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Nature Therapy

Anna I. Guerdjikova, PhD, LISW, CCRC

Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

Currently over 50% of the world’s population is living in urban areas with limited opportunity to engage with nature. In North America most adults spend ∼90% of their time indoors. Ecotherapy, also known as nature therapy or green therapy, is the applied practice of the rapidly evolving field of ecopsychology, a term coined by Theodore Roszak in 1992. Ecotherapy builds on the biophilia hypothesis proposed by E. O. Wilson which suggests that human beings are genetically hardwired to “affiliate with other forms of life”. He proposed that the connection humans seek and have with other life forms and nature is deeply rooted in our biology. If prevented from sufficient contact with nature, we are at risk for developing a “nature-deficit disorder” which can lead to negative consequences for our mental and physical health.

It is established through research from all over the world that people with good access to natural environments are more likely to experience wellness. For example, green space has been associated with improvements in cognitive functioning and self-esteem and reductions of depression, stress and anxiety. Blue spaces, defined as environments predominately consisting of water, lower levels of anxiety and mood lability, and are positively associated with self-reported mental and general health. Physical activities in natural settings are associated with less anger, fatigue, and sadness and might reduce the blood flow to the part of the brain responsible for despondency. Mere exposure to nature can be healing, it has been consistently shown that simply looking at environments dominated by greenery or water is significantly more effective in promoting recovery and restoration as compared to milieus lacking nature.

Nature based interventions (NBIs ) include programs and activities engaging people in nature-based experiences to enhance general health through promotion of wellness and prevention of illness. NBIs include interventions that alter the environments where people live and interventions designed to change individual’s behavior (such as promoting walks outside or gardening).

Prescription: A Dose of Nature

Some examples of NBIs as listed below. Of note, nature based interventions can be a helpful adjunct in the treatment of mental illness along with pharmacotherapy and psychotherapy.

  • Physical exercise outdoors: walking, jogging, biking, doing yoga or other exercises in a park fosters increased awareness of the natural world and can be recommended for reducing stress, anxiety, depression, and anger. Walk-and-talk therapy is a gaining popularity treatment model, encouraging patients to be more physically active for mental and physical reasons and helping them move forward, literally and metaphorically speaking, when facing challenging problems
  • Nature meditation: using nature as focus point and incorporating it in meditation and mindfulness experiences. Forest bathing, for example, is a well stablished practice in Japan since the 1980s. It requires that one just sits in the presence of trees, without engaging in any physical activity. It has been shown that in the week after the forest visit, the activity of human natural killer cells (implicated in cancer prevention and immunity) increases and those positive effects can last up to a month following each weekend in the woods. Furthermore, forest environments might help decrease contisol, pulse rate, and blood pressure as compared to city environments.1
  • Horticultural therapy: Various forms of gardening and landscaping are known to improve community connectedness, create a sense of purpose and can promote better eating habits.
  • Animal-assisted therapy: Extensive data supports the use of this complementary type of therapy, with canine and equine-assisted therapy being the most well researched, to improve the social, emotional, or cognitive functioning in various settings  (mental health centers, nursing homes, schools and prisons) and across diagnoses (dementia, ADHD, PTSD and autism to name a few).2
  • Indoor nature exposure- enriching indoor work and living spaces with nature elements (plotted plants, pictures and photos with view of nature, window view of grass or woods etc.) are known to improve attention, moods and productivity and  to reduce stress and heart rate. In one study, for example, sunlight and/or a nature view increased job satisfaction, reduced intention to quit and lowered feelings of being  worn out uptight.3

A study published in the summer of 2019 examined a representative sample of over 20000 people in England and concluded that a “two-hour “dose” of nature a week significantly boosts health, and life satisfaction”, including among those with long-term illness and disabilities.4  If spending only twenty minutes per day in natural environments can make a difference, it is certainly worth giving it  a try.

References :

  1. Environ Health Prev Med. 2010 Jan;15(1):18-26. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y.
  2. Complement Ther Med. 2018 Dec;41:203-207.”We need them as much as they need us”: A systematic review of the qualitative evidence for possible mechanisms of effectiveness of animal-assisted intervention (AAI).Shen RZZ, Xiong P, Chou UI, Hall BJ.
  3. Health Promot Int. 2015 Mar;30(1):126-39  Indoor nature exposure (INE): a health-promotion framework. Mcsweeney J, Rainham D2, Johnson SA, Sherry SB, Singleton J.
  4. Sci Rep. 2019 Jun 13;9(1):7730.Spending at least 120 minutes a week in nature is associated with good health and wellbeing. White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, Fleming LE.