapy camp on depression in alcoholics
© The Japanese Society for Hygiene 2011
Received: 8 October 2010
Accepted: 30 March 2011
Published: 19 April 2011
To evaluate the effect of a forest experience on the levels of depression of alcoholics.
Prior to the study, 92 alcoholics were divided into treatment and control groups. During the summer of 2009, the treatment group participated in a series of forest therapy programs, while the control group followed their normal daily routines. Both groups were re-tested upon completion of the program by the treatment group and the depression levels compared.
There was a significant improvement in the depression level of alcoholics who had participated in the forest camp program (treatment group). Those participants in their 40s who had severe levels of depression at the beginning of the program showed the most significant improvement during the program experience.
The forest therapy camp experience can considerably reduce and ameliorate the depression levels of alcoholics.
In modern society, individuals spend most of their time drawing on their own resources to deliberately direct attention or pay attention to various issues . The information- and high technnology- based demands placed upon most people in everyday life are resulting in mental fatigue. In contrast, natural environments, such as forested landscapes, seem to effortlessly engage people’s attention, allowing them to be in a place where they do not have to actively pay attention. For this reason, Kaplan  suggests that contact with nature has a restorative function. Several investigations support Kaplan’s theory, indicating that exposure to a forest environment can effectively reduce stress [2, 3].
Alcoholism is a major psychological problem in South Korea. Recent changes in the socio-economic status of many South Koreans have resulted in major social and health problems related to alcohol (mis)use. There is substantial evidence that heavy alcoholism is associated with the development of psychological symptoms, such as depression and anxiety. In the last two decades, the body of knowledge on the physical and psychological aspects of alcoholism has improved considerable. Empirical studies investigating the relationships between alcoholism and a variety of concerns, such as depression, anxiety, low self-esteem, and difficulty with intimate relationships, have become increasingly more numerous . Among these are empirical studies on the psychologically restorative effects of the direct effect of forest environments, including wilderness areas , urban forest parks , nearby trees and grassy areas close to public housing , and even the view of a forest through windows . If contact with forest is attentionally restorative, how then might an attentional restorative program mitigate the depressive symptoms of alcoholics? The study reported here was designed to investigate the relationship between the experience of alcoholics participating in a restorative forest program and the effect of this program on their depression levels. Our interest was in the degree of changes in self-reported depression after completion of a 9-day forest program.
The subjects for this study consisted of 92 adult alcoholics enrolled in the Korean Alcohol Research Center in Chungbuk Province, South Korea. The Korean Alcohol Research Center is a national inpatient alcohol rehabilitation institute founded in 1997. All participants were chronic alcoholics whose drinking problems were severe enough to necessitate inpatient treatment. Only participants who were detoxified and oriented, but had not yet begun any psychological treatment, were included in the sample. Participants were excluded if they met criteria for any psychoactive substance dependence besides alcohol or if they had a severe medical illness. All 92 participants who complied with the above inclusion criteria consented to participate. Informed consent was obtained from all participants on the basis of a procedure that is officially approved by the Research Ethical Committee of Chungbuk National University. The participants were randomly assigned to a treatment and control group, respectively. This random assignment process resulted in 47 treatment participants and 45 control participants.
Background characteristics on the treatment and control alcoholics participants
Treatment group (n = 47)
Control group (n = 45)
44.66 ± 3.90
45.87 ± 3.85
13.26 ± 2.73
13.27 ± 2.51
Alcohol dependence levelb
37.28 ± 7.22
37.17 ± 6.71
The Beck Depression Inventory (BDI) was employed to determine the depression levels of the alcoholics, as this was a major dependent research variable in this study. The BDI is a self-report measure of 21 items in a multiple choice format. Score can range from 0 (no depression) to 63 (high depression). This measurement tool has been used extensively in clinical research and demonstrates validity and reliability.
The 9-day forest healing camp was conducted and data for this study were collected from Saneum Recreational Forest in South Korea. A primary reason why this forest was selected for the study is that the recreation forest was designated as a “model forest for human health” by the Korea Forest Service.
The study area (Saneum Recreational Forest) is located in Kyungggi Province, about 80 km away from Seoul, the capital of South Korea. Saneum Recreational Forest has 2,140 ha of forest area mainly composed of oaks and pine. The numbers of visitors was 76,559 in 2007.
Summary of forest therapy camps
Interacting with nature/forest
Nature–game, nature–interpretation, etc.
Mountain-climbing, tracking, orienteering, etc.
Nature-meditation, Counseling in forest environment, etc.
A set of questionnaires, including a personal-profile and the Korean version of the BDI, was administered and completed by the participants in order to collect baseline data during the orientation at the first session of the camp. For comparative data collection, the same type of questionnaire was distributed to each participant at the end of the final session of the camp.
Statistical analysis was performed using Windows SPSS (ver. 15; SPSS, Chicago, IL). The descriptive analysis was presented as means and standard deviations (SD) for continuous measures and as frequencies for categorical measures. Group comparisons for outcome measures were conducted using t tests and analysis of variance (ANOVA) for continuous measures and χ2 tests for categorical measures.
Socio-demographic characteristics of the subjects
The principle demographic characteristics of the 92 participants taken into consideration were: age (mean 45.26 ± 3.89 years); gender (84 males, 8 females); education (3 elementary school graduates, 6 junior high school graduates, 45 high school graduates, 38 college or university graduates); marital status (33 unmarried, 35 married, 24 divorced).
Forest therapy camp experience and improvement in the depression level of the alcoholics
In addition to comparing the BDI scores, we also analyzed a number of relatively objective variables (i.e., difficulty in falling and difficulty in staying asleep). The result of the χ2 analysis, which was based on self-reporting, indicated that, relative to alcoholics in the control group, the alcoholics with forest camp experience had less difficulty in falling asleep (p ≤ 0.001) and had less difficulty in staying asleep (p ≤ 0.009).
Differences in the change in depression scores (Beck Depression Inventory) between the pre- and post-test based on a number of respondents’ personal variables
Base-line depression levels
In this study, we examined how a forest program experience can be beneficial to alcoholics and how it can improve their depression levels. The study cohort comprised 92 alcoholics who were detoxified and oriented, but who had not yet begun any psychological treatment. The results indicate that the forest program experience played a significant role in the amelioration of the depression levels of these alcoholics. Consistent with previous research on nature’s ability to improve mood and reduce stress, produce positive feelings, boost feelings of energy, have positive psychological effects, and increase healing [1–3], we found that the depression levels of the participating alcoholics decreased after their forest program experiences.
The forest provides a refuge from the artificial and man-made constructions that exist in our society, and the forest environment clearly occupies a prominent position among most individual’s favorite places. Moreover, the forest environment seems to be particularly closely associated with restorative outcomes. The feelings most frequently associated with a desirable location and its contribution to psychological well-beings are relaxation, calmness, and comfort, with happiness, enjoyment, and excitement being frequently mentioned. Because people tend to forget their worries and reflect on personal matters more so in the forest, it has been suggested that this environment is vital for reducing depression levels .
The findings in this study provide strong evidence for the potential effect of the forest environment on depression levels, a topic that has been largely unexplored. Further studies should include different types of participants undergoing different types of experiences at different locations, a wider inventory of disposition items, and variables that define different aspects and components of the forest experience benefits, including descriptive information on the benefits of forest.
- Kaplan S. The restorative benefits of nature: toward an integrative framework. J Environ Psychol. 1995;15:169–82.View ArticleGoogle Scholar
- Ulrich RS, Simons RF, Miles MA. Effects of environmental simulations and television on blood donor stress. J Archit Planning Res. 2003;20:38–47.Google Scholar
- Hartig TH, Evans GW, Jamner LD, Davis DS, Garling T. Tracking restoration in natural and urban field settings. J Environ Psychol. 2003;23:109–23.View ArticleGoogle Scholar
- Kashubeck S, Christensen SA. Parental alcohol use, family relationship quality, self-esteem, and depression in college students. J Coll Stud Dev. 1995;36:431–43.Google Scholar
- Shin WS. Self-actualization and wilderness attitudes: a replication. J Soc Behav Pers. 1993;8:241–56.Google Scholar
- Shin WS, Kwon HK, Hammitt WE, Kim BS. Urban forest park use and psychological outcomes: a case study in six cities across South Korea. Scand J For Res. 2005;20:441–7.View ArticleGoogle Scholar
- Shin WS. The influence of forest view through a window on job satisfaction and job stress. Scand J For Res. 2007;22:248–53.View ArticleGoogle Scholar