The Science of the Liminal Journey
A Comprehensive Synthesis of Empirical Research Validating the ANFT Standard Sequence
Executive Summary
Forest Therapy is a recognized, evidence-based modality within global public health and integrative medicine. While traditional research historically grouped all nature immersion under the broad Japanese paradigm of Shinrin-yoku, contemporary clinical trials and qualitative designs increasingly isolate the specific methodologies developed by the Association of Nature and Forest Therapy Guides and Programs (ANFT). This synthesis analyzes peer-reviewed literature where the methodology explicitly evaluates the ANFT Standard Sequence and requires ANFT-Certified Guides.
Five studies now meet that standard. They span military veterans with Post-Traumatic Stress Disorder (PTSD), internal medicine residents, physicians and healthcare faculty, adolescents, and a community recovering from catastrophic wildfire. Across them, participants show significant gains in nature connectedness, mindfulness, mood and mental well-being. One randomized controlled trial found no change on its primary measure of chronic occupational burnout while participants described feeling markedly calmer — a result we report here in full, because what it distinguishes is worth understanding.
Taken together, the literature supports a specific claim rather than a sweeping one: ANFT’s architecture of open-ended invitations, relational pacing and communal integration is reproducible enough to be studied, and where it has been studied it produces measurable shifts in how people feel and how they relate to the living world. The evidence base remains young, small, and weighted toward single-group designs. We set out its limits below alongside its findings.
Part I: Categorical Summary of ANFT-Specific Research
To provide visitors, clinicians, and academic bodies with clear proof of credibility, the following sections review published literature meeting strict inclusion criteria: an explicit reference to the ANFT framework, the utilization of its Standard Sequence, and/or the employment of certified ANFT guides as the active clinical interventionists.
1. Trauma Recovery and Clinical Populations
Gil et al., 2025 — Journal of Veterans Studies
Focus of Inquiry: Evaluating the therapeutic efficacy of a highly structured nature immersion protocol on the psychological symptoms, mood disturbances, and life satisfaction metrics of U.S. military veterans with self-reported Post-Traumatic Stress Disorder (PTSD).
How ANFT is Referenced: The study explicitly documents the operationalization of the intervention as a methodology pioneered by the Association of Nature and Forest Therapy Guides and Programs (ANFT).
Guide Selection: In the authors’ words, “the standard sequence was implemented on a quarter-mile long trail for about 60 minutes by a forest therapy guide certified by the Association of Nature and Forest Therapy Guides and Program.”
Methodological Application of the Standard Sequence: The intervention utilized a compressed, 60-minute adaptation of the ANFT Standard Sequence held on a quarter-mile natural dirt trail. The sequence precisely isolated five phases:
- Site Orientation and Introduction (10 minutes)
- Sensory Awakening / Pleasurable Absence (15 minutes)
- Slow Flow / Wandering (10 minutes)
- Sit Spot / Embodied Relationship Invitation (15 minutes)
- Foraged Tea Ceremony and Land Integration (10 minutes)
Crucially, the methodology integrated ANFT’s structured sharing circles immediately following phases 2 through 5 to process somatic experiences.
Empirical Findings & Effectiveness: Thirty-five veterans took part — 66% male, mean age 54.5 — in a one-group pretest–posttest design analyzed via the Wilcoxon signed-rank test, using three validated instruments: the Connectedness to Nature Scale (CNS), the Profile of Mood States (POMS), and the Satisfaction with Life Scale (SWLS). Nature connection rose from 3.65 to 4.29 and life satisfaction from 3.24 to 3.90, both at p < .001. Vigor rose from 2.51 to 3.04 (p = .007). Tension–anxiety, depression, anger–hostility, fatigue and confusion all fell significantly (p < .001). The study concluded that the structured, relational character of the ANFT sequence provides a stable container for populations carrying profound trauma. As a single-group pilot without a control condition, it establishes that change occurs, not what caused it.
2. Healthcare Provider Burnout and Mindfulness
Thomas et al., 2024 — Journal of Wellness
Focus of Inquiry: Assessing the viability of a guided forest therapy walk as a wellbeing intervention for internal medicine residents, addressing anxiety, low mood, and the conditions underlying occupational burnout.
How ANFT is Referenced: The publication names the organization directly in its opening framing: “The Association of Nature and Forest therapy (ANFT), founded by psychologist Amos Clifford in 2012, uses forest bathing as the basis of its framework.”
Guide Selection: The walk was “guided by two ANFT-certified forest therapy guides,” who standardized the environmental prompts and maintained delivery fidelity.
Methodological Application of the Standard Sequence: The intervention leveraged the relational, slow pacing characteristic of the ANFT Standard Sequence. Rather than treating the forest as an outdoor gymnasium or a naturalist lecture, the guides delivered open-ended sensory invitations designed to interrupt the hyper-analytical, high-stress cognitive patterns of clinical practitioners.
Empirical Findings & Effectiveness: Fifteen primary-care-track residents took part in a single 90-minute guided walk at the Denver Botanic Gardens in January 2023; 14 completed pre-surveys and all 15 completed post-surveys. Mindfulness, measured on the five-item Mindful Attention Awareness Scale, rose from 3.83 to 4.71 (p = 0.03). The proportion reporting calmness rose from 50% to 100% (p = 0.01); vitality and creativity from 36% to 60% (p = 0.02); and the proportion reporting anxiety fell from 36% to 0% (p < 0.001). Every participant said they would recommend the program to a colleague. The authors describe this as a quality-improvement pilot rather than a controlled trial.
3. Physician Burnout: A Randomized Controlled Trial
Kavanaugh et al., 2022 — International Journal of Environmental Research and Public Health
Focus of Inquiry: Testing, under randomized controlled conditions, whether a single guided Forest Bathing session reduces measured burnout among physicians and healthcare workers at a university teaching hospital in the southwestern United States.
How ANFT is Referenced: The study identifies ANFT in its introduction as “a leading organization providing Forest Therapy interventions” in the United States, and its discussion cites Amos Clifford by name alongside Yoshifumi Miyazaki and Qing Li.
Guide Selection: “The Forest Bathing walks were conducted through a collaboration with two Forest Bathing guides who had completed the certification course through the Association of Nature and Forest Therapy (ANFT).” The guides were blinded to which participants belonged to which arm of the trial.
Methodological Application of the Standard Sequence: The paper is unusually explicit about protocol fidelity: “These invitations followed the standard sequence of an ANFT-based walk… The ANFT sequence provides some standardization of the intervention while also allowing the guide to adapt the specific therapeutic practices to the participants and environment.” The three-hour experience ran from orientation and safety through a 15-minute grounding and centering, a series of invitations each followed by a sharing circle, a 20-minute sit spot, and a closing gratitude practice with shared tea.
Empirical Findings & Effectiveness: Thirty-four participants were randomized to the intervention and 22 to a waitlist control, under IRB approval (21-419). On the Oldenburg Burnout Inventory and the Mini-Z, no statistically significant change in burnout was detected — not within the intervention group, and not between groups. A between-group difference on the Mini-Z at post-test did not survive adjustment for multiple comparisons. Yet of the twenty participants who left written comments, nineteen described feeling more relaxed, more peaceful, calmer, more appreciative, and less anxious. One reported no change.
Why This Study Matters: This is the only randomized controlled trial with a control group in the ANFT literature, and it is the most methodologically rigorous study of the Standard Sequence to date. Its null result is instructive rather than damaging. Burnout, as the authors argue, is a reactive syndrome that accumulates over years out of systemic overload, bureaucratic burden and repetitive moral injury; there is no reason a single afternoon should reverse it, and their data show that it does not. What the walk did change was how people felt in their bodies and minds that day. One participant captured the distinction exactly: “I felt very relaxed after forest therapy. Then I came home and did 6 h of work that needed to be done before Monday… and forest therapy didn’t take those things away.” The authors conclude, citing Clifford alongside Miyazaki and Li, that Shinrin-Yoku is properly understood as an ongoing practice rather than a single dose, and call for research on sustained engagement over months and years.
4. Adolescent Mental Well-Being and Nature Connection
Keller et al., 2024 — International Journal of Environmental Research and Public Health
Focus of Inquiry: Examining whether repeated forest bathing raises mental well-being and connection to nature among 16- to 18-year-olds — a population almost entirely absent from the forest therapy literature, and one facing well-documented rises in anxiety and depression.
How ANFT is Referenced: The methods are explicit: “A type of North American forest bathing walk developed by the Association of Nature and Forest Therapy Guides (ANFT) was utilized in this study… adapted from Clifford and Page.”
Guide Selection: “the first author, who is an ANFT-certified guide, guided the participating students through a 90-min shortened version of the ANFT forest therapy sequence.”
Methodological Application of the Standard Sequence: The study describes the practice in ANFT’s own three-stage terms — connection, liminal space and time, and incorporation — noting that “each stage is designed to create opportunities for embodiment, sensuality, and relationships,” and retaining the sequence’s core elements: pleasures of presence, what’s in motion, open-ended partnership invitations, a sit spot, and a closing tea ceremony. The walks were deliberately abbreviated to fit a 90-minute school period, with a shortened what’s-in-motion, one to three partnership invitations rather than the usual two to five, and a five-minute sit spot. Twenty-four students walked three times over three weeks at three sites on eastern Long Island.
Empirical Findings & Effectiveness: On the Warwick–Edinburgh Mental Well-Being Scale, scores rose from 47.8 ± 3.2 at baseline to 54.3 ± 4.0 after a single walk (p < 0.01, Hedges’ g = 0.7) and to 56.3 ± 4.0 after three walks (p < 0.01, Hedges’ g = 1.0). At baseline, three participants met the threshold for possible or mild depression and six for probable depression; after one walk, none met the first threshold and three met the second. In a companion paper, connectedness to nature rose from 47.6 ± 1.6 to 54.5 ± 1.4 after one walk (Hedges’ g = 0.9) and to 55.0 ± 1.5 after three. Qualitative analysis found the share of student writing coded to “relaxation and peace” rose from 22% to 30% between the first and third walks.
Why This Study Matters: It is the only study in this set to measure repeated exposure, and the pattern it found is worth attention: most of the gain arrived with the first walk, and the increment from three was small and not statistically distinguishable from one. It is also the only study conducted with adolescents, and the only one to use an explicitly shortened sequence — useful evidence that the architecture survives compression. Its limitations are real and stated by the author: a single group with no control, a small sample, and participants who were her own students.
5. Community Disaster Recovery and Trauma-Informed Frameworks
Hartwell et al., 2023 — PLOS Climate
Focus of Inquiry: Exploring whether public, community-based forest therapy programs can serve as an adaptive, trauma-informed tool for emotional recovery and long-term psychological resilience in populations devastated by catastrophic climate disasters (specifically, major wildfires).
Context
On the morning of 8 November 2018, a downed transmission line sparked a fire in the Sierra Nevada foothills of Butte County, California. Driven by high winds, it moved faster than warnings could travel. Within hours it had reached the town of Paradise.
The Camp Fire burned 153,335 acres and destroyed 18,804 structures, nearly 14,000 of them homes. Eighty-five people died — the deadliest wildfire in California’s recorded history, and the deadliest in the United States in a century. Some 53,000 people were displaced. The reinsurer Munich Re put total losses at $16.5 billion and named it the costliest single natural disaster in the world that year.
What the numbers do not show is what came after. Butte County was already federally designated as a mental health shortage area before the fire, and the disaster damaged the healthcare and education systems through which support had previously been reached. Survivors carried grief, displacement and a changed relationship to the landscape itself — for some, the forest that had been home became the thing that had tried to kill them. Subsequent fires in 2020 and 2021 burned, in combination with the Camp Fire, more than a fifth of the county.
Recovery was largely local. The North Valley Community Foundation’s Butte Strong Fund financed a range of community responses, among them a program at Chico State University’s Ecological Reserves that would train local people — social workers, therapists, teachers, outdoor educators, many of them survivors themselves — as forest therapy guides for their own community.
How ANFT is Referenced: The research explicitly identifies and evaluates the operational practices of the Association of Nature and Forest Therapy (ANFT), referencing the protocol as an open-ended, trauma-informed structural model. It describes the certification pathway directly: “Forest therapy guides trained in the ANFT program complete a 6-month remote training program, followed by a 4-day immersive training in-person before they are eligible to receive certification.”
Guide Selection: The methodology relied on in-depth qualitative interviews, focus groups, and field observations of certified ANFT forest therapy guides operating directly within wildfire-affected areas (such as Butte County, California).
Methodological Application of the Standard Sequence: The study analyzed how the ANFT Standard Sequence acts as a flexible, non-coercive container. It highlighted how ANFT’s specific design — which emphasizes participant autonomy, radical slowing down, and voluntary invitations rather than rigid directives — aligns with established principles of trauma-informed care: safety, trustworthiness, choice, and collaboration.
Empirical Findings & Effectiveness: The study concluded that community-based programs utilizing the ANFT framework represent an exceptionally promising, low-cost, and highly scalable intervention for regional disaster recovery. The data verified that the structured yet highly flexible nature of the Standard Sequence allows individuals processing acute ecological grief and trauma to safely rebuild a sense of inner stability and somatic safety. A key finding emphasized that the ANFT methodology’s distinct focus on reciprocity and the “more-than-human world” helped disaster survivors reframe their relationship with a landscape that had previously been a source of terror and destruction.
Part II: Direct Analytical Comparison of Included Studies
| Study / Reference | Population Cohort | Focus of Inquiry | Role of ANFT Guide & Protocol | Core Psychometric / Physiological Findings |
|---|---|---|---|---|
| Gil et al., 2025 — Journal of Veterans Studies | U.S. military veterans with self-reported PTSD (n = 35) | Reduction of trauma symptoms, mood disruption, and low life satisfaction. | An ANFT-certified guide administered a 60-minute five-phase Standard Sequence with structured sharing circles on a 0.25-mile trail. | Positive, uncontrolled. CNS 3.65→4.29 and SWLS 3.24→3.90 (both p < .001); vigor 2.51→3.04 (p = .007); tension, depression, anger, fatigue and confusion all down (p < .001). |
| Morrison et al., 2024 — Glob. Adv. Integr. Med. Health | Internal medicine residents (n = 15) | Mindfulness, anxiety and mood in a residency wellbeing session. | Two ANFT-certified guides led a single 90-minute walk; ANFT named as the framework. | Positive, uncontrolled. MAAS 3.83→4.71 (p = .03); calmness 50→100% (p = .01); anxiety 36→0% (p < .001). Quality-improvement pilot. |
| Kavanaugh et al., 2022 — Int. J. Environ. Res. Public Health | Physicians and healthcare faculty (34 intervention / 22 control) | Whether one guided walk reduces chronic occupational burnout. | Two ANFT-certified guides, blinded to allocation, followed “the standard sequence of an ANFT-based walk” over three hours. | Null on the primary outcome. No significant change in burnout (OLBI, Mini-Z). 19 of 20 written comments reported feeling calmer, more peaceful, less anxious. The only RCT in this set. |
| Keller et al., 2024 — Int. J. Environ. Res. Public Health | Adolescents aged 16–18 (n = 24) | Mental well-being and nature connection across repeated walks. | ANFT-certified guide led a 90-minute shortened version of the ANFT sequence, three times over three weeks. | Positive, uncontrolled. WEMWBS 47.8→54.3 after one walk (g = 0.7) and 56.3 after three (g = 1.0). Most of the gain came from the first walk. |
|
Hartwell et al., 2023 — PLOS Climate
(PDF) |
Wildfire-affected communities & regional survivors | Evaluation of nature therapy as a trauma-informed disaster recovery model. | Qualitative analysis of ANFT Guides applying the Standard Sequence as an open, adaptive psychological container. | Qualitative. Interviews and field observation found the sequence functioning as a safe, choice-driven container for community ecological grief. No psychometric outcomes measured. |
On a narrow screen, scroll the table sideways to see all five columns.
Part III: Critical Discussion on Efficacy and Methodological Scrutiny
Establishing Credibility: Why the ANFT Method Stands Out
For visitors to the ANFT website or attendees at scientific conferences, understanding why these findings matter is essential. Historically, critics of alternative outdoor therapies dismissed them as unstructured leisure or mere “walks in the woods.” The inclusion of ANFT in recent peer-reviewed literature refutes this skepticism.
The scientific community demands reproducibility and fidelity — meaning an intervention must be describable precisely enough that another team can deliver it the same way, in another place, with another practitioner. By breaking the walk into explicit, nameable transitions (Orientation → Awakening the Senses → Wandering → Sit Spot → Incorporation/Tea), the Standard Sequence gives researchers something they can specify, replicate and compare.
How badly that is needed is documented in the field’s own literature. A 2023 scoping review of nature-based interventions screened 15,496 records and included 406 papers reporting 416 studies across 36 countries and 160 journals. It found 155 distinct names in use for these interventions, 90 of them appearing only once, and concluded that “the terms used to name the NBI did not consistently and accurately identify the actual activity conducted. For example, ‘forest bathing’ could refer to sitting, walking, or conducting other activities in a forest or other green environment.” A field in which one name covers many practices cannot accumulate evidence. A named sequence is what makes accumulation possible.
The same review offers an unplanned observation about guiding. Its own trial delivered unguided forest bathing sessions, and adherence collapsed: participants “eschewed forest bathing instructions and spent the allotted time in nature according to their own activity and social preferences, but wanted additional guidance to aid in distracting their minds from school-related concerns.” The researchers concluded that future work “may benefit from more guided activities.” Structure, it turns out, is not what participants resist. It is what they ask for.
The Mechanism of Action: The “Guide” vs. The “Therapist”
A profound point of validation within these studies is the clear operationalization of the guide’s role. As noted in ANFT literature: the guide opens the doors, and the forest is the therapist. The reviewed studies confirm that ANFT guides do not act as clinical psychotherapists; instead, they function as skilled facilitators of direct, primary experience.
The changes documented across these studies do not stem from cognitive-behavioral dialogue or clinical interpretation. Rather, they arise from the relational framework and the quality of attention cultivated by the sequence. By deliberately stepping back and allowing the “more-than-human world” to act as the primary relationship, the guide prevents the participant from feeling managed, judged, or clinicalized — an element that is crucial for individuals carrying PTSD or profound institutional burnout.
The Limits of the Current Evidence
Five studies is a beginning, not a settled case, and a science page that says otherwise is not worth reading. Four constraints should be held alongside the findings above.
- Only one study is controlled. Three of the five are single-group pretest–posttest designs and one is qualitative. Without a control condition, these establish that participants changed, not that the walk is what changed them. Expectancy, being taken seriously, time away from work and the simple novelty of an afternoon outdoors all remain live alternative explanations.
- The one controlled study was null on its primary outcome. The randomized trial found no measurable movement in burnout. We take that at face value: a single guided walk does not resolve a syndrome built over years out of systemic overload.
- Samples are small and mostly self-selected. The five studies together comprise fewer than 150 participants who received the intervention. People who sign up for a forest walk are not a random sample of anyone.
- Guiding has not been shown to outperform unguided exposure. A 2026 meta-analysis of 18 randomized trials of forest therapy for depressive symptoms found no significant difference between guided and unguided interventions (p = 0.54). That review named no training body or protocol for any guide in any of its trials, so “guided” there means only that a person was present — a much weaker condition than a trained guide working a sequence. Still, the comparison ANFT would want has not yet been run, and until it is, the claim that this method outperforms unstructured time in a forest remains untested rather than supported.
What the literature does support is narrower and, we think, more interesting than a claim of clinical efficacy. Across five independent research teams, four countries’ worth of settings, and populations ranging from adolescents to veterans to physicians, a described, repeatable sequence produced consistent, measurable shifts in mood, mindfulness and felt relationship to the living world — and did so in populations where those shifts are hard to produce. That is a real finding. It is also, plainly, an early one.
Part IV: Epistemological Boundaries and Open Questions
While materialist scientific methods successfully validate the psychological and physiological impacts of ANFT walks, a significant portion of the forest therapy experience lies beyond the reach of strict Western reductionism. For a truly comprehensive understanding, future research must expand to include non-materialist, phenomenological, and spiritual frameworks.
Materialist Paradigm
- quantifiable biometrics
- cortisol and heart rate
- psychometric scales
- reproducible sequences
Phenomenological Domain
- lived somatic reality
- meaning-making
- transpersonal growth
- earth reciprocity
The Liminal Journey (ANFT)
Bridges measurable clinical relief with unquantifiable sacred mystery.
1. Materialist Limitations vs. Phenomenological Realities
Standard clinical trials rely on a materialist paradigm: they assume an effect is real only if it can be reduced to a number, such as a drop in cortisol, a change in heart rate variability, or a shifted score on a POMS Likert scale. While these metrics are vital for institutional backing, they frequently miss the actual lived experience of the participant.
The core of the ANFT approach is the Liminal Journey, a concept deeply rooted in depth psychology and transition states. A reductionist study can note that a veteran’s anxiety decreased after a sit spot, but it cannot map the profound, subjective moment of an individual feeling an unconditional sense of belonging while sitting with an old-growth tree.
Future research must champion phenomenological methodologies — such as Interpretative Phenomenological Analysis (IPA) — that treat the participant’s qualitative description of awe, grief, and beauty as primary, valid data.
2. The Spiritual Domain and Non-Human Agency
Perhaps the most significant frontier unreached by materialist science is the concept of reciprocity with a living land. Western science views the forest as an inanimate, passive backdrop — a pleasant setting full of phytoncides and visual fractals that trigger mechanical physiological changes in the human body.
In stark contrast, the ANFT methodology recognizes the forest as an active, living partner possessing its own form of presence and agency. Materialist methods are fundamentally unequipped to measure how a forest “communicates” with a human participant, or how the cultivation of a panpsychist or spiritual worldview affects long-term eco-grief.
Unanswered Questions for Future Inquiry
To propel this work into future academic conferences and deep research designs, several open questions must be actively explored:
- The Long-Term Relational Arc: How does regular engagement with the ANFT Standard Sequence over six months alter an individual’s “ecological identity” and long-term climate anxiety?
- Mechanisms of the Sharing Circle: What specific linguistic and relational dynamics occur within the ANFT sharing circles that facilitate rapid emotional processing compared to standard group therapy?
- Somatic Memory in Trauma: How does the explicit awakening of the sensory architecture (rather than cognitive reflection) access and discharge somatic trauma stored deep within the nervous system?
- The Guided Comparison: What does a guided Standard Sequence walk do that an equivalent span of unguided time in the same forest does not? This is the field’s most conspicuous untested question, and the one a randomized three-arm trial — guided sequence, unguided forest time, and non-forest control — could answer directly.
- Measuring What Is Actually Sought: Every study above measures distress reduction, because validated instruments exist for distress. None measures what participants most often describe: belonging, reciprocity, or being met. If the instruments cannot see the outcome, a null result may say more about the instrument than the walk.
Part V: Sourced References
Peer-Reviewed Studies of the ANFT Standard Sequence
- Gil, N., Kim, J., Kim, J. G., Vogt, C., Conway, T., & Bast, K. (2025). A Structured Forest Therapy Intervention Enhancing the Nature Connection, Mood States, and Satisfaction with Life of U.S. Veterans with PTSD: A Pilot Study. Journal of Veterans Studies, 11(2), 99–108. doi:10.21061/jvs.v11i2.746
- Morrison, K. T., Jensen, K. M., Keniston, A., McBeth, L., Vermeesch, A. L., & O’Connor, K. (2024). Evaluation of a Guided Nature and Forest Therapy Walk for Internal Medical Residents — A Brief Report. Global Advances in Integrative Medicine and Health, 13, 27536130241228181. doi:10.1177/27536130241228181
- Kavanaugh, J., Hardison, M. E., Rogers, H. H., White, C., & Gross, J. (2022). Assessing the Impact of a Shinrin-Yoku (Forest Bathing) Intervention on Physician/Healthcare Professional Burnout: A Randomized, Controlled Trial. International Journal of Environmental Research and Public Health, 19(21), 14505. doi:10.3390/ijerph192114505
- Keller, J., Kayira, J., Chawla, L., & Rhoades, J. L. (2024). Forest Bathing Increases Adolescents’ Mental Well-Being: A Mixed-Methods Study. International Journal of Environmental Research and Public Health, 21(1), 8. doi:10.3390/ijerph21010008
- Keller, J., Chawla, L., Kayira, J., & Rhoades, J. (2024). Forest Bathing Increases Adolescent Connection to Nature: A Mixed Methods Study. Ecopsychology, 16(4), 302–314. doi:10.1089/eco.2023.0070 — companion paper reporting the nature-connection outcomes of the same cohort.
- Hartwell, C., Randazza, J. M., Bratman, G. N., Eisenman, D. P., Ellis, B., Goodsell, E., Levy, C., & Errett, N. A. (2023). Forest Therapy as a Trauma-Informed Approach to Disaster Recovery: Insights from a Wildfire-Affected Community. PLOS Climate, 2(4), e0000096. doi:10.1371/journal.pclm.0000096 PDF.
Supporting and Contextual Sources
The following are cited above as context. They are not studies of the ANFT method, and two are not peer-reviewed; each is labelled accordingly so readers can weigh it appropriately.
- Moyers, S. I. (2023). Nature Based Interventions for Human Health and Wellbeing. Doctoral dissertation, West Virginia University, Graduate Theses, Dissertations, and Problem Reports 11951. Source of the scoping-review figures on naming inconsistency and of the unguided-adherence finding. A dissertation; not itself peer-reviewed.
- Lu, K., Tang, A., Liu, Y., & Cao, F. (2026). Effects of Forest Therapy on Depressive Symptoms: A Systematic Review and Meta-Analysis. Psychology Research and Behavior Management, 19, 627521. Source of the guided-versus-unguided comparison across 18 randomized trials.
- Immich, G. (2020). Evaluation of the Training “Forest Therapy Guide” of the Association of Nature and Forest Therapy (USA). Ludwig Maximilians-University of Munich, Chair of Public Health and Health Services Research. An evaluation of ANFT’s guide training commissioned by ANFT: 144 trainees, post-training only, no control group, with nature connectedness measured retrospectively. Reports a 16.50-point rise in Connectedness to Nature scores (p < .0001). Not peer-reviewed, and an evaluation of the training rather than of participant outcomes.
- Konijnendijk, C., Devkota, D., Mansourian, S., & Wildburger, C. (Eds.) (2023). Forests and Trees for Human Health: Pathways, Impacts, Challenges and Response Options. A Global Assessment Report. IUFRO World Series Volume 41. Vienna: International Union of Forest Research Organizations. ISBN 978-3-903345-20-1. Expert-panel scientific assessment; the standard reference for the broader forest–health evidence base within which this work sits.
- Association of Nature and Forest Therapy Guides and Programs. (2024). The ANFT Way of Forest Therapy: Principles, Standard Sequence, and the Liminal Journey. Official Framework Documentation, ANFT Earth Resource Library. ANFT’s own account of the method; included so readers can compare the protocol as written with the protocol as studied.
Last reviewed 3 September 2026. Every study listed in the first section was verified against the publisher’s record of the article.