Research
evidence base

Employees viewed real hydrangeas at close range; alpha brain wave activity increased relative to viewing an empty table.

Real bouquets, given as gifts, were associated with improved mood for several days across three studies, and with increased social contact, compared with a fruit basket or a candle.

A narrative synthesis reviewing prior studies found real flower images evoke a stronger embodied emotional response than drawn flowers or mandalas, which elicit more cognitive reactions.

2,006 people rated 52 flower photographs for beauty; flower shape accounted for more of the variation in ratings than colour.

A pre-registered study across three experiments found people did not consistently rate flowering plants lower than fruiting ones, suggesting habitat-selection theory alone does not explain aesthetic preference for flowers.

Thirty-one office employees viewed real roses or an empty room; heart-rate variability increased in the rose condition.

A pooled reanalysis of 214 participants' physiological data, including the 2014 office-worker study above, found viewing fresh roses had a self-normalising effect: sympathetic activity fell in those who started elevated and rose in those who started low.

After a stress-inducing task, participants viewed a flower photograph or a matched scrambled control image; salivary cortisol fell further in the flower condition.

Fifty employees viewed white, red and yellow roses for three minutes each; yellow roses produced the strongest relaxation response and were rated most preferred and mood-improving.

670 people rated computer-generated flower images of different colours; white, blue and orange were most preferred, blue was most linked to relaxation, and warm colours evoked greater positive mood.

A meta-analysis and systematic review found digital nature produced stress-reduction effects statistically equivalent to actual nature exposure, with no significant difference between the two.

147 participants spent time in a real forest, a nature-inspired room, or a plain control room; the forest was rated most fascinating and evoked the most creative thinking, while mood improved in the control and nature-inspired rooms but not significantly in the forest itself.

High school students viewed real pansies, artificial pansies or no flowers; real pansies significantly reduced sympathetic nerve activity and produced greater feelings of comfort and relaxation than artificial pansies.

Prefrontal cortex activity was recorded while participants viewed a photograph of a foliage plant or the actual plant; the real plant produced a significantly larger increase in prefrontal activity, though subjective comfort ratings were similar for both.

Participants viewed a real plant, an artificial plant, or a photograph of a plant; the real plant produced distinct physiological changes and significantly higher comfort and relaxation ratings than the other two conditions.

Eighteen adults with diagnosed stress or burnout spent thirty minutes in a nature park and thirty minutes viewing a 97-photograph slideshow of the same park; the park setting was associated with greater energy and fascination than the slideshow.

A meta-analysis of 32 studies (2,356 participants) found nature contact associated with a moderate increase in positive affect and a smaller decrease in negative affect, with real nature producing larger positive-affect gains than simulated nature.

Elementary school students were shown a real plant, an artificial plant, a photograph of the plant, or no plant; only the real plant produced a significant decrease in attention-linked frontal brain activity.

A narrative review concluding that nature imagery shows fairly consistent evidence for reducing stress, pain and anxiety in healthcare settings, while other visual art forms show promising but less consistently tested effects.

Self-reported stress and salivary cortisol both fell significantly after a brief lunchtime visit to an art gallery, with cortisol normalising most in those with elevated levels beforehand.

186 cancer inpatients were randomised to rooms with artwork or without; patients rated rooms with artwork as more attractive, interesting and pleasant, with no difference in pain, anxiety, mood, depression, quality of life or length of stay.

A review of 37 indoor experiments found viewing nature, via images, video or real plants, consistently produced more relaxed physiological responses than control conditions.

Case studies from three Scottish hospitals examining the use and commissioning of visual art; the review concludes art can bring medical benefit, though evidence quality is uneven, with patients generally preferring calming nature imagery over abstract work.

Sixty psychiatric outpatients viewed nature or building photographs for three minutes; nature photographs were associated with a larger immediate mood improvement.

Images displayed in a mental health facility lounge were rotated over time; use of as-needed medication was significantly lower on days a realistic nature photograph was shown than during abstract-art or no-art conditions.

Interviews with hospital patients about how they use and experience art on the ward, including its role in distraction and a sense of home.

Simulated hospital patient rooms were fitted with ceiling-mounted photographic sky compositions or left without; rooms with sky compositions showed significantly higher environmental satisfaction and lower diastolic blood pressure, though systolic pressure did not differ.

Interviews with patients and family members found hospital artwork was experienced as emotionally moving, evoking a sense of home and stimulating imagination.

239 patients on an internal-medicine ward were surveyed after photography was displayed on the walls; most reported it made their stay more pleasant.

A systematic review of 38 studies (6,805 participants) found consistent evidence that viewing art supports wellbeing, with the strongest effects on eudaimonic wellbeing (meaning, purpose and personal growth).

Healthy volunteers underwent a laboratory pain task while viewing one of four types of nature photograph or a blank screen; images with mixed prospect-refuge qualities significantly reduced pain compared with no image, though no single image type was consistently most effective.

76 rehabilitation inpatients in rooms with nature imagery rated their rooms as more satisfying than patients in standard rooms.

Healthy students viewed nature or building photographs while mood and brain activity were recorded; nature photographs were associated with greater calm.

A critical review of 21 experimental studies found the evidence for indoor plants' psychological benefits mixed overall, with only a few effects, such as pain tolerance, recurring consistently; one included study compared a real plant, a photograph of it, and no plant, and found no significant difference.

A systematic review of 175 experiments testing simulated nature found that study quality and outcome measure predicted results: studies lacking a control group, and those measuring perceived restoration, reported disproportionately more positive findings, suggesting possible publication bias.

157 women newly diagnosed with breast cancer were assigned to nature-based activity (visiting scenic spots, gardening) or a control condition; the nature-based group showed greater improvement in attentional capacity.

Real plants were placed in workplaces across nine organisations for several months; they significantly improved workspace attractiveness, satisfaction and sense of privacy, with no significant effect on mood, stress, concentration, sick leave or job satisfaction.

Records of 244 psychiatric inpatients showed no difference in length of stay between tree and man-made window views, but greenness and brightness, analysed as continuous measures, were both associated with a shorter stay.

Ninety post-surgical patients in rooms with real plants reported lower pain and anxiety than patients in rooms without plants.

A meta-analysis of 28 studies found window views of nature consistently associated with better physiological, psychological and physical health outcomes.

A retrospective review of 46 gallbladder-surgery patients found those with a window view of trees left hospital sooner than those facing a brick wall.

120 students watched ten-minute videotapes of natural or urban scenes after a stress-inducing task; recovery was significantly faster and more complete after natural scenes across physiological and emotional measures.

A pre-registered replication across ten sites and 959 participants tested whether physiological arousal recovers differently after viewing nature versus built scenes; arousal fell during recovery regardless of scene type.

A scoping review found nature-based bereavement interventions such as gardening, care farming and animal-assisted therapy promising and well accepted, but identified no studies focused specifically on perinatally bereaved parents.

Sixty women following recent pregnancy loss were randomised to four sessions of art-making (clay, collage, drawing) plus relaxation, or to routine care; the art therapy group showed significantly higher quality-of-life scores.

A WHO scoping review concluding that arts engagement can play a significant role in both preventing illness and promoting health, and in managing and treating illness across the lifespan.

An essay examining the institutional and design considerations that shape what artwork is selected for healthcare settings.