The effects of nature images on pain in a simulated hospital patient room

HERD. 2010 Spring;3(3):42-55. doi: 10.1177/193758671000300306.


Background: Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options.

Objective: This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood?

Methods: An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds.

Results: The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance.

Conclusions: Although there was no clear "most" therapeutic image, the mixed prospect and refuge image showed significant potential to reduce sensory pain. The hazard image was the most effective at distracting participants from pain, but it should not be considered a positive distraction because it also received the highest mood disturbance scores of all groups.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Analysis of Variance
  • Blood Pressure
  • Female
  • Focus Groups
  • Heart Rate
  • Humans
  • Interior Design and Furnishings*
  • Male
  • Nature*
  • Pain / psychology*
  • Pain Measurement
  • Patients' Rooms*
  • Photography*
  • Surveys and Questionnaires
  • Young Adult