The Effectiveness of Forest Therapy on Psychotic Patients: Focusing on Changes in Inflammatory Pathways and The Psychotic Condition of Patients

NCT07436481 | Completed DMC

• 2 other identifiers: 085/EC/KEPK/FK-UNDIP/IV/202548/UN7.F4/HK/IV/2025
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

General Formulation Are there any changes in the inflammatory pathway and psychotic conditions in patients given Forest Therapy compared to conventional psychotic disorder therapy? Specific Are there any differences in the levels of inflammatory factors such as CRP, IL-6, and BDNF in patients given Forest Therapy compared to conventional psychotic disorder therapy? Are there differences in the psychotic conditions of patients, as assessed by PANSS, MADRSS, DASS-21, YMRS, Zung Anxiety Self Questionnaire, PSQI, and WHO-QL BREF, in patients receiving Forest Therapy compared to conventional psychotic disorder therapy? 1.3 Research Objectives 1.3.1 General Objective To determine the changes that occur in the inflammatory pathway and psychotic condition in patients receiving Forest Therapy compared to conventional psychotic disorder therapy. 1.3.2 Specific Objective To determine changes in the inflammatory pathway, particularly CRP, IL-6, and BDNF, in patients receiving Forest Therapy compared to conventional psychotic disorder therapy. To determine changes in psychotic conditions using the PANSS, BDI, MADRS, DASS-21, YMRS, Zung Anxiety Self Questionnaire, PSQI, and WHO-QL-BREF questionnaires in patients receiving Forest Therapy compared to conventional psychotic disorder therapy. To investigate the relationship between changes in inflammatory pathways and changes in psychotic conditions in patients receiving Forest Therapy compared to conventional psychotic disorder therapy. The research group will be divided into two groups using randomisation. The treatment group will receive forest therapy in the Mangkang forest from June to September 2025, with one session every two weeks for a total of eight sessions, while the control group will receive treatment for psychotic disorders as usual. Both groups will undergo psychometric testing, which includes assessment of psychotic symptoms, mood, insomnia, anxiety, stress levels, and quality of life. Blood samples will also be collected for complete blood count and inflammatory factor testing.

Conditions

Psychotic Disorder

Keywords

forest therapy; psychotic disorder; inflammation pathway; mindfulness

Outcome Measures

Primary Outcomes (4)

• CRP level in mg/L

  hs-CRP level in miligram/Liter, interval

  8 weeks

• BDNF levels in pg/ml

  BDNF levels in picogram/miiliter, interval

  8 weeks

• IL-6 level in pg/ml

  IL-6 levels in picogram/miiliter, interval

  8 weeks

• Psychotic Condition with Positive and Negative Syndrome Scale (PANSS)

  Psychotic Condition with Positive and Negative Syndrome Scale (PANSS) score, total score ranges from 30 to 210, with higher scores indicating greater symptom severity in schizophrenia patients.

  8 weeks

Study Arms (2)

Forest therapy group intervention

EXPERIMENTAL

The intervention group will receive standard psychotic therapy and participate in forest therapy activities consisting of mindful forest walking, sun bathing, forest hugging and meditation. These activities will be carried out over 8 sessions, with each session taking place once a week. This group will be randomly divided into 4 small groups, each consisting of 10 participants. Each small group will be led by a trained therapist. These activities will last for 2 hours per session.

Behavioral: Forest Therapy

Control group

NO INTERVENTION

The control group will only receive standard psychotic therapy.

Interventions

Forest Therapy BEHAVIORAL

The intervention group will receive standard psychotic therapy and participate in forest therapy activities consisting of mindful forest walking, sun bathing, forest hugging and meditation. These activities will be carried out over 8 sessions, with each session taking place once a week. The control group will be randomly divided into 4 small groups, each consisting of 10 participants. Each small group will be led by a trained therapist. These activities will last for 2 hours per session.

Also known as: Shinrin-yoku

Forest therapy group intervention

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Aged 18-60 years old
• Diagnosed with psychosis based on medical records at Dr. Kariadi General Hospital, Diponegoro National Hospital, Elisabeth Hospital Semarang and Banyumanik I Hospital Semarang
• Minimum education level of junior high school (SMP)
• Willing to participate in research

You may not qualify if:

• Consuming alcohol and immunosuppressants 1 month before sampling. Patients diagnosed with autoimmune disorders

Sponsors & Collaborators

• Natalia Dewi Wardani, MD: lead
• The Indonesian Red Cross: collaborator
• Indonesian Red Cross: collaborator

Study Sites (1)

Kendal Forest- PMI Semarang

Semarang, Central Java, 50131, Indonesia

Location

Related Publications (1)

• Bielinis E, Jaroszewska A, Lukowski A, Takayama N. The Effects of a Forest Therapy Programme on Mental Hospital Patients with Affective and Psychotic Disorders. Int J Environ Res Public Health. 2019 Dec 23;17(1):118. doi: 10.3390/ijerph17010118.

  PMID: 31877954 BACKGROUND

MeSH Terms

Conditions

Psychotic Disorders

Interventions

Forest Therapy

Condition Hierarchy (Ancestors)

Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Relaxation Therapy; Mind-Body Therapies; Complementary Therapies; Therapeutics

Study Officials

• Natalia Dewi Wardani NDW Wardani, Doctoral

  Medical Faculty Diponegoro University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: Each patient was assigned an identification number, and the researcher who drew blood did not know whether the patient was in the treatment group or the control group
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Head of Psychiatry Residency Program Medical Faculty Diponegoro University, Principal Investigator

Model Details: The treatment group will receive forest therapy in the Mangkang forest from June to September 2025, with a frequency of once every two weeks for 8 sessions, while the control group will undergo psychotic disorder therapy as usual. Both groups will undergo psychometric testing, including assessment of psychotic symptoms, mood, insomnia, anxiety, stress levels, and quality of life. Blood samples will also be collected for complete blood count and inflammatory factor testing.

Study Record Dates

• First Submitted: February 21, 2026
• First Posted: February 27, 2026
• Study Start: June 1, 2025
• Primary Completion: September 1, 2025
• Study Completion: December 31, 2025
• Last Updated: March 2, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

ID (1)