Anxiety, Depression
Conditions
Keywords
Nature-based therapy, anxiety, depression, adolescent, prevalence
Brief summary
This three-phase study first assesses the prevalence of anxiety and depressive symptoms among adolescents, then evaluates the effectiveness of a randomized controlled nature-based therapy intervention. The final phase explores emotional, behavioral, and psychosocial changes through qualitative interviews with parents of adolescents in the intervention group. The study aims to provide evidence for nature-based therapies as effective complementary interventions for adolescent mental health.
Detailed description
This study aims to determine the prevalence of anxiety and depressive symptoms among adolescents, evaluate the effectiveness of a structured nature-based therapy (NBT) intervention, and explore psychosocial changes observed in adolescents through parental perspectives. Adolescence represents a critical developmental period marked by intense biological, emotional, and cognitive transitions that increase vulnerability to internalizing disorders such as anxiety and depression. When not addressed early, these symptoms may persist into adulthood and result in long-term psychological impairment. The research is conducted using a three-phase mixed-methods design. In the first phase, a large-scale screening is implemented to assess the prevalence of anxiety and depressive symptoms within the adolescent population using standardized psychological assessment tools. This stage aims to identify individuals at elevated risk and determine eligibility for the intervention phase. The second phase consists of a randomized controlled trial in which eligible participants are randomly assigned to either an experimental group receiving the nature-based therapy program or a control group receiving standard follow-up without therapeutic intervention. The nature-based therapy program is delivered in natural outdoor environments and incorporates experiential activities, group-based therapeutic exercises, emotional regulation practices, mindfulness-oriented techniques, and reflective components. The intervention is designed to enhance psychological well-being, reduce stress, improve emotional coping skills, strengthen social interaction, and promote adaptive functioning. Anxiety and depression levels are assessed at baseline, post-intervention, and follow-up to evaluate treatment effectiveness. The third phase involves qualitative semi-structured interviews conducted with parents of adolescents who participated in the intervention group. These interviews aim to explore observed emotional, behavioral, social, and relational changes in adolescents following the therapy process. This qualitative component provides an in-depth understanding of therapeutic outcomes and supports the quantitative findings through parental observations. Primary outcome measures include changes in anxiety and depressive symptom severity, while secondary outcomes focus on improvements in emotional regulation, psychosocial functioning, and overall psychological well-being. It is hypothesized that adolescents participating in the nature-based therapy program will demonstrate significant symptom reduction and enhanced psychosocial outcomes compared to the control group. This study seeks to contribute robust empirical evidence regarding the clinical effectiveness of nature-based therapeutic interventions for adolescent mental health and to support their integration as accessible, holistic, and developmentally appropriate treatment approaches within mental health services.
Interventions
BEHAVIORALNature-Based Therapy
The nature-based therapy program is a structured psychosocial intervention conducted in outdoor natural environments for adolescents experiencing anxiety and depressive symptoms. The program combines experiential activities in nature with therapeutic techniques including emotional regulation practices, mindfulness-based exercises, reflective discussions, and group-based interactions. Sessions emphasize active engagement with natural surroundings to support stress reduction, emotional awareness, attention regulation, and social connectedness. Therapeutic components aim to strengthen adaptive coping strategies, enhance psychological resilience, and improve interpersonal functioning within a supportive group setting. The intervention follows a standardized session framework to ensure consistency while allowing flexibility based on developmental needs.
Sponsors
Muş Alparslan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This study utilizes a three-phase mixed-methods design. The first phase involves a large-scale screening to determine the prevalence of anxiety and depressive symptoms among adolescents using standardized assessment tools. In the second phase, eligible participants are randomly assigned to either a nature-based therapy intervention group or a control group in a randomized controlled trial. The intervention is delivered in natural outdoor environments and includes experiential therapeutic activities and emotional regulation practices. Quantitative assessments are conducted at baseline, post-intervention, and follow-up. The third phase consists of semi-structured qualitative interviews with parents of adolescents in the intervention group to explore observed psychosocial changes following therapy.
Eligibility
Sex/Gender
ALL
Age
14 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* Adolescents within the defined age range of the study * Not having a psychiatric diagnosis * Not receiving psychological or psychiatric support * Not having a physical disability that would limit participation in therapy sessions * Having obtained parental consent to participate in the study
Exclusion criteria
* Presence of severe psychiatric disorders requiring immediate clinical intervention (e.g., psychosis, severe suicidal risk) * Ongoing intensive psychological or psychiatric treatment during the study period * Physical or medical conditions limiting participation in outdoor activities * Cognitive impairments preventing comprehension of intervention activities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anxiety and Depression Symptom Severity | Baseline (22.06.2025), post-intervention (27.07.2025), and Follow-up (27.10.2025) (Exactly 3 months after the last intervention program.) | Changes in anxiety and depressive symptom severity will be assessed using standardized psychological assessment scales administered at baseline, post-intervention, and follow-up to evaluate the effectiveness of the nature-based therapy program. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Environmental Attitudes Toward Nature | Baseline (22.06.2025), post-intervention (27.07.2025), and follow-up (27.10.2025) (Exactly 3 months after the last intervention program.) | Change in adolescents' environmental attitudes and responsible environmental behaviors will be assessed using the Environmental Behavior Scale for Middle and High School Students, developed by Ardahan (2022). This self-report instrument consists of 13 items and 3 subscales designed to measure environmentally responsible behaviors and daily habits related to nature. Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher total scores indicate greater environmental sensitivity and more frequent pro-environmental behaviors. The unit of measure is total score change from baseline to post-intervention and follow-up. The scale has demonstrated good internal consistency (Cronbach's alpha = 0.88). |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORMurat GENÇ, PhD
Muş Alparslan University
Outcome results
None listed