Nature as Medicine for the Healing Brain: Utilization of a Nature-based Exposure Intervention for Decreasing Concussion Recovery Timeline and Symptom Load

The overall goal of this research is to provide pilot data that informs and drives a larger scale research project, incorporating multiple contemporary measurement modalities, to understand the utility and pathological mechanisms by which exposure to nature-based settings may aid in recovery time and symptom relief of individuals suffering from concussion, and decrease their risk of developing Persistent Post-Concussion Syndrome (PPCS).

We hypothesize that successful adherence to a nature-based exposure therapy intervention program will decrease recovery time and severity of symptom trajectory of concussion, as measured through multimodal assessments of brain structural and functional integrity.

Study Overview

• Status: Not yet recruiting
• Conditions: Concussion (Diagnosis)
• Intervention / Treatment: Behavioral: Nature-based Guided Awareness Group; Behavioral: Standard Guided Awareness Group

Detailed Description

This study will use a resting state combined electrophysiological-imaging measure of brain region activation, a blood-based measure of neuroinflammatory protein circulation, and a brief but comprehensive neuropsychological functional assessment to identify recovery status of the brain pre- and post-intervention. Measures will be taken at two pre-determined time intervals following concussion for each participant (1-3 days, 28-30 days) and frame the start and end point of a 4-week nature-based exposure therapy intervention program. The self-administered nature-based exposure therapy intervention will consist of 4 weeks of 120 minutes per week (spread over 3-7 days) of nature-based exposure coupled with a guided environmental awareness prompt list per week (Harries et al., 2025; Leão et al., 2025; White et al., 2019).

The primary aim of this study will be to assess the utility of a nature-based exposure therapy intervention in decreasing symptom severity and timeline of concussion. The intervention will include a multi-week program during which patients will participate in a specified duration of emersion in "nature-based environments". This intervention will inform a low-risk, holistic method for concussion management and may decrease risk of PPCS onset. A multimodal measurement battery will assess structural, functional, and behavioral concussion recovery factors as they relate to the nature-based intervention. Trends in recovery measures will be recorded at pre- and post-intervention, as well as throughout the intervention time period to assess both the feasibility/adherence and efficacy of nature-based exposure on recovery from concussion.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Owen Griffith, PhD; Phone Number: 15709858794; Email: omg5007@psu.edu

Study Locations

• United States
  • Pennsylvania
    • University Park, Pennsylvania, United States, 16802
      • Recreation Building
      • Contact: Owen Griffith, PhD; Phone Number: 5709858794; Email: omg5007@psu.edu
      • Principal Investigator: Owen Griffith, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Require that any participant is 14-35 years old
2. Required that any participant under 18 years old can be accompanied by a parent or legal guardian for the duration of the study
3. Required that participants be English speakers
4. Required that persons be able to provide consent for themselves
5. Required that the participant must have suffered a clinically diagnoses concussion 5 days or less prior to the first study visit
6. Concussion must have been diagnosed by a licensed clinical medicine professional.
7. No additional professional treatment modalities outside of normal clinical concussion recovery recommendations may have been received prior to study participation. These include participation in a separate concussion rehabilitation study, cognitive behavioral therapies, vestibule-ocular therapies (balance), in-patient physical therapy, consumption of stimulant medication, and chiropractic manipulation.
8. Injury must have been diagnosed as a concussion or mild-traumatic brain injury. Participant must not have been diagnosed with of severe traumatic brain injury, hematoma, fractured skull or facial bones, or comatose.

Exclusion Criteria:

1. Exclude persons under 14 years old or over 35 years old
2. Exclude persons taking anti-inflammatory drugs (both prescription and OTC), or those who will have taken them within 24 hours prior to Visit 1
3. Exclude smokers and former smokers, as defined by CDC. (Anyone who smokes daily or who has smoked at least 100 cigarettes in their lifetime)
4. Those with presence of an active infection (including a dental infection)
5. Exclude persons who have migraines
6. Exclude persons taking mood stabilizer medications
7. Exclude persons who have consumed alcohol within 48 hours prior to study participation, participants will be asked this by one of the study members through the exclusion criteria screening form when they first contact the study
8. Exclude persons who are pregnant.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Nature-based Guided Awareness Group; Participants in the nature-based guided awareness group will be instructed to perform their intervention prompt in a one of the safe, accessible natural settings provided on the study's Nature-Based Location Guide, 3-7 times per week, for a total duration of 120 minutes per week.	Behavioral: Nature-based Guided Awareness Group; Participants in the nature-based guided awareness group will be instructed to perform their intervention prompt in a one of the safe, accessible natural settings provided on the study's Nature-Based Location Guide, 3-7 times per week, for a total duration of 120 minutes per week.
Experimental: Standard Guided Awareness Group; Participants in the standard guided awareness group will be instructed to perform the prompt in a quiet, controlled indoor environment, 3-7 times per week, for a total duration of 120 minutes per week.	Behavioral: Standard Guided Awareness Group; Participants in the standard guided awareness group will be instructed to perform the prompt in a quiet, controlled indoor environment, 3-7 times per week, for a total duration of 120 minutes per week.
No Intervention: No Intervention Group; The No Intervention Group will proceed with their standard clinical care instructions for concussion recovery as provided by their health care professional.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Concussion Symptoms Scales	All participants will complete daily Post-Concussion Symptom Scale surveys, offering self-report quantifiable measures of concussion recovery.	Daily, for the duration of the 28 day study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stroop Task	Neuropsychological test of processing speed and inhibition	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.
Oral Digit Symbol Modalities Task	Neuropsychological measure of attention and memory	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.
Beck's Depression Inventory	Depression symptom questionnaire	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.
Hamilton Anxiety Scale	Anxiety symptom questionnaire	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.
Neuroinflammatory Biomarker Concentration	Blood analysis for circulating concentration of neuroinflammatory protein, Interluken-6	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.
EEG-fNRIS	Combined EEG-fNIRS brain scan to identify regional brain activation. Specifically a resting state EEG-fNIRS will be utilized to compare the timecourse of frontal theta-, beta-, and alpha-wave peak frequency and absolute power versus BOLD signal (oxygenated hemogloben) in the frontal region. Synchronized EEG and fNIRS scans will aid in confirming type and degree of alterations in subcortical brain activity.	On day 1 (visit 1) and day 28 (visit 2) of the 28 day study.

Collaborators and Investigators

• Sponsor: Penn State University
• Collaborators: Social Sciences Research Institute at Penn State University

Publications and helpful links

General Publications

• Leao ER, Savieto RM, Borba GB, da Silva Victor E, Bomfim SB, Hingst-Zaher E, Lima LM, Longo LGR, de Oliveira LB, Noguchi DT, Oliveira LPG, Moredo RF, Santos CO, Menini A, Bass LM, Patricio KP, Catissi G, Rosa JM, Soldado EBR, Bertini F, de Barros CG, Kiriyama EJ. Efficacy of a multicomponent nature-based intervention on well-being and environmental engagement: A randomized clinical trial. Environ Int. 2025 Feb;196:109286. doi: 10.1016/j.envint.2025.109286. Epub 2025 Jan 19.
• Leao ER, Hingst-Zaher E, Savieto RM, Patricio KP, de Oliveira LB, Catissi G, Lima LM, Borba GB, Bomfim SB, de Abreu FB. A time with e-Natureza (e-Nature): a model of nature-based health interventions as a complex adaptive system. Front Psychol. 2023 Aug 22;14:1226197. doi: 10.3389/fpsyg.2023.1226197. eCollection 2023.
• Gay M, Ray W, Johnson B, Teel E, Geronimo A, Slobounov S. Feasibility of EEG Measures in Conjunction With Light Exercise for Return-to-Play Evaluation After Sports-Related Concussion. Dev Neuropsychol. 2015;40(4):248-53. doi: 10.1080/87565641.2015.1014486.
• Corazon SS, Olsen LJ, Kaereby N, Poulsen DV, Sidenius U, Bekke-Hansen S, Marschner L. Nature-Based Therapeutic Intervention for Individuals with Post-Concussion Symptoms. Behav Sci (Basel). 2024 Jul 12;14(7):594. doi: 10.3390/bs14070594.

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): August 1, 2027

Study Registration Dates

• First Submitted: April 8, 2026
• First Submitted That Met QC Criteria: June 9, 2026
• First Posted (Actual): June 11, 2026

Study Record Updates

• Last Update Posted (Actual): June 11, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Injuries, Traumatic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Pathologic Processes; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds, Nonpenetrating; Brain Injuries; Pathological Conditions, Signs and Symptoms; Disease; Brain Concussion
• Other Study ID Numbers: Nature Intervention Concussion

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No