Design for Healing

By Vasiliki Meletaki, PhD, Mike Avery, MArch, MS, Freddie Moross, Louie Schwartzberg, and Anjan Chatterjee, MD 

Emerging research in neuroscience highlights increasing interest in the impact of space on human behavior — and how to better understand the impact of design on social and individual experiences. There is an opportunity for architects to harness this wealth of research to understand and service the needs and desires of diverse users. 

Research is often defined by a limited scope which is a challenge to translate meaningfully towards actualizable design strategies. Much of architectural research is focused on connecting research from other fields to an architectural design context. The following case study showcases one means to collect data led by disciplines outside of architecture to learn about human interaction within environments and how different user journeys shape experiences. In this case, an actualized construction demonstrates how the physical environment can influence stress and drug abuse recovery, an area of research that has been underserved.  

— Chang-Yeon Cho, RA, LEED AP, co-founder of Synthetic Studio, a data and intelligence consulting firm for the built environment. 

Alpas Wellness, located in Maryland, is a new behavioral health facility that offers residential treatment for the complicated combination of substance abuse disorder and mental health problems. Biophilia is the idea that humans have an innate connection to nature. Biophilic design attempts to incorporate elements from nature into the built environment. Biophilic principles inspired the interior design of the facility’s private and shared spaces. The authors collaborated with Alpas Wellness administrators on the design of two refresh rooms, one for healthcare staff and one for patients. Each element of the rooms was selected to create a sensory experience of tranquility in the midst of a stressful day at work or on a difficult journey to healing. The rooms aim for single-person occupancy to provide patients and staff privacy. There are plans to test the effectiveness of the space in reducing stress, providing a template for others hoping to create and assess healing environments. 

In the 1940s, Hans Hofmann said to Jackson Pollock, “You do not work from nature. This is no good, you will repeat yourself. You work by heart, not from nature.”  

Pollock famously replied, “I am nature.” 

The artist’s assertion underscores a connection between artistic expression and the natural world. This aligns with the biophilia hypothesis, which posits that humans have an innate affinity for nature. Pollock’s work, with its patterns, shapes, and fractals, exemplifies a merging of the artist’s creative instincts and organic forms. The term biophilia was coined by Erich Fromm (1964, 1992), popularized later by Edward O. Wilson (1984), and viewed as an evolutionary adaptation. The benefits of nature on physiological, emotional, and cognitive function is increasingly appreciated (Joye, 2007). Recently, biophilic ideas have become popular within the design industry which aims to incorporate nature and its salubrious effects in the built environment. However, little scientific evidence exists to support the beneficial claims, such as increases in productivity and enhanced learning. How does nature relate to interior design? And can design alleviate stress in a vulnerable population?  

THEORIES OF HUMAN/NATURE CONNECTION 

Attention Restoration Theory (Kaplan, 1995) suggests that exposure to natural environments, with elements such as greenery and water, replenishes cognitive resources and alleviates mental fatigue, enhancing people’s focus. However, the broad definition of “nature” in this theory complicates empirical research, making it difficult to categorize restorative environments with specificity. 

Stress Reduction Theory (Ulrich, 1993) posits that nature mitigates stress through its restorative impact. Natural settings evoke positive emotions, reduce physiological stress (heart rate and cortisol levels), and contribute to a sense of well-being. However, the complexity of psychological and physiological stress responses as related to differences in natural environments require further research. 

Prospect-Refuge Theory (Appleton, 1975) argues that humans are drawn to environments offering a balance of open spaces (prospect) and shelter (refuge) because they are evolutionarily beneficial and preferred aesthetically. Open interior spaces are experienced as more natural and beautiful, and are preferred over closed spaces. While modern urban environments complicate the application of this theory, the need for safety and comfort remains relevant. 

Fractal Fluency Theory (Appleton, 1975) focuses on the visual aesthetics of fractals. These complex geometric shapes exhibit similar patterns across different spatial scales found in nature, including in trees, clouds, ferns, and seashells. This theory suggests that mid-range fractals promote “effortless looking,” enhancing cognitive processes and aesthetic appreciation (Taylor, 2021). In its current conception, it is limited to visual aesthetics and does not address other sensory modalities. 

Human-centered design and architecture considers the aesthetic properties of the built environment. These approaches acknowledge the impact of natural elements within architectural structures on well-being, emphasizing the need for research at the intersection of neuroscience, psychology, and architecture (Chatterjee, Coburn & Weinberger, 2021). 

Our approach is framed by the aesthetic triad, a brain-based theoretical framework adapted for architecture (Coburn et al., 2017). This framework suggests that aesthetic experiences of the built environment are shaped by sensorimotor, knowledge-meaning, and emotion-valuation systems. The sensorimotor system refers to “bottom-up” sensory processing of the built environment, such as visual, tactile, auditory, olfactory, and vestibular properties. The knowledge-meaning system refers to “top-down” processing influenced by personal experiences, culture, and knowledge about the space. The emotion-valuation system refers to the emotions and feelings evoked by the space, and integrates information from the first two systems creating a holistic emotional experience.  

The exact features of the environment that drive aesthetic experiences remain under investigation. Research by Coburn et al. (2020) identified three dimensions — coherence, fascination and hominess — that explain almost 90 percent of the variance in aesthetic experiences. Coherence refers to the organization and legibility of a space. Fascination refers to the richness and complexity of a scene creating a desire to explore. Hominess refers to a feeling of warmth, coziness, and belonging. These dimensions influence how people move through spaces and vary by expertise and population, highlighting the importance of considering individual differences in design preferences. 

CASE STUDY: BIOPHILIC REFRESH ROOMS 

This case study focuses on a healthcare and mental health facility where design choices can impact physical and mental health. Healthcare construction is constrained by efficiency, cost, and regulations that often minimize the importance of aesthetics and forego designing for the emotional well-being of occupants. However, environmental factors such as natural light, and exposure to natural scenery and sounds might ameliorate the experience of pain, seasonal affective disorder, and depression. The built environment can also potentially harm the mental and physical health of occupants — for example, respiratory disease as a result of poor air quality, a feeling of helplessness because of lack of personal control, or stress from noise This amplifies the need for better research on the links between the built environment and mental health.  

Comfort, safety, attractiveness, size, privacy, and location are key design properties that medical health providers could focus on to improve the therapeutic effects.  

Light Exposure to natural light can reduce perceived pain and depressive symptoms. Sunlight increases levels of serotonin, a pain-inhibiting neurotransmitter.  

Our rooms feature wide windows with black-out curtains to control exposure to natural light, dimmable ceiling lights, and floor lamps to allow participants to control the lighting. We also installed light sensors to monitor participants’ preferred light patterns.  

Furniture The refresh rooms include different seating options, such as a three-person couch, a rocking chair, and a pouf ottoman with fractal patterns. Extra pillows and soft blankets are included to add vibrant colors and soft textures. These options cater to different comfort needs and preferences, enhancing the welcoming atmosphere of the space. 

Nature Living nature in indoor spaces can reduce stress. A recent academic review (Sal Moslehian et al., 2023) identifies natural indoor plants in healthcare facilities as an “efficient, low-cost, highly effective, and sustainable strategy for creating healing and therapeutic environments.” 

We installed custom-made vertical living gardens in both rooms, donated by Garden on the Wall LLC. We included several plants of different sizes with green leaves and smooth edges such as Zamioculcas zamiifolia (ZZ plant) and Philodendron.  

Audio-visual experience Viewing nature is linked with beneficial psychophysiological outcomes such as an increase in positive emotions, a decrease in negative emotions, less stress and pain, and reduced length of stay. Louie Schwartzberg created several videos showing natural landscapes and Freddie Moross created the soundscape using ambient and acoustic music without narration or lyrics. Participants can choose to watch these videos.  

Artwork Representational art is generally preferred over abstract art. Complex abstract art can produce frustration and confusion. We selected artwork for the rooms that is not emotionally challenging. Works include both representational paintings and craftwork with color patterns that fit the design of the space. The representational paintings focus on landscapes, natural elements, and the craftwork on texture and materiality.  

Olfaction Aromatherapy and essential oils have been popular for centuries as alternative therapy and relaxation aids. To create a multisensory experience congruent with the nature-inspired design and audio-visual material, we included reed diffusers with natural scents carefully selected to avoid potential triggers such as flower or spice smells that might resemble alcoholic cocktails or emotional memories of holiday gatherings (e.g., “Christmas smells”).  

ASSESSMENT 

We plan to collect psychological and physiological data from participants before, during, and after they use the refresh room. Before entering, participants will rate their levels of stress, and positive and negative emotions on a questionnaire. While in the room, participants will wear a biometric sensor (Emotibit) that will collect their heart rate, heart rate variability and skin conductance, which will be analyzed for changes in physiological arousal. After leaving, participants will rate again their levels of stress, and positive and negative emotions. They will rate the aesthetic properties of the room based on Coherence, Fascination, and Hominess, and report on how the room made them feel and why they used the room, and provide feedback or suggestions to improve the space. They will also rate the audio-visual materials. This psychological and physiological data will provide valuable information about the impact of the refresh rooms on the emotional and aesthetic experience of the participants.  

Architects and designers implicitly predict how the building will function, relate to the environment, and affect inhabitants. Meaningful collaboration between psychologists, neuroscientists and architects would ideally start early at the conceptual phase of design and then later at or after occupancy to evaluate prior predictions with the goal of improving future designs. Correcting prediction errors is a fundamental mechanism for how humans learn (Friston, 2018).  

For practical reasons, post-occupancy information might be difficult to obtain. Concerns about the privacy of residents, limited budgets, and even the undesirability of finding out that outcomes are not optimal are barriers to this kind of research.  

Our refresh rooms, including music and videos designed from scratch, are informed by psychology and neuroscience research in collaboration with experts in design, music, and cinematography. Our observational study “in the wild” is the first to our knowledge that includes a holistic measurement approach including physiological data while participants experience the biophilic refresh room.  

We will incorporate an iterative process for design. We plan to get feedback from participants on what they found useful and which elements were less optimal for their needs. We start with similarly designed rooms for staff and patients but based on feedback, we will be able to alter some elements of the spaces. We also plan to recreate the spaces in immersive virtual reality. Such digital spaces can accelerate our ability to explore changes we might consider to the spaces as we proceed. Future studies in VR could isolate the effects of individual design elements in the space in a way difficult to do in a real-world setting.  

For vulnerable populations such as people suffering from substance abuse and sensitive populations like healthcare employees, we wish to convey a sense of trust that might be beneficial to their self-esteem and desire for independence. A welcoming environment that can reduce stress also applies to staff. Nurses have high rates of burnout. A supportive physical environment can increase staff satisfaction, productivity, and effectiveness, and reduce the costs of staff turnover (Ulrich et al., 2008).  

Healthcare architecture and design have inspired recent interest in making spaces comforting and safe for workers and patients. Trending terms like “healing” architecture, “restorative” or “affective” design and related literature emphasize the need for human-centered design catering to physical and emotional healing. However, the enthusiasm for such design is not matched by scientific evidence for their benefits. Refresh rooms have the potential to alleviate physical and psychological distress. We aim to measure these benefits as we proceed. This template is a meaningful collaboration between neuroscience, psychology, and architecture, aided by contributions from design, audio, and video experts. 

ANJAN CHATTERJEE, Professor of Neurology, Psychology, and Architecture, is founding director of the Penn Center for Neuroaesthetics, author of The Aesthetic Brain, and co-editor of several volumes on neuroscience and art. He is recipient of the Leadership in Innovation Award from the Global Wellness Institute and served as president of the International Association of Empirical Aesthetics and the Cognitive Neurology Society. 

VASILIKI MELETAKI is a postdoctoral research fellow at the Penn Center for Neuroaesthetics, investigating the role of art and design in wellness and emotion regulation. Before joining the PCfN, she worked at the Laboratory of Cognitive Neurosciences of CNRS in Marseille. 

Mike Avery teaches at the University of Pennsylvania, offering seminars covering design processes, fabrication, architecture, and health. He also consults in the fields of healthcare quality improvement, medical device design, and architecture, while prioritizing a human-centered and collaborative design philosophy. 

LOUIE SCHWARTZBERG is an award-winning cinematographer and director who uses time-lapse and macro techniques to reveal nature’s beauty and wisdom. His films include Fantastic Fungi, Mysteries of the Unseen World, and Wings of Life. His Visual Healing program transforms spaces with immersive nature films, benefiting health and well-being. 

FREDDIE MOROSS founded Myndstream with a mission to unlock the transformative power of music for enhanced well-being. Awarded the 2022 Debra Simon Award for his innovative approach to wellness, Moross now pioneers a new era of audio in spa and hospitality, crafting guest experiences that enhance well-being and foster a deeper emotional connection between a brand and its clientele. 

REFERENCES  

Appleton, J. (1975). The experience of landscape. London, New York: Wiley 

Chatterjee, A., Coburn, A., & Weinberger, A. (2021). The neuroaesthetics of architectural spaces. Cognitive processing, 22(Suppl 1), 115-120. https://doi.org/10.1007/s10339-021-01043-4 

Coburn, A., Vartanian, O., & Chatterjee, A. (2017). Buildings, beauty, and the brain: A neuroscience of architectural experience. Journal of Cognitive Neuroscience, 29(9), 1521–1531. https://doi.org/10.1162/jocn_a_01146 

Coburn, A., Vartanian, O., Kenett, Y. N., Nadal, M., Hartung, F., Hayn-Leichsenring, G., … Chatterjee, A. (2020). Psychological and neural responses to architectural interiors. Cortex, 126, 217–241. https://doi.org/10.1016/j.cortex.2020.01.009 

Friston, K. (2018). Does predictive coding have a future? Nature Neuroscience, 21(8), 1019–1021. https://doi.org/10.1038/s41593-018-0200-7 

Fromm, E. (1992). The anatomy of human destructiveness. Macmillan Fromm, Erich (1964). The Heart of Man. Harper & Row. 

Joye, Y. (2007). Architectural Lessons From Environmental Psychology: The Case of Biophilic Architecture. Review of General Psychology, 11(4), 305–328. https://doi.org/10.1037/1089-2680.11.4.305 

Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15(3), 169–182. https://doi.org/10.1016/0272-4944(95)90001-2 

Sal Moslehian, A., Roös, P. B., Gaekwad, J. S., & Van Galen, L. (2023). Potential risks and beneficial impacts of using indoor plants in the biophilic design of healthcare facilities: A scoping review. In Building and Environment (Vol. 233, Issue February). https://doi.org/10.1016/j.buildenv.2023.110057 

Taylor, R. P. (2021). The potential of biophilic fractal designs to promote health and performance: A review of experiments and applications. Sustainability (Switzerland), 13(2), 1–22. https://doi.org/10.3390/su13020823 

Ulrich, R. D. (1984). View through a window may influence recovery from surgery. Science, 224, 42–421 

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H. B., Choi, Y. S., … Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. HERD. https://doi.org/10.1177/193758670800100306  

Wilson, E. O. (1984). Biophilia. Cambridge: Harvard University Press.  

Captions: 

The interior of the interior of Penn Center for Neuroaesthetics Refresh Room at Alpas Wellness, a behavioral health facility in Maryland Photo: Vasiliki Meletaki 

The authors collaborated on the Refresh Rooms for residents and staff. Now it’s time to study and test the impact Photo: Vasiliki Meletaki