Nature-Based Guided Imagery as an Intervention for State Anxiety

Anxiety is a major global mental health concern, and research into effective interventions is crucial. Spending time in nature has demonstrated anxiolytic effects, but this isn't always feasible. Guided imagery (GI) is another effective anxiety-reduction technique. This study hypothesized that combining nature and GI would create a more potent intervention, addressing limitations of solely relying on nature exposure. The study aimed to be the first to directly compare nature-based GI with traditional GI in reducing state anxiety, exploring the potential of an accessible and cost-effective intervention for managing anxiety symptoms. The findings would have implications for developing and providing effective anxiety interventions.

Extensive research supports the anxiolytic benefits of nature, linking it to enhanced vitality, happiness, mood, and self-esteem. Studies have shown that individuals with stronger connections to nature report lower anxiety levels, particularly those with experiential familiarity. While studies have explored the benefits of exercise in nature and the connection between nature relatedness and anxiety, there's a gap in understanding nature's therapeutic potential for anxiety reduction. Previous research on guided imagery (GI) has established its effectiveness in managing anxiety across various populations. GI uses external instruction to internally generate images triggering emotional and physiological responses. Although many GI protocols for anxiety incorporate relaxation techniques, which could also influence the results, there is a strong evidence base for its use. This study aimed to address the gap by examining nature-based GI as an anxiety intervention for the first time.

This within-group study used a two-way repeated measures ANOVA to compare a nature-based GI intervention with a non-nature-based (urban) GI intervention. Forty-eight participants (18 males, 30 females; Mage = 34.54, SDage = 12.91) with moderate trait or state anxiety (STAI ≥ 39) were recruited online. Participants completed the STAI, the Vividness of Visual Imagery Questionnaire (VVIQ), the Connectedness to Nature Scale (CNS), and the Nature Relatedness Scale (NRS). Participants were randomly assigned to begin with either a nature-based or urban-based GI audio session. One week later, they completed the other condition. Pre- and post-state anxiety scores were collected for each session, along with qualitative data describing their imagery. Data analysis included checks for normality, homogeneity of variance, and order effects. A two-way repeated measures ANOVA examined the main effects of condition (nature vs. urban) and time (pre vs. post), and their interaction. Qualitative data were analyzed thematically. Missing data was imputed using Expectation-Maximization.

Both hypotheses were supported. Firstly, GI itself reduced anxiety: both nature-based and urban-based GI sessions resulted in significantly lower post-session anxiety scores compared to pre-session scores (Nature: Pillai's trace = 0.436, F(1,47) = 37.06, p < 0.001, Mdiff = -10.10; Urban: Pillai's trace = 0.342, F(1,47) = 24.40, p < 0.001, Mdiff = -6.77). Secondly, nature-based GI was more effective than urban-based GI: a significant interaction effect between condition and time was found (Pillai's trace = 0.101, F(1,47) = 5.29, p = 0.026, η² = 0.101), indicating a greater anxiety reduction in the nature condition. No significant order effects or gender differences were observed. Correlations between pre-post change scores and CNS, NRS, and VVIQ scores were minimal. Thematic analysis of qualitative data revealed that imagery in the nature condition frequently involved water features, mountains, meadows, forests, and backyard nature scenes. Urban imagery typically included homes, apartments, cafes, cityscapes, and shopping malls. Interestingly, some participants in the urban condition integrated elements of nature into their imagery.

The findings support the effectiveness of both GI and nature-based GI in reducing state anxiety. The greater effectiveness of nature-based GI aligns with existing research showing the anxiolytic effects of exposure to natural environments. The superior results for nature-based imagery may be due to richer multi-sensory experiences and opportunities for restorative attentional engagement, possibly reducing rumination. Participants' active choice of imagery and focus on positive aspects might also contribute. However, the study's design doesn't allow conclusions about the underlying mechanisms. Further research is needed to clarify the mechanisms (perception, sensory focus, memory, relationship with environments) driving the anxiety-reduction effect of nature-based GI.

This study provides the first evidence that nature-based GI is an effective intervention for reducing state anxiety, even more so than traditional GI. Future studies should explore long-term effects, investigate different types of nature environments, use larger and more diverse samples, and examine the role of factors like trait mindfulness. Clinicians could confidently use nature-based imagery within GI interventions, tailoring the content to individual experiences and relationships with nature. The accessibility of audio-based GI makes this a valuable tool beyond traditional therapeutic settings.

The study's online recruitment might have resulted in a sample skewed toward Australians, potentially influencing the types of nature scenes imagined. The relatively small sample size limits the generalizability of the findings. Further investigation is needed to identify underlying mechanisms beyond simply the presence of nature imagery. The study lacked a true control group to isolate the effect of GI alone. The use of self-reported measures (STAI) might be susceptible to subjective biases.