The Effects of Virtual, Imaginary, and Traditional Forest Bathing on People with Cancer-Related Fatigue

Many patients experience persistent exhaustion (fatigue) after cancer. This form of fatigue is often more severe than normal exhaustion and can significantly impair daily life, concentration, and emotional well-being. The exact causes are varied and can include both physical factors (e.g., effects of cancer treatment or inflammatory processes) and psychological stress. There is no clearly established standard treatment for this form of fatigue. Exercise, psychosocial support, and complementary therapies are frequently recommended.

The goal of the FOREST study is to compare three different nature-based approaches in terms of their effects on symptoms and quality of life following a cancer diagnosis: traditional “forest bathing” in a real forest, a virtual forest experience using virtual reality (VR) goggles, and a guided visualization exercise. Each session lasts 30 minutes and takes place once a week over an 8-week period. The goal is to achieve positive effects on the body and mind through sensory experiences such as sight, hearing, smell, and touch. To this end, patients are randomly assigned to four groups: there are three therapy groups and one group that initially receives no treatment but is allowed to experience one VR forest bathing session at the end. The study is open-label, meaning that both the medical team and the patients know which intervention is being administered. The primary objective of the study is to specifically assess fatigue, sleep, depressive symptoms, and concentration after an 8-week period.

Patients who have completed their cancer treatment (with the exception of long-term adjuvant endocrine therapy) and suffer from fatigue are eligible to participate. Patients for whom certain health reasons preclude participation are excluded. These include severe depression that has not been adequately treated, asthma, allergies to pine or citrus scents, a lack of sense of smell, severe motion sickness or seizures, as well as visual or hearing impairments that cannot be compensated for by assistive devices.