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1. Introduction
Stress-related illnesses are a growing health problem in the Western world [1,2], including Denmark [3]. It is estimated that around one-fourth of sick leave days in Denmark are due to stress [4] and 21.3% of the adult population report a high level of perceived stress [5]. Stress is not a disease in itself; but, in addition to affecting the person’s well-being and quality of life negatively, stress increases the risk of cardiovascular disease and mental illness, such as depression [6]. In addition to its effect on the individual’s health and quality of life, stress also has economic consequences for society since it affects productivity, leads to increased use of health services, increased sick-leave compensation, and early retirement [3]. One attempt to calculate the costs of stress in Denmark estimates that the annual cost is approximately DKK 14 billion [3]. This has led to an increased demand for interventions to prevent and treat stress-related symptoms. Different forms of cognitive behavioral therapy (CBT) are recommended by the Danish Health Authority [7]. Many other treatment forms also exist. One of the alternative treatments to CBT that has gained more public attention over the few past years is nature-based therapy (NBT). This is an umbrella term for a range of psychotherapeutic practices that integrate natural environments and nature-related activities into the therapy [8]. However, the field still relies to a large extent on qualitative research or quantitative research that lacks comparative groups [9]. To bolster the scientific standards of this therapy form, a randomized controlled trial (RCT) was conducted in the University of Copenhagen’s therapy garden, which is called Nacadia®. The aim of a previous study with respect to the RCT was to test the efficacy of the Nacadia® nature-based therapy (NNBT), measured by mental health metrics regarding general psychological well-being and burnout. The NNBT was compared to a validated cognitive behavioral therapy known as STreSS (Specialized Treatment for Severe Bodily Distress Syndromes) [10]. The study found that the Nacadia® NBT was equal in efficacy to the STreSS with regard to improving the subjects’ mental health status, measured from before to immediately after treatment [11]. Furthermore, the positive effect on mental health was found to be sustained a year after the treatment...