Global Review of Literature on Forest Bathing

Schlüsselbegriffe: Grüne Therapie, naturbasierte Therapie, Naturtherapie, Gesundheits­wesen, psychische Gesundheit, shirin-yoku

Available at https://doi.org/10.53203/fs.2402.3

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Abstract

Forest bathing, or shinrin-yoku, is a practice that involves immersion in forest environments to improve health and well-being, associated with stress reduction, immune system strengthening and mood enhancement. The aim of the present analysis is to quantify and evaluate scientific output, map collaboration among researchers, as well as identify prolific and prominent researchers, identify prolific journals, and analyze thematic trends. The set of 285 documents was extracted from the Web of Science, processed with Microsoft Excel and VOSviewer programs, and the analysis was performed following the traditional rules of bibliometrics. The number of publications show exponential growth, demonstrating the interest of the scientific community. The core of prolific journals is composed of only two journals, and the most prominent author is M. Yoshifumi from Chiba University (47 articles and 2208 citations). Japan and South Korea stand out as the most prolific countries. The researchers focus on the positive effects of forest bathing on mental health, especially in mitigating symptoms of depression, anxiety and stress.

Zusammenfassung

Waldbaden oder Shinrin-yoku ist eine Praxis, die das Eintauchen in Waldumgebungen zur Verbesserung der Gesundheit und des Wohlbefindens beinhaltet und mit Stressabbau, Stärkung des Immunsystems und Verbesserung der Stimmung in Verbindung gebracht wird. Ziel der vorliegenden Analyse ist es, die verfügbare wissenschaftlichen Literatur zu erfassen und zu bewerten, die Zusammenarbeit zwischen Forschern darzustellen sowie zentrale Forschende zu identifizieren, wichtige Zeitschriften zu identifizieren und thematische Trends zu analysieren. Die 285 Dokumente wurden aus Web of Science extrahiert, mit Microsoft Excel und VOSviewer bearbeitet und die Analyse wurde nach den traditionellen Gesetzen der Bibliometrie durchgeführt. Die Anzahl der Dokumente weist ein exponentielles Wachstum auf, was das Interesse der wissenschaftlichen Gemeinschaft an diesem Thema deutlich macht. Im Zentrum der Publikation stehen nur zwei Journale und der prominenteste Autor ist M. Yoshifumi von der Universität Chiba (47 Artikel und 2208 Zitate). Japan und Südkorea sind die Länder mit der höchsten wissenschaftlichen Output. Die Forscher konzentrieren sich auf die positiven Auswirkungen des Waldbadens auf die psychische Gesundheit, insbesondere auf die Linderung der Symptome von Depression, Angst und Stress.

1 Introduction

Today, due to climate change, population growth and uncontrolled development of cities, decreasing biodiversity and forest degradation, which has been steadily depleting over the last decades, are real problems for our planet (Sandifer et al., 2015). This situation is motivating many collectives and individuals, world organisations, governments, public administrations and associations, to increase their concern and appreciation for natural environments, forests and ecosystems, given the benefits that nature and biodiversity can offer to quality of life and the health of the population, and the potential negative consequences resulting from their degradation (Bermejo-Martins et al., 2022; Honeyman, 1992; Kotera et al., 2022; Sandifer et al., 2015; Ulrich, 1984; Ulrich et al., 1991). For decades, researchers have studied how the beneficial relationship with nature has influenced human evolution and people's state of health (Q. Li, 2022; Millward & Appleton, 1988; Orians & Heerwagen, 1992; Wilson, 1984).

In 1982, the Japanese Ministry of Agriculture, Forestry and Fisheries introduced the term "Shinrin-yoku", which means "forest bathing" in Japanese (B. J. Park et al., 2008). Forest bathing is a natural therapeutic technique that involves spending time in a forest or natural environment. This therapy is believed to have numerous positive effects on people's mental and physical health, as evidenced by several studies that investigated the relationship between forest bathing and its potential health benefits, such as: reducing stress (Miyazaki et al., 2014a; Stier-Jarmer et al., 2021; Zhu et al., 2021), improving cardiovascular function (J. Lee et al., 2009; Ochiai et al., 2015; Stier-Jarmer et al., 2021; Tsunetsugu et al., 2007), strengthening the immune system (Q. Li et al., 2007, 2008, 2010; Stier-Jarmer et al., 2021) and alleviating symptoms of chronic diseases such as anxiety, depression and insomnia (Baek et al., 2022; Kang et al., 2022; H. Kim et al., 2020; López-Pousa et al., 2015; Qiu et al., 2022; Stier-Jarmer et al., 2021; Timko Olson et al., 2020). We can establish some differences between forest bathing and forest therapy, both being nature-based practices aimed at promoting wellness, but differing in their approach and structure. Forest bathing, originating in Japan, involves immersing oneself in natural environments, mostly forests, to relax and connect with nature through sensory engagement and mindfulness. It emphasizes informal activities such as walking and meditation. Forest therapy, meanwhile, is a more structured approach, led by trained facilitators or therapists, that incorporates specific therapeutic techniques in the forest setting to address the physical, emotional and mental health needs of individuals. While both practices recognize the benefits of nature for personal wellness, forest therapy offers a more intentional and therapeutic framework for healing and support (Baek et al., 2022; Kang et al., 2022; H. Kim et al., 2020; López-Pousa et al., 2015; Qiu et al., 2022; Stier-Jarmer et al., 2021; Timko Olson et al., 2020)..

Some authors suggest that by going into forests and surrounding oneself with trees and vegetation, the body and mind relax, benefiting from the healing effects of nature. This activity, such as forest bathing, could be done alone or in groups, including activities such as walking, meditation, yoga or just sitting and enjoying the environment (Yu et al., 2021). Even in pure virtual reality forests can serve as relaxation environment (Hejtmánek et al., 2022).In this regard, one of the main benefits of forest bathing is its ability to improve people's mental health, notably its ability to reduce stress (Miyazaki et al., 2014b; Stier-Jarmer et al., 2021; Zhu et al., 2021), as well as being an effective treatment for depression and anxiety (H. Li et al., 2022; Q. Li et al., 2016; Muro et al., 2021). Chronic stress is one of the leading causes of illness worldwide (Torrades, 2007) and spending time in nature has been shown to help lower cortisol levels (J. Lee et al., 2011; B. J. Park et al., 2008; Tsunetsugu et al., 2007, 2010), a stress-related hormone, in the body (Torrades, 2007). In addition, being surrounded by trees and vegetation also increases serotonin levels, a brain chemical related to well-being and happiness (B. J. Park et al., 2020; S. Park et al., 2021), thus improving people's mood and having positive effects on anxiety and depression (Muro et al., 2021).

Forest bathing also has benefits for cardiovascular health (J. Lee et al., 2009; Ochiai et al., 2015; Stier-Jarmer et al., 2021; Tsunetsugu et al., 2007). Spending time in nature has been linked to a reduction in blood pressure (J. Lee et al., 2009; B. J. Park et al., 2007, 2010) and improved cardiovascular system function (Jimenez et al., 2021). In addition, walking in natural environments has positive effects on heart rate and respiration, which helps to strengthen the cardiovascular system (J. Lee et al., 2009; B. J. Park et al., 2008, 2010; Tsunetsugu et al., 2007). Another important benefit of forest bathing is its ability to strengthen the immune system (Q. Li et al., 2007, 2008, 2010), spending time in natural spaces has been found to be associated with an increase in the number of immune cells in the body, which helps prevent disease and accelerates recovery from existing illnesses (Q. Li et al., 2007, 2008, 2010).

On the other hand, it has also been shown that forest bathing can have benefits in improving insomnia (H. Kim et al., 2020; López-Pousa et al., 2015). Studies have found that spending time in nature has the potential to enhance the quality of sleep, shorten the time required to initiate sleep, and extend the overall duration of sleep (H. Kim et al., 2020; López-Pousa et al., 2015). In addition, walking in natural environments can help regulate circadian rhythms, which may be beneficial for people with sleep disorders (H. Kim et al., 2020; López-Pousa et al., 2015).

Moreover, forest bathing not only has a prominent role in improving people's health, but the practice can also be understood as an opportunity for the improvement of socio-economic development in rural areas (Ohe et al., 2017). The evolution of society, new tourism trends or the consequences of the COVID-19 pandemic have boosted the practice of recreational activities carried out in nature (Peng et al., 2023; Vada et al., 2019; Wen et al., 2020). Thus, the importance of tourism modalities related to the health and well-being of tourists (Dillette et al., 2020; Heung & Kucukusta, 2013; Peng et al., 2023), with forest immersion being an emerging tourism practice worldwide (Farkic et al., 2021; Kil et al., 2021; Ohe et al., 2017), should now be highlighted. 

Thus, in previous literature there are some studies that have highlighted the effects that this immersion in nature can have from the point of view of different dimensions, thus adopting a multidisciplinary character (Farkic et al., 2021; Ohe et al., 2017). This study's main objective was to analyse the scientific production published in the Web of Science (WoS) on forest baths, checking the trend followed by annual publications, identifying the prolific and prominent researchers, journals with the highest production and lines of research on forest baths.

2 Material and Methods

2.1 Design and data sources

This scientific mapping was a descriptive bibliometric study based on data extracted from the Web of Science (WoS) core collection, in the editions: Science Citation Index Expanded (SCI-Expanded) and Social Sciences Citation Index (SSCI). Web of Science is a popular database for bibliometric analysis due to its broad multidisciplinary coverage, high quality content, citation tracking capabilities and advanced functionalities that allow efficient and reliable searching, filtering and generation of impact metrics; these being tools that other databases lack. (Ding & Li, 2020; Lu et al., 2019; Mulet-Forteza et al., 2019; Y. Wang et al., 2022). The data strategy followed included the search vector: "forest bathing" (Topic) or "shinrin yoku" (Topic) or "Shirin-yoku" (Topic) or "forest therapy" (Topic) and Articles or Review articles (Documents types); without time or language restrictions.

 

2.2 Data analysis

The phase of scientific development of the object of study was studied, applying Price's Law of Exponential Growth of Science (Dobrov et al., 1979; Price, 1976). The author data was cleaned, eliminating duplicate identities. The most relevant journals in the subject were identified, applying Bradford's Law of concentration of scientific production, calculating the Bradford zones and the adjustment of the dataset to this law (Desai et al., 2018; Morse & Leimkuhler, 1979; Venable et al., 2016). This law states that the scientific literature can be divided into a core and fringe, where a small number of journals contain most of the important articles (Desai et al., 2018; Morse & Leimkuhler, 1979; Venable et al., 2016). Each of these zones should accumulate approximately 33% of the total papers. Lotka's Law was used to identify the prolific co-authors (Coile, 1977; Vega-Muñoz et al., 2022). Hirsch index (h-index) was used to identify the most cited articles, considering as these, the h articles with h or more citations (Hirsch, 2005). Matching prolific co-authors to co-authors of the most cited papers, prolific co-authors who submitted one or more articles among the most cited papers were considered prominent co-authors (Mendoza-Muñoz et al., 2022). A descriptive analysis was carried out with the countries involved in the topic. The keywords most used by the authors were located, applying Zipf's Law (Bulick & Bulick, 1978; Valderrama-Zurián et al., 2021). Data processing and visualisation was carried out with Microsoft Excel v.2204 and VOSviewer software. The network plots generated for co-authors and keywords represented a strength of association analysis. This is a measure that indicates the strength of the relationship between two terms or elements in a bibliographic dataset. This measure is based on the frequency with which two terms appear together in the documents analyzed.

3 Results

We found 285 articles (234 articles and 51 article reviews) indexed in WoS and published between 1998 and 2022, assigned to 63 WoS categories. The categories with the highest number of articles were: Environmental Sciences (121), Public Environmental Occupational Health (119), Forestry (65), Environmental Studies (49) and Urban Studies (32). 

The topic of study was found to be in a phase of exponential growth between 2006 and 2021 (the years prior to 2006 were excluded as there was no continuity in the annual publications, as well as the year 2022, as there was not yet complete data on the publications for that year), with an adjustment of 94.3% (R²) (Figure 1).

The Bradford zones formed by the journals, according to the number of articles published, were adjusted, with a margin of error of 2%, to the estimates obtained by applying Bradford's law of dispersion of the scientific literature. The core group of journals with the most publications on the subject consisted of two journals that accounted for 43% of the articles: International Journal of Environmental Research and Public Health (94 articles) and Urban Forestry & Urban Greening (29 articles). Bradford's zone 1 was made up of 13 journals, accumulating 68% of the publications between the core journals and zone 1 (Table 1). In terms of the number of citations, the core was made up of three journals, which accounted for 37.9% of the citations: International Journal of Environmental Research and Public Health (2029 citations, 94 articles), Urban Forestry & Urban Greening (651 citations, 29 articles) and Ecosystem Services (486 citations, 1 article).

A total of 971 researchers were found with at least one article on the subject. With only one published article, 763 co-authors were found, with 122 researchers co-authoring only two articles, with the number of co-authors dropping to one researcher with 47 co-authored publications (Figure 2).

Applying Lotka's Law to the authors, it was estimated that the prolific authors should be the 31 authors with the highest number of publications. We found 54 co-authors with at least 4 articles, and 29 co-authors with 5 or more articles, so the latter were considered the prolific authors (Supplementary Material 1). A graph of the interrelationships of the 29 prolific co-authors was produced (Method: Fractionalization. Attraction: 6. Repulsion: -6). In this graph the colors represent groups of collaborating authors, the nodes are authors (their size indicates productivity/importance), and the lines indicate collaborations between them. Eight collaborative clusters were found. The main cluster was led by Yoshifumi Miyazaki, together with 14 other researchers (Figure 3).

To identify the prominent co-authors the most cited articles (documents with 47 or more cites), according to the h-index, and prolific co-authors (5 or more documents) were combined, identifying 22 authors with at least one paper among the most cited papers on forest bathing. Yoshifumi Miyazaki emerged as the prominent co-author (47 articles and 2208 citations, 18 most cited papers). Table 2 shows the prominent co-authors in the field of study.

The set of papers consisted of 280 articles written in English, 4 in French and 1 in German. Japan (78 articles, 4011 citations), South Korea (69 articles, 1665 citations), China (49 articles, 788 citations) and United States of America (34 articles, 1876 citations) were the countries with the highest number of publications, among the 35 countries found, publishing on the subject. Figure 4 shows the interrelationships between countries, the size of the node is a function of the number of articles cited from each country, while the colour is a function of the average date of publication, where it can be seen how there are countries that have been adding to the subject in recent years (Method: Fractionalization. Attraction: 10. Repulsion: -6). The lines between the nodes (countries) would indicate scientific collaborations between researchers from different countries in the publication of scientific articles.

Forty-seven articles were found with at least 47 citations, these being the most prominent articles on the object of study. The most cited article was a review entitled “Exploring connections among nature, biodiversity, ecosystem services, and human health and well-being: Opportunities to enhance health and biodiversity conservation” with 486 citations (Sandifer et al., 2015), followed by “The influence of urban green environments on stress relief measures: A field experiment” (432 citations) (Tyrväinen et al., 2014) y “The effect of contact with natural environments on positive and negative affect: A meta-analysis” (265 citations) (McMahan & Estes, 2015). Table S1 (Supplementary materials) shows the 47 most cited articles.

Applying Zipf's Law to the keywords used most by the authors, 26 words stood out, used in at least 8 articles, being: forest therapy (74 occurrences), forest bathing (64), shinrin.yoku (37), heart rate variability (28) and blood pressure (21). Figure 5 shows the interrelationship graph of the 26 keywords most frequently used by the authors.

4 Discussion

This is the first bibliometric analysis based on published research on forest baths on the WoS database (285 documents), verifying the trend followed by annual publications on the subject, identifying the most productive and cited co-authors and journals, the countries most involved in this object of study, the most referenced documents and the mostly used keywords by co-authors. However, we found similar bibliometrics based on the Scopus database (Paletto et al., 2024), two mappings of research in the field of natural therapies (Rodríguez-Redondo et al., 2023; X. Wang et al., 2022), and a review using a different methodology than our study, which does not use the traditional laws of bibliometrics (Hansen et al., 2017), in addition to literature reviews, scoping reviews and systematic reviews (Antonelli et al., 2019; Corazon et al., 2019; Hansen & Jones, 2020; Ideno et al., 2017; Jones et al., 2021; Langemeyer et al., 2021; I. Lee et al., 2017; Oh et al., 2017; Rojas-Rueda et al., 2019; Vibholm et al., 2020; Wolf et al., 2020).

We found that annual publications on forest baths followed a trend of exponential growth, with a very high volume of publications in the last three years, far exceeding the number of publications accumulated in the previous 20 years. These findings show the high interest of researchers, journals and publishers in this topic, giving support to a study like this one. Although they did not demonstrate exponential growth in annual publications on forest therapies, X. Wang et al. (2022). found a massive increase in annual publications on the topic. We also find growing interest outside the scientific field, in Germany organizations have promoted projects such as Kur- und Heilwald, which focus on the promotion of health and well-being through contact with nature. Projects of this type favor the discovery of this type of therapies making them more visible to the population.

Two journals that made up Bradford's core, International Journal of Environmental Research and Public Health (MDPI) and Urban forestry & Urban Greening (Elsevier), standing out as the most productive journals in the subject, coincided with the most productive journals found in the bibliometrics of Wang et al (X. Wang et al., 2022). In this study, journals such as Forests (MDPI), Sustainability (MDPI) and Frontiers in Psychology (Frontiers Media) also appeared in the top 10 journals with the highest number of publications.

The term Shinrin-yoku (forest bathing) has its origins in Japan (B. J. Park et al., 2010), from where it became established in the rest of Eastern Asia countries, and later expanded to the rest of the world. Thus, Japan is the country with the highest number of publications, followed by South Korea and China, something that has been reflected in the most productive authors: Miyazaki, Song, Ikei, Kagawa, Takayama, Li, among others, all of them Japanese; Park, Shin or Kim, co-authors from South Korea; and Wei, Chen, or Jiang, co-authors from China. All of them are among the prolific co-authors, coinciding with the most productive countries in forest therapies (X. Wang et al., 2022). Similarly, many of the most cited papers were published by authors from those countries (J. Lee et al., 2009, 2011, 2014; Q. Li et al., 2008; Morita et al., 2007; B. J. Park et al., 2011). Among the prominent co-authors, a single co-author from a Western country is present, Bielinis (Poland), co-authored 10 papers, with "The effect of winter forest bathing on psychological relaxation of young Polish adults" (Bielinis et al., 2018) being his most cited paper. However, the three most cited papers were published by co-authors from the USA (McMahan & Estes, 2015; Sandifer et al., 2015) and Finland (Tyrväinen et al., 2014). The most cited paper assessed the state of knowledge on the relationships between human health and nature and biodiversity, as well as the positive health effects found (Sandifer et al., 2015), concluding that more initiatives and research by administrations and researchers are needed. Tyrväinen et al. (2014) investigated the psychological and physiological effects of short-term visits to urban natural environments, suggesting that short-term visits to natural areas have positive effects on the relief of perceived stress compared to the built environment, similar to the third most cited paper by McMahan and Estes (McMahan & Estes, 2015).

The effects of forest baths on mental health, such as anxiety and depression states, psychological discomfort or stress have been highly concerned among researchers and so numerous articles and reviews have been found that have evaluated this, finding positive health effects (Bielinis et al., 2019; Chen et al., 2018; J. G. Kim et al., 2020; Kotera et al., 2022; Q. Li, 2019; Song et al., 2018), although results have been found in which they have reported that these effects are not clear (Vibholm et al., 2020). Therefore for the above pathologies, forest baths have been presented as alternative non-pharmacological treatments (Rosa et al., 2021), as well as means of prevention of mental pathologies, or of other pathologies such as hypertension (Bielinis et al., 2021; Ochiai et al., 2015; Wajchman-Świtalska et al., 2021; Yeon et al., 2021; Zhang et al., 2020), finding positive effects on blood pressure. Relaxation exercises, physical activity and exercise in natural spaces, such as green exercise, or walking in green spaces, have been some of the topics of interest for researchers in which positive effects on the physical and mental health and well-being of participants have been evaluated (Kondo et al., 2018; H. Li et al., 2021; Rogerson & Barton, 2015; Shin et al., 2012; Yamaguchi et al., 2006) even in virtual reality forest (Hejtmánek et al., 2022).

When comparing what we found with what was found by Paletto et al. (2024) we observed that 285 documents were found in WoS, compared to the 224 found by them. In both cases, the oldest document is the one written by Ohtsuka et al. (1998), entitled “Shinrin-yoku (forest-air bathing and walking) effectively decreases blood glucose levels in diabetic patients”, although they also found another document in the same year by the same author. The annual growth curves are similar in both databases, finding a gap between 1999 and 2005, both included. The most cited keywords coincide and when analyzing the connections between them we find a similar distribution, in the case of the review carried out in Scopus they did not apply Zipf's law to check the most relevant set of words, so they selected the words with four or more appearances, this being what is observed in their network graph. When we compare countries between both databases we observe that Japan and the United States present a similar number of documents, but that South Korea and China present a difference of 41 documents in the first case and 24 documents in the second, the number of publications located in Scopus being lower. Finally, when comparing the most powerful organizations resulting from the Scopus analysis with the most relevant authors in the WoS analysis, we find a certain discrepancy. The analysis carried out by Paletto et al. (2024) indicates that “Forestry and Forest Products Research Institute” (Japan) is the most powerful organization and “Chiba University” (Japan) the second, in the present analysis the opposite is found, the authors of “Chiba University” (Japan) accumulate a greater number of documents than those of “Forestry and Forest Products Research Institute” (Japan), this may be due to the difference in the number of documents that exists between both databases. We could say with this comparison that when locating documents related to forest toilets it would be more appropriate to use the Web of Science, since it provides a greater number of documents.

More research is needed to explore the effects of forest bathing in different populations, with different cultural characteristics, on the mental and physical health and quality of life of its practitioners. Recently in other countries research is emerging, with new researchers joining in and collaborations established between research groups are filling the gaps in this field of knowledge. 

 

4.1 Limitations and Practical applications

This study was based on the publications of journals indexed in the WoS main collection, despite being the most widely used database in bibliometric studies and one of the most prestigious in the scientific field, this study presents a selection bias, as it does not include documents that could be published in journals indexed in other databases, this being an important limitation. Future research could carry out bibliometric studies that take into account other databases. This research provides important information on who are the most important researchers in the field of forest baths, which journals are most involved, most cited papers and most important research trends. This could facilitate both collaboration between researchers and the identification of research trends.

5 Conclusions

Forest bathing is a growing interest in the scientific field, with annual publications following an exponential growth trend. Countries such as Japan, South Korea and China are the leading producers in this field, with Yoshifumi Miyazaki, the prominent co-author, and International Journal of Environmental Research and Public Health, the journal with the highest number of publications.

The effects of forest bathing on mental health, such as depression, anxiety or stress, are the topics of greatest interest among researchers, and positive effects of forest bathing have been found on the symptomatology of all of them.

Forest baths have been proposed as a preventive treatment to improve mental health and reduce blood pressure. Among the activities to be carried out during forest bathing, relaxation exercises, physical exercise in nature or green exercise, or walking in the natural environment, are some of the activities that have been found in published research.

In short, given the growing interest in this practice from a scientific point of view and taking it to a more practical dimension, we believe that it is necessary to promote this type of therapeutic tourism based on natural resources, whose benefits could be defined in two ways: on the one hand, by promoting the socio-economic development of rural populations, while having a minimal impact on the environment. And, on the other hand, in terms of health, with all the benefits that this immersion in nature means for the health of the people who practise it. To this end, it would be necessary to increase the number of projects such as Kur- und Heilwald in Germany, which promote the use of natural resources.

Acknowledgments

The author ADZ (FPU20/04201) was supported by a grant from the Spanish Ministry of Education, Culture and Sport. Grants FPU20/04201 funded by NCIN/AEI/10.13039/501100011033 and, as appropriate, by “European Social Found Investing in your future” or by “European Union Next Generation EU/PRTR”.

Supplementary Material

Table S1: Most cited articles on forest bathing.

Tabelle S1: Meist zitierte Artikel zum Thema Waldbaden.

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