Nature Therapy

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Introduction[edit | edit source]

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.[1] According to the 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."[2]

Being in nature has beneficial effects on our health. This has been commonly known for centuries and is 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 which 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[edit | edit source]

Nature therapy is lead by certified Nature Therapists (also known as Forest Therapy Guides) or other qualified healthcare practitioner. Simply put, nature therapy is about mindfully connecting patients with the outdoors to promote mental and/or physical health.

Nature Therapy versus Being in Nature[edit | edit source]

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 outdoor.[3]

Ill health effects associated with indoor air pollutants include:[3]

  • 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 then led multiple 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.[4]A 2019 systematic review and meta-analysis found exercise performed outdoors was perceived to offer greater physical benefit than exercise performed indoors.[5]

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 a specific and individualised goals. Medical doctors and psychological therapists are using nature therapy as a therapeutic tool, or prescribing it to their patients to complement treatments. Nature is also being brought indoors via virtual reality. Recent studies show positive results which indicate the potential of virtual reality as a adjunct tool to nature therapy.[6]

Common Forms of Nature Therapy[edit | edit source]

  • Adventure therapy. Examples include rafting and rock climbing[7]
  • Animal-assisted interventions[7]
  • 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.[7]
  • Blue exercise
  • Dark nature. Examples include stargazing.[7]
  • Green exercise. Performing physical exercise in a green space, such as running, walking, or a bicycle ride.[7]
  • Shinrin-yoku. 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.[8]
  • [9]
    [10]
  • Therapeutic farming or horticulture[7]
  • Wilderness therapy. This includes hiking or building shelters. This form works well in group situations.[7]

Shinrin-Yoku[edit | edit source]

Literally "forest bathing", the practice has been integrated to the Japanese health care system since 1982 with the aim to promote wellness and disease prevention, aiming particularly for workers' stress management. It consists of simply "taking in" the forest environment through all five senses and paying close attention to those. These videos provide further details on how it is practiced.

[9]
[10]

Physiological Effects[edit | edit source]

As of now, evidence surrounding the physiological effects of spending time in the forest is mainly connected to cardiovascular and immunological systems. Quantitative data was gathered mostly in Asian countries and with healthy populations, stroke patients and people with a diagnosis of hypertension. [11]

Cardiovascular[edit | edit source]

Nature and Forest Therapies have been shown to reduce overall blood pressure, and lower the heart rate, while activating the parasympathetic nervous system and reducing the sympathetic nervous system. [12]

Immune system[edit | edit source]

By acting on the autonomous nervous system, Nature Therapy can therefore benefit the immune system directly. As we know, the immune response is at its best when the body is relaxed and resting, which is why 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.[13]

Phytoncides and NK cells[edit | edit source]

Phytoncides, oils that trees emit to protect themselves from pathogens and parasites, have been shown to have a direct effect on the activity of NK (natural killer) 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.[14][15][16]

Stress[edit | edit source]

Spending time in the forest has been shown to diminish the cortisol levels in the body and therefore reduce physiological stress. [17]

Psychological Effects[edit | edit source]

Nature therapy has been shown to reduce depression and anxiety, as well as affecting on the mood.[18]

Forest as Clinical Environment[edit | edit source]

From Z's lecture: landscape, soundscape, smellscape

Gardening

home healing spaces

As the benefits of carrying therapy sessions in the forest or other natural environments, the use of virtual reality or the presence of plants inside clinical spaces have proven equally effective on certain levels. Since it is not always possible to carry out therapy sessions in natural spaces, those alternatives can be useful in hospitals or for patients who are unable to access such spaces. [19] [18] The use of essential oils has also shown to have direct, beneficial effects on the mood and stress response of hospital workers. These oils contain the Phytoncides molecules (as described earlier), same effects are observed on the immune system and anxiety levels. [20][15]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Wikipedia. Nature Therapy. Available from: https://en.wikipedia.org/wiki/Nature_therapy (accessed 25/April/2023).
  2. ↑ The International Nature and Forest Therapy Alliance. Forest Therapy. Available from: https://infta.net/home/public-health/forest-therapy/ (accessed 26/April/2023).
  3. ↑ 3.0 3.1 United States Environmental Protection Agency. Indoor Air Quality. Available from: https://www.epa.gov/report-environment/indoor-air-quality# (accessed 26/April/2023).
  4. ↑ Lackey NQ, Tysor DA, McNay GD, Joyner L, Baker KH, Hodge C. Mental health benefits of nature-based recreation: a systematic review. Annals of Leisure Research. 2021 May 27;24(3):379-93.
  5. ↑ Lahart I, Darcy P, Gidlow C, Calogiuri G. The effects of green exercise on physical and mental wellbeing: A systematic review. International journal of environmental research and public health. 2019 Apr;16(8):1352.
  6. ↑ Rozmi MD, Rambli DR, Sulaiman S, Zamin N, Muhaiyuddin ND, Mean FO. Design considerations for a virtual reality-based nature therapy to release stress. In2019 International Conference on Advances in the Emerging Computing Technologies (AECT) 2020 Feb 10 (pp. 1-4). IEEE.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 WebMD. Do You Need a Nature Prescription?. Available from: https://www.webmd.com/balance/features/nature-therapy-ecotherapy (accessed 26/April/2023).
  8. ↑ Kotera Y, Richardson M, Sheffield D. Effects of shinrin-yoku (forest bathing) and nature therapy on mental health: A systematic review and meta-analysis. International Journal of Mental Health and Addiction. 2020 Jul 28:1-25.
  9. ↑ 9.0 9.1 Association of Nature and Forest Therapy. Introduction to Forest Therapy and Shinrin-Yoku. Available from: https://youtu.be/mxLbmMwlI4U[last accessed 24/4/2022]
  10. ↑ 10.0 10.1 World Economic Forum. What is Japanese “forest bathing” and how can it improve your health. Available from: https://youtu.be/stuZaKB9j7I[last accessed 24/4/2022]
  11. ↑ Stier-Jarmer, M., Throner, V., Kirschneck, M., Immich, G., Frisch, D., & Schuh, A. (2021, February 2). The psychological and physical effects of forests on human health: A systematic review of systematic reviews and meta-analyses. International Journal of Environmental Research and Public Health. MDPI AG.
  12. ↑ Bikomeye JC, Beyer AM, Kwarteng JL, Beyer KM. Greenspace, Inflammation, Cardiovascular Health, and Cancer: A Review and Conceptual Framework for Greenspace in Cardio-Oncology Research. International Journal of Environmental Research and Public Health. 2022 Feb 19;19(4):2426.
  13. ↑ Chae Y, Lee S, Jo Y, Kang S, Park S, Kang H. The Effects of Forest Therapy on Immune Function. International Journal of Environmental Research and Public Health. 2021;18(16):8440.
  14. ↑ Andersen, L., Corazon, S., & Stigsdotter, U. (2021). Nature Exposure and Its Effects on Immune System Functioning: A Systematic Review. International journal of environmental research and public health, 18(4), 1416.
  15. ↑ 15.0 15.1 Li, Q., Nakadai, A., Matsushima, H., Miyazaki, Y., Krensky, A. M., Kawada, T., & Morimoto, K. (2006). Phytoncides (wood essential oils) induce human natural killer cell activity. Immunopharmacology and immunotoxicology, 28(2), 319–333. https://doi.org/10.1080/08923970600809439
  16. ↑ Li Q, Kobayashi M, Wakayama Y, Inagaki H, Katsumata M, Hirata Y, Hirata K, Shimizu T, Kawada T, Park BJ, Ohira T. Effect of phytoncide from trees on human natural killer cell function. International journal of immunopathology and pharmacology. 2009 Oct;22(4):951-9.
  17. ↑ Antonelli, M., Barbieri, G., & Donelli, D. (2019, August 15). Effects of forest bathing (Shinrin-Yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. International Journal of Biometeorology. Springer New York LLC.
  18. ↑ 18.0 18.1 Kim, W., Lim, S. K., Chung, E. J., & Woo, J. M. (2009). The effect of cognitive behavior therapy-based psychotherapy applied in a forest environment on physiological changes and remission of major depressive disorder. Psychiatry investigation, 6(4), 245–254. https://doi.org/10.4306/pi.2009.6.4.245
  19. ↑ Syed Abdullah SS, Awang Rambli DR, Sulaiman S, Alyan E, Merienne F, Diyana N. The Impact of Virtual Nature Therapy on Stress Responses: A Systematic Qualitative Review. Forests [Internet]. 2021 Dec 15;12(12):1776. Available from: http://dx.doi.org/10.3390/f12121776
  20. ↑ Zamanifar, S., Bagheri-Saveh, M. I., Nezakati, A., Mohammadi, R., & Seidi, J. (2020). The Effect of Music Therapy and Aromatherapy with Chamomile-Lavender Essential Oil on the Anxiety of Clinical Nurses: A Randomized and Double-Blind Clinical Trial. Journal of medicine and life, 13(1), 87–93. https://doi.org/10.25122/jml-2019-0105
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