Fostering holistic and spiritual wellbeing for older women: A protocol for a usbased feasibility study of forest bathing

Objective: In the US, most attendees of forest bathing (Shinrin-yoku) are older women During perimenopause and menopause, women often deal with anxiety or depression, or seek new meaning in life Forest bathing research from Japan and Korea identifies both physiologic and psychological benefits However, little research has investigated holistic wellbeing outcomes, including spiritual wellbeing, and few studies have focused on women or have been located within the US culture Methods: In this protocol paper we delineate a mixedmethods feasibility study to: (1) investigate forest bathing experiences while preserving fidelity to the intervention;and (2) explore relevant holistic outcomes Forest bathing, as practiced in the US by certified Association of Nature and Forest Therapy (ANFT) guides, consists of a forestbased sensory experience lasting 120 - 180 minutes Forty women over 40 years old will be recruited to participate in one of four forest bathing experiences Validated self-report measures will be collected before and after the experience, as well as, 1 and 2 weeks later Results: Holistic wellbeing will be quantified using the Self- Assessment of Change (SAC), a rigorously created measure for integrative medicine whole systems research (Ritenbaugh, 2011) Spiritual wellbeing, as previously defined (Fisher, 2011), will be measured as the quality of the relationship one has with self, community, nature, and transcendent other(s) Other validated scales will assess perceived stress, depression, anxiety, and both positive and negative affect states Qualitative data will derive from participant drawings and interviews designed to illicit the women's experiences in forest bathing We will also report adaptations in implementation that are necessitated by COVID times Conclusion: This protocol focuses on exploring older women's experiences during and after a manualized forest bathing intervention led by certified forest therapists The completed feasibility study will set the stage for a large randomized controlled trial of forest bathing in older women in the US