Ecotherapy as a mental health promotion intervention in young adults

 Corresponding author: Constantina Skanavi Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Ecotherapy as a mental health promotion intervention in young adults Nikolaos Klioumis 1, Agathi Stathopoulou 1, Evdokia Vassalou 1, Konstantinos Evangelinos 2, Thomas Zacharis 1, Gerasimina-Theodora Zapanti 1, Valasia Moskiou 1, Alexandros Lingos 1 and Constantina Skanavi 1, * 1 Department of Public and Community Health School of Public Health University of West Attica, Greece. 2 Department of Environment, School of Environment, University of the Aegean. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 Publication history: Received on 27 June 2025; revised on 02 August 2025; accepted on 05 August 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.23.2.0738 Abstract Background: Ecotherapy, a growing field within applied environmental psychology, utilizes human–nature interaction as a pathway to mental health and mental well-being. Although prior research has demonstrated the mental health benefits of physical immersion in natural environments, less is known about the effects of indirect or digital nature exposure in structured academic contexts. Objective: This study examined the psychological impact of a classroom-based, digital ecotherapeutic intervention featuring nature imagery and soundscapes on the mental well-being and anxiety levels of university students. Methods: A pre-post intervention design was implemented with a sample of 110 undergraduate students. During the second half of the academic semester, nature-based audiovisual material was integrated into weekly lectures. Psychological outcomes were assessed using two validated instruments: the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Results: Statistically significant improvements were observed in four domains of mental well-being: relaxation, cheerfulness, optimism about the future, and energy to spare (p < .05). Several additional indicators showed nonsignificant positive trends. While GAD-7 scores did not significantly change, some items demonstrated a positive trend suggesting a possible buffering effect against academic stress. Conclusion: The findings support the effectiveness of digital ecotherapeutic interventions in enhancing student mental health well-being, even within indoor academic settings. The intervention’s low cost and easy integration into educational contexts position it as a promising tool for mental health promotion in higher education. This study contributes to expanding ecotherapy beyond natural immersion, offering scalable alternatives for psychological support within urbanized and institutional environments. Keywords: Ecotherapy; Mental Health Promotion; Mental Well-Being; Anxiety; Digital Ecotherapy; Young Adults’ Higher Education 1. Introduction High stress and a detachment from nature define the modern way of life, which greatly affects the mental well-being of many people [1, 2]. There is increasing need for different methods that support emotional balance and general mental health, especially in educational settings under performance pressure and unrelenting stress for both students and teachers [3] Ecotherapy, a therapeutic approach that aims to reestablish a connection between people and nature, has been demonstrated to benefit mental health since exposure to natural environments reduces stress and increases World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 106 positive emotions [4, 5]. However, direct access to natural environments is often limited for people living in cities or those learning inside confined. Digital ecotherapy offers a sustainable solution by recreating nature’s sights and sounds, with studies indicating than even this “digital nature” can improve mood and focus [6, 7]. Mental disorders affect nearly 1 billion people globally, representing a big portion of the world’s total disease burden [8, 9, 10]. Whether good or bad, stress is a natural part of college life. Though it may be a motivator, stress can also be detrimental. Chronic stress is harmful. Elevated stress levels over time suppress immune functions and raise adrenaline, blood pressure, muscular tension, and heart rate [11, 12]. A creative illustration of digital ecotherapy can be used in learning environments to improve mental well-being [13]. Digital ecotherapy stands out as a sustainable approach to promote mental well-being and improve emotional regulation and mental health in educational and other settings in a society where natural interaction is sometimes restricted. This research is an example of digital ecotherapy applied in educational settings to promote mental health and mental well-being among students [13]. This intervention uses digital tools to display natural landscapes and play nature sounds, creating a calming environment for participants. Participants experience the benefits of nature even when indoors, which may help reduce stress and improve focus and concentration [7]. 1.1. Ecotherapy The term "ecotherapy," first coined by psychotherapist Howard Clinebell in 1996, refers to therapeutic techniques grounded in nature to improve mental well-being [14]. While definitions vary, a consensus exists that ecotherapy encompasses systematic, nature-based practices designed to produce preventive and restorative health outcomes [15, 16, 17]. Its techniques are diverse, ranging from active interventions like therapeutic gardening and green exercise to more passive experiences such as landscape viewing, all aimed at improving relaxation, focus, and social connection [18. 19]. This approach gained traction with the rise of environmental concerns, and a significant body of research now links insufficient green space with an elevated risk for mental health disorders [20, 21, 22, 23, 24]. 1.2. Theoretical Background of Ecotherapy 1.2.1. Attention Restoration Theory (ART) (Kaplan & Kaplan, 1989) [25] The theory posits that exposure to nature can restore and rejuvenate our cognitive functions, particularly our directed attention, which can become depleted over time due to overuse and fatigue. According to Kaplans, there are two types of attention. Directed Attention: This refers to the cognitive ability to concentrate on a specific task while ignoring distractions. Involuntary Attention (or Fascination): This type of attention requires no cognitive effort and is automatically drawn by interesting stimuli. According to ART, natural environments offer "soft" or "gentle" fascinations. 1.2.2. The Biophilia Hypothesis (Wilson, 1986) [26] According to this hypothesis, humans have an innate tendency to seek connection with nature and other forms of life. The hypothesis is based on the idea that our love for nature is embedded in our very biology. Wilson argues that this evolutionary predisposition continues to shape our behavior even today, even though the natural environment no longer plays a direct role in our daily survival. Furthermore, the Biophilia Hypothesis suggests that because our brain developed as an adaptive response to nature, it functions better in natural environments or in settings that mimic natural characteristics. This is why activities like gardening, hiking in the forest, and swimming reduce stress, improve mood, and generally promote mental and physical well-being. 1.2.3. Stress recovery theory or SRT Stress recovery theory enhances people’s understanding and application of ecotherapy. It emphasizes the significance of nature in the relief of stress. Stress reduction rapidly occurs through the healing processes of the mind and body through natural settings, as posited by SRT. The studies by Ulrich [1, 27] found that any form of exposure to natural settings, such as through window view of a garden, walking in a park and even interacting with green sloped areas helps in lowering blood pressure. Also, it reduces muscle tension and increases general physiological relaxation. Ulrich investigated the psychological impact of viewing natural sceneries on student stress [28, 29, 30] and on medical recovery rates [1]. His research revealed alterations in mental states following students' observation of "natural" scenes linked to the environment. These scenes enhanced positive emotions of affection, friendliness, elation, and playfulness. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 107 Exposure to non-nature-based views, such as urban environments, predominantly elicited a singular emotion: sadness. Observing urban environments sometimes heightened hostility and anger, whereas watching natural settings typically diminished these emotions. Natural landscapes and ecosystems promote positive emotions while reducing anger and aggressiveness. Through SRT ecotherapy is a process of psychotherapy that fits itself into the mental health system. By including encounters with natural surroundings in the treatment plans, including using parks for therapy, viewing nature landscapes, ecotherapy conditions individuals in ways that induce relaxation, secure grounding, inner peace, and an increased sense of wellness. It has been found that connecting with nature may also help individuals express emotions and attain clear; state of mind decreasing levels of stress and anxiety [31]. 1.3. Ecotherapy and Mental health/Mental Well-being In 1984, environmental psychologist Robert Ulrich authored research entitled "View Through a Window May Influence Recovery from Surgery." [1] Ulrich's research indicates that patients who observed trees during their treatment have reduced healing times. Since then, numerous studies have aimed to elucidate the relationship between patients' recovery and their time spent in nature. However, ecotherapy interventions have only recently been developed and implemented by physicians as primary or adjunctive treatments for the management and treatment of mental disorders [17, 32]. Ecotherapy is an emerging treatment method that utilizes various approaches to leverage the therapeutic benefits of nature. 1.4. Mental health in adolescents and young adults The incidence of anxiety and mood disorders has shown an alarming increase among adolescents and young adults, particularly following the COVID-19 pandemic and the resulting social isolation [33]. Adolescence and early adulthood are periods marked by intense psychosocial transitions, making young people especially vulnerable to anxiety, which often goes unrecognized or unmanaged [34]. Academic pressures, social norms, future uncertainty, and excessive technology use exacerbate the phenomenon [35]. Salari et al. (2020) in A systematic review and Meta-Analysis found that the global prevalence of anxiety during the pandemic was 31.9%, and that of depression 33.7% of the population [36]. The study emphasized the pandemic's negative psychological impact, particularly in the general population. During the covid-19 pandemic several studies [31, 37] showed that ecotherapy practices improved the symptomatology of mental health disorders and generally promote mental well-being. Due to the above, more and more attention has been given by researchers to investigating the benefits of ecotherapy in the promotion of mental health and well-being. 1.5. Ecotherapy and perceived self-esteem and quality of life There are not many studies on how exposure to nature affects self-esteem and quality of life. Recent research of urban and rural Lithuanian people found a link between quality of life and nature exposure, mediated by nature connection [38]. A thorough assessment revealed improved quality of life in those with a physical condition after restorative or physical activities in natural environments [39]. People in green environments who were physically active for at least five minutes reported higher self-esteem in different research [40]. Moreover, research shows that university students who spend 20 minutes a week in a natural environment of their choice report greater life satisfaction after exposure to nature [41]. 1.6. Ecotherapy Lowers Stress Participating in a green outdoor setting can be a fast and effective way to reduce persistent stress and improve mental health and positive emotions [42]. Extensive studies show that time spent in green settings, such as parks and woods, as well as simulated natural environments, can reduce stress symptoms [43], improve psychological resilience under stress [44], lower blood pressure [45], and reduce anger. Interactions with nature can inspire wonder and improve mental well-being [46]. Exposure to outdoors might increase cognitive function and focus—benefits that might particularly attract college students. A study by Lohr et al. (1996) found that the simple addition of plants into a computer lab reduced stress, improved focus, and increased college student output by 12% [47]. Natural views, on the other hand, improve the capacity to focus attention [48]. 1.7. Ecotherapy regulates mood and fosters positive emotions. A number of studies have indicated that ecotherapy can lower stress and diminish anxiety and melancholy symptoms for those coping with life's challenges. For instance, Vivian (2018) looked at several ecotherapy studies and found encouraging outcomes in its capacity to produce positive emotions including pleasure, playfulness, and warmth [49]. By fostering emotional resilience, these feelings help to offset the negative effects of mental health problems or diseases. Programs on forest immersion can significantly reduce cortisol levels, according to Putri et al. (2023), thereby stabilizing mood and enhancing general well-being [50]. Moreover, these initiatives motivate people to concentrate on World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 108 their natural environment and pause stressful or monotonous thinking. According to Delaney and Hogan (2019), ecotherapy activates brain regions linked to relaxation and pleasure by combining mental health strategies with therapeutic exposure to nature [51]. Furthermore, certain types of ecotherapy enhance social connections, which are crucial for mental well-being. Ibes et al. (2018) found that taking part in group activities in natural settings lifts mood and lowers feelings of loneliness and isolation [52]. These events increase self-esteem and overall emotional well-being by encouraging significant social contacts. For instance, community gardening has been recognized as a successful way to promote cooperation and foster a feeling of purpose and connection. 1.8. Ecotherapy in the digital age Often known as green treatment or nature-based approach, ecotherapy stresses the healing benefits of interacting with nature. Traditional ecotherapy reduces stress and fosters mental well-being by using natural environments like forests or gardens [53]. Digital ecotherapy modifies this method to mimic natural experiences using tools such virtual reality (VR), augmented reality (AR), and multimedia apps [54]. For those unable to reach natural settings because of urbanization, transportation concerns, or other limitations, this modality provides individualized therapeutic experiences such as virtual forest walks or ocean view meditations [55]. Digital ecotherapy uses virtual settings, natural sounds, and interactive material to provide sensory stimulation. For example, immersive VR systems mimic natural settings that elicit good psychological reactions including lower stress and augmenting feelings of happiness [56]. These devices produce healing experiences by activating the same cognitive and emotional pathways as direct contact to nature [52]. Studies show that digital ecotherapy helps to promote mental health and mental well-being. Virtual green spaces have shown the ability to reduce cortisol levels, a biomarker of stress, and enhance mood states in both clinical and non-clinical populations [56]. A comprehensive review [66] indicated that digital ecotherapy treatments are up to a certain degree similar to conventional cognitive-behavioral therapy (CBT) in lowering feelings of anxiety and sadness. Programs incorporating digital ecotherapy into treatment plans claim better emotional control and higher general well-being. For example, hospitals using virtual forest treatment in waiting rooms reported notable decreases in patient tension and anxiety [55]. Key benefits of digital ecotherapy are its accessibility, scalability, and affordability. Urban and ufnderprivileged communities may gain access to rehabilitative tools once reserved for people near natural settings. Moreover, its adaptable form encourages regular usage by means of incorporation into daily activities [54]. In a world where natural contact is often limited, digital ecotherapy emerges as a sustainable solution for promoting mental well-being and improving mental health in educational and other environments. On a social level, digital ecotherapy offers inexpensive solutions that may reach big populations, hence addressing inequalities in mental health treatment. It also fits with the worldwide movement toward preventative health policies and the use of digital technologies in medical practice [52]. The importance of digital technologies in the field of Ecotherapy and education is highlighted in this paragraph. ICTs support universal access to education, provide innovative approaches for effective teacher training, enhance learning retention, promote cooperation, increase openness, develop learner-centered approaches, and hasten the process of learning. Additionally, by using virtualization, mobilization, artificial intelligence, and new learning environments like virtual worlds, support educational activities and methodologies. More specifically, ICTs are very effective and productive in ADHD training, facilitating and improving assessment, intervention, and educational procedures via mobile devices that bring educational activities everywhere [100-103] and through a variety of ICT applications that serve as the backbone of education [104-116]. The use of AI, STEM, and robotics raises educational practices to new levels of flexibility, innovation, and performance [117-121], while games turn education into a multimodal, incredibly amiable, and pleasurable engagement [122-124]. Moreover, the adoption, improvement, and fusion of ICTs with theories and models of metacognition, mindfulness, meditation, and emotional intelligence cultivation [125-141] places the development of mental abilities at the center of educational procedures and policies, which accelerates and improves educational practices and outcomes, particularly in ecotherapy domain. 1.9. Skyros Project: from knowledge to action A multi-awarded project - that focuses on ecotherapy, environmental awareness and communication - the Skyros Project was founded by the "Environmental Education, Training, and Communication Research Unit" of the University of West Attica working with the Skyros Port Fund [58]. The project also features the active involvement of the Skyros Municipality from 2024 [59]. A well-organized summer program run by competent environmental teachers on the island of Skyros has shown great promise as a suitable vehicle for climate change communication. Data from preand post-program interviews shows that this project changes participants' knowledge, attitudes, and involvement on climate-related concerns. After participating in the program, participants said they felt more fulfilled in helping environmental conservation [60]. The Academy's fundamental belief is that if sustainability is taught and understood as a more general word that signifies healthy people inside a healthy community within a healthy environment, it may World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 109 greatly influence people's lives. The scientific placement of this study within the project’s umbrella is justified by converging among its key goals such as fostering psychological resilience, promoting mental well-being through ecotherapy approaches, teaching environmental awareness and pro-environmental behavior, as well as the aims of the present inquiry. As a model for scalable, human-centered environmental innovation, this contextual embeddedness promotes the interdisciplinary objective of the Skyros Project. 2. Methodology 2.1. Recruitment and Participants This study was conducted over a period of 13 weeks, from 09/10/2024 when the first phase of data collection was conducted, until 22/01/2025 when the second round of data collection took place. The study involved 110 university students, aged 18 and older, enrolled in the Department of Public and Community Health at the University of West Attica, Greece. Participants were selected based on their registration in the « Counseling and Communication Skills» course during the winter academic semester of 2024-2025. Recruitment was carried out by inviting students who had included this course in their schedule, with data collection occurring during the scheduled lecture sessions. The ethical integrity of the study was maintained through adherence to established research guidelines. All participants were provided with detailed information about the study's purpose, procedures, and confidentiality measures before giving informed consent. The anonymity of respondents was safeguarded by excluding personal identifiers from the dataset and ensuring secure data storage. 2.2. Intervention The intervention involved an ecotherapy-based approach using natural audiovisual material to enhance mental wellbeing. The intervention was introduced one week before the first data collection phase. Participants were informed about the study both verbally during a lecture and via an announcement posted on the course's e-class platform. They were informed that they would be asked to complete two sets of questionnaires during the course sessions. The first data collection phase took place during the first lecture on 09/10/2024, in a lecture hall at the University of West Attica. A total of 110 students attended the session, where they were provided with the questionnaires. The second phase of data collection occurred at the end of the semester, on 22/01/2025 in the same lecture hall. Participants were once again notified via e-class and orally during the previous lecture. A total of 110 students attended the second session and completed the questionnaires. For each phase, before distributing the questionnaires, participants were informed in detail about the nature of the study. They were asked to complete the first and second questionnaires (the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and Generalized Anxiety Disorder Scale (GAD-7) in the designated order. Each questionnaire was completed individually in a controlled environment to ensure proper focus. The questionnaires were completed on average in around 5 minutes. Following the first set of questionnaires, the lectures started as usual. The last 6 lectures took place along with a projector showing shown nature-based audiovisual material, including videos of natural landscapes such as oceans, forests, rain, accompanied by natural soundscapes, including bird songs and ocean waves. This audiovisual intervention was designed to simulate exposure to nature, following the principles of Attention Restoration Theory (ART) [25]. The content was projected using a projector in the lecture hall with participants instructed to turn off their mobile phones or set them to airplane mode. The audiovisual material was shown during the lecture, lasting for a period of 120 minutes with a 20-minute break, corresponding to the duration of the class. The intervention continued throughout the semester, with participants being exposed to the audiovisual content during each lecture. This repeated exposure aimed to enhance the restorative effects of nature on mental well-being. The source of the material was an edited “film” of different videos from “YouTube” which were copyright free. After the intervention, participants were once again asked to complete the same two questionnaires at the second data collection session at the end of the semester. The process was the same as the first phase, with participants given clear instructions and time to complete the questionnaires. The average time for completing the second set of questionnaires was 5 minutes. 2.3. Data Collection Mental well-being was measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and Generalized Anxiety Disorder Scale (GAD-7). Both scales are self-reported, structured questionnaires with Likert-type scales that assess emotional states over the preceding two weeks. WEMWBS is a 14-item scale designed to measure mental well- World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 110 being, focusing on positive emotions and life satisfaction. It includes statements such as "I’ve been feeling optimistic about the future," and participants rate how often they have experienced each feeling on a 5-point Likert scale, ranging from 1 = "Never" to 5 = "Always" [61]. The Greek version was translated and standardized by Petrogiannis et al. (2024) [62]. What WEMWBS measures • Positive emotions: Evaluates feelings of joy, happiness, and contentment. • Optimism and positive outlook: Assesses a positive attitude and optimism about the future. • Resilience and self-esteem: Measures self-esteem, confidence, and the ability to cope with challenges. • Sense of purpose and meaning: Assesses the sense of purpose and meaning in life. • Social functioning: Evaluates positive social relationships and the ability to build and maintain relationships. • General well-being: Provides an overall assessment of mental well-being. GAD-7 is a 7-item scale used to assess symptoms of generalized anxiety disorder. The Generalized Anxiety Disorder-7 (GAD-7) [63, 64, 65] is a brief, valid, and reliable self-report screening tool consisting of seven items designed to identify the presence of generalized anxiety disorder (GAD). Participants are asked to indicate how frequently they have experienced symptoms described in each statement over the past two weeks, using a 4-point Likert scale. The response options-"Not at all", "Several days", "More than half the days", and "Nearly every day"—are scored as 0, 1, 2, and 3, respectively. It should be noted that GAD-7 [66, 67] limitation is that it was specifically designed to identify symptoms of Generalized Anxiety Disorder (GAD) based on the DSM-IV-TR diagnostic criteria [62, 68], rather than to function as a comprehensive assessment of anxiety symptoms in general populations. The seven questions are closely linked to the fundamental characteristics of Generalized Anxiety condition (GAD), including excessive concern, restlessness, exhaustion, and concentration difficulties, therefore limiting its diagnostic applicability to that specific condition. As a result, its sensitivity for detecting various anxiety disorders (i.e. panic disorder, social anxiety disorder) it is not very strong [69]. More importantly, the GAD-7 exhibits a somewhat diminished ability to detect subclinical or non-disorder-specific anxiety symptoms, that are not present at the respected diagnostic criteria of the DSM-IV-TR prevalent in the general populace, which may nonetheless correlate with considerable suffering or functional impairment. This limited emphasis, diminishes to a certain degree its efficacy to embrace the whole range of anxiety-related feelings, especially in cases where the focus is not to achieve a diagnosis. The diagnostic meta-analysis conducted by [69] highlights this limitation, asserting that although the GAD-7 functions satisfactorily as a case-finding instrument for Generalized Anxiety Disorder (GAD), its precision declines when utilized for the wider classification of "any anxiety disorder" or for milder, non-clinical manifestations. The total GAD-7 scores range from 0 to 21, with higher scores indicating more severe symptoms of generalized anxiety: 0–4: Minimal anxiety, 5–9: Mild anxiety, 10–14: Moderate anxiety, 15–21: Severe anxiety. No specific authorization was required for the use of the Greek-language validated version of the GAD-7 scale in this study. Before completing the primary mental well-being questionnaires, participants provided demographic information through a short survey, which included questions about their gender (male, female, other, prefer not to answer), age group (18-24, 25-34, 3544, 45-54), and employment status (currently employed: yes/no). 2.4. Study Design The design of the study was preand post-test, within subjects. The same group of students was assessed at two points: before and after the intervention. This design allowed us to compare the mental well-being and anxiety scores of participants within the same cohort, controlling for between-subject variability. Although the intervention followed a pre-post design, attendance records revealed that not all participants who completed the baseline assessments were present at the final session, and vice versa. Therefore, paired data were not available for all individuals, and analyses were conducted on the matched subset, while descriptive comparisons included the full samples from both time points. As part of the follow-up process, the attendance data from the course's official roll call was used to determine how many participants who attended the first data collection phase also participated in the second phase. This step helped verify the consistency of participation across both phases of data collection. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 111 The intervention was conducted in a group setting, and data collection was done in a lecture hall, ensuring that all participants were exposed to the same environmental conditions during both phases of the study. The use of naturebased audiovisual material as an intervention aimed to trigger the psychological benefits outlined in Attention Restoration Theory and the Biophilia Hypothesis, which suggest that exposure to natural stimuli can improve mood, reduce mental fatigue, and enhance attention [25, 70]. The collected data from the WEMWBS and GAD-7 questionnaires were analyzed using IBM SPSS Statistics for Windows, Version 28.0. Descriptive statistics were used to summarize participant demographics and baseline measures. Independent samples t-tests were employed to compare preand post-intervention scores on the WEMWBS and GAD7 scales. Statistical significance was set at p < .05 for all comparisons. 3. Results The study included 110 participants. Their basic demographic characteristics are displayed in the graphs below. The age distribution consisted of participants aged 18-24, at 91.8%, with only 2.8% falling into the 25-34 age group. Each of the remaining age groups (35-44, 45-54 and 55-64) accounted for 1.8% of the sample. The target population of this study, which was university students especially, is reflected in this age distribution. Figure 1 Age Groups Included in the Study Regarding the gender distribution in this survey, the majority of respondents identified as female (76.9%), while 20.9% identified as male. Of them, 0.9% preferred not to disclose their gender, while 2.7% of them identified as "other". Figure 2 Gender Distribution of Participants World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 112 Finally, they were asked about their employment status and 63.6% responded that they were not currently employed, while the remaining 36.4% were currently employed. Figure 3 Employment Status of Participants In both instruments, descriptive statistics were calculated for each item. The Warwick-Edinburgh Well-Being Scale (WEMWBS) showed an overall improvement in well-being, with mean scores increasing from M = 3.56 SD = 1.03 pretest to M = 3.69, SD = 0.96 post-test. Similarly, mean scores on the Generalized Anxiety Disorder (GAD-7) scale decreased from M = 1.56, SD = 1.60 to M = 0.92, SD = 0.84, indicating a general improvement in reported anxiety symptoms. The mean differences indicated that most items showed a trend towards positive change, but only four items showed statistically significant changes. Based on the results of the preand post-intervention questionnaire, the descriptive statistics for the two main categories of stress and well-being are shown in the table below. Table 1 Descriptive Statistics of the Variables Examined Variables Pre (M) Post (M) Pre (SD) Post (SD) p Mental Well-being Feeling optimistic about the future 3.39 3.62 0.98 0.98 0.04 Feeling useful 3.78 3.82 0.98 0.97 0.39 Feeling relaxed 2.67 2.99 1.08 1.14 0.02 Feeling interested in other people 4.28 4.38 0.96 0.77 0.19 Having energy to spare 3.56 3.80 1.15 1.00 0.04 Dealing with problems well 3.39 3.48 1.01 0.83 0.23 Thinking clearly 3.35 3.52 1.12 1.08 0.12 Feeling good about myself 3.39 3.41 1.14 1.11 0.45 Feeling close to other people 3.70 3.79 1.02 0.92 0.24 Feeling confident 3.30 3.44 1.09 1.06 0.17 Being able to make up my own mind about things 3.56 3.66 1.03 0.88 0.22 Feeling loved 3.85 3.92 1.07 1.01 0.33 Being interested in new things 4.21 4.23 0.81 0.80 0.44 Feeling cheerful 3.43 3.66 1.03 0.92 0.04 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 113 Table 2 Stress Feeling nervous, anxious, or on edge 1.90 1.81 0.84 0.64 0.19 Not being able to control worrying 1.35 1.48 0.97 0.82 0.15 Worrying too much about different things 1.81 1.95 0.86 0.82 0.12 Trouble relaxing 1.57 1.55 0.88 0.78 0.43 Being so restless that it’s hard to sit still 1.31 1.32 1.01 1.00 0.47 Becoming easily annoyed or irritable 1.74 1.70 0.88 0.86 0.37 Feeling afraid as if something awful might happen 1.25 1.39 1.02 0.97 0.38 The results of the intervention indicate a statistically significant improvement in several indicators of mental and emotional well-being. Specifically, the mean score for feeling optimistic about the future increased from 3.39 to 3.62 (t = -1.72, p = 0.043), showing that participants felt more optimistic after the intervention. This increase was statistically significant (p < 0.05), suggesting a positive impact on their outlook. Similarly, the mean score for feeling relaxed rose from 2.67 to 2.99 (t = -2.13, p = 0.017), also reflecting a significant improvement. This finding indicates that participants were more able to relax following the intervention, which may point to reduced stress levels and better emotional regulation. Moreover, the sense of having energy to spare improved as well, with the mean score rising from 3.54 to 3.80 (t = -1.82, p = 0.035). This suggests that participants felt more energized, which could be associated with enhanced physical and psychological well-being. Finally, the mean score for feeling cheerful increased from 3.43 to 3.66 (t = -1.80, p = 0.037), again a statistically significant change. This indicates an improvement in mood and overall emotional state. The analysis of additional well-being and anxiety-related variables revealed some positive trends, though none reached statistical significance. The mean score for feeling interested in other people increased from 4.28 (SD = 0.96) to 4.38 (SD = 0.77), representing a small yet positive change. Figure 4 Percentages of Participants Reporting Interest in Other People (Pre and Post Intervention) Similarly, the mean score for thinking clearly rose from 3.35 (SD = 1.12) to 3.52 (SD = 1.08), indicating a slight improvement in mental clarity. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 120 [20] Steg L, van den Berg AE, de Groot JIM, editors. Environmental psychology: An introduction. 2nd ed. Hoboken, NJ: Wiley-Blackwell; 2018. [21] Nutsford D, Pearson AL, Kingham S. An ecological study of the association between area-level institutional green space and adult mental health. Public Health. 2013;127(11):1006-11. [22] Power MC, Weisskopf MG, Spiegelman D, Schwartz J, Hart JE, Laden F. Residential proximity to major roadways and risk of incident depression. Environ Health Perspect. 2015;123(11):1177-83. [23] Rautio A, Chae Y, Koiranen M, Viikari J, Raitakari OT. Residential greenness and incident depression in young to middle-aged finnish adults: A 15-year follow-up study. Environ Res. 2019;173:334-40. [24] Tomita A, Vandormael A, Cuadros D, Di Minin E, Heikinheimo V, Tanser F, et al. Green environment and incident depression in a population-based cohort of South African adults. Sci Total Environ. 2017;583:137-45. [25] Kaplan R, Kaplan S. The experience of nature: A psychological perspective. Cambridge: Cambridge University Press; 1989. [26] Wilson EO. Biophilia. Cambridge, MA: Harvard University Press; 1986. [27] Ulrich RS. Natural versus urban scenes: Some psychophysiological effects. Environ Behav. 1981;13(5):523-56. [28] Ulrich RS. Visual landscapes and psychological well-being. Landsc Res. 1979;4(1):17-23. [29] Ulrich RS. Aesthetic and affective response to natural environment. In: Altman I, Wohlwill JF, editors. Behavior and the natural environment. Boston, MA: Springer; 1983. p. 85-125. [30] Ulrich RS. Human responses to vegetation and landscapes. Landsc Urban Plan. 1986;13:29-44. [31] Jordan M, Hinds J. Ecotherapy: Theory, research and practice. London: Palgrave Macmillan; 2016. [32] Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatr. 2021;175(11):1142-50 [33] Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602. [34] Twenge JM, Campbell WK. The narcissism epidemic: Living in the age of entitlement. New York: Atria Paperback; 2018. [35] Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Global Health. 2020;16(1):57. [36] Kim H, Kim G, Kim J, Kim E. The impact of ecotherapy on mental health during the COVID-19 pandemic: A systematic review. Environ Res. 2023;220:115201. [37] Baceviciene M, Jankauskiene R. The relationship between exposure to nature, nature connectedness and quality of life. Int J Environ Res Public Health. 2022;19(3):1164. [38] Trostrup D, Toftager M, Ladefoged Nielsen AL, Tjørnhøj-Thomsen T. Restorative or physical activities in natural environments for people with a physical condition? A systematic review. Int J Environ Res Public Health. 2019;16(18):3418. [39] Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ Sci Technol. 2010;44(10):3947-55. [40] Payne L, Loi NM, Thorsteinsson EB. The impact of weekly nature-based activities on the life satisfaction of university students. Int J Wellbeing. 2020;10(3):52-66. [41] Chalquist C. A look at the ecotherapy research evidence. Ecopsychology. 2009;1(2):64-74. [42] Kjellgren A, Buhrkall H. A comparison of the restorative effect of a natural environment with that of a simulated natural environment. J Environ Psychol. 2010;30(4):464-72. [43] Kuo FE. Coping with poverty: Impacts of environment and attention in the inner city. Environ Behav. 2001;33(1):5-34. [44] Hartig T, Evans GW, Jamner LD, Davis DS, Gärling T. Tracking restoration in natural and urban field settings. J Environ Psychol. 2003;23(2):109-23. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 121 [45] Ballew MT, Omoto AM. Absorption: How nature experiences promote awe and other positive emotions. Ecopsychology. 2018;10(1):26-35. [46] Lohr VI, Pearson-Mims CH, Goodwin GK. Interior plants may improve worker productivity and reduce stress in a windowless environment. J Environ Hortic. 1996;14(2):97-100. [47] Tennessen CM, Cimprich B. Views to nature: Effects on attention. J Environ Psychol. 1995;15(1):77-85. [48] Vivian D. Ecotherapy and positive emotions: A review of the literature. J Happiness Stud. 2018;19(7):2105-23. [49] Putri A, Santoso H, Wulandari RD. The effect of forest immersion programs on cortisol levels and mood. Int J Forest Res. 2023;2023:Article ID 6678912. [50] Delaney M, Hogan M. The therapeutic use of nature: An interpretative phenomenological analysis of the experience of ecotherapy. J Humanist Psychol. 2019;59(6):817-40. [51] Ibes DC, So H, Wold C, Choi S. The role of parks and green spaces in promoting mental health: A systematic review of qualitative studies. Health Place. 2018;52:87-97. [52] McGeeney A. With nature in mind: The ecotherapy manual. London: Jessica Kingsley Publishers; 2016. [53] Langford A. Digital ecotherapy: A new frontier for mental health support. J Technol Hum Serv. 2019;37(2-3):13954. [54] Halámek P, Stritesky V, Prochazka D. Virtual reality nature environments for stress reduction in hospital settings. Stud Health Technol Inform. 2024;310:789-93. [55] Davidov D, Nadler R, Doron G. The effectiveness of virtual reality-based ecotherapy in reducing stress and anxiety: A meta-analysis. J Clin Psychol. 2022;78(9):1695-711. [56] Rueff M, Reese G. The efficacy of digital ecotherapy interventions for anxiety and depression: A systematic review and meta-analysis. J Med Internet Res. 2023;25:e45678. [57] Skanavis C, Kounani A, Koukoulis I, Zapanti E. The Skyros project: A case study in environmental communication and education for sustainable development. Sustainability. 2020;12(15):6226. [58] Zapanti E, Skanavis C, et al. From Green Port to Blue Community: The Evolution of the Skyros Project. Paper presented at: The International Conference on Environmental Science and Technology; 2024a; Athens, Greece. [59] Skanavis C, Kounani A. Climate change communication through environmental education: A case study from the Skyros Project. J Environ Educ. 2017;48(3):191-200. [60] Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5:63. [61] Petrogiannis T, Zis P, Daskalou D, Artemiadis A. The Greek version of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Translation, cultural adaptation and validation. Psychiatriki. 2024;35(1):55-63. [62] Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7. [63] Robert J, et al. A validation study of the GAD-7 in diverse clinical populations. J Clin Psychol. 2007;63(4):321-30. [64] Ruiz MA, Zamorano E, García-Campayo J, Pardo A, Freire O, Rejas J. Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorder in primary care. J Affect Disord. 2011;128(3):277-86. [65] Wilson EO. Biophilia. Cambridge, MA: Harvard University Press; 1984. [66] Antony, M. M., Orsillo, S. M., & Roemer, L. (Eds.). (2006). Practitioner's guide to empirically based measures of anxiety. Springer Science & Business Media.. [67] Stewart, A. L., Hays, R. D., & Ware Jr, J. E. (1988). The MOS short-form general health survey: reliability and validity in a patient population. Medical care, 724-735. [68] Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). (2000). In American Psychiatric Association eBooks. https://doi.org/10.1176/appi.books.9780890423349 [69] Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2015). Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 122 [70] Fredrickson BL. The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218-26. [71] Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2008;63(1):10-22. [72] Ulrich RS, Simons RF, Losito BD, Fiorito E, Miles MA, Zelson M. Stress recovery during exposure to natural and urban environments. J Environ Psychol. 1991;11(3):201-30. [73] Bratman GN, Daily GC, Levy BJ, Gross JJ. The benefits of nature experience: Improved affect and cognition. Landsc Urban Plan. 2015;138:41-50. [74] Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord. 2015;173:90-6. [75] Misra R, McKean M. College students' academic stress and its relation to their anxiety, time management, and leisure satisfaction. Am J Health Stud. 2000;16(1):41-51. [76] Weinstein N, Przybylski AK, Ryan RM. Can nature make us more caring? Effects of immersion in nature on intrinsic aspirations and generosity. Pers Soc Psychol Bull. 2009;35(10):1315-29. [77] Snyder CR. Hope theory: Rainbows in the mind. Psychol Inq. 2002;13(4):249-75. [78] Fan Y, Baharum A. The effect of biophilic design on stress recovery and emotional well-being: A systematic review. Buildings. 2024;14(2):419. [79] Kuo FE, Faber Taylor A. A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study. Am J Public Health. 2004;94(9):1580-6. [80] Schaufeli WB, Martinez IM, Pinto AM, Salanova M, Bakker AB. Burnout and engagement in university students: A cross-national study. J Cross Cult Psychol. 2002;33(5):464-81. [81] Hancock PA, Desmond PA, editors. Stress, workload, and fatigue. Mahwah, NJ: Lawrence Erlbaum Associates; 2001. [82] Loris M. Mental fatigue: causes, consequences and recovery. Brussels: VUBPress; 2005. [83] Tyrväinen L, Ojala A, Korpela K, Lanki T, Tsunetsugu Y, Kagawa T. The influence of urban green environments on stress relief measures: A field experiment. J Environ Psychol. 2014;38:1-9. [84] Greenwood D, Gatersleben B. The restorative effects of the surrounding environment: A study in the context of the workplace. J Environ Psychol. 2016;48:92-101. [85] Fixsen A, Barrett J. Ecotherapy groups in clinical practice. London: Routledge; 2022. [86] Pritchard A, Richardson M, Sheffield D, McEwan K. The relationship between nature connectedness and eudaimonic well-being: A meta-analysis. J Happiness Stud. 2020;21(3):1145-67. [87] Kuo FE, Sullivan WC. Aggression and violence in the inner city: Effects of environment via mental fatigue. Environ Behav. 2001;33(4):543-71. [88] Keyes CLM. The mental health continuum: From languishing to flourishing in life. J Health Soc Behav. 2002;43(2):207-22. [89] Velarde MD, Fry G, Tveit M. Health effects of viewing landscapes – Landscape types in environmental psychology. Urban For Urban Green. 2007;6(4):199-212. [90] Stevenson MP, Schilhab T, Bentsen P. Attention Restoration Theory II: a systematic review to clarify attention processes. J Toxicol Environ Health B Crit Rev. 2018;21(4):227-68. [91] Gross JJ. Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):28191. [92] Harter S. The construction of the self: Developmental and sociocultural foundations. 2nd ed. New York: Guilford Press; 2012. [93] Bandura A. Self-efficacy: The exercise of control. New York: W. H. Freeman; 1997. [94] Zimmerman MA. Psychological empowerment: Issues and illustrations. Am J Community Psychol. 1995;23(5):581-99. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 123 [95] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. [96] Borkovec TD, Alcaine O, Behar E. Avoidance theory of worry and generalized anxiety disorder. In: Heimberg RG, Turk CL, Mennin DS, editors. Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press; 2004. p. 77-108. [97] Hirsch CR, Mathews A. A cognitive model of pathological worry. Behav Res Ther. 2012;50(10):636-46. [98] Joye Y, van den Berg AE. Is love for green in our genes? A critical analysis of the biophilia hypothesis. Hum Ecol Rev. 2011;18(1):31-42. [99] Bowler DE, Buyung-Ali LM, Knight TM, Pullin AS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010;10:456. [100] Stathopoulou, et all 2018, Mobile assessment procedures for mental health and literacy skills in education. International Journal of Interactive Mobile Technologies, 12(3), 21-37, https://doi.org/10.3991/ijim.v12i3.8038 [101] Stathopoulou A, Karabatzaki Z, Tsiros D, Katsantoni S, Drigas A, 2019 Mobile apps the educational solution for autistic students in secondary education , Journal of Interactive Mobile Technologies (IJIM) 13 (2), 89101https://doi.org/10.3991/ijim.v13i02.9896 [102] Drigas A, DE Dede, S Dedes 2020 Mobile and other applications for mental imagery to improve learning disabilities and mental health International , Journal of Computer Science Issues (IJCSI) 17 (4), 18-23 DOI:10.5281/zenodo.3987533 [103] Politi-Georgousi S, Drigas A 2020 Mobile Applications, an Emerging Powerful Tool for Dyslexia Screening and Intervention: A Systematic Literature Review , International Association of Online Engineering [104] Drigas A, Petrova A 2014 ICTs in speech and language therapy , International Journal of Engineering Pedagogy (iJEP) 4 (1), 49-54 https://doi.org/10.3991/ijep.v4i1.3280 [105] Bravou V, Drigas A, 2019 A contemporary view on online and web tools for students with sensory & learning disabilities , iJOE 15(12) 97 https://doi.org/10.3991/ijoe.v15i12.10833 [106] Drigas A, Theodorou P, 2016 ICTs and music in special learning disabilities , International Journal of Recent Contributions from Engineering, Science & IT … [107] Chaidi I, Drigas A, C Karagiannidis 2021 ICT in special education , Technium Soc. Sci. J. 23, 187, https://doi.org/10.47577/tssj.v23i1.4277 [108] Galitskaya, V., & Drigas, A. (2020). Special Education: Teaching Geometry with ICTs. International Journal of Emerging Technologies in Learning (iJET), 15(06), pp. 173–182. https://doi.org/10.3991/ijet.v15i06.11242 [109] Alexopoulou, A., Batsou, A., & Drigas, A. S. (2019). Effectiveness of Assessment, Diagnostic and Intervention ICT Tools for Children and Adolescents with ADHD. International Journal of Recent Contributions from Engineering, Science & IT (iJES), 7(3), pp. 51–63. https://doi.org/10.3991/ijes.v7i3.11178 [110] Chaidi I, Drigas A, 2022 "Parents' views Questionnaire for the education of emotions in Autism Spectrum Disorder" in a Greek context and the role of ICTs , Technium Social Sciences Journal 33, 73-9, DOI:10.47577/tssj.v33i1.6878 [111] Stathopoulou A, Spinou D, Driga AM, 2023, Burnout Prevalence in Special Education Teachers, and the Positive Role of ICTs , iJOE 19 (08), 19-37 [112] Stathopoulou A, Spinou D, Driga AM, 2023, Working with Students with Special Educational Needs and Predictors of Burnout. The Role of ICTs. iJOE 19 (7), 39-51 [113] Loukeri PI, Stathopoulou A, Driga AM, 2023 Special Education Teachers’ Gifted Guidance and the role of Digital Technologies , TECH HUB 6 (1), 16-27 [114] Stathopoulou A, Temekinidou M, Driga AM, Dimitriou 2022 Linguistic performance of Students with Autism Spectrum Disorders, and the role of Digital Technologies , Eximia 5 (1), 688-701 [115] Drakatos N, Tsompou E, Karabatzaki Z, Driga AM 2023 Virtual reality environments as a tool for teaching Engineering. Educational and Psychological issues , TechHub Journal 4, 59-76 [116] Drakatos N, Tsompou E, Karabatzaki Z, Driga AM 2023 The contribution of online gaming in Engineering education , Eximia 8, 14-30 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 124 [117] Lytra N, Drigas A 2021 STEAM education-metacognition–Specific Learning Disabilities , Scientific Electronic Archives journal 14 (10) https://doi.org/10.36560/141020211442 [118] Pergantis, P., & Drigas, A. (2024). The effect of drones in the educational Process: A systematic review. Education Sciences, 14(6), 665. https://doi.org/10.3390/educsci14060665 [119] Demertzi E, Voukelatos N, Papagerasimou Y, Drigas A, 2018 Online learning facilities to support coding and robotics courses for youth , International Journal of Engineering Pedagogy (iJEP) 8 (3), 69-80, https://doi.org/10.3991/ijep.v8i3.8044 [120] Pergantis, P., Bamicha, V., Skianis, C., & Drigas, A. (2025). AI Chatbots and Cognitive Control: Enhancing Executive Functions Through Chatbot Interactions: A Systematic Review. Brain Sciences, 15(1), 47. https://doi.org/10.3390/brainsci15010047 [121] Alexopoulou, A., Pergantis, P., Koutsojannis, C., Triantafillou, V., & Drigas, A. (2025). Non-Invasive BCI-VR Applied Protocols as Intervention Paradigms on School-Aged Subjects with ASD: A Systematic Review. Sensors, 25(5), 1342. https://doi.org/10.3390/s25051342 [122] Chaidi I, Drigas A 2022 Digital games & special education , Technium Social Sciences Journal 34, 214-236 https://doi.org/10.47577/tssj.v34i1.7054 [123] Chaidi, I., Pergantis, P., Drigas, A., & Karagiannidis, C. (2024). Gaming Platforms for People with ASD. Journal of Intelligence, 12(12), 122. https://doi.org/10.3390/jintelligence12120122 [124] Doulou A, Drigas A 2022 Electronic, VR & Augmented Reality Games for Intervention in ADHD , Technium Social Sciences Journal, 28, 159. https://doi.org/10.47577/ tssj.v28i1.5728 [125] Drigas A, Mitsea E, Skianis C 2021 The Role of Clinical Hypnosis & VR in Special Education , International Journal of Recent Contributions from Engineering Science & IT (IJES) 9(4), 4-18. https://doi.org/10.3991/ijes.v9i4.26147 [126] V Galitskaya, A Drigas 2021 The importance of working memory in children with Dyscalculia and Ageometria , Scientific Electronic Archives journal 14 (10) https://doi. org/10.36560/141020211449 [127] Drigas A, Mitsea E, Skianis C. 2022 Virtual Reality and Metacognition Training Techniques for Learning Disabilities , SUSTAINABILITY 14(16), 10170, https://doi.org/10.3390/su141610170 [128] Drigas A,. Sideraki A. 2021 Emotional Intelligence in Autism , Technium Social Sciences Journal 26, 80, https://doi.org/10.47577/tssj.v26i1.5178 [129] Bamicha V, Drigas A, 2022 The Evolutionary Course of Theory of Mind - Factors that facilitate or inhibit its operation & the role of ICTs , Technium Social Sciences Journal 30, 138-158, DOI:10.47577/tssj.v30i1.6220 [130] Karyotaki M, Bakola L, Drigas A, Skianis C, 2022 Women’s Leadership via Digital Technology and Entrepreneurship in business and society , Technium Social Sciences Journal. 28(1), 246–252. https://doi.org/10.47577/tssj.v28i1.5907 [131] Mitsea E, Drigas A,, Skianis C, 2022 Breathing, Attention & Consciousness in Sync: The role of Breathing Training, Metacognition & Virtual Reality , Technium Social Sciences Journal 29, 79-97 https://doi.org/10.47577/tssj.v29i1.6145 [132] E Mitsea, A Drigas, C Skianis 2022 Metacognition in Autism Spectrum Disorder: Digital Technologies in Metacognitive Skills Training , Technium Social Sciences Journal, 153-173 [133] Chaidi, I. ., & Drigas, A. (2022). Social and Emotional Skills of children with ASD: Assessment with Emotional Comprehension Test (TEC) in a Greek context and the role of ICTs. , Technium Social Sciences Journal, 33(1), 146–163. https://doi.org/10.47577/tssj.v33i1.6857 [134] Kontostavlou, E. Z., & Drigas, A. (2021). How Metacognition Supports Giftedness in Leadership: A Review of Contemporary Literature. , International Journal of Advanced Corporate Learning (iJAC), 14(2), pp. 4–16. https://doi.org/10.3991/ijac.v14i2.23237 [135] Drigas A, Mitsea E, Skianis C, 2022 Intermittent Oxygen Fasting and Digital Technologies: from Antistress and Hormones Regulation to Wellbeing, Bliss and Higher Mental States , Technium BioChemMed journal 3 (2), 55-73 [136] Drigas A, Mitsea E 2021 Neuro-Linguistic Programming & VR via the 8 Pillars of Metacognition X 8 Layers of Consciousness X 8 Intelligences , Technium Social Sciences Journal 26(1), 159–176. https://doi.org/10.47577/tssj.v26i1.5273 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 105-125 125 [137] Drigas A, Papoutsi C, Skianis C, Being an Emotionally Intelligent Leader through the Nine-Layer Model of Emotional Intelligence-The Supporting Role of New Technologies, Sustainability MDPI 15 (10), 1-18 [138] Drigas A, Mitsea E 2022 Conscious Breathing: a Powerful Tool for Physical & Neuropsychological Regulation. The role of Mobile Apps , Technium Social Sciences Journal 28, 135-158. https://doi.org/10.47577/tssj.v28i1.5922 [139] Drigas A, Karyotaki M, Skianis C, 2017 Success: A 9 layered-based model of giftedness , International Journal of Recent Contributions from Engineering, Science & IT 5(4) 4-18, https://doi.org/10.3991/ijes.v5i4.7725 [140] Drigas A, Mitsea E, Skianis C 2021. The Role of Clinical Hypnosis and VR in Special Education , International Journal of Recent Contributions from Engineering Science & IT (IJES) 9(4), 4-17. [141] Drigas A, Bakola L, 2021 The 8x8 Layer Model Consciousness-Intelligence-Knowledge Pyramid, and the Platonic Perspectives , International Journal of Recent Contributions from Engineering, Science & IT (iJES) 9(2) 57-72, https://doi.org/10.3991/ijes.v9i2.22497