The Effect of Nature therapy for Stress, Anxiety, Depression and Demoralization on Breast Cancer Patients

  • Yun-Chen  Chang
  • Tzuhui Angie Tseng
  • Shih-Che Chiu 


Background: Patients with breast cancer experience extreme stress that may cause mental disorders. Research has found that exposure to natural landscapes and gardening improves the mental wellbeing of patients. Objective: To investigate the effects of exposure to natural landscapes and gardening on the physiological health (salivary cortisol and blood cortisol) and mental health (anxiety, depression, and demoralization) of patients with breast cancer. Methods: Eighteen patients with breast cancer participated in this study and were divided into an experimental group (n = 10) and control group (n = 8). The experimental group underwent two weeks of nature therapy (exposure to natural landscapes and gardening), whereas the control group underwent no treatment. The participants’ physiological and psychological indicators of stress (cortisol), anxiety, depression, and demoralization were tested before and after the nature therapy. The independent variables were breast cancer and nature therapy; the dependent variables were stress, anxiety, depression, and demoralization. The tools used were the Hospital Anxiety and Depression Scale, the demoralization scale, and saliva and blood tests for stress hormones. The research methods focused on quantitative statistics, and SPSS 20 software was used to perform the Wilcoxon signed-rank test and Mann–Whitney U test. Qualitative analysis was secondary. Results: The Wilcoxon signed-rank test found significant differences in blood cortisol and demoralization for the experimental group (z = −2.483; p ≤ 0.05; z = −2.023; p ≤ 0.05, respectively). Significant differences were discovered between the group’s posttest saliva (z = −2.176; p ≤ 0.05) and demoralization scores (z = −2.575; p ≤ 0.05). Conclusions: Exposure to natural landscapes and gardening had positive psychological effects on the patients with breast cancer; thus, in addition to medications for stress, anxiety, depression, and demoralization, nature therapy can be used to treat patients. These results can be used by medical professionals to treat physical and psychological ailments.

How to Cite
CHANG, Yun-Chen ; TSENG, Tzuhui Angie; CHIU , Shih-Che. The Effect of Nature therapy for Stress, Anxiety, Depression and Demoralization on Breast Cancer Patients. GSTF Journal of Nursing and Health Care (JNHC), [S.l.], v. 5, n. 1, apr. 2018. ISSN 2345-7198. Available at: <>. Date accessed: 17 june 2019.