Supervisors:
Sabine Müller, Karin Helms
Introduction
This thesis has as a starting point Russia’s full-scale invasion of Ukraine in 2022, with an unforeseeable ending date. It is certain that the consequences are going to be multiple: on a physical, psychological, social, environmental, and economic level. One can already see these impacts happening (Fornaro et al. 2025), (Kalaitzaki 2023), (Hryhorczuk et al. 2024), (Kurapov et al. 2023), (UNITED24 Media 2025), (Rządeczka 2024).
The survivors of a long-term conflict like this need and will need societal rehabilitation. Zooming in on the city of Lviv, situated in western Ukraine, is strategic. With Lviv considered to be a safer place, away from the borders with Russia, over 150,000 citizens had already fled there (“Lviv, the City Became the Backbone of Ukraine’s Resistance,” n.d.). That makes it a more densely populated city with much that needs to be done to accommodate this increasing number of internally displaced people, and has already led to initiatives related to healing and community integration, including healing gardens (The Village Україна 2024), (Onufriv and Lukashchuk 2025).
An ever-increasing number of internally displaced people flee to Lviv to be and feel safe (Lviv Now 2023). They need to heal (Landoni 2023), (Pavlova 2024), and feel part of the city. Additionally, a sizeable proportion of those people are veterans, traumatized physically and/or mentally and often diagnosed with Post-Traumatic Stress Disorder (PTSD).
This thesis explores how nature can support veterans’ healing journeys by integrating therapeutic forest experiences into their everyday lives through trails in and near the city of Lviv. There are projects that address healing nature, but most focus on gardens and highly curated settings that can feel like formal therapy, which is not always beneficial. By contrast, when contact with nature becomes a more everyday ritual through ordinary walks, rather than framed as a treatment session, it may offer more accessible, sustainable and long-term benefits (“Outdoor Activities Improve Mental Health in Veterans, Study Finds,” n.d.). It is also important to state that because of stigma associated with mental health, many of those people struggling to cope are not seeking help. However, even propositions to design those trails and curate healing experiences is a way to combat that stigma (“Breaking Stigmas: Nature’s Potential for PTSD, Suicide, and Veterans in the US - Forest Therapy Hub,” n.d.), (Shorer et al. 2023).
This project contributes to the field of Landscape Architecture by using evidence-based health design in landscape architecture (EBHDL) combined with nature-based therapy (NBT) in war-related situations, demonstrating how narrative exploration and atmosphere can coexist with spatial strategy and a research-through-design (RtD) approach. It also presents a methodology for how to conduct a project remotely, using digital tools and personal experiences, before grounding it to the site through community engagement. It relies on using locals’ knowledge, experience and needs, as they would be the future users. This method could have beneficial applications even in non-remote (on-site) projects.
The main research question that forms the basis for this project is how forest trails can be designed to support veterans with Post-Traumatic Stress Disorder (PTSD), using insights from nature-based therapies and lived experiences in Oslo and Lviv. More precisely, it focuses on what is known historically and currently about the healing effects of nature and nature-based interventions, what PTSD is and what is specific about PTSD in veterans, how veterans can benefit from nature, and what types of nature-based programs already exist for them.
This thesis responds to the gap in research and practice of Landscape Architecture, especially on everyday healing attained through walks in nature and not structured therapy programs, in Eastern European post-war cities like Lviv, and on the integration and healing of veterans. Additionally, it adds a level of understanding of how landscape architects can co-design projects with input from future/potential users acquired by closely engaging with their needs, while responding to current calls to connect nature-based interventions (NBI) with real communities.
Working through the author’s own mental health experiences and perspectives from walks near the city of Oslo, combined with the literature review, a research-through-design approach, spatial diagrams interpreting current research, a mapping of Lviv, and a hypothetical community engagement event with the future users in Lviv are elements of the main method of work for this thesis. The ultimate aim is to create a toolkit for designing everyday nature-based interventions for veterans with PTSD.
Methodology
When this project started, the main challenge was that the site was located in an active warzone (even though Lviv is considered safer, it still was not easily accessible), combined with the fact that I had never visited Ukraine or Lviv. Over time, these constraints became an opportunity to develop a creative methodological approach, turning distance from the site into a central feature of both process and results. At the same time, the literature revealed several gaps which required finding alternative ways to connect theory, site and users.
To address this, the project drew on personal reflections and observations as a starting point. An initial solitary walk in a forest near Oslo was used to record experiential notes and musings, which were later related to existing research on nature and mental health healing effects. A second visit to the same forest focused on taking intentional photographs of paths and spatial situations, and a third walk in a different forest and different weather conditions explored how changing atmospheres influenced the perceived healing effect. These walks led to the development of chapter 2, where personal photographs are paired with narrative descriptions and scientific terms for the spatial situations they depict.
In chapter 3, this perspective is mirrored by searching for similar situations in publicly available Google photo postings and maps of Lviv. Places that resembled the observed forest situations were identified as potential waypoints for proposed trails in and around the city, starting at the Unbroken rehabilitation center and symbolically ending at the Rozsadnyk (=nursery) community garden. A hypothetical community engagement event with future users in Lviv is proposed as a way to validate or adjust these routes and to identify additional locations with comparable spatial qualities.
Together, these steps form the backbone of a research through design approach. In parallel, conversations with environmental psychologists, researchers working with nature based interventions and people from Ukraine provided further perspectives and contextual knowledge that could not be accessed through internet research alone.
Background Research
History of the term “therapeutic landscape”
The term “therapeutic landscape” was first introduced by health geographer Wilbert Gesler in 1992 to describe how certain environments foster healing and well-being. Since then, the idea has expanded as researchers have examined the material, emotional, and socio-cultural dimensions that shape health experiences in specific places. More recent work highlights how therapeutic landscapes are not static but evolve in response to contemporary social tensions and shifting cultural values, particularly as spaces of retreat and healing diverge from everyday sociability. Scholars have also emphasized the importance of cultural traditions and place-based values in sustaining physical, emotional, mental, and spiritual health. Therapeutic landscapes remain a valuable lens within health geography and landscape architecture, contributing to wider interdisciplinary debates about healthy spaces, cultural practices, and the design of environments that support well-being (Bell et al. 2018), (Marques 2021).
Using nature as a therapeutic medium is not a recent mode for recovery. It is both an ancient and a modern concept (Pouya and Demirel 2015). Restorative or healing gardens were part of healing diseases since medieval times. Throughout history, humans have always used nature as part of their dwellings. Later, nature became part of hospitals, hospices, rehabilitation centers, and nursing homes (Gerlach-Spriggs et al. 2004). During the early 20th century, this relationship between humans and nature was lost due to advanced medical technology and science. In the late 20th century, though, designers and medical staff became interested again in order to create new types of facilities that are cost-effective (Marcus and Barnes 1999).
Effects of nature on health and well-being
Based on the biophilia hypothesis, formulated by Edward O. Wilson in 1984, humans show an inherent preference for natural environments and are healthier when around nature (Understanding the Biophilia Hypothesis - TerraMai 2018), (Salingaros 2015). There is a biological connection with nature at a physical, spiritual, and social level, leading to a positive influence on well-being, productivity, and social relations when a person is surrounded by natural elements (Göker 2020).
Based on research from various fields, just being in nature can affect health in a positive way; thus, a place that can immerse users in an enhanced experience of nature is a place for healing (Winterbottom and Wagenfeld 2015).
First of all, there are the physical benefits that contact with the natural environment can offer, such as boosting the immune system, fostering relaxation and decreasing stress. Additionally, it has been shown that spending time in nature can lower blood pressure, heart rate, and cortisol and cholesterol levels as tested in saliva (Qiu et al. 2022). Research also suggests that the impact of forest-based interventions on various aspects of mental health (stress, anxiety, depression, negative emotions, quality of life/well-being) is significant (Stier-Jarmer et al. 2021), (Keeler, n.d.).
It has been proven by R. Ulrich in 1984 and, through his stress recovery theory, that nature’s role significantly aids in recovery from surgery, among other circumstances that may require hospitalization, especially for patients experiencing stress or anxiety (Ulrich et al. 1991). Regarding hospital gardens specifically, he concluded that they provide some sense of control and access to privacy, social support, physical movement and exercise, and various positive distractions (Ulrich 2024). It must be noted that although research has shown and continues to indicate that nature is beneficial to health, the exact reason behind that is yet unknown (Winterbottom and Wagenfeld 2015).
In the Japanese philosophy called Shinrin Yoku, or Forest Bathing, being surrounded by nature means much more than just a walk in the forest. It engages all senses (sight, hearing, taste, smell, and touch), allowing people to fully immerse themselves in nature. Studies have shown that this also has a large impact on health, leading to the conclusion that forest bathing can actually become forest medicine (Peterfalvi et al. 2021).
Not having to go on a long journey to visit a forest can be even more beneficial. Hence, using Lviv’s forests and parks in and around the city is expected to be an added factor for recovery by more conveniently incorporating forest walks into everyday life.
Understanding PTSD
In order to understand Post-Traumatic Stress Disorder (PTSD) and how it differs in veterans, first we need to clarify the term, although it is important to state that treatment of PTSD first focused on combat veterans (Shea 2002).
PTSD is a very heterogeneous disorder, as it can affect every individual in a different way and to a different extent, depending on previous traumatic experiences, individual level of pathology, personality attributes, and socio-demographic characteristics. Those can either protect a veteran or cause a more severe form of PTSD. It was not until 1980 that PTSD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which greatly contributed to theory, research, and treatment of the psychological consequences of trauma (Shea 2002).
Symptoms can occur after a major traumatic event such as a rape, accident, war, etc. These are events that involve actual, perceived, or threatened death, or serious injury, or a threat to the physical integrity of oneself or others (Sunil J . Wimalawansa 2013). It is a complex, disabling disorder, associated with hippocampal impairment in cognitive flexibility, where one re-experiences the traumatic event, relives the past, and disassociates from the present. Hence, the sufferer avoids reminders of the trauma, and presents a pattern of increased arousal, where hypervigilance, irritability, memory, difficulty concentrating, sleep disturbances, and an exaggerated startle response are present and are the main indications for a PTSD diagnosis.
PTSD involves a psychological, psychiatric, biological, and neuroanatomical interrelationship, which needs to be taken into consideration in order to treat it, since it is very common for people with PTSD to develop alcoholism, depression, drug abuse, and suicidal tendencies, among other consequences (van der Kolk 2000), (Winterbottom and Wagenfeld 2015). Nevertheless, it is not easily diagnosed and is more often than not misdiagnosed, leading to recurrences that can be harmful for both the patient and the patient’s environment (Sunil J . Wimalawansa 2013).
The first stage occurs as a traumatic shock, meaning that one needs to process what has happened to them, whether they were victims or witnesses. This stage comes in the form of fear, anxiety, confusion, or disbelief, leading to a loss of a sense of calm and safety. The second stage, or denial or numbing stage, leads to a defensive mechanism to avoid thoughts and emotions. Stage three is the intrusive or repetition stage, where memories are very intense, invading one’s thoughts and dreams, distressing both the body and the mind. Reliving the traumatic experience comes in flashbacks and triggers moments in their everyday life, feeling that they cannot get out of this loop of thought. During the fourth stage, the transition or integration stage, one starts to extinguish reality from past traumatic stressors, something that makes them accept it and continue towards healing it, instead of denying it. But that does not mean that their body does not react to that transition. The fifth and final stage – the recovery or post-traumatic growth stage – has to do with their sense of control. Naturally, the healing process of PTSD does not take place in a linear progression and it depends on the individual’s symptoms, among other factors (“The Five Stages of PTSD,” n.d.).
PTSD in veterans
As previously mentioned, the probability of PTSD appearing increases after a traumatic event. It is logical to assume that during war, those traumatic events are very common, leading to battle trauma (shell shock), combat deployment, training accidents, and military sexual trauma (MST). Research shows that 7 out of 100 veterans will develop PTSD at some point in their life and it is even more common among female veterans, with 13 out of 100 versus 6 out of 100, whilst there is no research on other genders (“How Common Is PTSD in Veterans? - PTSD: National Center for PTSD,” n.d.). It is important to note that these numbers are obtained from U.S. surveys and there are no results from the war in Ukraine, as of the date of this paper.
That being said, if left untreated, trauma can cause epigenetic alterations that will affect future generations due to chemical marks on genomes (Mental Health in Ukraine 2023), but also lead to alcohol and drug abuse, which is very common amongst veterans and people with PTSD, along with the other symptoms which can affect everyone around them (“Post-Traumatic Stress Disorder (PTSD) and War-Related Stress | Veterans Affairs Canada,” n.d.).
While PTSD in veterans shares some similarities with PTSD in civilians (re-experiencing of the traumatic event, avoidance of situations, negative mood and beliefs, being hyperaroused or hypervigilant), there are some distinct differences that are important when one is designing for this target group. For example, the triggers are mainly related to combat scenes and military settings, but also on the loss of fellow service members. They may feel the need to always be on guard by facing the door, constantly scanning for threats, and overreacting to loud noises (Chambliss et al. 2024). Some of the many other symptoms include disturbing thoughts and feelings, dreams about the traumatic events, mental or physical distress, sleeping difficulties, changes in a person’s thoughts and feelings. (“PTSD Support & Resources for Veterans | WWP,” n.d.)
An additional, everyday battle that is common amongst veterans and internally displaced persons (IDPs) is the fact that both groups show high levels of depression, isolation, anxiety, relational conflict, and intrusive memories. Both groups struggle with social adaptation and the feeling of isolation, of being misunderstood by the community and disconnected from civilian life (Singh et al. 2021).
The process of healing is not linear, but the important point is for veterans to forgive themselves, practice self-compassion, and regain a sense of control (Dahm et al. 2015), (Smith et al. 2018). Emotional helplessness and physical paralysis need to be counteracted with new experiences that promote safety, anxiety management, and emotional processing, to focus not only in reducing symptoms, but also curing PTSD (van der Kolk 2000).
Healing PTSD through nature
As outlined above, treating PTSD requires addressing both hyperarousal and dissociation, and supporting the person in “being in the moment.” Nature is particularly suited to this, as it offers multisensory, low-threat stimuli that invites gentle engagement of all senses (wind in the trees, birdsong, the smell of soil, changing light). Such sensory regulation can support parasympathetic activation, reducing the likelihood of flashbacks and helping trauma survivors anchor attention in present-moment experience (Shirazi et al. 2024).
An important part of healing is creating new, positive memories that directly contradict earlier experiences of helplessness and paralysis. Even though forests may appear chaotic, they can be beneficial when they offer a clear sense of safety and visible escape routes, along with giving users the power to choose different paths and durations. In terms of design, trails should provide both prospect and refuge, as this balances how people with PTSD experience and trust the environment (Contractor et al. 2023), (Claims 2024).
When walking or hiking is framed as a hospital-based therapy, it can feel deterrent or overly clinical, yet as an everyday activity it is highly accessible and can be adapted to an individual’s pace, distance and needs. Rhythmic, bilateral movement during walking has been compared to EMDR-like methods, supporting the processing of traumatic material while remaining grounded in the present. In low-stimulation natural settings with few manmade distractions, this movement can be combined with quiet time for reflection, gradually making it less frightening to be alone with one’s thoughts; such calm, everyday walks can therefore play an important role on the “ladder” of healing (Change 2025). When those walks are specifically designed for people affected by trauma, they can restore safety, dignity, and make sufferers feel connected (Musharbesh 2025).
Nature inherently carries symbolisms that can be read in parallel with a veteran’s healing journey, and noticing these parallels can itself be therapeutic. Cycles of growth and decay, seasonal change, shifting light and water all suggest that disturbance and loss are followed by renewal, helping veterans imagine the possibility of life after trauma (Havlick et al. 2021).
Together, these mechanisms suggest why carefully designed everyday forest trails may function as salutogenic environments for veterans with PTSD, beyond formal therapy settings (Golembiewski 2022).
Nature-based interventions for veterans with PTSD
Incorporating nature into veterans’ everyday lives through forest trails around the hospital can reduce the stigma around mental health difficulties. Instead of feeling like they are formally “asking for help,” they can simply go for a walk in a nearby forest as part of their therapeutic and regular routine. Many veterans describe nature as a place where they feel more relaxed, partly because there are fewer expectations placed on them than in clinical settings (Poulsen et al. 2016), (“Breaking Stigmas: Nature’s Potential for PTSD, Suicide, and Veterans in the US - Forest Therapy Hub,” n.d.).
Being surrounded by nature, with few man made elements, can reduce hypervigilance, which is a core PTSD symptom for many veterans. Even though some have combat experience in similar terrains, forests are not usually a primary trigger, and many report that their “alarm system” is quieter there, giving them time to reflect. There are reports that setting a goal to visit nature gives meaning and in some cases can even prevent suicidal thoughts caused by a loss of meaning in life (Ellekrog, n.d.), (Ross and Gladfelter 2021).
Walking along a forest trail can support solitary grounding, but it is also about creating new, positive memories, especially for veterans who have been away from relatives for long periods. Some may also find it helpful to walk with others facing similar challenges, which can reduce feelings of isolation in their healing journey.
Path design
Creating a safe and therapeutic environment is about finding the correct balance between mystery and legibility, coherence and complexity and was put forward as Attention Restoration Theory (ART) by Rachel and Stephen Kaplan in 1989. It still is one of the most important theories in environmental psychology that was specifically formed for people’s recovery from mental fatigue by using nature. Environments largely shaped by nature often are more effective in evoking restorative experiences, offering the possibility to escape from the source of stress (being away), to be distracted (soft fascination), to be immersed in (extent), and to draw our interest (compatibility) (Winterbottom and Wagenfeld 2015), (Cameron 2023).
Going more in depth with the principles of ART, one needs to understand each parameter and the benefits each can offer to trauma therapy in order to translate them into design. Coherence and legibility are linked to understanding. Space is immediately perceived as it is. Elements form organized and recognizable patterns, while maintaining a good sense of orientation, while clear pathways and wayfinding create a spatial situation that is easy to interpret and feel at peace in. Complexity and mystery are connected to exploration, but a good number of hints of the unknown and what remains out of sight remain. A curve in a path, where the ending is not visible, can draw attention towards what is there and what new spatial information might appear, creating a new unknown scene, pulling a person to explore it and engage with it. Coherence and complexity are about the “here, now”, while legibility and mystery are about the “there, then” (Kaplan and Kaplan 1989).
Linking this back to PTSD, there is a significant conclusion for path design for veterans. There is a very thin line in balancing these principles; a path may invite mystery but must be complemented by paths that prioritize legibility; exploring the wilderness of nature, while having a clear wayfinding plan, being able to see the open sky, not feeling entrapped at any moment. Walking along a clear, straight trail that at some point becomes more meandering, observing repetitive textures while also noticing details and differences, or even walking from a dense forest to a sudden clearing with different light and spatial conditions, ideally balance and combine all four principles and promote healing.
Based on personal reflections and background research on therapeutic landscapes, PTSD, veterans, and nature based interventions, some design principles for healing walks and trails can be outlined. These principles provide the framework for later design decisions.
- Safety and exit routes: Paths avoid dead ends and blind corners and offer visible options to end the walk at the chosen moment, which is very important for people with PTSD.
- Legibility and power of choice: Clear wayfinding and alternative route lengths allow users to orient themselves and choose how far and how long they want to walk, depending on the day and their healing stage.
- Sensory anchors: The presence of water elements, light conditions and seasonal changes provides fascination without demanding extra effort.
- Prospect and refuge: Combinations of forest clearings and more enclosed spots support both visual oversight and moments of privacy.
- Everyday integration and low stigma: Trials are integrated into urban and peri urban landscapes so that participation does not mark users as “patients”, reducing feelings of stigma and potentially increasing use.
- Reflection and new memories: Spaces that invite pauses, encouraging activities, and enabling the creation of new, positive associations with the city and with nature, and perhaps with other people and one’s own thoughts.
- Symbolism: Seasonal change, growth and walking from darker to lighter spots can be used as symbolic resources related to recovery and continuity of life after trauma.
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Contact
Dimitra Peppa / dipeppa@outlook.com / +47 930 55 905 / LinkedIn / Website