Nature Therapy

Original Editor - Charles Senay

Top Contributors - Stacy Schiurring, Charles Senay and Kim Jackson  

Introduction

Nature Therapy (also known as nature-based interventions, ecotherapy, green therapy, and forest therapy) is an overarching term to describe the use of nature or natural elements to improve mental and /or physical health. According to the International Nature and Forest Therapy Alliance (INFTA), forest therapy is "an evidence-based public health practice. Guided Forest Therapy walks combine a specific blend of complementary physical and mental exercises in suitable forest surroundings leading to a lower heart beat, blood pressure and stress levels while, at the same time, the immune system, breathing and the overall physical and mental fitness and agility are strengthened."

Being in nature has beneficial effects on our health. This has been commonly known for centuries and is the cornerstone for many "traditional" or "folk" medicine practices. However, the healing power and beneficial effects of nature have become the focus of scientific research within the last few decades. Following a global movement towards cities that disconnects us from nature, isolation following the COVID-19 pandemic, and the ever-present climate crisis may explain the novelty of this emerging focus in research.

Nature Therapy

Nature therapy is led by certified Nature Therapists (also known as Forest Therapy Guides) or other qualified healthcare practitioners. Simply put, nature therapy is about mindfully connecting patients with the outdoors to promote mental and/or physical health. It can be performed individually or in a group situation.

Nature Therapy versus Being in Nature

According to the United States Environmental Protection Agency (EPA), Americans spend up to 90% of their time indoors. EPA research has found that the quantity of certain air pollutants can be 2 to 5 times more concentrated in indoor environments than outdoors.

Ill health effects associated with indoor air pollutants include:

• Irritation of the eyes, nose, and throat
• Headaches, dizziness, and fatigue
• Respiratory diseases, heart disease, and cancer

In 2007, the research group "Forest Medicine Study Group" was formally established in Japan. The group has since led research on the physiological and psychological effects of forests on human health. A 2021 systematic review found that just being in nature had a positive association with mental health. This included improvements in affect, cognition, well-being, and decreased negative symptoms of anxiety and depression.A 2019 systematic review and meta-analysis found exercise performed outdoors was perceived to offer greater physical benefit than exercise performed indoors.

While there are no doubt that being out and spending time in nature is beneficial to a person's overall well-being, taking part in nature therapy is more formal than simply being outdoors. Like any therapeutic intervention, nature therapy is structured with planned interventions working toward achieving specific and individualised goals. Medical doctors and mental health therapists are using nature therapy as a therapeutic tool, or prescribing it to their patients to complement treatments.

Common Forms of Nature Therapy

• Adventure therapy. Examples include rafting and rock climbing

• Animal-assisted interventions. This technique can involve spending time with animals at a farm or ranch setting, or with pets indoors or outdoors. Equine or hippotherapy can be included in this category.
• Arts and crafts. This can include creating art inspired by nature, such as painting a beautiful vista; the use of natural materials, like clay or wood; or creating in a natural space.
• Dark nature. Examples include stargazing.
• Green exercise. Performing physical exercise in a green space, such as running/ walking, bicycle or horseback riding.
• Landscape. The selection of location for nature therapy can play an important role in the therapy. A therapeutic landscape should feel like a "healing place" and be an actor in the intervention it self.
• Nature-based meditation.
• Shinrin-yoku. This translates to forest bathing or "immersing oneself in nature using one’s senses." A 2020 systematic review and meta-analysis found that utilising shinrin-yoku while performing walking, yoga or mindful breathing was effective in reducing mental health symptoms, especially anxiety; and influence cortisol levels to decrease stress levels.
• Smellscape. Integrating the use of natural smells, commonly plant scents, into therapeutic interventions has been found to aid in stress reduction and mental recovery. The use of essential oils has been shown to have a direct beneficial effect on the mood and stress response of hospital workers.
• Soundscape. Sound can have a strong effect on a patient's experience in nature. A study by Cerwén et al compared patient's responses to sounds of nature, technology, and human. Nature sounds were unanimously considered a positive element, while technology sounds a negative element, human sounds had mixed results depending on the patient mood and treatment phase.
• Therapeutic gardening or horticulture. This technique usually involves gardening or farming, but can also include caring for or spending time with indoor plants.
• Wilderness therapy. This includes camping, hiking or building shelters. This form works well in group situations.

Patients who are unable to participate in outdoor activities can still benefit from modified versions of nature therapy indoors.

• Nature is can be brought indoors via virtual reality. Recent studies show positive results which indicate the potential of virtual reality as an adjunct tool to nature therapy.
• Patients can easily create healing space inside their homes using evidence-based design and healing principles.
  

Special topic: creating a healing space inside your home.

Your home and typical surroundings can have a large impact on your sense of well-being. For those with the ability to change and modify their home environment, making small simple changes can have a significant impact on mental and physical health.

1. Bring nature into your home. This can include adding flowers or houseplants to your home, opening windows, utilising natural light, or adding artwork of natural spaces.
2. Decorate with intention. This involves displaying objects that have special and personal meaning such a family photographs, religious symbols, or meaningful artwork created by loved ones or yourself. This can also include arranging furniture in a way that encourages interaction or relaxation. Having a quiet place for reflection is also recommended.
3. Simplify. This can include removing unwanted or unneeded things from your home, cleaning and decluttering. Arrange and use your spaces in a way that best suits your needs and reduces stress.
4. Use colour theory. Research supports colour and emotional response, use colour to encourage certain feelings in your space. For example: red often brings about feelings of surprise, energy/stimulation, and powerfulness; green is associated with calmness, peacefulness, hopefulness, relaxation, and comfort; blue with calmness, peacefulness, harmony, and serenity.
5. Support sleep. Create a dark, clutter-free sleep space, eliminate or limit use of screens around bedtime, keep the area cool when sleeping, use of a weighted blanket and soft comfortable bedding can aid in relaxation and rest.

Please view the following short optional videos for more information on forest therapy and Shinrin-yoku.

Benefits of Nature Therapy

• Nature therapy has been shown to reduce overall blood pressure, and lower the heart rate, while activating the parasympathetic nervous system and reducing the sympathetic nervous system.
• Nature therapy can benefit the immune system by acting on the autonomous nervous system. The immune response is at its best when the body is relaxed and resting, any practice that may reduce stress and facilitate relaxation is beneficial for the immune system. Furthermore, certain chemical compounds present in the forest air would have a direct effect on the immune system.
• Phytoncides, oils that trees emit to protect themselves from pathogens and parasites, have been shown to have a direct effect on the activity of natural killer (NK) cells in the body. NK cells are responsible for identifying and destroying potentially harmful organisms that enter the bloodstream. Higher activity of those cells means increase immune defense.
• Exposure to nature or images of nature can provide subjective pain reduction.
• Nature therapy has been shown to reduce depression and anxiety, as well as affecting on the mood..
• Spending time in nature has been shown to diminish the cortisol levels in the body and therefore reduce physiological stress.
• Exercising in nature can help ease the symptoms of post-traumatic stress disorder (PTSD).
• Participating in nature therapy has been found to improve overall quality of life and well-being.
• Exercising in nature and regular exposure to a natural landscape can improve the symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children.

Risks of Nature Therapy

• Insect bites
• Snake or animal bites
• Contact with poisonous plants
• Sunburn
• Falls or other bodily injury
• Seasonal allergies
• Exacerbate discomfort or fear of being outside or in wide open spaces
• Not recommended for patients who have had a traumatic experience in the suggested natural environment
• Not recommended for patients who experience hallucinations, delusions, or seizures.

Resources

Optional Recommended Reading

• Owens M, Bunce HL. Nature-Based Meditation, Rumination and Mental Wellbeing. International Journal of Environmental Research and Public Health. 2022 Jul 26;19(15):9118.
• Pálsdóttir AM, Spendrup S, Mårtensson L, Wendin K. Garden smellscape–experiences of plant scents in a nature-based intervention. Frontiers in psychology. 2021 Jun 29;12:667957.
• Wen Y, Yan Q, Pan Y, Gu X, Liu Y. Medical empirical research on forest bathing (Shinrin-yoku): A systematic review. Environmental health and preventive medicine. 2019 Dec;24(1):1-21.

Recommended Physiopedia Page Reading

• Sunlight, Outdoor Light, and Light Therapy in Disease Management
• Lifestyle Medicine, Sleep Hygiene and Psychological Well-being for Managing Chronic Low Back Pain

Nature Therapy Organisations

• American Horticultural Therapy Association
• Association of Nature and Forest Therapy
• Forest Therapy Society
• The International Nature and Forest Therapy Alliance