CLINICAL TRIAL article
Front. Psychol.
Sec. Environmental Psychology
Spending time in a forest versus a virtual forest simulation: qualitative and quantitative effects on stress perception and psychological well‑being in a randomised cross-over trial of highly sensitive persons
Provisionally accepted
- Institute for Exercise and Occupational Medicine, Department of Medicine, Faculty of Medicince, Medical Center-University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg im Breisgau, Germany, Freiburg, Germany
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Forest bathing ("Shinrin-yoku"), traditionally practiced in Japan, has shown positive effects on stress perception and psychological well-being in highly sensitive persons (HSP), but it is unclear whether a simulation can produce the same effects. Forty-nine HSP underwent in randomised order a 40-minute exposure to both an authentic forest environment and a 360° video-based virtual forest simulation using a head-mounted display, complemented by natural forest sounds and essential spruce oil diffusion. Quantitatively, well-being and stress reduction measured with the Change in Subjective Self-Perception as pre-specified primary outcome (CSP‑14; Cohen's d: 0.931; p < 0.001) and secondary outcome state anxiety (STAI‑S: Cohen's d: 1.5 vs. 0.275; p < 0.001) improved significantly more in the real forest. The forest condition also yielded greater reductions in heart rate (- 7.94 vs. - 3.47 bpm; Cohen's d: 0.335; p = 0.026) and superior improvements on Basel Well-Being Subscales vitality, intrapsychic balance, and vigilance (Cohen's d: 0.751, 0.466, 0.629; all p < 0.001). Furthermore, we analysed qualitative interviews which revealed that authentic multisensory experiences in the forest significantly enhanced relaxation, reduced stress, and promoted emotional security compared to the simulation. Although the virtual environment provided temporary calming effects and facilitated reflection, technical limitations, such as visual blurring, repetitive audiovisual loops, and limited sensory diversity, considerably impaired the immersive experience. Particularly for HSP, authentic natural environments seemed to be important in our setting in achieving deeper and more sustainable psychological benefits considering the existing limitations of video-based virtual forest simulation. This study emphasises the important value of real forest interactions in promoting psychological well-being and effective stress management. Clinical Trial Registration: German Clinical Trials Register (DRKS), identifier DRKS00025421.
Keywords: 360° Video, Cross-over trial, Forest bathing, Highly sensitive persons, psychological well‑being, qualitative interviews, stress perception, virtual reality forest
Received: 17 Sep 2025; Accepted: 12 Jan 2026.
Copyright: © 2026 Kühn, Huber, Oomen-Welke and Sättele. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Joel Kühn
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