{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:03:57Z","timestamp":1785218637003,"version":"3.55.0"},"reference-count":94,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Stress-related health problems have increased sharply over the last two decades and have become a serious issue at all levels of society. In the J\u00f6nk\u00f6ping Region in southern Sweden, a nature-based rehabilitation (NBR) program for adults with Exhaustion Syndrome has been developed and then implemented into the Swedish National Healthcare System. The main aim of this study was to investigate the effectiveness of this NBR-program. This was achieved by examining patients\u2019 quality of life, exhaustion symptoms and overall health using self-assessment instruments, comparing the results before participation to immediately after, three months after and six months after. With a sample size of 67 participants, the results show a statistically significant improvement for all points. From a public health perspective, and with background knowledge of the nature of the patient group under treatment, the studied program would appear to be effective and economic, having a satisfied patient group as well as a favourable comparison with the outcomes of other research programs. Although the results are promising, as this is a naturalistic field study, there is no control group, and further research is encouraged. We suggest randomised controlled studies, longitudinal studies and investigation of mediators.<\/jats:p>","DOI":"10.3390\/ijerph20176677","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T10:30:52Z","timestamp":1693391452000},"page":"6677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Medical Nature-Based Rehabilitation Program for Individuals with Exhaustion Syndrome: Changes in Quality of Life, Exhaustion Symptoms and Overall Health"],"prefix":"10.3390","volume":"20","author":[{"given":"Eleanor","family":"Petitt","sequence":"first","affiliation":[{"name":"Department of Psychology, Lund University, 221 00 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Rolander","sequence":"additional","affiliation":[{"name":"Futurum\u2014The Academy for Health and Care, Region J\u00f6nk\u00f6ping, 553 05 J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Johnsson","sequence":"additional","affiliation":[{"name":"Department of Psychology, Lund University, 221 00 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"ref_1","unstructured":"W\u00e4hrborg, P. (2002). Stress och den Nya Oh\u00e4lsan, Natur och Kultur."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ekl\u00f6f, B., Larsson, H., Ellbin, S., Jonsdottir, I.H., O\u2019Dwyer, S., and Hansson, C. (2022). The role of self-reported stressors in recovery from Exhaustion Disorder: A longitudinal study. BMC Psychiatry, 22.","DOI":"10.1186\/s12888-022-04172-y"},{"key":"ref_3","unstructured":"Perski, A. (2012). Ur Balans, Bonnier."},{"key":"ref_4","first-page":"19","article-title":"Stress som orsak till psykisk oh\u00e4lsa","volume":"107","author":"Grape","year":"2010","journal-title":"L\u00e4kartidningen"},{"key":"ref_5","unstructured":"Hasson, D. (2008). Stressa R\u00e4tt! \u00d6ka din Energi, H\u00e4lsa och Effektivitet, Viva."},{"key":"ref_6","unstructured":"\u00c5sberg, M., Glise, K., Herlofson, J., Jacobsson, L., Krakau, I., and Nygren, \u00c5. (2003). Utmattningssyndrom\u2013en Kunskaps\u00f6versikt om Stressrelaterad Psykisk Oh\u00e4lsa, Socialstyrelsen."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/s41574-019-0228-0","article-title":"The human stress response","volume":"15","author":"Russell","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_8","unstructured":"W\u00e4hrborg, P. (2023). Komplexa Syndrome, Studentlitteratur."},{"key":"ref_9","unstructured":"F\u00f6rs\u00e4kringskassan (2023, April 28). Svar p\u00e5 Regeringsuppdrag: Rapport\u2014Uppf\u00f6ljning av Sjukfr\u00e5nvarons Utveckling 2020. Version 1.0. 001382-2020. Stockholm. F\u00f6rs\u00e4kringskassan. Available online: https:\/\/www.forsakringskassan.se\/download\/18.3a5418591814e228e441158\/1657123531728\/uppfoljning-av-sjukfranvarons-utveckling-2020-svar-pa-regeringsuppdrag-dnr-001382-2020.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/sjop.12251","article-title":"Stress-related exhaustion disorder\u2014Clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout","volume":"56","author":"Grossi","year":"2015","journal-title":"Scand. J. Psychol."},{"key":"ref_11","unstructured":"Arenlind, E. (2015). KBT vid Utmattningssyndrom. [Bachelor\u2019s Thesis, Lund University]. Available online: http:\/\/lup.lub.lu.se\/student-papers\/record\/5469603."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Adamsson, A., and Bernahrdsson, S. (2018). Symptoms that may be stress-related and lead to exhaustion disorder: A retrospective medical chart review in Swedish primary care. BMC Fam. Pract., 19.","DOI":"10.1186\/s12875-018-0858-7"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Linds\u00e4ter, E., Sv\u00e4rdman, F., Rosquist, P., Wallert, J., Ivanova, E., Lekander, M., S\u00f6derholm, A., and R\u00fcck, C. (2023). Characterization of exhaustion disorder and identification of outcomes that matter to patients: Qualitative content analysis of a Swedish national online survey. Stress Health, 1\u201315.","DOI":"10.1002\/smi.3224"},{"key":"ref_14","unstructured":"Socialstyrelsen (2020, January 15). Internationell Statistisk Klassifikation av Sjukdomar och Relaterade H\u00e4lsoproblem. Systematisk F\u00f6rteckning. Svensk Version 2011 (ICD-10-SE). Available online: http:\/\/www.socialstyrelsen.se\/publikationer2010\/2010-11-13."},{"key":"ref_15","unstructured":"Sandstr\u00f6m, A. (2010). Neurocognitive and Endocrine Dysfunction in Women with Exhaustion Syndrome. [Ph.D. Thesis, Ume\u00e5 University]. Available online: http:\/\/urn.kb.se\/resolve?urn=urn:nbn:se:umu:diva-37280."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"752707","DOI":"10.3389\/fpsyg.2021.752707","article-title":"\u201dWho I Am Now, Is More Me.\u201d An Interview Study of Patients\u2019 Reflections 10 Years After Exhaustion Disorder","volume":"12","author":"Ellbin","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e038230","DOI":"10.1136\/bmjopen-2020-038230","article-title":"Facing a blind alley\u2014Experiences of stress-related exhaustion: A qualitative study","volume":"10","author":"Ali","year":"2020","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"40s","DOI":"10.1016\/S0924-9338(02)80180-8","article-title":"Job-stress, exhaustion and depression","volume":"17","year":"2002","journal-title":"Eur. Psychiatry"},{"key":"ref_19","first-page":"484","article-title":"Att Skilja Mellan Depression och Utmattningssyndrom","volume":"110","author":"Nygren","year":"2013","journal-title":"L\u00e4kartidningen"},{"key":"ref_20","unstructured":"Socialstyrelsen (2023, April 28). Utmattningssyndrom. Stressrelaterad Oh\u00e4lsa. Underlag Fr\u00e5n Experter. Stockholm: Socialstyrelsen. Available online: https:\/\/kognitivateametrehab.se\/wp-content\/uploads\/2015\/09\/socialstyrelsen-utmattning.pdf."},{"key":"ref_21","unstructured":"Forte (2020). En Kunskaps\u00f6versikt Psykisk Oh\u00e4lsa, Arbetsliv och Sjukfr\u00e5nvaro, Holmbergs."},{"key":"ref_22","unstructured":"F\u00f6rs\u00e4kringskassan (2023, April 28). Socialf\u00f6rs\u00e4kringsrapport 2020: 8. Sjukfr\u00e5nvaro i Psykiatriska Diagnoser. Available online: https:\/\/www.forsakringskassan.se\/download\/18.7fc616c01814e179a9f329\/1656660446139\/sjukfranvaro-i-psykiatriska-diagnoser-socialforsakringsrapport-2020-8.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1037\/ocp0000069","article-title":"The cost of work-related stress to society: A systematic review","volume":"23","author":"Hassard","year":"2018","journal-title":"J. Occup. Health Psychol."},{"key":"ref_24","unstructured":"European Risk Observatory (2014). Calculating the Cost of Work-Related Stress and Psychosocial Risks, Publications Office of the European Union. Literature Review; European Agency of Safety and Health at Work."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1037\/ocp0000053","article-title":"Born and bred to burn out: A life-course view and reflections on job burnout","volume":"22","author":"Hakanen","year":"2017","journal-title":"J. Occup. Health Psychol."},{"key":"ref_26","unstructured":"Ekman, R., and Arnetz, B.B. (2013). Stress: Gen, Individ, Samh\u00e4lle, Liber. Suppl. 3."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Grahn, P., P\u00e1lsd\u00f3ttir, A.M., Ottosson, J., and Jonsdottir, I.H. (2017). Longer Nature-Based Rehabilitation May Contribute to a Faster Return to Work in Patients with Reactions to Severe Stress and\/or Depression. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14111310"},{"key":"ref_28","unstructured":"P\u00e1lsd\u00f3ttir, A.M. (2014). The Role of Nature in Rehabilitation for Individuals with Stress-Related Mental Disorders Alnarp Rehabilitation Garden as Supportive Environment. [Ph.D. Thesis, SLU Alnarp]. Available online: https:\/\/res.slu.se\/id\/publ\/55146."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"79","DOI":"10.17660\/ActaHortic.2016.1121.12","article-title":"The theoretical model and universal definition of horticultural therapy","volume":"1121","author":"Son","year":"2016","journal-title":"Acta Hortic."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2340\/16501977-1259","article-title":"Nature-assisted rehabilitation for reactions to severe stress and\/or depression in a rehabilitation garden: Long-term follow-up including comparisons with a matched population-based reference cohort","volume":"46","author":"Petersson","year":"2014","journal-title":"J. Rehabil. Med."},{"key":"ref_31","unstructured":"Sahlin, E. (2014). To Stress the Importance of Nature, Nature-Based Therapy for the Rehabilitation and Prevention of Stress-Related Disorders. [Ph.D. Thesis, Swedish University of Agricultural Sciences]."},{"key":"ref_32","first-page":"8","article-title":"How do participants in nature-based therapy experience and evaluate their rehabilitation?","volume":"22","author":"Sahlin","year":"2012","journal-title":"J. Ther. Hortic."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ruwaard, J., Lange, A., Schrieken, B., Dolan, C.V., and Emmelkamp, P. (2012). The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0040089"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.brat.2011.03.009","article-title":"Acceptance and commitment therapy for the treatment of stress among social workers: A randomized controlled trial","volume":"49","author":"Brinkborg","year":"2011","journal-title":"Behav. Res. Ther."},{"key":"ref_35","first-page":"1692","article-title":"Fysisk aktivitet bra mot stressrelaterad psykisk sjuklighet","volume":"108","author":"Glise","year":"2011","journal-title":"L\u00e4kartidningen"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s12199-009-0086-9","article-title":"The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): Evidence from field experiments in 24 forests across Japan","volume":"15","author":"Park","year":"2010","journal-title":"Environ. Health Prev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1037\/1076-8998.13.3.214","article-title":"Individual and group cognitive-behavioral treatment for work-related stress complaints and sickness absence: A randomized controlled trial [Elektronisk version]","volume":"13","author":"Kamphuis","year":"2008","journal-title":"J. Occup. Health Psychol."},{"key":"ref_38","unstructured":"Grossi, G. (2008). Hantera din Stress Med Kognitiv Beteendeterapi, Viva."},{"key":"ref_39","first-page":"1295","article-title":"Behandling av l\u00e5ngtidssjukskrivna patienter med stressdiagnoser","volume":"101","author":"Grossi","year":"2004","journal-title":"L\u00e4kartidningen"},{"key":"ref_40","unstructured":"Lidfors, L., Wahlgren, E.G., Vestlund, C., and Johansson, A. (2023, April 28). Green Rehabilitation as Treatment on a Farm\u2014Development of Methods in Nature-Assisted Rehabilitation with an Interdisciplinary Care Team to Treat Exhaustion Syndrome (2021, 8). Uppsala: SLU Future One Health. Available online: https:\/\/pub.epsilon.slu.se\/22856\/1\/lindfors_l_et_al_210329.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.3390\/ijerph120201928","article-title":"Using nature-based rehabilitation to restart a stalled process of rehabilitation in individuals with stress-related mental illness","volume":"12","author":"Sahlin","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/02827581.2011.558521","article-title":"Can boreal forest be used for rehabilitation and recovery from stress-related exhaustion? A pilot study","volume":"26","author":"Nordin","year":"2011","journal-title":"Scand. J. For. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4306\/pi.2012.9.2.100","article-title":"What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?","volume":"9","author":"Detweiler","year":"2012","journal-title":"Psychiatry Investig."},{"key":"ref_44","first-page":"37","article-title":"The view from all fours: A look at an animal-assisted activity program from the animals\u2019 perspective","volume":"20","author":"Hatch","year":"2007","journal-title":"Anthrozoos A Multidiscip. J. Interact. People Anim."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/0002764203255209","article-title":"Section introduction: Human-animal bond and primary prevention","volume":"47","author":"Cantazaro","year":"2003","journal-title":"Am. Behav. Sci."},{"key":"ref_46","unstructured":"Grahn, P., and Ottosson, \u00c5. (2010). Bonnier Existens."},{"key":"ref_47","unstructured":"Engstr\u00f6m, \u00c5., Juuso, P., Liljegren, M., and Lundmark Alfredsson, L. (2022). V\u00e5rd, Omsorg och Rehabilitering Utomhus\u2014Teori, Praktik och nya Perspektiv, Studentlitteratur AB."},{"key":"ref_48","unstructured":"Ernvik, U. (2022). Ekopsykoterapi, Psykoterapi i och Med Naturen f\u00f6r Vuxna och Barn, Studentlitteratur AB."},{"key":"ref_49","unstructured":"Daniel, M. How Does Your Garden Grow? The Value of Horticultural Therapy. Medscape, Available online: https:\/\/www.medscape.com\/viewarticle\/960708#vp_2."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Bergenheim, A., Ahlborg, G., and Bernhardsson, S. (2021). Nature-Based Rehabilitation for Patients with Long-Standing Stress-Related Mental Disorders: A Qualitative Evidence Synthesis of Patients\u2019 Experiences. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18136897"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/1403494810396400","article-title":"Nature-assisted therapy: Systematic review of controlled and observational studies","volume":"39","author":"Annerstedt","year":"2011","journal-title":"Scand. J. Public Health"},{"key":"ref_52","unstructured":"Bischoff, A., Kissow, A.-M., Johansen, J.S., Mygind, O., and Vibholm, P. (2019). Rehabilitering ude: Nye Ressourcer og Perspektiv er i Rehabilitering, Nota."},{"key":"ref_53","unstructured":"Larsson, A.-L. (2020). Gr\u00f6na Rehabs Modell\u2014Vid Stressrelaterad Oh\u00e4lsa. Andra Upplagan, Studentlitteratur AB."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"7094","DOI":"10.3390\/ijerph110707094","article-title":"The Journey of Recovery and Empowerment Embraced by Nature\u2014Clients\u2019 Perspectives on Nature-Based Rehabilitation in Relation to the Role of the Natural Environment","volume":"11","author":"Persson","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_55","unstructured":"Ottosson, J. (2007). The Importance of Nature in Coping, Creating Increased Understanding of the Importance of Pure Experiences of Nature to Human Health. [Ph.D. Thesis, SLU Alnarp]."},{"key":"ref_56","unstructured":"Lindstr\u00f6m, M. (2023, April 28). Naturbaserad Rehabilitering och Naturunderst\u00f6dda Aktiviteter\u2014Evidens och Lokala Till\u00e4mpningar F\u00f6rstudierapport. (CVU-2017-978). Region \u00d6sterg\u00f6tland, Sverige: Verksametsutveckling V\u00e5rd och H\u00e4lsa. Available online: https:\/\/vardgivarwebb.regionostergotland.se\/pages\/375406\/F%C3%B6rstudie%20NBR%20slutlig.pdf."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.ufug.2015.06.002","article-title":"\u201cNature\u2019s effect on my mind\u201d\u2014Patients\u2019 qualitative experiences of a forest-based rehabilitation programme","volume":"14","author":"Stenlund","year":"2015","journal-title":"Urban For. Urban Green."},{"key":"ref_58","unstructured":"Ahlborg, G., Bergenheim, A., Eriksson, M., Jiveg\u00e5rd, L., Sundell, G., Svanberg, T., Svensson, M., and Bernhardsson, S. (2020). Nature-Based Rehabilitation for Patients with Longstanding Stress-Related Disorders\u2014An Updated Report. (2020, 112), V\u00e4stra G\u00f6talandsregionen, Sahlgrenska Universitetssjukhuset."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"234","DOI":"10.3389\/fpsyg.2012.00234","article-title":"Psychosocial and psychophysiological effects of human-animal interactions: The possible role of oxytocin","volume":"3","author":"Beetz","year":"2012","journal-title":"Front. Psychol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2527\/af.2014-0021","article-title":"Research in the use of animals as a treatment for humans","volume":"4","author":"Thodberg","year":"2014","journal-title":"Anim. Front."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Fine, A.H., Weaver, S.J., Van den Bosch, M., and Bird, W. (2018). Oxford Textbook of Nature and Public Health: The Role of Nature in Improving the Health of a Population, Oxford University Press.","DOI":"10.1093\/med\/9780198725916.001.0001"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/01426390701773813","article-title":"The Role of Natural Settings in Crisis Rehabilitation: How Does the Level of Crisis Influence the Response to Experiences of Nature with Regard to Measures of Rehabilitation?","volume":"33","author":"Ottosson","year":"2008","journal-title":"Landsc. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"7","DOI":"10.17660\/ActaHortic.2016.1121.2","article-title":"Using indoor plants and natural elements to positively impact occupants of residential aged-care facilities","volume":"1121","author":"Scott","year":"2016","journal-title":"Acta Hortic."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/0272-4944(95)90001-2","article-title":"The restorative benefits of nature: Toward an integrative framework","volume":"15","author":"Kaplan","year":"1995","journal-title":"J. Environ. Psychol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1080\/10937404.2016.1196155","article-title":"Attention Restoration Theory: A systematic review of the attention restoration potential of exposure to natural environments","volume":"19","author":"Ohly","year":"2016","journal-title":"J. Toxicol. Environ. Health"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/S0272-4944(05)80184-7","article-title":"Stress recovery during exposure to natural and urban environments","volume":"11","author":"Ulrich","year":"1991","journal-title":"J. Environ. Psychol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Altman, I., and Wohlwill, J. (1983). Human Behavior and Environment (Vol 6), Behavior and Natural Environment, (85\u2013125), Plenum Press.","DOI":"10.1007\/978-1-4613-3539-9"},{"key":"ref_68","unstructured":"Penning-Rowsell, E.C., and Lowenthal, D. (1986). Landscape Meanings and Values, Routledge."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/01426397508705780","article-title":"The experience of Landscape","volume":"1","author":"Appleton","year":"1975","journal-title":"Landsc. Res."},{"key":"ref_70","unstructured":"Wilson, E.O. (1986). Biophilia, Harvard University Press."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.ufug.2014.09.007","article-title":"Outdoor environments in healthcare settings: A quality evaluation tool for use in designing healthcare gardens","volume":"13","author":"Bengtsson","year":"2014","journal-title":"Urban For. Urban Green."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Jones, R., Tarter, R., and Ross, A.M. (2021). Greenspace Interventions, Stress and Cortisol: A Scoping Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18062802"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1359105310365577","article-title":"Gardening Promotes Neuroendocrine and Affective Restoration from Stress","volume":"16","author":"Custers","year":"2011","journal-title":"J. Health Psychol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/S1090-0233(02)00237-X","article-title":"Neurophysiological correlations of affiliative behavior between humans and dogs","volume":"165","author":"Odendaal","year":"2003","journal-title":"Vet. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0022-3999(00)00183-5","article-title":"Animal-assisted therapy\u2014Magic or medicine?","volume":"49","author":"Odendaal","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"102514","DOI":"10.1016\/j.ctim.2020.102514","article-title":"Effect of nature exposure on perceived and physiologic stress: A systematic review","volume":"53","author":"Shuda","year":"2020","journal-title":"Complement. Ther. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.physbeh.2013.05.023","article-title":"Inducing physiological stress recovery with sounds of nature in a virtual reality forest--results from a pilot study","volume":"118","author":"Annerstedt","year":"2013","journal-title":"Physiol. Behav."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/BF03393073","article-title":"Relational Frame Theory: An Overview of the Controversy","volume":"25","author":"Gross","year":"2009","journal-title":"Anal. Verbal Behav."},{"key":"ref_79","unstructured":"Friedman, H.S., and Markey, C.H. (2023). Encyclopedia of Mental Health, Elsevier Inc.. [3rd ed.]."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Didonna, F. (2009). Clinical Handbook of Mindfulness, Springer Science Business Media.","DOI":"10.1007\/978-0-387-09593-6"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"xi","DOI":"10.1016\/j.copsyc.2019.02.005","article-title":"Foreword: Seeds of a necessary global renaissance in the making: The refining of psychology\u2019s understanding of the nature of mind, self, and embodiment through the lens of mindfulness and its origins at a key inflection point for the species","volume":"28","year":"2019","journal-title":"Curr. Opin. Psychol."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"(1990). The EuroQol Group\u2014A New Facility for the Measurement of Health-Related Quality of life. Health Policy, 16, 199\u2013208. Available online: https:\/\/euroqol.org\/eq-5d-instruments\/.","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/16506073.2016.1143526","article-title":"The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation","volume":"45","author":"Lindner","year":"2016","journal-title":"Cogn. Behav. Ther."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S0022-3999(99)00007-0","article-title":"Chronic burnout, somatic arousal and elevated cortisol levels","volume":"46","author":"Melamed","year":"1999","journal-title":"J. Psychosom. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-12-1","article-title":"Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ)","volume":"12","author":"Jonsdottir","year":"2012","journal-title":"BMC Public Health"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1037\/str0000235","article-title":"The reliability and factorial validity of different versions of the Shirom-Melamed Burnout Measure\/Questionnaire and normative data for a general Swedish sample","volume":"28","author":"Jansson","year":"2021","journal-title":"Int. J. Stress Manag."},{"key":"ref_87","unstructured":"Osadolor, C., and Bagley, A. (2022). Stress and Burnout: A Correlation Study Using the PSS-10 and the SMBQ. [Bachelor\u2019s Thesis, Ume\u00e5 University]. Available online: http:\/\/urn.kb.se\/resolve?urn=urn:nbn:se:umu:diva-198954."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Norlund, S., Reuterwall, C., H\u00f6\u00f6g, J., Lindahl, B., Janlert, U., and Birgander, L.S. (2010). Burnout, working conditions and gender\u2014results from the northern Sweden MONICA study. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-326"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5271\/sjweh.987","article-title":"Disturbed sleep and fatigue in occupational burnout","volume":"32","author":"Ekstedt","year":"2006","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1037\/1040-3590.4.1.92","article-title":"Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment","volume":"4","author":"Frisch","year":"1992","journal-title":"Psychol. Assess."},{"key":"ref_91","unstructured":"Frykheden, O. (2014). Effektiv M\u00e4tning av Livskvalitet\u2014Brunnsviken Brief Quality of Life Inventory (BBQ)\u2014En Psykometrisk Utv\u00e4rdering. [Master\u2019s Thesis, Psykologiska Institutionen, Stockholms Universitet]. Available online: http:\/\/urn.kb.se\/resolve?urn=urn:nbn:se:su:diva-111136."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s11136-010-9649-x","article-title":"Feasibility, reliability, and validity of the EQ-5D-Y: Results from a multinational study","volume":"19","author":"Wille","year":"2010","journal-title":"Qual. Life Res."},{"key":"ref_93","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Routledge. [2nd ed.]."},{"key":"ref_94","unstructured":"Corder, G.W., and Foreman, D.I. (2014). Nonparametric Statistics: A Step-by-Step Approach, Wiley."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/17\/6677\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:41:59Z","timestamp":1760128919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/17\/6677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,29]]},"references-count":94,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["ijerph20176677"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20176677","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,29]]}}}