Nature-Based Guided Imagery as an Intervention for State Anxiety

The study addresses anxiety as a major mental health issue and examines whether guided imagery (GI) that features natural environments can reduce state anxiety, especially when physical access to nature is limited (e.g., urban settings, therapy rooms). Building on evidence that both nature exposure and GI independently reduce anxiety, the research asks: (1) Does the process of GI itself reduce state anxiety? (2) Is nature-based GI more effective than non-nature (urban)-based GI in reducing state anxiety? The purpose is to test these hypotheses and explore whether individual differences in connectedness/relatedness to nature and vividness of mental imagery influence outcomes.

Nature and Anxiety: Prior work shows nature benefits psychological health, including vitality, happiness, mood, self-esteem, and stress reduction. Studies link nature exposure and nature connectedness with lower anxiety and its antecedents. For example, higher nature connectedness correlates with lower state and trait cognitive anxiety (Martyn & Brymer, 2014), and outdoor exercise predicts lower anxiety compared with indoor exercise (Lawton et al., 2017). Green environments may be more restorative, with nature’s rich sensory stimuli potentially reducing rumination (Bratman et al., 2015a,b). However, access to nature can be limited and mechanisms are not fully understood. Guided Imagery and Anxiety: GI uses externally guided instructions to evoke multisensory internal representations, which can produce emotional and physiological responses similar to real experiences. Imagery can act as an emotional amplifier and is particularly effective for anxiety, a perceptually based emotion (Holmes & Mathews, 2005, 2010). GI has reduced anxiety in diverse populations (e.g., students, medical patients, first-time mothers, speech anxiety). Some GI protocols include suggestions to relax, complicating attribution of effects. Although imagery of nature has been suggested (e.g., safe place visualizations), no prior study explicitly isolated nature-based GI to test anxiolytic effects. Theoretical perspectives (ecological dynamics and evolutionary accounts) suggest nature imagery might be especially effective due to richer multisensory landscapes and human attunement to natural information.

Design: Within-subjects design comparing a nature-based GI condition to a non-nature (urban)-based GI condition. Two-way repeated measures ANOVA assessed effects of condition (nature vs urban) and time (pre vs post). Order effects tested via two-way mixed-design ANOVA with order as a between-subjects factor (nature-first vs urban-first). Participants: 48 adults completed both conditions (18 males, 30 females; Mage = 34.54, SD = 12.91; age 19–71). Most resided in Australia (95.8%). Inclusion required age ≥18 and current anxiety symptoms (screened with STAI; score ≥39 on state or trait). Recruitment occurred online via social media, organizations, and a university forum; participation was anonymous and online. Measures: - State-Trait Anxiety Inventory (STAI; 20-item state and 20-item trait scales). Used for screening (state or trait ≥39) and as primary outcome (state pre/post each session). Validity supported; test-retest reliability: trait 0.97; state 0.45. - Vividness of Visual Imagery Questionnaire (VVIQ; internal consistency α=0.88) to assess imagery vividness. - Connectedness to Nature Scale (CNS; α=0.82) and Nature Relatedness Scale (NRS; α=0.87) to assess trait nature connection/relatedness. - Qualitative check: brief open-ended question after each GI (“what images did you see in your mind?”) to verify imagery content and identify themes. Interventions (GI Audios): Two ~10-minute audio scripts (mp3) developed by researchers with a GI-trained psychologist, following adapted PETTLEP and imagery scripting guidelines. Scripts were identical in process but differed in content focus: - Nature-based GI: participants transported themselves to a self-chosen natural environment and engaged multisensory details (visual, auditory, tactile, olfactory). - Urban-based GI: participants transported themselves to a self-chosen urban environment (examples provided: house, apartment building, shopping mall), engaging multisensory details. No explicit relaxation suggestions were included to isolate environmental content effects. Procedure: After consent and screening, eligible participants completed demographics, VVIQ, CNS, and NRS. Participants were randomized to the order of conditions (nature-first n=23; urban-first n=25). Before each GI session, participants completed STAI-state (pre). They listened to the assigned GI in a quiet environment, then completed STAI-state (post) and described imagery content. One week separated sessions. Only those completing both sessions were analyzed. Data Analysis: Missing data evaluated with Little’s MCAR test (χ²=3.64, p=.89); missing values imputed via Expectation Maximization. Assumptions of normality and homogeneity were met (Shapiro-Wilk, Fmax, Levene’s). Order effects evaluated with two-way mixed ANOVA. Main effects/interactions assessed with two-way repeated measures ANOVA (Pillai’s trace reported). Gender by treatment effects explored. Correlations between change scores and CNS, NRS, VVIQ were examined; due to minimal relationships (r=.01–.12) and small sample, these were not used as covariates. Qualitative data underwent thematic analysis with coding cross-checked by two researchers and integrated with quantitative findings for interpretation.

- Assumptions met (normality, homogeneity). Missingness was MCAR (χ²=3.64, p=.89) and imputed. - No order effects: Pillai’s trace = 0.007, F(1,46)=0.32, p=0.57, η²=0.007. - No significant gender by treatment effects: F(1,46)=0.005, p=0.946. - Minimal correlations between change scores (urban and nature) and CNS, NRS, VVIQ (r=.01–.12); thus not included as covariates. - Significant Condition × Time interaction: Pillai’s trace = 0.101, F(1,47)=5.29, p=0.026, η²=0.101, indicating greater pre–post anxiety reduction for nature GI compared to urban GI. - Both conditions significantly reduced state anxiety: • Nature GI: Pillai’s trace = 0.436, F(1,47)=37.06, p<0.001; Mean difference (post–pre) = −10.10, 95% CI [−13.47, −6.73], η²=0.436. • Urban GI: Pillai’s trace = 0.342, F(1,47)=24.40, p<0.001; Mean difference (post–pre) = −6.77, 95% CI [−9.52, −4.01], η²=0.342. - Descriptive means (STAI-State): • Nature: Pre M=44.16 (SD=11.90), Post M=34.06 (SD=10.80). • Urban: Pre M=42.27 (SD=11.39), Post M=35.50 (SD=11.46). - Qualitative themes confirmed compliance with instructed environments; some urban imagery included elements of urban nature (e.g., tree-lined streets, gardens).

Findings confirm that guided imagery, independent of explicit relaxation instructions, reduces state anxiety, supporting the idea that imagery functions as an emotional amplifier for perceptually based emotions like anxiety. Mechanistically, engaging multisensory details during GI may approximate real perceptual experiences, influencing similar emotional systems and enabling participants to focus on safe, comfortable action possibilities (ecological perspective). Crucially, nature-based GI produced a significantly larger reduction in state anxiety than urban-based GI. This aligns with prior research showing stronger restorative and stress-recovery responses to natural versus urban scenes, potentially due to richer sensory stimuli and reduced rumination in nature. The inclusion of nature elements by some participants during urban GI suggests that even minimal urban nature may confer anxiolytic imagery effects. The results were not moderated by gender, imagery vividness, or trait nature connectedness/relatedness, indicating broad applicability. Practically, nature-based GI offers a cost-effective, accessible anxiety management tool that can be used where direct contact with nature is not feasible and can be tailored to clients’ personal affiliations with natural environments.

The study demonstrates that guided imagery effectively reduces state anxiety and that nature-based guided imagery yields greater reductions than urban-based imagery, even without explicit relaxation cues. This contributes novel evidence that the content of imagery—specifically natural environments—enhances GI’s anxiolytic effects. Nature-based GI is accessible, low-cost, and suitable for therapeutic and self-guided use. Future research should examine long-term effects (including trait anxiety), clinical populations, the influence of different natural/urban contexts and levels of greenery, cross-cultural/geographical differences, incorporate control groups and manipulation checks, and compare GI with related interventions (e.g., mindfulness) while exploring mechanisms such as sensory engagement, perception, memory associations, and rumination.

- Immediate, short-term effects only; no assessment of long-term or trait anxiety outcomes. - No non-contextual control group; potential expectancy/demand characteristics not fully ruled out. - Limited depth in assessing GI content/mechanisms; manipulation checks were not included. - Sample primarily from Australia, potentially limiting generalizability; participants may have imagined landscape types familiar to that region. - Some participants incorporated nature elements into the urban imagery, potentially attenuating differences between conditions. - Online, self-administered setting without researcher presence; potential variability in listening environment. - Modest sample size; although order and gender effects were analyzed, broader subgroup analyses were limited. - No direct measurement of physiological indices (e.g., heart rate) or rumination mechanisms.