Abstract Background Anxiety disorders represent a globally prevalent mental health issue, with traditional treatment approaches often exhibiting certain limitations. Exposure to natural environments has been demonstrated to exert positive effects on stress reduction. Rural landscapes, blending natural elements with cultural textures, possess soothing qualities that may offer unique psychological relief spaces for anxiety patients. However, existing research predominantly focuses on general nature exposure, with limited empirical studies specifically examining professionally designed rural landscapes as targeted interventions. Therefore, this study explores the effects of exposure to purposefully designed rural landscapes on improving emotional and physiological indicators in anxiety patients, aiming to identify key effective elements. Methods The study employed a randomized controlled trial. Seventy-two patients meeting diagnostic criteria for mild to moderate anxiety disorders were recruited and randomly assigned to an experimental group (n = 36) and a control group (n = 36). Both groups received routine counseling. During the 6-week intervention, the experimental group participated in twice-weekly, 90-minute structured activities within a professionally designed rural healing landscape (e.g., mindful observation, horticultural experiences, nature walks). The landscape emphasized integrated use of water features, woodlands, pastoral elements, and native materials. The control group visited an urban park during the same period. Assessments used the Hamilton Anxiety Rating Scale (HAMA) and the anxiety factor of the Symptom Checklist 90 (SCL-90) at baseline (T0) and post-intervention (T1). Salivary cortisol was collected as a physiological stress indicator. Data were analyzed using covariance analysis in SPSS 25.0. Additionally, 15 participants in the experimental group completed semi-structured interviews, with data analyzed thematically. Results ANCOVA showed that at T1, the experimental group had a significantly lower adjusted mean HAMA score (11.2) than the control group (15.8, p.001). The SCL-90 anxiety factor also decreased more significantly in the experimental group (p.01). Physiologically, salivary cortisol decreased significantly in the experimental group (p.05), but not in the control group. Interview analysis revealed three therapeutic themes: First, "Sensory Immersion and Cognitive Disengagement": 93% of respondents reported that visual openness and natural sounds (e. g., wind, birdsong) effectively interrupted anxious rumination. Second, "Non-threatening Social Ambiance": 80% felt that casual encounters and simple communication within the landscape reduced social pressure. Third, "Symbolic Connection to Vitality": 73% gained calm and hope by observing plant growth and seasonal changes. Discussion Research confirms that exposure to purposefully designed rural landscapes simultaneously improves both psychological subjective experiences and physiological stress levels in anxiety disorder patients, demonstrating superior efficacy compared to typical urban green spaces. The core therapeutic mechanism involves shifting attention through multisensory immersion, rebuilding a sense of security within low-pressure social environments, and deriving positive metaphors from observing life processes. These findings hold clear practical value, providing empirical support for integrating “landscape prescriptions” into anxiety disorder adjunctive treatment and rehabilitation planning. It is recommended that specialized therapeutic landscapes be created within rural wellness projects and community mental health service centers. Future research should explore the differential benefits of various landscape elements (e.g., water body proportions, plant coloration) and determine optimal exposure durations.
Le Wang (Sun,) studied this question.