Therapist-Guided Forest Therapy in Adolescents: Operational Feasibility and Anxiety-Symptom Signals from a Two-Classroom Quasi-Experimental Pilot Study.

Adolescence is a sensitive period for anxiety symptoms, yet evidence on repeated forest therapy in secondary-school populations remains limited. This two-classroom quasi-experimental pilot examined operational delivery, acute affective responses, and follow-up anxiety-symptom signals after four therapist-guided forest therapy sessions in a coastal pine forest. Two intact, non-clinically selected classrooms were allocated without randomization. The principal all-classroom-assigned analysis included 26 intervention-classroom and 28 usual-activities control-classroom students aged 17-18 years. The sole principal outcome domain was the Spence Children's Anxiety Scale (SCAS) total raw score, measured at baseline and four follow-ups through 10-11 weeks; acute mood was assessed with the Profile of Mood States-Adolescents (POMS-A) before and after each session. Descriptively larger SCAS reductions occurred in the intervention classroom at every follow-up. The largest baseline-adjusted difference occurred 8-9 weeks post-intervention (coefficient = -5.14 points, 95% confidence interval [-10.25, -0.04]; two-sided