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Healthcare (Basel, Switzerland)2026; 14(2); 260; doi: 10.3390/healthcare14020260

Animal-Assisted Therapy for Reducing Anxiety in Vulnerable Clinical Populations: A Systematic Review.

Abstract: : Anxiety is highly prevalent among individuals living with disability, chronic illness, or hospitalisation, yet it often remains insufficiently addressed in healthcare settings. Animal-assisted therapy (AAT) has been proposed as a complementary intervention to reduce anxiety; however, existing evidence is fragmented across populations and methodologies. : A systematic review was conducted following PRISMA 2020 guidelines. The review protocol was registered in PROSPERO (CRD42024494109); no amendments were made to the protocol after registration. Four databases (Scopus, APA PsycInfo, Web of Science, and PubMed) were searched for empirical studies (2013-2023) evaluating AAT delivered by trained professionals using domesticated species and reporting anxiety outcomes in individuals with disability, illness, or hospitalisation. : Thirty-one studies met eligibility criteria and were included in the review. Across heterogeneous designs, most interventions-primarily using dogs or horses-reported significant post-intervention reductions in anxiety. Randomised clinical trials consistently showed superior results compared with control conditions. AAT demonstrated beneficial effects across populations including PTSD, paediatric hospitalisation, chronic illness, disability, acute care, and trauma exposure. Long-term outcomes were mixed, and methodological variability limited comparability across studies. : AAT appears to be a promising complementary intervention for anxiety management within clinical, psychosocial, and healthcare settings. Evidence supports short-term anxiolytic effects across diverse populations, although standardisation and long-term evaluations remain insufficient. Future research should establish optimal intervention parameters, mechanisms of action, and strategies for integrating AAT into multidisciplinary mental healthcare.
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Publication Date: 2026-01-21 PubMed ID: 41595396PubMed Central: PMC12840666DOI: 10.3390/healthcare14020260Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research article systematically reviews the effectiveness of animal-assisted therapy (AAT) in reducing anxiety among vulnerable clinical populations such as those with disabilities, chronic illnesses, or who are hospitalized.
  • The review analyzes studies from the past decade to evaluate how AAT, primarily involving dogs and horses, impacts anxiety levels across various clinical settings.

Introduction and Background

  • Anxiety is common among individuals with disabilities, chronic illnesses, or those undergoing hospitalization, yet it is often inadequately addressed in healthcare.
  • Animal-assisted therapy (AAT) has been suggested as a complementary intervention to improve anxiety symptoms by leveraging interactions with trained animals.
  • Previous evidence on AAT’s efficacy is fragmented due to differences in study populations, methodologies, and inconsistent outcome measures.

Research Objectives and Methodology

  • The authors aimed to systematically review empirical studies evaluating AAT’s effectiveness in reducing anxiety in clinical populations.
  • They followed PRISMA 2020 guidelines for systematic reviews to ensure rigorous methodology and transparency.
  • The review protocol was registered with PROSPERO (CRD42024494109) to prevent bias and protocol deviations.
  • Four major databases were searched for relevant studies published between 2013 and 2023: Scopus, APA PsycInfo, Web of Science, and PubMed.
  • Inclusion criteria focused on:
    • Empirical studies involving AAT administered by trained professionals.
    • AAT interventions using domesticated animals, primarily dogs or horses.
    • Populations consisting of individuals with disabilities, illnesses, or hospitalizations.
    • Measured anxiety outcomes post-intervention.

Key Findings

  • A total of 31 studies met eligibility criteria and were included for review.
  • Most studies reported significant reductions in anxiety following AAT interventions.
  • Randomized clinical trials, regarded as the highest evidence level, consistently demonstrated superior anxiety reduction in AAT groups compared to controls.
  • AAT showed beneficial effects across diverse clinical groups including:
    • Post-Traumatic Stress Disorder (PTSD) patients.
    • Children undergoing hospitalization.
    • Individuals with chronic illnesses.
    • People living with disabilities.
    • Patients in acute care and those exposed to trauma.
  • However, long-term effects of AAT on anxiety were less consistent across studies.
  • Variability in study design, sample sizes, types of animals used, and anxiety measures made direct comparison across studies challenging.

Conclusions

  • Animal-assisted therapy is a promising complementary intervention for managing anxiety in various vulnerable clinical populations.
  • Evidence supports its short-term anxiolytic (anxiety-reducing) effects in clinical, psychosocial, and healthcare settings.
  • Current research lacks standardization of AAT protocols and sufficient long-term follow-up data.
  • Future research directions include:
    • Defining optimal intervention parameters such as session duration, frequency, and animal type.
    • Investigating the biological, psychological, or social mechanisms through which AAT reduces anxiety.
    • Developing strategies to integrate AAT into multidisciplinary mental health care frameworks effectively.

Implications for Clinical Practice

  • Healthcare providers may consider incorporating AAT as a complementary approach to anxiety management especially in settings where conventional interventions are limited or insufficient.
  • Trained animal handlers and appropriate patient selection are critical to maximize therapeutic benefits and ensure safety.
  • AAT offers a human-animal bond element that may enhance patient engagement and emotional wellbeing during clinical care.

Cite This Article

APA
Hernández-Espeso N, Bronchud LD, Bernabé-Valero G. (2026). Animal-Assisted Therapy for Reducing Anxiety in Vulnerable Clinical Populations: A Systematic Review. Healthcare (Basel), 14(2), 260. https://doi.org/10.3390/healthcare14020260

Publication

Healthcare (Basel, Switzerland)
ISSN: 2227-9032
NlmUniqueID: 101666525
Country: Switzerland
Language: English
Volume: 14
Issue: 2
PII: 260

Researcher Affiliations

Hernández-Espeso, Nazaret
  • Faculty of Psychology, Catholic University of Valencia San Vicente Mártir, Av. De La Ilustración, 2, Burjassot, 46100 Valencia, Spain.
Bronchud, Laura Durbán
  • Faculty of Psychology, Catholic University of Valencia San Vicente Mártir, Av. De La Ilustración, 2, Burjassot, 46100 Valencia, Spain.
Bernabé-Valero, Gloria
  • Faculty of Psychology, Catholic University of Valencia San Vicente Mártir, Av. De La Ilustración, 2, Burjassot, 46100 Valencia, Spain.

Conflict of Interest Statement

No potential conflict of interest was reported by the authors.

References

This article includes 59 references
  1. Institute for Health Metrics and Evaluation (IHME) Anxiety Disorders Prevalence [Dataset]. Global Burden of Disease—Mental Health Prevalence. Our World in Data. 2024. [(accessed on 15 November 2023)]. Available online: https://ourworldindata.org/grapher/anxiety-disorders-prevalence.
  2. World Health Organization. COVID-19 Pandemic Triggers 25% Increase in Prevalence of Anxiety and Depression Worldwide. World Health Organization Geneva, Switzerland: 2022; 2 March 2022.
  3. Hsieh K, Scott HM, Murthy S. Associated Risk Factors for Depression and Anxiety in Adults With Intellectual and Developmental Disabilities: Five-Year Follow Up. Am. J. Intellect. Dev. Disabil. 2020;125:49–63.
    doi: 10.1352/1944-7558-125.1.49pmc: PMC7959169pubmed: 31877262google scholar: lookup
  4. Maresca G, Portaro S, Naro A, Crisafulli R, Raffa A, Scarcella I, Aliberti B, Gemelli G, Calabrò RS. Hippotherapy in neurodevelopmental disorders: A narrative review focusing on cognitive and behavioral outcomes. Appl. Neuropsychol. Child 2022;11:553–560.
    doi: 10.1080/21622965.2020.1852084pubmed: 33949903google scholar: lookup
  5. Villafaina-Domínguez B, Collado-Mateo D, Merellano-Navarro E, Villafaina S. Effects of dog-based animal-assisted interventions in prision population: A systematic review. Animals 2020;10:2129.
    doi: 10.3390/ani10112129pmc: PMC7697666pubmed: 33207818google scholar: lookup
  6. IAHAIO The IAHAIO Definitions for Animal Assisted Intervention and Guidelines for Wellness of Animals Involved for Wellness of Animals. 2018. [(accessed on 11 November 2023)]. Available online: https://iahaio.org/wp/wp-content/uploads/2021/01/iahaio-white-paper-2018-english.pdf.
  7. Binder AJ, Parish-Plass N, Kirby M, Winkle M, Skwerer DP, Ackerman L, Brosig C, Coombe W, Delisle E, Enders-Slegers M-J. Recommendations for uniform terminology in animal-assisted services (AAS). Hum.-Anim. Interact. 2024;12:1–10.
    doi: 10.1079/hai.2024.0003google scholar: lookup
  8. Pandey RP, Himanshu Gunjan Mukherjee R, Chang CM. The role of animal-assisted therapy in enhancing patients’ well-being: Systematic study of the qualitative and quantitative evidence. JMIRx Med 2024;5:e51787.
    doi: 10.2196/51787pmc: PMC10986847pubmed: 38606668google scholar: lookup
  9. Helmer A, Wechsler T, Gilboa Y. Equine-assisted services for children with attention-deficit/hyperactivity disorder: A systematic review. J. Altern. Complement. Med. 2021;27:477–488.
    doi: 10.1089/acm.2020.0482pubmed: 33835856google scholar: lookup
  10. Wilson EO. Biophilia. Harvard University Press; Cambridge, MA, USA: 1984.
  11. Nisbet EK, Zelenski JM. The NR-6: A new brief measure of nature relatedness. Front. Psychol. 2013;4:813.
    doi: 10.3389/fpsyg.2013.00813pmc: PMC3814587pubmed: 24198806google scholar: lookup
  12. Ein N, Li L, Vickers K. The effect of pet therapy on the physiological and subjective stress response: A meta-analysis. Stress Health 2018;34:477–489.
    doi: 10.1002/smi.2812pubmed: 29882342google scholar: lookup
  13. Santaniello A, Dicév F, Carratú RC, Amato A, Fioretti A, Menna LF. Methodological and terminological issues in animal-assisted interventions: An umbrella review of systematic reviews. Animals 2020;10:759.
    doi: 10.3390/ani10050759pmc: PMC7277107pubmed: 32349351google scholar: lookup
  14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE. Declaración PRISMA 2020: Una guía actualizada para la publicación de revisiones sistemáticas. Rev. Española Cardiol. 2021;74:790–799.
    doi: 10.1016/j.recesp.2021.06.016pubmed: 34446261google scholar: lookup
  15. Sánchez-Meca J, Botella J. Revisiones sistemáticas y meta-análisis: Herramientas para la práctica profesional. Papeles Psicólogo 2010;31:7–17.
  16. Ouzzani M., Hammady H., Fedorowicz Z., Elmagarmid A. Rayyan—A Web and Mobile App for Systematic Reviews. Syst. Rev. 2016;5:210. doi: 10.1186/s13643-016-0384-4.
    doi: 10.1186/s13643-016-0384-4pmc: PMC5139140pubmed: 27919275google scholar: lookup
  17. Arnon S., Fisher P.W., Pickover A., Lowell A., Turner J.B., Hilburn A., Jacob-McVey J., EMalajian B., Farber D.G., Hamilton J.F., et al. Equine-assisted therapy for veterans with PTSD: Manual development and preliminary findings. Mil. Med. 2020;185:e557–e564. doi: 10.1093/milmed/usz444.
    doi: 10.1093/milmed/usz444pmc: PMC7282489pubmed: 32034416google scholar: lookup
  18. Barker S.B., Knisely J.S., Schubert C.M., Green J.D., Ameringer S. The effect of an animal-assisted intervention on anxiety and pain in hospitalised children. Anthrozoös. 2015;28:101–112. doi: 10.2752/089279315X14129350722091.
    doi: 10.2752/089279315X14129350722091google scholar: lookup
  19. Bergen-Cico D., Smith Y., Wolford K., Gooley C., Hannon K., Woodruff R., Spicer M., Gump B. Dog ownership and training reduces post-traumatic stress symptoms and increases self-compassion among veterans: Results of a longitudinal control study. J. Altern. Complement. Med. 2018;24:1166–1175. doi: 10.1089/acm.2018.0179.
    doi: 10.1089/acm.2018.0179pubmed: 30256652google scholar: lookup
  20. Cappelen H., Ivarsson A., Jormfeldt H. The Effects of an Equine-Assisted Therapeutic Intervention on Well-Being in Persons Diagnosed with Schizophrenia. A Pilot Study. Issues Ment. Health Nurs. 2023;44:104–111. doi: 10.1080/01612840.2022.2158408.
    doi: 10.1080/01612840.2022.2158408pubmed: 36649626google scholar: lookup
  21. Carey B., Dell C.A., Stempien J., Tupper S., Rohr B., Carr E., Cruz M., Acoose S., Butt P., Broberg L., et al. Outcomes of a controlled trial with visiting therapy dog teams on pain in adults in an emergency department. PLoS ONE. 2022;17:e0262599. doi: 10.1371/journal.pone.0262599.
    doi: 10.1371/journal.pone.0262599pmc: PMC9064456pubmed: 35263346google scholar: lookup
  22. Coakley A.B., Annese C.D., Empoliti J.H., Flanagan J.M. The experience of animal assisted therapy on patients in an acute care setting. Clin. Nurs. Res. 2021;30:401–405. doi: 10.1177/1054773820977198.
    doi: 10.1177/1054773820977198pubmed: 33242977google scholar: lookup
  23. Demiralay Ş., Keser İ. The effect of pet therapy on the stress and social anxiety levels of disabled children: A randomized controlled trial. Complement. Ther. Clin. Pract. 2022;48:101574. doi: 10.1016/j.ctcp.2022.101574.
    doi: 10.1016/j.ctcp.2022.101574pubmed: 35366488google scholar: lookup
  24. Earles J.L., Vernon L.L., Yetz J.P. Equine-assisted therapy for anxiety and posttraumatic stress symptoms. J. Trauma. Stress. 2015;28:149–152. doi: 10.1002/jts.21990.
    doi: 10.1002/jts.21990pubmed: 25782709google scholar: lookup
  25. Fisher P.W., Lazarov A., Lowell A., Arnon S., Turner J.B., Bergman M., Ryba M., Such S., Marohasy C., Zhu X., et al. Equine-assisted therapy for posttraumatic stress disorder among military veterans: An open trial. J. Clin. Psychiatry. 2021;82:21m14005. doi: 10.4088/JCP.21m14005.
    doi: 10.4088/JCP.21m14005pubmed: 34464523google scholar: lookup
  26. Fiori G., Marzi T., Bartoli F., Bruni C., Ciceroni C., Palomba M., Zolferino M., Corsi E., Galimberti M., Moggi Pignone A., et al. The challenge of pet therapy in systemic sclerosis: Evidence for an impact on pain, anxiety, neuroticism and social interaction. Clin. Exp. Rheumatol. 2018;36:135–141.
    pubmed: 30277859
  27. Giuliani F., Jacquemettaz M. Animal-assisted therapy used for anxiety disorders in patients with learning disabilities: An observational study. Eur. J. Integr. Med. 2017;14:13–19. doi: 10.1016/j.eujim.2017.08.004.
    doi: 10.1016/j.eujim.2017.08.004google scholar: lookup
  28. Hinic K., Kowalski M.O., Holtzman K., Mobus K. The effect of a pet therapy and comparison intervention on anxiety in hospitalized children. J. Pediatr. Nurs. 2019;46:55–61. doi: 10.1016/j.pedn.2019.03.003.
    doi: 10.1016/j.pedn.2019.03.003pubmed: 30852256google scholar: lookup
  29. Holman L.F., Ellmo F., Wilkerson S., Johnson R.S. Quasi-experimental single-subject design: Comparing seeking safety and canine-assisted therapy interventions among mentally ill female inmates. J. Addict. Offender Couns. 2020;41:35–51. doi: 10.1002/jaoc.12074.
    doi: 10.1002/jaoc.12074google scholar: lookup
  30. Holman L.F., Wilkerson S., Ellmo F., Skirius M. Impact of animal assisted therapy on anxiety levels among mentally ill female inmates. J. Creat. Ment. Health. 2020;15:428–442. doi: 10.1080/15401383.2020.1729918.
    doi: 10.1080/15401383.2020.1729918google scholar: lookup
  31. Hunt M.G., Chizkov R.R. Are Therapy Dogs Like Xanax? Does Animal-Assisted Therapy Impact Processes Relevant to Cognitive Behavioral Psychotherapy? Anthrozoös. 2014;27:457–469. doi: 10.2752/175303714x14023922797959.
    doi: 10.2752/175303714x14023922797959google scholar: lookup
  32. Johnson R.A., Albright D.L., Marzolf J.R., Bibbo J.L., Yaglom H.D., Crowder S.M., Carlisle G.K., Willard A., Russell C.L., Grindler K., et al. Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans. Mil. Med. Res. 2018;5:1–13. doi: 10.1186/s40779-018-0149-6.
    doi: 10.1186/s40779-018-0149-6pmc: PMC5774121pubmed: 29502529google scholar: lookup
  33. Johnson R.A., Albright D.L., Marzolf J.R., Bibbo J.L., Yaglom H.D., Crowder S.M., Carlisle G.M., Grindler K., Harms N., Willard A., et al. Experiences of military veterans in a therapeutic horseback riding program. Clin. Nurs. Res. 2021;30:923–933. doi: 10.1177/10547738211003580.
    doi: 10.1177/10547738211003580pubmed: 33855883google scholar: lookup
  34. Kang K.D., Jung T.W., Park I.H., Han D.H. Effects of equine-assisted activities and therapies on the affective network of adolescents with internet gaming disorder. J. Altern. Complement. Med. 2018;24:841–849. doi: 10.1089/acm.2017.0416.
    doi: 10.1089/acm.2017.0416pubmed: 29698054google scholar: lookup
  35. Kiesewetter J., Herbach N., Landes I., Mayer J., Elgner V., Orle K., Grunow A., Langkau R., Gratzer C., Jansson A.F. Dog assisted education in children with rheumatic diseases and adolescents with chronic pain in Germany. GMS J. Med. Educ. 2023;40:Doc44. doi: 10.3205/zma001626.
    doi: 10.3205/zma001626pmc: PMC10407579pubmed: 37560047google scholar: lookup
  36. López-Fernández E., Palacios-Cuesta A., Rodríguez-Martínez A., Olmedilla-Jodar M., Fernández-Andrade R., Mediavilla-Fernández R., Sánchez-Díaz J.I., Máximo-Bocanegra N. Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: Effectiveness on reduction of pain, fear, and anxiety. Eur. J. Pediatr. 2024;183:843–851. doi: 10.1007/s00431-023-05284-7.
    doi: 10.1007/s00431-023-05284-7pmc: PMC10912116pubmed: 37938352google scholar: lookup
  37. Marchand W.R. Potential mechanisms of action and outcomes of equine-assisted services for veterans with a history of trauma: A narrative review of the literature. Int. J. Environ. Res. Public Health. 2023;20:6377. doi: 10.3390/ijerph20146377.
    doi: 10.3390/ijerph20146377pmc: PMC10379349pubmed: 37510609google scholar: lookup
  38. Mattila-Rautiainen S., Venojärvi M., Rautiainen H., Keski-Valkama A. The impact on physical performance, pain and psychological wellbeing of chronic low back pain patients during 12-weeks of equine-facilitated therapy intervention. Front. Vet. Sci. 2023;10:1085768. doi: 10.3389/fvets.2023.1085768.
    doi: 10.3389/fvets.2023.1085768pmc: PMC10043450pubmed: 36998640google scholar: lookup
  39. McCullough A., Ruehrdanz A., Jenkins M.A., Gilmer M.J., Olson J., Pawar A., Holley L., Sierra-Rivera S., Linder D.E., Pichette D., et al. Measuring the effects of an animal-assisted intervention for pediatric oncology patients and their parents: A multisite randomized controlled trial. J. Pediatr. Oncol. Nurs. 2018;35:159–177. doi: 10.1177/1043454217748586.
    doi: 10.1177/1043454217748586pubmed: 29268667google scholar: lookup
  40. Monroe M., Whitworth J.D., Wharton T., Turner J. Effects of an equine-assisted therapy program for military veterans with self-reported PTSD. Soc. Anim. 2019;29:577–590. doi: 10.1163/15685306-12341572.
    doi: 10.1163/15685306-12341572google scholar: lookup
  41. Mulvaney-Roth P., Jackson C., Bert L., Eriksen S., Ryan M. Using Pet Therapy to Decrease Patients’ Anxiety on Two Diverse Inpatient Units. J. Am. Psychiatr. Nurses Assoc. 2023;29:112–121. doi: 10.1177/1078390321999719.
    doi: 10.1177/1078390321999719pubmed: 35130738google scholar: lookup
  42. Nepps P., Stewart C.N., Bruckno S.R. Animal-assisted activity: Effects of a complementary intervention program on psychological and physiological variables. J. Evid.-Based Complement. Altern. Med. 2014;19:211–215. doi: 10.1177/2156587214533570.
    doi: 10.1177/2156587214533570pubmed: 24789913google scholar: lookup
  43. Perez M., Cuscaden C., Somers J.F., Simms N., Shaheed S., Kehoe L.A., Holowka S.A., Aziza A.A., Shroff M.M., Greer M.-L.C. Easing anxiety in preparation for pediatric magnetic resonance imaging: A pilot study using animal-assisted therapy. Pediatr. Radiol. 2019;49:1000–1009. doi: 10.1007/s00247-019-04407-3.
    doi: 10.1007/s00247-019-04407-3pubmed: 31030334google scholar: lookup
  44. Romaniuk M., Evans J., Kidd C. Evaluation of an equine-assisted therapy program for veterans who identify as ‘wounded, injured or ill’ and their partners. PLoS ONE. 2018;13:e0203943. doi: 10.1371/journal.pone.0203943.
    doi: 10.1371/journal.pone.0203943pmc: PMC6160012pubmed: 30260975google scholar: lookup
  45. Shelton A.M. An Interpretative Phenomenological Analysis of the Adult Equine-Assisted Therapy Experience (Tesis de Maestría/Doctoral) ProQuest Dissertations Publishing; Ann Arbor, MI, USA: 2022.
  46. Silva N.B., Osório F.L. Impact of an animal-assisted therapy programme on physiological and psychosocial variables of pediatric oncology patients. PLoS ONE. 2018;13:e0194731. doi: 10.1371/journal.pone.0194731.
    doi: 10.1371/journal.pone.0194731pmc: PMC5884536pubmed: 29617398google scholar: lookup
  47. Vegue Parra E., Hernández Garre J.M., Echevarría Pérez P. Impact of dog-assisted therapy for institutionalized patients with dementia: A controlled clinical trial. Altern. Ther. Health Med. . 2021;27:26–31.
    pubmed: 34197338
  48. Spielberger C.D., Gorsuch R.L., Lushene R.E., Vagg P.R., Jacobs G.A. Manual for the State-Trait Anxiety Inventory (Form Y) Consulting Psychologists Press; Palo Alto, CA, USA: 1983.
  49. Weathers F.W., Litz B.T., Herman D.S., Huska J.A., Keane T.M. The PTSD Checklist: Reliability, Validity, and Diagnostic Utility; Proceedings of the 9th Annual Conference of the International Society for Traumatic Stress Studies; San Antonio, TX, USA. 24–27 October 1993.
  50. Bliese P.D., Wright K.M., Adler A.B., Cabrera O., Castro C.A., Hoge C.W. Validating the Primary Care Posttraumatic Stress Disorder Screen and the PTSD Checklist with soldiers returning from combat. J. Consult. Clin. Psychol. 2008;76:272–281. doi: 10.1037/0022-006X.76.2.272.
    doi: 10.1037/0022-006X.76.2.272pubmed: 18377123google scholar: lookup
  51. Parra E.V. Benefits of dog-assisted therapy in patients with dementia. Int. J. Environ. Res. Public Health. 2021;18:1471. doi: 10.3390/ijerph18041471.
    doi: 10.3390/ijerph18041471pmc: PMC7914582pubmed: 33557254google scholar: lookup
  52. Harper N.J., Dobud W.W., Magnuson D. Adolescent wilderness therapy: The relationship of client outcomes to reasons for referral, motivation for change, and clinical measures. Youth. 2024;4:382–394. doi: 10.3390/youth4010027.
    doi: 10.3390/youth4010027google scholar: lookup
  53. Brymer E., Araújo D., Davids K., Pepping G.-J. Conceptualizing the human health outcomes of acting in natural environments: An ecological perspective. Front. Psychol. 2020;11:1362. doi: 10.3389/fpsyg.2020.01362.
    doi: 10.3389/fpsyg.2020.01362pmc: PMC7378676pubmed: 32765336google scholar: lookup
  54. Brymer E., Freeman E.L., Richardson M. One Health: The Well-Being Impacts of Human-Nature Relationships. Frontiers Media SA; Lausanne, Switzerland: 2019.
    pmc: PMC6710441pubmed: 31481906
  55. Brymer E., Sharma-Brymer V., Willis R., Leach M. Adventure and mental health: An ecological perspective. Front. Psychol. 2024;15:1352352. doi: 10.3389/fpsyg.2024.1352352.
    doi: 10.3389/fpsyg.2024.1352352pmc: PMC11394177pubmed: 39282664google scholar: lookup
  56. Bettmann J.E., Tucker A.R., Tracy J., Parry K.J. An Exploration of Gender, Client History, and Functioning in Wilderness Therapy Participants. Resid. Treat. Child. Youth. 2014;31:155–170. doi: 10.1080/0886571x.2014.943554.
    doi: 10.1080/0886571x.2014.943554google scholar: lookup
  57. Harper N., Dobud W.W., editors. Outdoor Therapies: Introduction to Practices, Possibilities, and Critical Perspectives. Routledge; Abingdon, UK: 2021.
  58. Gabrielsen L.E., Fernee C.R., Aasen G.O., Eskedal L.T. Why randomized trials are challenging within Adventure Therapy research; Lessons learned in Norway. J. Exp. Educ. 2015;39:5–14. doi: 10.1177/1053825915607535.
    doi: 10.1177/1053825915607535google scholar: lookup
  59. Fernee C.R., Gabrielsen L.E., Andersen A.J.W., Mesel T. Unpacking the black box of wilderness therapy: A realist synthesis. Qual. Health Res. 2017;27:114–129. doi: 10.1177/1049732316655776.
    doi: 10.1177/1049732316655776pubmed: 27354386google scholar: lookup

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