Testing nature-based biopsychosocial resilience theory: a research programme protocol

Interventions that use nature contact to promote health and well-being exist at the societal/infrastructural level (incl. nature-based solutions) and the individual/group level (incl. nature-based therapies). One way nature-based therapies promote health is by fostering resilience to manage stressors. Nature-based biopsychosocial resilience theory (NBRT) provides a framework to explain how nature plays a role in how resilience-related adaptive resources are built and maintained but this has yet to be tested. The current paper outlines a four-year multi-country (Austria, Belgium, Bulgaria, Denmark, Italy, the Netherlands, Spain, Sweden, the UK) research programme that tests the NBRT framework and explores how nature-based therapies can build and maintain individual and community resilience. As well as reviewing and mapping existing interventions globally, nine case studies across Europe are exploring how nature promotes resilience across: (1) whole populations (three case studies); (2) individuals at-risk of metabolic syndrome (three case studies); and (3) individuals with existing issues such as chronic stress, mobility challenges, or cognitive impairments (three case studies). Three case studies use longitudinal cohorts, five use randomised controlled trials, and one a practitioner shared-experience approach. The determinants and impacts of nature-based therapies are also considered beyond effects on individual participants, by assessing distributional issues (e.g., health equity), environmental impacts, financial implications, broader societal acceptability and engagement, as well as the barriers and enablers to successful implementation. In three specific case studies (Barcelona, Padua and Salzburg), this is done through multi-sectoral social innovation actions we refer to as ‘Resilience Hubs’. Results will be summarised in academic publications, a series of sector-specific guides, and an overall ‘What works’ guide for practitioners, policy makers, and the public. We use a novel theoretical framework to structure a research and innovation programme to inform the implementation of nature-based therapies across Europe and globally. Challenges include the integration of terminology and research practices from multiple disciplinary perspectives, participant recruitment and attrition, especially among marginalised groups, a potential lack of local stakeholder time and interest, potentially small effect sizes of time-limited interventions, and difficulties in identifying distinct causal mechanisms. Mitigation strategies are discussed. Of nine case studies (CSs), five are intervention trials and have been registered: a) CS4 doi.org/10.1186/ISRCTN74582097 (22.07.2024); b) CS5 doi.org/10.1186/ISRCTN14169596 (10.06.2024); c) CS6 clinicaltrials.gov/study/NCT06622629 (30.09.2024); d) CS7 doi.org/10.1186/ISRCTN93192592 (29.05.2024); e) CS8 clinicaltrials.gov/study/NCT06205940 (15.05.2024). All nine case studies have received ethical approval (see Declarations section).

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Journal
Archives of Public Health
Published
2026-04-24
DOI
https://doi.org/10.1186/s13690-026-01903-5
Primary Topic
Urban Green Space and Health
Type
article
Field-Weighted Citation Impact
0.00

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article

Testing nature-based biopsychosocial resilience theory: a research programme protocol

Sabine Pahl, Ilaria Doimo, Leanne Martin, Angel M. Dzhambov et al.
Archives of Public Health
Urban Green Space and Health
article

Testing nature-based biopsychosocial resilience theory: a research programme protocol

Sabine Pahl, Ilaria Doimo, Leanne Martin, Angel M. Dzhambov, Todora Rogelja, Nooshin Razani, Sus Sola Corazon, Caroline Costongs, Christina Pichler, Francesca Pazzaglia, Angel Burov, Angelica Moè, Terry Hartig, Nancy M. Wells, Jill Litt, Colm O'Driscoll, Alexandria Poole, Melissa Lem, James Grellier, María C. Uyarra, Aynur Mammadova, Freddie Lymeus, Benedict W. Wheeler, Arnulf Hartl, Ulrika K. Stigsdotter, Matilda van den Bosch, Laura Secco, Alba Godfrey, Sarai Pouso, Ángel Borja, Stine Bekke-Hansen, A.E. van den Berg, Giulia Amato, Svea Busse, Julia A.M. Egger, Georgina Sowman, Mathew P. White, Rebecca Lovell, Thomas Astell-Burt, Cecil Konijnendijk, Donka Dimitrova, Patrik Karlsson Nyed, Lewis R. Elliott, Johan Östberg, Sarah Morgan Trimmer, Thomas van Rompay, Martin Voracek
article en

Abstract

Interventions that use nature contact to promote health and well-being exist at the societal/infrastructural level (incl. nature-based solutions) and the individual/group level (incl. nature-based therapies). One way nature-based therapies promote health is by fostering resilience to manage stressors. Nature-based biopsychosocial resilience theory (NBRT) provides a framework to explain how nature plays a role in how resilience-related adaptive resources are built and maintained but this has yet to be tested. The current paper outlines a four-year multi-country (Austria, Belgium, Bulgaria, Denmark, Italy, the Netherlands, Spain, Sweden, the UK) research programme that tests the NBRT framework and explores how nature-based therapies can build and maintain individual and community resilience. As well as reviewing and mapping existing interventions globally, nine case studies across Europe are exploring how nature promotes resilience across: (1) whole populations (three case studies); (2) individuals at-risk of metabolic syndrome (three case studies); and (3) individuals with existing issues such as chronic stress, mobility challenges, or cognitive impairments (three case studies). Three case studies use longitudinal cohorts, five use randomised controlled trials, and one a practitioner shared-experience approach. The determinants and impacts of nature-based therapies are also considered beyond effects on individual participants, by assessing distributional issues (e.g., health equity), environmental impacts, financial implications, broader societal acceptability and engagement, as well as the barriers and enablers to successful implementation. In three specific case studies (Barcelona, Padua and Salzburg), this is done through multi-sectoral social innovation actions we refer to as ‘Resilience Hubs’. Results will be summarised in academic publications, a series of sector-specific guides, and an overall ‘What works’ guide for practitioners, policy makers, and the public. We use a novel theoretical framework to structure a research and innovation programme to inform the implementation of nature-based therapies across Europe and globally. Challenges include the integration of terminology and research practices from multiple disciplinary perspectives, participant recruitment and attrition, especially among marginalised groups, a potential lack of local stakeholder time and interest, potentially small effect sizes of time-limited interventions, and difficulties in identifying distinct causal mechanisms. Mitigation strategies are discussed. Of nine case studies (CSs), five are intervention trials and have been registered: a) CS4 doi.org/10.1186/ISRCTN74582097 (22.07.2024); b) CS5 doi.org/10.1186/ISRCTN14169596 (10.06.2024); c) CS6 clinicaltrials.gov/study/NCT06622629 (30.09.2024); d) CS7 doi.org/10.1186/ISRCTN93192592 (29.05.2024); e) CS8 clinicaltrials.gov/study/NCT06205940 (15.05.2024). All nine case studies have received ethical approval (see Declarations section).

Archives of Public HealthVol. 84(1)
Uppsala University (SE), University of Copenhagen (DK), Powerlink Queensland (Australia) (AU), The University of Sydney (AU), University of Vienna (AT), University of Padua (IT), University of British Columbia (CA), Universitat Pompeu Fabra (ES), University of California, San Francisco (US), European Forest Institute (FI), Cornell University (US), University of Architecture, Civil Engineering and Geodesy (BG), University of Exeter (GB), Paracelsus Medical University (AT), Medical University Plovdiv (BG), Westmead Hospital (AU), Swedish University of Agricultural Sciences (SE), EuroHealthNet (BE), Institute of Nature Management (BY), Complexity Science Hub (AT), Family Planning NSW (AU), Zero Emissions Resource Organisation (NO), Vienna Biocenter (AT), New York State University College of Human Ecology (US), Barcelona Institute for Global Health (ES), Marine Technology Unit (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), University of Southampton (GB), Sheffield Hallam University (GB), University of Twente (NL)
UK Research and Innovation, HORIZON EUROPE European Research Council
Industry, innovation and infrastructure
Openalex Percentile: Top 17%
Urban Green Space and Health
DOIOpen Access PDFOpenAlex
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