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Individual differences in the psychological effects of forest sounds based on type A and type B behavior patterns

Song et al. Journal of Physiological Anthropology 2013, 32:14

http://www.jphysiolanthropol.com/content/32/1/14

ORIGINAL ARTICLE

Open Access

Individual differences in the physiological effects

of forest therapy based on Type A and Type B

behavior patterns

Chorong Song1, Harumi Ikei1, Juyoung Lee2, Bum-Jin Park3, Takahide Kagawa4 and Yoshifumi Miyazaki1*

Abstract

Background: In recent years, the physiological relaxation effects of natural environments have been widely

exploited, and although individual differences in the effects of forest therapy are known, assessment methods have

not been clearly established. This study used a classification based on Type A and Type B behavior patterns to

explain individual differences in physiological responses to forest environments.

Methods: We performed physiological experiments in 44 forest and urban (controls) areas. In total, 485 male

university students (age, 21.8 ± 1.6 years) participated in the study. The subjects were asked to visit forest or urban

environments randomly and observe each landscape for 15 min. The subjects’ pulse rates and blood pressures were

tested to evaluate their physiological responses. The Kwansei Gakuin daily life questionnaire was used to identify

Type A and Type B behavior patterns in subjects.

Results: The pulse rate was significantly lower in the Type B group after exposure to forest areas than after

exposure to urban areas, whereas no significant difference was observed in the Type A group. In addition, the pulse

rate was significantly lower in the low scoring subjects in the Type B group, which was consistent with changes in

their diastolic blood pressure.

Conclusions: These results suggest that individual differences in pulse rate and blood pressure in response to

forest environments can be explained by Type A and Type B behavior patterns.

Keywords: Forest bathing, Urban environment, Pulse rate, Blood pressure, Individual difference, Type A behavior

pattern, Type B behavior pattern, Kwansei Gakuin (KG) daily life questionnaire

Background

It is widely believed that contact with the natural envir-

onment can improve the physical and mental health of

people. Since 1980, many studies have demonstrated a

significantly positive relationship between people’s ex-

posure to natural environments and their health. Several

questionnaire-based studies have reported restorative ef-

fects related to psychological stressors or mental fatigue

[1-3] and improved mood states and cognitive function

[4-7]. Improved physiological measurement techniques

in recent years have generated further scientific evidence

based on physiological parameters. Studies on the physio-

* Correspondence: ymiyazaki@faculty.chiba-u.jp

1Center for Environment, Health and Field Science, Chiba University, Chiba,

Japan

Full list of author information is available at the end of the article

logical effects of relaxation in forest environments have

tested such parameters as cerebral activity in the pre-

frontal cortex [8], pulse rate [9-13], blood pressure

[10,11,13,14], heart rate variability [9,10,12-14], salivary

cortisol concentration [8,9,11-13], and natural killer cell

activity [15-18]. A significant amount of scientific evi-

dence has been reported [19-21]. Park et al. [20]

reported that forest therapy mitigated stress and led to

biological relaxation based on the results of experiments

using 420 subjects in 35 locations throughout Japan.

Forest therapy is a health-promotion method and uses

medically proven effects of forests, such as relaxation,

that can improve the health of the body and mind. It is

aimed at achieving a preventive medical effect by im-

proving the immune system response.

Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and

reproduction in any medium, provided the original work is properly cited.

Song et al. Journal of Physiological Anthropology 2013, 32:14

http://www.jphysiolanthropol.com/content/32/1/14

Page 2 of 7

However, individual differences within these effects

have been noted, and this phenomenon has posed sev-

eral questions in a variety of fields that must be clarified.

Thus far, methods for interpreting these individual dif-

ferences have not been established. Previous studies on

individual differences in the generated responses have

produced distinctive results for individuals with Type A

and Type B behavior patterns. Type A and Type B

behavior patterns were proposed by Friedman and

Rosenman [22] on the basis of specific behavior patterns

in patients with heart disease. The Type A behavior pat-

tern can be defined as an overt behavioral syndrome re-

lated to lifestyle that is characterized by excessive

competitiveness, striving for achievement, aggressive-

ness, time urgency, acceleration of common activities,

restlessness, hostility, hyperalertness, explosiveness of

speech amplitude, facial musculature tension, feelings of

struggling against the limitations of time, and insensitiv-

ity to the environment [23]. Type B behavior pattern is

characterized by the absence of Type A characteristics.

Miyazaki and Tsunetsugu [24] examined individual dif-

ferences in hemoglobin concentration in the prefrontal

cortex when chocolate was used as a gustatory stimulus.

The activities of the prefrontal cortex stimulated by

chocolate significantly increased in the Type B group,

whereas the Type A group showed no changes in their

activities. The results showed that physiological responses

in Type B and Type A subjects were significantly different.

Park et al. [25] investigated changes in cortisol concentra-

tion after administering a eucalyptus-flavored drink. The

concentration of salivary cortisol significantly decreased

after ingestion of a eucalyptus-flavored drink in the Type

B group, but changes in the Type A group were statisti-

cally insignificant. Furthermore, Lee and Watanuki [26]

reported differences in the cardiovascular responses of

Type A and Type B subjects after visual stimulation using

displeasure-evoking images and nature video clips. How-

ever, the majority of the previous studies were laboratory

experiments, which were limited by small sample sizes. It

is necessary to use both laboratory experiments and field

experiments with large sample sizes to assess individual

differences.

Therefore, a field experimental design was used to

study individual differences in the physiological effects

of forest therapy based on Type A and Type B behavior

patterns in a sample size of 485 subjects. Furthermore,

because this study used a large sample size, we examined

additional details from the classification of the Type A

and Type B groups.

Methods

Subjects and study sites

From 2005 to 2010, we performed physiological experi-

ments in 44 areas of Japan (Figure 1). Two study sites, a

Figure 1 Map showing experimental locations.

forest and an urban environment, were selected for each

of the 44 areas. Twelve male university students partici-

pated in each of the experiments (in total, 528 subjects),

and no student reported a history of physical or psychi-

atric disorder. Of these, we were able to measure the

blood pressure and pulse rate of 485 subjects (21.8 ± 1.6

years old) for analysis. The study was performed according

to the regulations of the Ethics Committee of the Center

for Environment, Health, and Field Sciences, Chiba

University or the Institutional Ethics Committee of

the Forestry and Forest Products Research Institute in

Japan.

Measurements

A digital blood pressure monitor based on oscillometric

methods (HEM1000, Omron, Japan) was used to measure

the pulse rate and blood pressure (systolic and diastolic

blood pressure) in the right upper arm.

We used the KG daily life questionnaire to determine

Type A and Type B behavior patterns [27]. The KG daily

life questionnaire comprises 55 items (44 that determine

Type A and Type B behavior patterns and 11 irrelevant

or dummy questions). The subjects were asked to

choose one of the three options as a reply (yes, ?, or no)

for each question; with respective scores of 2, 1, or 0 for

the replies. It was found that a score of <43 points indi-

cated a Type B behavior pattern, while >44 points indi-

cated a Type A behavior pattern.

Song et al. Journal of Physiological Anthropology 2013, 32:14

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Experimental design

On the day before the experiment, the subjects were

fully informed about the aims and procedures involved.

After receiving a description of the experiment, the sub-

jects signed an agreement to participate. All subjects

were instructed to reside in a hotel with identical single

rooms and eat the same category of food during the on-

going procedure, to minimize individual differences

caused by these factors. Alcohol and tobacco were

prohibited, and caffeine consumption was controlled.

After orientation, the subjects visited and previewed the

forest and urban study sites before commencement of

the experiment. Measurement practice of the physio-

logical indices was performed at the hotel. The subjects

were asked to complete the KG daily life questionnaire

in their individual rooms after dinner.

Twelve subjects were randomly assigned to the forest

or urban environment groups for each of the 44 areas,

to eliminate the ordering effect. On the first day of the

experiments, six subjects were sent to a forest site, and

the other six subjects were sent to an urban site. On the

second day, the sites were interchanged. After arriving at

the site, each subject was asked to sit on a chair and

view the landscape (the forest or urban environment) for

a period of 15 min in the afternoon. Figure 2 shows ex-

amples of two experimental viewing areas. Physiological

measurements were recorded before and after viewing.

We measured each physiological index three times;

mean values were used for comparative purposes.

Figure 2 An example of experimental landscapes in the

experimental area. Top: Forest area, Bottom: Urban area.

Data analysis

We used the differences in the physiological values,

i.e., ‘postviewing’ minus ‘previewing’, to determine the

change in the physiological response to viewing. The re-

sponse data from forest and urban environments were

compared between Type B and Type A subject groups

and between four subgroups, which were obtained by

dividing each of the Type A and Type B subject groups

according to their KG daily life questionnaire scores.

We divided each group according to the median. The

below-median Type B subgroup (N = 252) was the low

scoring Type B subgroup (N = 126), and the above-

median Type B subgroup was the high scoring Type B

subgroup (N = 126). The Type A group was subdivided

in the same way.

A two-way repeated measures analysis of variance

(ANOVA) with one between-subjects factor (that is,

Type A or B behavior pattern with two or four levels)

and one within-subjects factor (that is, environment with

two levels) was performed, to determine whether the in-

dividual responses to the two environments differed sig-

nificantly with respect to the Type A and Type B

behavior patterns. Furthermore, a simple effect test with

Bonferroni correction was performed for the post-hoc

analysis. SPSS 20.0 (SPSS Inc., Chicago, IL, USA) was

used to perform statistical analysis of the physiological

data. In all cases, values of P < 0.05 were considered to

indicate statistical significance.

Results

The distribution of the KG questionnaire scores is

shown in Figure 3. Based on the scores in the KG daily

0 8 16 24 32 40 48 56 64 72 80 88

Score of KG daily life questionnaire

Figure 3 Distribution of the Kwansei Gakuin (KG) daily life

questionnaire scores. N = 485.

Song et al. Journal of Physiological Anthropology 2013, 32:14

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life questionnaire, we divided the subjects into Type B

group (12 to 43 points, N = 252) or Type A group (44 to

82 points, N = 233). Figure 4 shows a comparison of the

changes in the pulse rates of Type B and Type A sub-

jects. The ANOVA showed a significant main effect for

the environment [F (1,483) = 5.720, P < 0.05] and envir-

onment × the behavior pattern interaction [F (1,483) =

4.464, P < 0.05], which indicated that the pulse rates

were changed by the environment and that the differ-

ences in the pulse rates for the forest environment and

urban environment depended on the subject’s behavior

type (i.e., Type A or Type B behavior pattern). The sim-

ple main effect of the difference between the two envi-

ronments was significant in the Type B subject group

(P < 0.01). For this group, viewing a forest environment

decreased the pulse rate by 2.5 beats/min (from 65.7

beats/min to 63.2 beats/min); this was significantly

lower than the change after viewing an urban environ-

ment. However, the results for Type A subjects

exhibited no significant differences between the forest

and urban environments.

In addition, we analyzed four subgroups, which were

obtained by dividing each of the two Type A and Type B

subject groups on the basis of the scores of the KG daily

life questionnaire. Figure 5 shows a comparison of

changes in the pulse rates of the four subgroups. The

ANOVA detected a significant main effect for the en-

vironment [F (1,481) = 5.428, P < 0.05] and a trend in

the environment × the behavior pattern interaction

[F (3,481) = 2.121, P = 0.097], which indicated that the

pulse rates for the environment and forest and urban

environments varied among the four subgroups. The

simple main effect of the difference between the two

environments was significant in the low scoring Type B

subgroup (12 to 35 points, N = 126, P < 0.01). The low

scoring Type B subgroup exhibited a significant reduc-

Type B group Type A group

0.0

− 1.0

− 2.0

− 3.0

** − 4.0

Forest

Urban

Figure 4 Changes in pulse rates in the Type B and Type A

groups after exposure to the two environments. Type B group:

N = 252, Type A group: N = 233. Mean ± standard error. **P < 0.01

by two-way analysis of variance (ANOVA) for repeated measures

with post-hoc contrasts.

Type A behavior pattern score

Type B group Type A group

0~34 35~43 44~50 51~88

0.0

− 1.0

− 2.0

− 3.0

− 4.0 **

Forest

Urban

Figure 5 Changes in the pulse rates of the four subgroups after

exposure to the two environments. Low scoring Type B

subgroup: N = 126, high scoring Type B subgroup: N = 126, low

scoring Type A subgroup: N = 116, high scoring Type A subgroup: N

= 117. Mean ± standard error. **P < 0.01 by two-way analysis of

variance (ANOVA) for repeated measures with post-hoc contrasts.

tion of 1.7 beats/min after the subjects were exposed to

the forest area compared with the pulse rate of the sub-

jects after exposure to urban areas. In the other three

subgroups (high scoring Type B subjects: 35 to 43

points, N = 126; low scoring Type A subjects: 44 to 50

points, N = 116; and high scoring Type A subjects: 51 to

82 points, N = 117), differences in the pulse rates on ex-

posure to the forest and urban areas were statistically

insignificant.

Analysis of diastolic blood pressure showed no signifi-

cant difference between the forest and urban environ-

ments compared with: the Type B subject group (12 to

43 points, N = 243) and Type A subject group (44 to 82

points, N = 232); however, ANOVA of the four sub-

groups, which were obtained by dividing each of the two

Type A and Type B subject groups on the basis of the

scores in the KG daily life questionnaire, showed a trend

in the environment × the behavior pattern interaction [F

(3,471) = 2.457, P = 0.062], which suggested that there

were differences in the diastolic blood pressure for the

forest environment and urban environments in the four

subgroups (Figure 6). The simple main effect of the dif-

ference in the diastolic blood pressure between the two

environments was significant in the low scoring Type B

subgroup (12 to 34 points, N = 121, P < 0.05). The low

scoring Type B subgroup exhibited a more significant

reduction for forest environments than for urban envi-

ronments. In the other three subgroups (high scoring

Type B subjects: 35 to 43 points, N = 122; low scoring

Type A subjects: 44 to 50 points, N = 116; and high

scoring Type A subjects: 51 to 82 points, N = 116), there

was no significant difference in the forest and urban

environments.

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Type A behavior pattern score

Type B group Type A group

0~34 35~43 44~50 51~88

0.0

− 1.0

− 2.0

* − 3.0

Forest

Urban

Figure 6 Changes in diastolic blood pressure of the four

subgroups after exposure to the two environments. Low scoring

Type B group: N = 121, high scoring Type B group: N = 122, low scoring

Type A subgroup: N = 116, high scoring Type A subgroup: N = 116.

Mean ± standard error. **P < 0.01 by two-way analysis of variance

(ANOVA) for repeated measures with post-hoc contrasts.

Discussion

In this study, we aimed to elucidate individual differ-

ences in the physiological response to forest therapy by

evaluating changes in the pulse rates and blood pres-

sures in 485 subjects after forest therapy in field experi-

ments, in which individuals were classified as having a

Type A or Type B behavior pattern. The results showed

that there was a significant reduction in the pulse rate

after viewing forest scenes compared with that found

after viewing urban areas, and that the reduction was re-

lated to the subject’s behavior pattern.

The reductions in the pulse rate and blood pressure

after viewing the forest for 15 min confirmed that forest

therapy induced a relaxed state. Although we only used

blood pressure and pulse rate data in this study to exam-

ine the individual difference, previous studies that have

used various physiological indexes have been reported.

According to previous studies, staying in a forest also

suppressed sympathetic nervous activity [10,12-14], in-

creased parasympathetic nervous activity [9,10,12-14],

decreased cortisol level [8,9,11-13], and reduced cerebral

blood flow in the prefrontal cortex [8]. It has been sug-

gested that human beings are more relaxed in forest en-

vironments. Thus, we considered that the reduced pulse

rate and blood pressure in the present study reflected a

relaxed physiological state. Classification into Type A

and Type B subjects showed that the pulse rate reduc-

tion was significant in the Type B group; however, there

was no significant difference in the Type A group. Thus,

the differences in the physiological effects of forest ther-

apy were only present in the subjects with the Type B

behavior pattern. When all of the subjects were divided

into four subgroups, there was only a significant de-

crease in the low scoring group of Type B subjects.

The Type A behavior pattern can be defined as an

overt behavioral syndrome related to lifestyle, which is

characterized by excessive competitiveness, striving for

achievement, aggressiveness, time urgency, restlessness,

hostility, feelings of struggling against the limitations of

time, and insensitivity to the environment [23]. The

Type A behavior pattern is also known to be linked to

patients with heart disease. Therefore, previous studies

of the Type A behavior pattern have primarily investi-

gated increases in stress-related conditions related to

sympathetic activity in Type A individuals. In general,

the heart rate and systolic blood pressure of Type A in-

dividuals increased more than those of Type B individ-

uals under stressful conditions [28], and muscular

vasodilation and secretion of norepinephrine, epineph-

rine, and cortisol were more pronounced in Type A in-

dividuals [29,30]. Dembroski et al. [31] also reported

that stressed Type A individuals exhibited a higher re-

sponse in their sympathetic activity than Type B individ-

uals, and Oishi et al. [32] suggested that stressors do not

affect the parasympathetic activity in Type A individuals.

We observed that the pulse rate and blood pressure

were significantly reduced in the Type B group after for-

est therapy but that there were no differences in the

Type A group. This result is consistent with the findings

of previous studies that investigated the Type A behavior

pattern response to natural stimulation. Lee et al. [33]

examined the correlation between the Type A behavior

pattern and changes in systolic blood pressure after

walking in a forest environment for 14 min. The systolic

blood pressure was reduced in the Type B group,

whereas it increased in the Type A group. Park et al.

[25] investigated changes in the cortisol concentration in

response to a eucalyptus-flavored drink. The cortisol

levels were significantly reduced in the Type B group,

whereas there were no changes in the Type A group.

Miyazaki and Tsunetsugu [24] investigated the response

of hemoglobin concentration changes in the prefrontal

cortex to gustatory chocolate stimuli. There was a sig-

nificant change in the Type B group, but no changes

were observed in the Type A group. These studies also

revealed that Type B subjects exhibited a more profound

change in response to exposure to natural stimuli than

Type A subjects, which agreed with our findings. How-

ever, the reasons for a higher response in the Type B

group, particularly in the low scoring subgroup of Type

B subjects, are currently unknown. Several previous

studies have detected an increase in the sympathetic ac-

tivity of Type A individuals under stressed states. How-

ever, forest therapy aimed to enhance parasympathetic

activity [9,10,12-14,17]; thus, our results may require a

Song et al. Journal of Physiological Anthropology 2013, 32:14

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different explanation from that given in previous studies.

A possible future research area would be to investigate

the mechanism of the physiological reaction in Type A

and Type B individuals.

This study used forest therapy to evaluate the effects

of physiological relaxation in a large sample of 485 sub-

jects and detected individual differences in the relaxation

effects, particularly in the subjects who exhibited a Type

B behavior pattern. We suggest that the results of this

study may help to elucidate physiological polymorphism,

which is an important concept in physiological anthro-

pology. However, this study was limited to men in their

20s; thus, verification of our results using subjects with

different attributes is necessary.

Conclusions

The pulse rate was significantly lowered by forest ther-

apy, and the level of the reduction varied depending on

whether the subjects exhibited a Type A or Type B be-

havior pattern. Individual differences related to changes

in pulse rate and diastolic blood pressure after forest

therapy were related to the Type A and Type B behavior

patterns.

Abbreviations

ANOVA: Analysis of variance; KG: Kwansei Gakuin.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CS carried out data acquisition, statistical analysis, interpretation of the

results, and manuscript preparation. HI, JL, and BP were involved with the

acquisition and interpretation of data. TK designed the study and was

involved with data acquisition. YM had an important a role in the overall

performance of this research, particularly experimental design, data

acquisition, and manuscript preparation. All authors contributed to the

preparation and are responsible for the final editing and approval of the

manuscript.

Acknowledgements

This study was supported partially by a Grant-in-Aid for Scientific Research

(S: 16107007) from The Ministry of Education, Culture, Sports, Science, and

Technology (MEXT).

Author details

1Center for Environment, Health and Field Science, Chiba University, Chiba,

Japan. 2Korea Forest Service, Daejeon, Korea. 3Depart of Environment &

Forest Resources, Chungnam National University, Daejeon, Korea. 4Forestry

and Forest Products Research Institute, Ibaraki, Japan.

Received: 5 March 2013 Accepted: 24 September 2013

Published: 2 October 2013

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