sustainability
Article
A Qualitative Study Comparing Mindfulness and Shinrin-Yoku
(Forest Bathing): Practitioners’ Perspectives
Fiona J. Clarke 1,* , Yasuhiro Kotera 2 and Kirsten McEwan 3
1 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
2 Human Sciences Research Centre, University of Derby, Derby DE22 1GB, UK; y.kotera@derby.ac.uk
3 College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK;
k.mcewan@derby.ac.uk
* Correspondence: f.j.clarke@bham.ac.uk
Citation: Clarke, F.J.; Kotera, Y.;
McEwan, K. A Qualitative Study
Comparing Mindfulness and
Shinrin-Yoku (Forest Bathing):
Practitioners’ Perspectives.
Sustainability 2021, 13, 6761.
https://doi.org/10.3390/su13126761
Abstract: The boundary between mindfulness and forest bathing, two conceptually related therapies,
is unclear. Accordingly, this study reports the strengths and challenges, similarities and differences,
and barriers and facilitators for both. Semi-structured interviews were conducted with seven trained
and experienced practitioners of both mindfulness and forest bathing. Reflexive thematic analysis
revealed four main themes: (i) differences between the approaches; (ii) the benefits of forest bathing;
(iii) biophilia through forest bathing; and (iv) inward versus outward attentional focus as a distinction
between the approaches. Both practices were found to benefit well-being, but practitioners revealed
key barriers to mindfulness. For vulnerable groups experiencing mental health challenges or difficul-
ties achieving a meditative state, mindfulness may introduce well-being risks. By offering a gentler,
more intuitive approach that encourages outward attentional focus, forest bathing was found to
overcome this barrier. Forest bathing is suitable for all groups, but adaptations are recommended for
those expressing fear or discomfort in forested environments. The findings inform how to position
both approaches in practice, as a first step towards social prescribing recommendations. Wider
implications concern forest bathing’s potential to impact environmental well-being. Future research
must garner comparative data, involve young people, and explore the feasibility of a forest bathing
social prescription.
Keywords: compassion; environment; forest bathing; mindfulness; nature connection; social pre-
scribing; therapeutic practice
Academic Editor: Takahide Kagawa
Received: 28 April 2021
Accepted: 8 June 2021
Published: 15 June 2021
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4.0/).
1. Introduction
1.1. Background
There is a global mental health crisis, with common issues such as depression and
anxiety constituting a large burden of disease affecting 13% of the population [1]. In the
UK, the resulting economic impact has been estimated at approximately £35 billion per
year [2]. Increased urbanization over the years has led to the introduction of multiple
life stressors [3]. Additionally, the impact of coronavirus disease 2019 (COVID-19) has
presented society with greater and potentially enduring mental health challenges [4–6] as
individuals have adjusted to national restrictions, fewer opportunities for social interaction,
and uncertainty around evolving circumstances [7]. In attempts to address the mental
health crisis, the popularity of third-wave therapies such as mindfulness and meditation
has increased over recent years [8], and specifically during the pandemic [9,10]. There are
additionally many calls to capitalize upon the multifaceted health and well-being benefits
of connecting with nature in attempts to alleviate mental health symptoms [11,12].
Social prescribing is an accessible and potentially effective way of protecting individu-
als’ mental health, by signposting to community-based interventions, such as meditation
groups, yoga classes, and nature-based programs [13]. In a social prescription, McE-
wan et al. [14] evaluated a smartphone app prompting users to notice the good things in
Sustainability 2021, 13, 6761. https://doi.org/10.3390/su13126761
https://www.mdpi.com/journal/sustainability
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urban nature, which led to clinically significant improvements in mental well-being. There
are key policy drivers for the National Health Service (NHS) to more routinely implement
social prescribing as an accessible and cost-effective solution. However, to promote uptake,
a robust evidence base must be established, making it explicit how to position interven-
tions within practice. Currently, mindfulness and shinrin-yoku (forest bathing) are two
therapeutic interventions, both originating in Eastern practice, that have been receiving
increased attention internationally for their well-being benefits [10,15,16].
1.2. Mindfulness
Defined as the non-judgmental awareness of one’s experiences taking place moment-
by-moment [17], mindfulness practice developed from Buddhist philosophy for use in
the West as a form of therapy, where it is recognized in national-level guidelines [16].
Mindfulness offers individuals the opportunity to effectively process cognitive and affective
information through sustained attentional focus [18,19]. It has been suggested that the
pathway to mindfulness’ therapeutic effects is through this attentional focus, encouraging
the development of increased self-regulation of thoughts and emotions, and bringing
mental stillness and clarity [18,20,21]. Self-compassion is also suggested to be an effective
component [22], where mindfulness places emphasis on non-judgement, detachment, and
acceptance; features that foster self-compassion in the face of adversity [23,24].
Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Re-
duction (MBSR) [25] are two frequently implemented examples of therapy. They have
gained significant attention [23], being indicated as appropriate for use with a variety
of groups and settings owing to their adaptability [26]. In support, evidence has been
found for mindfulness-based therapies in improving mental health symptoms for patients
experiencing chronic illness [27], depression [28,29], schizophrenia [23], transient ischemic
attack [30], and Alzheimer’s disease [31], as well as for military populations [32,33]. Among
non-clinical populations, mindfulness has been shown to be an effective treatment for stress
among the general population [34], and it led to lower stress and higher job satisfaction
among urban social work practitioners [35] and schoolteachers [36,37]. The feasibility of an
adapted MBCT intervention has been explored among NHS staff, leading to significant
improvements in stress management, self-compassion, physical and emotional health,
quality of work, and relationships with colleagues [38]. Among young offenders, inter-
vention led to significant improvements in impulsivity, mental well-being, and resilience;
and while initial engagement was challenging, those who persisted with the program
experienced well-being benefits [39]. Finally, there is evidence that repeated brief MBCT
interventions, some as short as five minutes long, can be effective in treating a variety of
health concerns [40].
Aligning with the desire to deliver brief interventions which can more easily be
integrated into daily routines, there has been a surge in interest around mindfulness-
based interventions available online via eHealth programs, making the practice highly
accessible [41]. Self-help smartphone apps, aiming to increase mindfulness and improve
mental well-being and self-efficacy, have become incredibly popular, and there is evidence
supporting their use [42]. However, despite the rise in popularity, unguided practice can
present well-being risks, and there is an indication that mindfulness may not be suitable
for all [42]. In particular, unguided practice has been met with criticism around the extent
to which such apps adhere to formal definitions of mindfulness as seen in therapy [43].
Further risk through unguided practice stems from potential for lack of understanding
about what mindfulness is, specifically through the common misconception that it is
concerned with emptying the mind of all thought [44]. With regards to those for whom
mindfulness may not be suitable, some have proposed that the inward focus can lead
to rumination, anxiety, or panic attacks [19,45], depersonalization [46], and recurrence of
traumatic memories [47,48]. Where mindfulness practice is not experienced as directed
enough, individuals may end up sleeping or feeling like time has been wasted [49]. Finally,
to maintain the benefits, a life commitment to the practice is needed, whereby those who
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have the highest well-being gains are those who use mindfulness apps regularly, as opposed
to only when in a crisis [42]. This commitment may not be feasible for all, leading to high
levels of attrition [42,50]. These findings provide an opening for the potentially harmful
effects of this practice to be explored more fully and to balance these with the benefits.
In summary, while traditional mindfulness has its limitations, there is evidence that
the general public find walking meditation to be a more accessible way to practice mindful-
ness [51]. Walking, specifically in nature, was revealed in a systematic review to produce
mental health benefits, particularly around a reduction in state anxiety [52]. Addition-
ally, natural spaces are increasingly recognized as suitable settings for therapy, where the
positive effects of sessions are enhanced by nature connectedness [53–56]. A systematic
review and meta-analysis also revealed the effectiveness of nature-based mindfulness
practice, especially in forested environments [57]. Together, these findings point to the
potential for nature-based therapy to improve well-being. One such therapeutic practice is
forest bathing.
1.3. Forest Bathing
Forest bathing, or in its native Japanese shinrin-yoku, has been defined as a therapeutic
practice to improve well-being [58]. As with the above, forest bathing involves mindful
immersion in the forest environment and conscious activation of the senses [58–60] (for an
overview of example exercises carried out during forest bathing, see McEwan et al. [61]).
Originally conceptualized as a form of preventative healthcare, forest bathing is now
used as a targeted intervention for specific mental health issues and forms part of the
national health service in Japan [59]. Over the past two decades, considerable emerging
evidence around the efficacy of forest bathing as a therapeutic practice has been developed,
principally stemming from Japan and South Korea [62,63].
A systematic review and meta-analysis conducted by Kotera et al. [11] outlines the ev-
idence in support of forest bathing as an effective mental health therapy, with regards to its
capacity to alleviate short-term mood disturbance. Forest bathing could be a suitable ther-
apy, given it is a relatively safe and gentle practice, carried out in a supportive environment.
It has been recommended as effective in the treatment of anxiety [11], depression [64], and
addiction [58], and has been studied as an intervention for inpatients experiencing affective
and psychotic disorders [65]. Miyazaki [59] additionally found support for forest bathing’s
capacity to increase positive psychological resources, while improving the cardiovascular,
immune, and respiratory systems.
Biophilia [66], the predominant theoretical framework used in the East, and Attention
Restoration Theory [67,68] have been suggested as contributing to forest bathing’s ther-
apeutic effects. The former describes individuals’ innate affiliation with and capacity to
connect with the natural world, while the latter describes nature’s capacity to reduce mental
fatigue, restore, and redirect attentional focus. These features of Attention Restoration
Theory may have implications for individuals who experience rumination, by provid-
ing opportunities for respite from recurring thought patterns. Using Stress Reduction
Theory [69] as an additional underpinning framework, it has been suggested that forest
bathing’s therapeutic qualities arise from an increase in parasympathetic nervous system
activity, typically captured by stress biomarkers such as changes in cortisol levels [70–72],
lowering of systolic and diastolic blood pressure [73], reduction in heart rate [61,74], and
reduction in allostatic load [75]. While Stress Reduction Theory has been explored rather
extensively, there is comparatively less evidence in support of Biophilia and Attention
Restoration Theory, pointing to a need to further explore their potential roles.
Given most forest bathing research has been conducted in Asia, there is considerable
scope and indeed a call to advance UK-based research, not only to replicate findings, but
crucially to expand the emerging evidence base [11,62]. McEwan et al. [61] have begun to
answer this call by carrying out the UK’s first pragmatic controlled trial comparing the
well-being benefits of forest bathing and the related construct of compassion. The authors
found that forest bathing produced comparative heart rate variability and self-reported
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well-being outcomes as an established compassion intervention, paving the way for future
UK-based research.
1.4. Summary
Due to their similarities and compatibilities, mindfulness and forest bathing are
often employed together to maximize therapeutic effects [10,76,77]. However, given their
compatibility, the boundary between the two is unclear. Additionally, while the challenges
for mindfulness have been discussed [78,79], those of forest bathing have not yet been
explored, with research having focused exclusively on its positive impact rather than its
acceptability [62]. To date, there has been no qualitative assessment of forest bathing.
As such, there is a clear need to expand the evidence base by contributing qualitative
evidence around both practices. For example, although studies have explored experiences
of mindfulness through participants [80–83], research is yet to capture the expertise offered
by mindfulness practitioners through their experiences of delivering interventions. Lived
experiences constitute an additional form of knowledge to identify where the benefits stem
from, and to identify barriers and facilitators to implementation, such as groups for whom
the practices may not be suitable. Finally, as most research tends to involve a single target
population, a further benefit is that practitioners have the capacity to inform around a
variety of groups and individuals simultaneously, constituting a rich source of evidence.
1.5. Aims
Accordingly, this study aims to compare the characteristics of mindfulness and for-
est bathing through semi-structured interviews with practitioners experienced in both
approaches. It will explore how the approaches are similar and different, the strengths
and weaknesses of both, and what the barriers and facilitators to implementation are.
In addressing these aims, this study provides a novel contribution to the psychother-
apy literature by informing around how to position these approaches. The findings may
have practical implications for social prescribers, general practitioners, and other health
professionals, as a first step towards signposting individuals to specific interventions.
2. Materials and Methods
2.1. Participants
Seven female practitioners of mindfulness and forest bathing were recruited as a
convenience sample via The Forest Bathing Institute’s professional network of guides.
The Forest Bathing Institute is an organization based in Guildford, Surrey, offering forest
bathing experiences to the general public. This organization trains practitioners in both
mindfulness and forest bathing practice. They are a central hub for UK forest bathing
research, practitioner training, and events. With a dedicated team of practitioners spanning
a variety of professional backgrounds, they are the UK’s principal source of practition-
ers trained in Forest Bathing +, combining elements of traditional forest bathing and
mindfulness. Inclusion criteria comprised being over the age of 18, possessing a relevant
qualification, such as completion of the MBSR program, and having a minimum of six
months’ experience in conducting both mindfulness and forest bathing sessions prior to
commencement of the study. Owing to a lack of suitable qualifications and/or experience,
one practitioner was unable to participate, despite expressing interest.
2.2. Procedure
Ethical approval was sought and granted by the University of Derby’s Ethics Commit-
tee (approval code: 280519YK). After providing consent, participants were invited to take
part in a semi-structured interview with one of the researchers (FC (MSc), YK (PhD), or KM
(PhD)). All interviewers had prior experience in qualitative research and/or therapeutic
intervention. At the time of the study, interviewers held occupational titles of Research
Associate, Academic Lead, and Senior Research Fellow, and participants only knew that
the interviewer was a psychology researcher from a UK university with an interest in
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mindfulness and forest bathing. The interviewers and practitioners had no contact before
commencement of the study, with the exception of one practitioner who was known to
one of the interviewers. Prior to interview, participants received the interview schedule
via email. Interviews were carried out and recorded via Skype, following a flexible struc-
ture, where participants were instructed to talk about their own personal experiences and
reflections. At the start of each interview, the interviewer confirmed privacy by showing
the room as otherwise empty of people, and this was reciprocated by interviewees. While
questioning, the interviewers took notes for cross-referencing with the results. Participants
were encouraged to discuss their perspective on what the main strengths and weaknesses
of mindfulness and forest bathing are, the groups for whom the practices are suited, and
the main similarities and differences. Questions were not pilot tested prior to interview,
as the research itself was exploratory in nature. Interviews lasted on average one hour,
after which time participants were debriefed. There was zero dropout of participants.
Interviews were transcribed by the corresponding interviewers using Microsoft Word. The
interviewers met to discuss data collection progress and agreed that with data from seven
participants, it was likely that saturation had been reached. Given the highly specialized
training of the practitioners and strict inclusion criteria, the authors agreed to conclude
data collection after a lack of additional forthcoming participants.
2.3. Analysis
In line with the most recent recommendations [84], this study applied reflexive the-
matic analysis. Interview transcripts were thematically analyzed by two female researchers
(FC and KM) using NVivo 12 Plus. Taking guidance from Braun and Clarke [85], the
researchers (i) initially familiarized themselves with the data, (ii) generated initial codes,
(iii) created themes, (iv) reviewed themes, and (v) defined and named final themes. Themes
with fewer than ten references were excluded from the analysis. To minimize bias, themes
were independently coded by the two researchers, before meeting twice to discuss findings
and rationale, and agree on theme definition. To more fully reduce bias, the researchers met
with the remaining interviewer (male, YK) to discuss findings and incorporate feedback.
Aligning with Braun and Clarke [84], rich, fully developed themes were actively created by
researchers through discussion and reflection until consensus was reached. The researchers
agreed on the quotes that were most representative of the themes. Participants were subse-
quently contacted and invited to review the key findings. Those who responded to this
invite expressed consensus that the findings conveyed the main messages of their interview.
3. Results
An overview of themes is presented in Table 1. The researchers agreed upon the cre-
ation of nine themes, of which the four major themes were defined as (i) Attentional Focus,
(ii) Benefits of Forest Bathing, (iii) Biophilia, and (iv) Differences between mindfulness and
forest bathing. It was noted that data concerning forest bathing were far richer than those
concerning mindfulness.
Table 1. Summary of major and minor themes, with * indicating a major theme.
Theme
N
Brief Description
Example Practitioner Excerpt
Practitioner
Number
Benefits of forest bathing *
45
Well-being benefits, e.g., the speed
through which results are seen
“You just get in that place much faster”
5
Biophilia *
34
Humans seek out opportunities to
connect with nature
“It [the natural world] has that advantage,
nature draws in naturally”
3
Attentional focus *
32
Mindfulness focuses on internal
state, forest bathing on external
environment
“In mindfulness . . . it’s sort of a cerebral
discussion. In forest bathing, a lot of the
invitations are using your senses to take
you out of your brain”
6
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Theme
Differences *
Developments
Barriers to engagement
Similarities
Intuition
Benefits of mindfulness
Table 1. Cont.
N
Brief Description
Example Practitioner Excerpt
Practitioner
Number
30
Key differences, e.g., the
incremental benefits of
forest bathing
“Forest bathing tends to multiply those
benefits and also add a lot more different
types of benefits, like feeling more
connected to nature”
7
29
Areas for future research into
both practices
“For both practices, . . . I would love these
to be more accessible and inclusive,
reaching more diverse audiences”
4
27
Barriers to forest bathing, e.g., lack
of positive experiences in nature
“Some people even find it quite, almost
scary, to take their shoes off [in the forest]”
1
Shared focus on slowing down,
“You are slowing down, you are being
25
engaging the senses, and
aware of your senses, and utilizing them.
2
deep breathing
There’s a focus on breathing”
17
Forest bathing comes naturally
and with ease
“Feels completely natural to us as
humans”
7
16
Benefits of non-judgemental
awareness, e.g.,
developing gratitude
“I have found it very beneficial for really
getting to become more aware of things
. . . get into the present moment and
appreciate things a lot more”
2
3.1. Major Themes
3.1.1. Differences
Table 2 summarizes the main conceptual and practical similarities and differences be-
tween mindfulness and forest bathing. Researchers reached consensus that the Differences
could be divided into three subthemes: accessibility (n = 7); incremental benefits of forest
bathing (n = 7); and structure (n = 10).
Table 2. Comparison of the main similarities and differences between mindfulness and forest bathing.
Similarities
Differences
Structure
Mindfulness and Forest Bathing
Presence of mind.
Focus on slow, conscious breathing.
Requiring a certain level of improvization and flexibility in delivery.
Exercises carried out in silence.
Engaging the senses.
Effective for mental health: mental disturbances, depression, anxiety, and rumination.
Mindfulness practice takes place in a structured and controlled “classroom” environment, where
a script may be used. In forest bathing, gentle guidance is provided, but there are no highly
structured exercises to complete. Individual flexibility is encouraged, bringing out aspects of
curiosity and exploration.
Mindfulness tends to be a more solitary pursuit compared with forest bathing, which has
elements of group sharing.
Forest bathing involves introductory talks and explanations around the history of the practice.
Frequency of practice and session length: forest bathing sessions are generally recommended to
last two hours, once per month, whereas mindfulness practice is carried out in shorter, regular
amounts of time, e.g., 20 min per day, every day.
Practiced indoors versus outdoors.
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Differences
Structure
Incremental benefits of
forest bathing
Accessibility
Table 2. Cont.
Mindfulness and Forest Bathing
When setting up for a mindfulness session, the practitioner sets up the environment, whereas in
forest bathing the practitioner adapts to the environment.
Mindfulness is largely stationery, whereas forest bathing involves slow movement.
Practitioners often carry out 1-2-1 work through mindfulness, depending on individual needs,
whereas forest bathing sessions tend to be more generalized.
Forest bathing provides incremental benefits, e.g., richer sensory experience in nature.
Mindfulness involves awareness of the self, but forest bathing raises awareness of
(and potentially compassion towards) others and nature.
The senses are engaged to encourage connection to nature.
Positive results are accelerated with forest bathing, even after one session.
With forest bathing, results are felt automatically without much effort, whereas mindfulness can
be more difficult to grasp.
Forest bathing has a gentler entry point and is suitable for most individuals.
Looking at aspects of the forest is easier than the mindfulness practice of sitting meditation,
where individuals are asked to become aware of thoughts and emotions.
While both practices involve slowing down, conscious breathing, and sensory acti-
vation, and both produce well-being benefits through a reduction in depression, anxiety,
and rumination, there are key structural differences between the two. For instance, one
is normally practiced indoors versus the other which is always outdoors. Another key
difference lies in accessibility, where forest bathing is considered more accessible for a wide
variety of populations. For example, one practitioner recalled a mindfulness participant
who became frustrated, stating, “‘I’m trying to be mindful!’”, with the practitioner explain-
ing that “of course that isn’t actually the crux of mindfulness anyway” [practitioner 6]. This
reflects the view that mindfulness can be more difficult to grasp. Another difference lies
in the added value of forest bathing. For instance, by connecting to nature, this approach
offers a richer sensory experience, and has the potential to increase compassion towards
the natural world. One practitioner summarized the differences by explaining:
I think, ultimately, they’re kind of the same thing, it’s just a different way to
access it. Even in my own healing journey I think that . . . we hope to be sitting
more comfortably with perhaps what we have dealt with as an obstacle . . . There
are often many different narratives to get into that place [practitioner 6].
This perspective reflects the view that both approaches effectively improve personal
well-being. They continue, “Some of that depends on how that relates to your own
experiences already in life . . . there’s many ways there and it just depends on what
works for you in that moment” [practitioner 6]. This highlights that a key distinction
lies in the barriers and facilitators to both. In other words, for an individual who is
experiencing extreme anxiety or depression, mindfulness may not always be suitable,
owing to potential risk to well-being through re-traumatization. As one practitioner
offered, “if you feel depression and are suffering poor mental health, it may not be the best
time to do mindfulness, while forest bathing can be used in that case” [practitioner 4].
3.1.2. Benefits of Forest Bathing
The second major theme agreed upon by researchers concerned the Benefits of Forest
Bathing (n = 38), which captured elements of the potential for forest bathing to facilitate
personal insight, relaxation, social connection, gratitude, and reconnecting with the self and
emotions. While both practices involve similar activities, in forest bathing, there is “less
tendency to judge” oneself [practitioner 4], a result that was not identified for mindfulness.
For example, one practitioner described how “it’s OK if you can’t smell very well today,
because our nose closes up when we’re in a city, you don’t want to smell all the pollution
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that is all around” [practitioner 5], reflecting the perspective that there is no pressure to
achieve with forest bathing, which places fewer demands on the individual.
Minor subthemes encapsulated the view that forest bathing can (i) benefit a wide
variety of groups; (ii) promote physical well-being; (iii) promote environmental well-being
(“it works both ways, it’s beneficial for us but it’s also beneficial for nature” [practitioner 6]);
and (iv) is accessible through its adaptability to accommodate particular needs or respond
to unpredictable weather conditions. For example, “sometimes you use just what comes
during the session; nature just responds in different ways, and you use what’s available
there” [practitioner 5].
3.1.3. Biophilia
The third major theme of Biophilia reflects the presence in forest bathing of elements
of belonging to nature, nature connectedness, and nature as the facilitator. In describing
their experiences of biophilia, one practitioner explained:
We evolved in nature and so intrinsically everyone is aware of that, but it just feels
that we’re at home basically. Because in our deep psyche we feel at home in nature,
even if we haven’t spent much time in it, but it can come back really quickly.
There is this recognition of ‘this is where I belong’ or ‘this feels comfortable’ or ‘it
feels safe’ [practitioner 7].
This reflects the view that the practitioner feels an affinity to the natural world and
their belonging within it.
Another practitioner described how forest bathing promotes a connection to nature,
by describing how they encourage participants to “take your coat off and feel the rain.
Usually you run away from it, but just for one minute, feeling it is great!” [practitioner 3].
This reflects a desire to reconnect with the basic elements of the natural world. Indeed,
through urbanization and the leading of hectic lives, humans appear to have drifted from
their true nature as organic beings. Yet, when prompted to return to our natural state,
such as by showing that humans are a part of nature, it is possible to achieve a connection
with nature that is reminiscent of times in childhood when nature was embraced more
instinctively. This notion was captured by one practitioner, who explained:
A lot of people, especially when we do the smelling of the earth, loads of people
come up with memories of their childhood or they think about their grand-
mother, doing different things as a child. So that really evokes lots of emotions
[practitioner 5].
In addition to nature connectedness, Biophilia reflected the concept that in forest
bathing, nature acts as the facilitator for the well-being benefits. For example, “I’m actually
really trusting the work and remembering that it is the trees, the nature that does the work
and it certainly isn’t me . . . the forest has the effects” [practitioner 6]. This quote reflects
the view that while the practitioner is important for safeguarding, their role is to act as a
guide who offers recommended activities to try. In this practitioner’s eyes, connecting with
the forest itself produces the well-being benefits, as opposed to the practitioner per se.
3.1.4. Attentional Focus
The final major theme identified by researchers was Attentional Focus, which was
divided into two subthemes, internal and external attentional focus. The former relates
to the emphasis in mindfulness on awareness and acceptance of internal thoughts and
emotions, such as feeling anxious or stressed. For example, “in mindfulness, the emphasis
is on being aware of what is exactly present to you, regardless of whether it’s pleasant or not
pleasant. You try to let that be, be with it” [practitioner 4]. Another practitioner explained:
You start with the senses, but the senses just allow you to slow down and become
more aware . . . and then that will increase going more inwards and noticing
what is happening to you. So, at the end, of the day, the change happens because
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there is a self-awareness . . . and that self-awareness is the one that then allows
you to make different choices [practitioner 5].
This reflects the view that mindfulness’ ability to facilitate awareness and acceptance of
one’s internal state underpins the well-being benefits. By improving emotional awareness
in this way, mindfulness can lead to personal insight which can help the individual to make
decisions, such as how to navigate a personal difficulty.
While both mindfulness and forest bathing involve attention regarding internal pro-
cesses such as sensory engagement, a slowing down of pace, and mindful breathing, the
latter subtheme of external attentional focus reflects the directing of attention in forest
bathing towards the external, rather than internal, environment. By engaging with the
forested environment through the senses, attentional focus is shifted away from cognitions
and emotions, to encourage engagement with nature. For example, in forest bathing, one
practitioner encourages participants to “take cues from what the environment is inviting us
to do” [practitioner 7]. This reflects the notion that individuals are invited to be responsive
to the dynamic nature of the forest. Another practitioner explained that focusing one’s
attention on the forest is perhaps more accessible than focusing attention on thoughts and
emotions. For example:
You can stay on the external things; you don’t have to come into internal thoughts
. . . The safety of paying attention to the external [practitioner 4].
This reflects that there is perhaps less risk to personal well-being when attention is
outwardly directed, echoing a known challenge for mindfulness around risk to well-being
through recurrence of trauma.
3.1.5. Minor Themes
The remaining minor themes firstly captured areas for future development around: (i)
improved marketing of forest bathing to raise awareness (“that it becomes more acknowl-
edged” [practitioner 1]) and reduce misconceptions (“massive pre-judging, . . . that it’s a
bit ‘woo-woo’” [practitioner 6]; “the term ‘forest bathing’, . . . it’s just a bit misunderstood”
[practitioner 2]); (ii) increasing accessibility of mindfulness for males (“getting that word
out there for men” [practitioner 6]); (iii) promoting forest bathing as a social prescription
(“to have it mainstream” [practitioner 7]); (iv) exploring the feasibility of forest bathing
intervention for children and young people; and (v) promoting forest bathing as a way to
increase caring motives towards the environment. For example:
How would you see from the heart, how would you smell from the heart, how
would you listen from the heart? . . . It’s about helping people to fall in love with
nature, because then once we really have a heart connection, then there is no way
we don’t want to spend more time in nature, or there’s no way that we wouldn’t
want to protect it and act in ways to conserve it [practitioner 7].
Minor themes additionally captured barriers to engagement for forest bathing, partic-
ularly perceived inaccessibility related to biophobia (“I think it may be hard for someone
who has less experience in nature; they need acclimatization” [practitioner 4]; “you are
brought up to not get your hands dirty” [practitioner 5]) and barriers to mindfulness,
namely, risk to well-being through recurrence of trauma (“their mind just goes all over
the place and that brings up a lot of anxiety. And they immediately feel ‘I’m no good at
this’ and they give up” [practitioner 7]). Similarly, risk to well-being was also considered a
barrier to engagement with forest bathing (“something occurs to me, as a woman, being
able to practice shinrin-yoku, you need to feel safe. This can be tricky” [practitioner 4]). This
finding highlights the point that being alone in nature may be frightening for some women.
Finally, participants expressed the intuitive nature of forest bathing and the ease with
which the exercises come to individuals. The last minor theme of Benefits of Mindfulness
is described in Table 3, covering aspects of accessibility and well-being.
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Table 3. Characteristic strengths and weaknesses of mindfulness and forest bathing.
Strengths
Weaknesses
Mindfulness
Generally regarded as accessible for a variety of
clinical and non-clinical populations. Can be adapted
to suit individual and contextual factors, and can be
practiced in a variety of locations.
Mental well-being benefits through non-judgmental
acceptance of thoughts and emotions. Focus on
breathing connects the individual to their senses
which can produce relaxational effects, such as
slowing down.
Perhaps more limited in scope.
Not as sensorily engaging as forest bathing.
Can be challenging if individuals do not have regular
support. Support and check-ins would help with
upkeep of practice. Needing access to someone with
whom individuals can talk about personal practice
and development.
Can be challenging to detach thoughts or
avoid rumination.
Mindfulness is considered more challenging and less
accessible than forest bathing. Meditation does not
come naturally to everyone.
Forest Bathing
Positively impacts mental well-being, through
encouraging gratitude, facilitating personal insight,
reconnecting the self with one’s emotions, encouraging
relaxation, and increasing social connection to others.
Promotes compassion towards the environment, and
engagement in pro-environmental behaviors.
Benefits physical health through the chemical effects of
the forest atmosphere, e.g., air quality, cancer fighting
cells, and stress reduction. The forest is viewed as a
natural healer that can be more effective than
traditional medication.
Highly accessible to almost anyone and is highly
adaptable to suit different personal needs and
weather conditions.
Presents all the main benefits of mindfulness, but
incrementally adds to these, such as through the
comparatively greater speed at which the benefits
are felt.
Suitable for a wide variety of populations.
Biophobia, for individuals who are not used to spending
time in nature, may act as a barrier. Some experiences of
insect bites and pain while lying down.
Weather may act as a barrier for some.
Requires a medium group size to benefit from group
sharing elements and to foster social connection. Larger
group sizes would require an additional forest bathing
guide. Some people feel uncomfortable with
group sharing.
To maximize the therapeutic effects, forest bathing must
take place in a forested environment as opposed to
meditating on a house plant: difference between
meditating on nature and immersing in the
forest environment.
Impractical given most individuals cannot access the
forest regularly, or do not have local access to a forest.
3.1.6. Strengths and Weaknesses
Table 3 highlights the comparative strengths and weaknesses of mindfulness and
forest bathing. In particular, practitioners discussed the two main benefits of mindfulness:
that it is generally regarded as accessible for most groups; and that it can lead to mental
well-being gains.
4. Discussion
This study had the novel aim of qualitatively comparing the key characteristics of
mindfulness and forest bathing, two conceptually related [10,86] but distinct therapeutic
approaches, through an applied lens. Seven practitioners experienced in both approaches
were interviewed, and thematic analysis of the data resulted in four major themes. These
revealed that: (i) while the approaches share similarities, they are differentiated by forest
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bathing’s incremental well-being benefits; (ii) the well-being benefits of forest bathing are
three-fold (mental, physical, and environmental); (iii) connecting to nature is a central
aspect of forest bathing; and (iv) mindfulness promotes awareness of internal states, but
forest bathing extends awareness to the external environment.
By capitalizing on trained and experienced practitioners as a rich source of knowledge,
this study informed around the similarities, differences, strengths, and challenges for both
practices, and defined the key barriers and facilitators to engagement. This is the first
study to capture the expertise offered by mindfulness and forest bathing practitioners
and qualitatively balance the benefits and challenges for both approaches. Additionally,
the results advance understanding around the previously unexplored main features and
challenges for forest bathing, by conveying negative experiences such as insect bites, pain
lying down, and discomfort in groups. The main barriers to forest bathing were identified
as biophobia [87], risk to well-being, misconceptions, the need to increase accessibility, and
the need to increase recognition. Both approaches share common well-being benefits, but
through acknowledgement of the differences identified by practitioners, forest bathing can
be recommended as a highly accessible and effective practice that produces three types of
well-being benefit and is suitable for a broad variety of groups. The findings hold wider
significance for forest bathing’s potential to increase compassion towards nature, a result
that did not come out for mindfulness. From a practical standpoint, the results explicitly
demonstrate how to position both approaches, and are the first step in developing policy
recommendations for social prescribing [12].
4.1. Differences
The major theme of Differences highlights the key practical and conceptual distinc-
tions between mindfulness and forest bathing. The finding that mindfulness is considered
less accessible for certain groups (those at risk of re-traumatization, experiencing extreme
depression or anxiety, or finding difficulty in achieving a mindful state) lends further
support to previous findings around the challenges for mindfulness [19,42,45–48,55,88].
While both approaches were found to produce similar well-being benefits, in terms of
stress reduction, emotional regulation, and clarity, forest bathing was shown to introduce
incremental benefits, specifically around the extension of the mental well-being benefits
to include physical and environmental well-being. While it was expected that practition-
ers would outline similarities between the approaches, given their shared philosophical
underpinnings [10], the fact that the Differences were defined as a major theme clearly
highlights the significance of these distinctions. The positive implication of this finding lies
in explicitly describing how to position the therapies within practice.
4.2. Attentional Focus
The finding of the second major theme of Attentional Focus is key, as it informs around
one of the main distinctions differentiating the practices. Forest bathing’s promotion of
external attentional focus is novel, as most therapeutic interventions encourage the inward
direction of attention. Practitioners placed value on the ability of both internal and external
focus to benefit well-being, although they expressed that external focus is more accessible
and produces less risk to well-being. When executed correctly, mindfulness brings many
mental well-being benefits through non-judgmental awareness and acceptance. However,
research would benefit from comparative data from practitioners to further explore the
mechanisms behind internal focus.
Aligning with the United Nations’ sustainable development goals [89] of climate
action and life on land, the results of this study indicate that participation in forest bathing
may promote interest and engagement in pro-environmental behaviors [90]. This finding
therefore highlights a transfer of benefit from the individual to the environment, whereby
increased awareness of the forest holds the potential to increase caring motives towards
it. Such a link builds on the findings of McEwan et al. [61] and Lumber et al. [91] around
the theoretical connections between forest bathing and compassion. While compassion is
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known to relate to mindfulness, it is interesting to note that the present results did not find
such an association for this practice. Further research is needed to explore whether this
might be due to previous associations having involved self-compassion, whereas forest
bathing in this study was associated with external compassion.
4.3. Benefits
The third major theme highlighted the gains of forest bathing, specifically that it
is (i) effective for mental, physical, and environmental well-being; (ii) suitable for all
groups (including those with mobility issues or vulnerable populations that may require
additional support); (iii) easy to grasp and progress is seen quickly; (iv) adaptable to
varying personal and environmental conditions; and (v) produces positive group-based
experiences. According to practitioners, not only does forest bathing lower the prevalence
of mental health symptoms, but it promotes flourishing and general well-being [92]. Indeed,
the findings echo the position of Mathias et al. [93], who reported the three-fold benefits
of forest bathing as physiological, psychological, and environmental. The present results
extend this report, by providing qualitative evidence indicating that forest bathing produces
well-being benefits for the self and environment.
4.4. Biophilia
The final major theme of Biophilia highlights that connection to nature and feeling
belonging in nature are key facilitators to the well-being benefits of forest bathing. Specifi-
cally, by focusing attention on the natural world, forest bathing instils awareness of being
part of a greater whole. The personal accounts of practitioners’ own health improvements
through forest bathing lend support to Kellert’s [94] position that nature connectedness
leads to meaningful, fulfilling life experiences. Adding to this, Howell et al. [95] found that
meaning in life mediates the relationship between nature connectedness and well-being,
highlighting that nature connectedness continues to be an important direction for future
research. It is, however, worth noting that biophilia is the predominant theoretical founda-
tion for forest bathing in Asia; and identification of this as a major theme may, in part, be a
product of formal training.
4.5. Limitations and Future Directions
While this study aimed to compare and contrast mindfulness and forest bathing, the
data supplied by practitioners were far richer for the latter. This is reflected by practitioner
6 s statement that if they had to choose between the two, their preference would be “100%
nature”. It is important to note that for inclusion in the study, practitioners were trained
in both approaches, actively delivering both approaches, and many began forest bathing
through prior training in mindfulness. Throughout the interviews, practitioners were
encouraged to offer honest and balanced data on both approaches. Yet, practitioners had
far more to say about forest bathing and were overtly positive about its benefits. While
the data around mindfulness were therefore not as rich as expected, it is nevertheless
interesting that this preference exists.
It is possible that a certain amount of bias was introduced, given that the practitioners
were all female. While accurate demographic data concerning practitioners of mindfulness
and forest bathing are not generally available, there is a tendency for psychotherapists, yoga
practitioners, and the psychology workforce to be largely female-oriented [96]. There is
additionally some indication that females may tend to be more environmentally conscious
than males [97]. While this does not necessarily represent a difficulty for interpretation of
the data, in the future it will be necessary to target male practitioners in addition to female.
Another limitation is the small sample size; however, despite this, practitioners offered
rich information and interviewers agreed that data had been saturated. It would be difficult
at present to access larger sample sizes, as recruitment was restricted by the criteria of being
trained and practicing in both approaches. Currently, there are few organizations offering
such specialized training. A final limitation is that most of the practitioners interviewed
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deliver sessions through The Forest Bathing Institute. The organization advertised to all
of their UK contacts, yet all but one of those interviewed currently practices through this
organization. It is worth commenting that the lack of uptake from practitioners in other
organizations, or indeed independent practice, is likely due to the inclusion criterion of
having formally trained in both approaches. This criterion is a pre-requisite of delivering
sessions through the Forest Bathing Institute.
Practitioners offered several leads for future research. Firstly, studies should explore
how to raise awareness of forest bathing, and reduce the stigma attached to its title, owing
to misconceptions around what it entails. For both mindfulness and forest bathing, research
should seek to improve accessibility for males. More research is needed to promote the
establishment of forest bathing as a social prescription. The results of this study can be
considered a starting point to achieving this goal, adding to those of McEwan et al. [61], to
begin the development of policy guidelines. Future research should explore the feasibility
of forest bathing intervention among the key demographic of children and young people,
as indicated by practitioners. In support, Birch et al. [98] found that connecting with
nature fostered a sense of self-identity and increased concern towards others and nature,
among young people experiencing mental health difficulties. Future research should also
target forest bathing’s potential to increase compassion towards nature. In addition, the
literature would benefit from cross-cultural comparison with Asian studies, concerning
an emerging ontological discussion regarding the extent to which humans are perceived
as separate from nature [99]. It will also be important to compare the results with other
mindfulness and forest bathing organizations, as currently there are no available qualitative
data for comparison. Finally, while stress reduction [69] was revealed as one pathway to
forest bathing’s therapeutic benefits, the crucial role played by outward attentional focus
warrants further investigation.
5. Conclusions
This qualitative study made the original contribution of exploring practitioners’ per-
spectives on the key characteristics of mindfulness and forest bathing. The findings are
the first to convey outward versus inward attentional focus as a central distinction be-
tween these approaches; a novelty, given that most therapies emphasize inward focus.
Additionally, this study is the first to assess negative experiences (barriers and risks) while
forest bathing. Reflexive thematic analysis resulted in the creation of four main themes:
(i) the benefits of forest bathing, (ii) biophilia, (iii) attentional focus, and (iv) differences
between the approaches. Practitioners expressed that while mindfulness produces many
stress-relieving benefits, it is not without its risks to well-being. Forest bathing presents
unique opportunities to engage a variety of individuals in a safe, gentle, accessible, and
effective intervention to not only protect against mental illness, but importantly to promote
overall well-being. Accordingly, these findings have practical implications for practice and
policy. Firstly, there have been many calls to increase the uptake of social prescriptions as
accessible and cost-effective healthcare solutions to reduce the global burden of disease.
The results of this study add value by informing around the key barriers and facilitators to
engagement with both practices, offering clear guidance on the groups these may (not) be
suitable for. Specifically, this study has highlighted the acceptability of mindfulness and
forest bathing for those who would benefit from an improvement in well-being. However,
through the finding of forest bathing’s greater accessibility when compared to mindfulness,
this study indicates that further adaptations need to be made to mindfulness practice
to increase its acceptability for a wider variety of groups. Those who are at risk of re-
traumatization, experiencing extreme mental health challenges, or who experience more
difficulty in achieving a mindful state would benefit from additional support and consid-
eration of forest bathing as a gentler pathway to the well-being gains. While generally
recommended as suitable for all, further adaptations to forest bathing are necessary when
individuals express biophobia, fear, or discomfort in the forest environment; and session
length may need to be reduced for more elderly populations. The findings can be used as a
Sustainability 2021, 13, 6761
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first step to signposting individuals to specific interventions. Finally, compassion for nature
as an outcome of forest bathing may have a role in preserving valuable green spaces [3],
and planning for the increased quantity and quality of new green spaces.
Author Contributions: Conceptualization, Y.K., F.J.C. and K.M.; methodology, Y.K., F.J.C. and
K.M.; formal analysis, F.J.C. and K.M.; investigation, F.J.C., K.M. and Y.K.; writing—original draft
preparation, F.J.C.; writing—review and editing, F.J.C., Y.K. and K.M.; visualization, F.J.C. All authors
have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted according to the guidelines of the
Declaration of Helsinki, and approved by the Ethics Committee of the University of Derby (protocol
code 280519YK on 12 June 2019).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Acknowledgments: The authors wish to express gratitude towards Gary Evans and Olga Terebenina,
founders of The Forest Bathing Institute, for their role in the recruitment of the practitioners involved
in this research (http://tfb.institute, accessed on 8 June 2021).
Conflicts of Interest: The authors declare no conflict of interest.
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