Table 2.

Research evidence for Ecotherapy in various disorders.

Physical and mental health disorders	Research evidence
Medical Recovery	✓ Enhanced recovery rates of patients undergoing appendectomies were attributed to flowering plants and foliage in hospital rooms (95) ✓ Generalized enhanced health outcomes in patients recovering from surgery were linked to indoor ornamental plants (96) ✓ Enhanced mental health recovery rates of coronary and pulmonary patients were associated with indoor plant exposure in Norway (118)
Pain Reduction	✓ Bio monitoring experimental sessions revealed increases in pain tolerance as a result of exposure to ornamental plants in a simulated hospital room (119) ✓ In a randomized clinical trial of patients undergoing flexible bronchoscopies combining nature sounds and images was shown to reduce pain (120) ✓ Exposure of increased levels of sunlight for patients having undergone spinal surgery resulted in reduced pain, stress, and use of painkilling medication (121)
Post-traumatic Stress Disorder (PTSD)	✓ Wilderness therapy, outdoor adventure and experience and green-space based ecotherapy (e.g., river rafting, interactions and participation in nature) have been shown to be effective therapeutic media for veterans coping with PTSD (84, 122)
Mood Modification, Stress Reduction	✓ Horticultural therapy has been shown to improve mood state reducing stress and positively contribute to coronary heart disease (54), improve self-esteem and reduce depression (57, 123). Healing gardens and natural ecosystem encounters have been shown to reduce depression (58), reduce stress (124) ✓ Spending time in nature, green exercise show positive effect on people's self-esteem and mood (82, 125)
Substance Abuse	✓ Horticultural activities (62) and integrated adventure therapy programs (89), have been shown to be useful in substance abuse treatment ✓ Wilderness and outdoor experiences has been quite useful with chemical dependency (126)
Attention Deficit Hyperkinetic Disorder (ADHD)	✓ Improvement in motor ability, concentration and social play are all positively influenced following interaction or play in nature in children with ADHD (101) ✓ Increased green outdoors activities result in reduced children's ADHD symptoms and have more positive affect effects on symptoms than activities in other settings (100) ✓ Adults and children tend to perform systematically better on objective attention measures after viewing or spending time in natural surroundings (101)
Dementia	✓ The modification of dementia residential design plans in order to incorporate plants, nature and gardens have shown positive effects (127) ✓ Environmental psychologists have shown that exposure to nature and natural settings decreases agitation (61, 103) which often occurs in late stage of dementia ✓ Horticulture therapy improve sleep and cognitive issues in dementia patients (59), improve engagement and mood-related to dementia (60)
Obesity	✓ People with ready access to nature are less likely to be obese, inactive (128) ✓ Increased vegetation and green space were reported to be associated with reduced weight (129) ✓ In eight major European cities, people were 40% less likely to be obese in the greenest areas of those cities (130)
Overall development	✓ Direct contact with nature significantly and positively impacts children's affective, cognitive, and moral development (131, 132) ✓ The greener a child's view from their apartment, the higher he or she scored on several measures of delay of gratification and impulse control (133) ✓ Many studies suggested a systematic relationship between outdoor curricula in green space and enhanced learning (134, 135) ✓ Research into childhood outdoor experiences has identified that a key benefit of interaction with ecosystems is increased cognitive functioning (136, 137)
Well-being, life satisfaction	✓ Even short-term walking interventions, particularly in green-spaces, energize and enhance personal well-being and vitality (81, 138, 139) ✓ Research has established a strong link between contacts with nature and enhanced human well-being (105) ✓ One of the most useful applications of wilderness and outdoor experiences has been with the improvement of family functionality and well-being (92, 140) ✓ Interaction and engagement with green space have been linked with increased length of life and deceased risk of mental illness across a number of countries (99)