Motivation and emotion/Book/2022/Nature therapy

Overview
Have you ever been standing outside somewhere and just taken a moment to appreciate the natural world? Maybe you have travelled, and seen oceans, skies, and places around the world. Maybe you have not, but still manage to be inspired by a clear blue sky, or pictures online. Regardless, we all know that nature has an undeniable beauty. What we do not necessarily know is that the natural environment gives back, positively affecting physical, mental and holistic health and wellbeing. There are many ways nature affects humanity, and through many forms. Nature therapy is a form of therapeutic practice that looks to integrate nature, whether it be through exposure, nature-based activities, greenspace, or just a change of setting. The benefits of nature are not limited to one group, but applicable to all types of people and communities.

Focus questions:
 * What is nature therapy?
 * What are the benefits of nature therapy?
 * How can nature therapy be applied?

What is nature therapy?


Nature therapy can be understood as the practice of involving nature as an active participant into therapeutic processes (Mayseless & Naor, 2021a), with the goal of increasing the overall health and wellbeing of the client (Annerstedt & Währborg, 2011; Berger, 2009). Many nature therapy practices revolve around the idea of being interconnected with natural environments (such as in Figure 1) and having an active relationship with nature, using techniques that involve exposure to, and immersive activities within natural environments (Annerstedt & Währborg, 2011; Berger, 2008; Craig et al., 2013). The practice of nature therapy belongs under the umbrella term ecopsychology, and is generally considered synonymous with ecotherapy. Many studies have focused on various aspects and benefits of nature therapy since the late twentieth century, with growing support for the practice (Banerjee & Chaudhury, 2020).

A range of practices, including Japanese forest bathing, horticulture, Indigenous practices, and even self-imposed isolation within nature are all associated with nature therapy, and have been shown to have similar benefits for holistic health and wellbeing (Bolam et al., 2013; Collado et al., 2021; Mayseless & Naor, 2020). Research with other therapeutic practices, such as person-centred therapy, has also involved ecotherapy, in order to better encompass a wide range of health and environmental benefits (Tudor, 2013). Some studies have also indicated that the act of reconnecting with nature can even be mutually beneficial, as nature therapy practices can encourage pro-environmental beliefs and the preservation of the environment (Lumber et al., 2017).

Case Study:

Carly works in a busy office in the middle of the city and feels she hardly has any time to herself. She has been feeling really stressed and lonely, and has decided to see a therapist for some help. After a few sessions conducted outdoors, in what her therapist calls “nature therapy”, Carly has noticed that she has started feeling calmer, happier and less stressed. She has started cycling to and from work and going on walks at lunch time, in order to spend more time connecting with herself and the environment around her.

Protective factors of nature
Exposure to the natural environment can be a protective factor in a number of ways. Whether it be through nature therapy, gardening and horticulture, local greenspace or just time spent in natural areas, the effects of nature are notable (Bolam et al., 2013; Fitzpatrick et al., 2022). Psychopathology is a big field of study that has connections to nature's role as a protective element. Symptoms of depression have been found to decrease from forest bathing (Collado et al., 2021), otherwise known as forest therapy, which is a variant of nature therapy. Forest bathing uses forest surroundings when engaging in positive health and wellbeing activities, including exercise, meditation (see Figure 2), games, and group activities (Collado et al., 2021). Similarly, a study conducted by Barrable and Touloumakos (2020) showed that, with early intervention, children who had experienced adversity were less likely to develop future psychopathologies as a result of engaging with nature. Similar studies focusing on adults have also demonstrated the same therapeutic qualities of nature therapy and exposure (Barrable & Touloumakos, 2020; Fitzpatrick et al., 2022).

There are cognitive and emotional benefits to the protective aspect of nature as well. Chances are, you have taken a stroll through a local park and felt refocused afterwards. You might have noticed the calming and sometimes awe-inspiring experience of nature welling up inside of you at some point. Yet, the connection between our wellbeing and nature is much more than a surface-level enchantment. Links to healthy emotional wellbeing have been demonstrated in multiple studies (see Carrasco et al., 2021; Craig et al., 2013), with some suggestions that context is important for nature’s ability to protect against low emotional wellbeing (Craig et al., 2013). Other studies indicate that perceived restoration through nature is what forms the link between positive emotional wellbeing and natural environment exposure (Carrasco et al., 2021). Nature also appears to be protective against dementia, particularly as stress has been found to have a role within the development of certain dementia subtypes (Fitzpatrick et al., 2022). Further evidence is required to study this claim, although the large volume of research demonstrating nature’s restoration of cognitive facilities supports the idea.

Psychological theories
A number of theories surrounding the benefits of nature to humanity exist today (Mayseless & Naor, 2021b). Discussed below are some of the most prominent ones. However, it should be noted that these are not the only theories relating to nature's positive effects.

The biophilia hypothesis


The term “biophilia” first appeared in 1973, with early definitions that would later develop and become the biophilia hypothesis (Gaekwad et al., 2022). Today’s accepted definition is that of an evolutionary perspective that indicates humans have an inner connection to nature that affects behaviour. This connection is complex, with a range of dimensions, including a proposed emotional one (Gaekwad et al., 2022; Mayseless & Naor, 2021b). A 2022 meta-analysis found a rise in positive affect and a decrease in negative affect that resulted from immersive nature experiences. These results both support the biophilia hypothesis, and demonstrate the emotional impact that the biophilic connection provides us with (Gaekwad et al., 2022). In some ways, the emotional aspect of the biophilia hypothesis seems relatively circular, as we might be able to see it in two ways. Do the emotional benefits arise from the biophilic connection, or does the biophilia hypothesis arise from the emotional evidence? Whilst this may be something to ponder, the hypothesis itself has been supported by numerous studies and is generally accepted.

A 2017 study (Fox & Xu) looking at biophilic connections across various socio-cultural contexts agreed that there is evidence for a cross-cultural component of the biophilia hypothesis. They also, however, found that cultural environments can influence the strength of connective feelings towards nature, and that nationality and current living environments affect biophilic tendencies (Fox & Xu, 2017). Correlations between people’s life satisfaction and time in spent in nature have also been demonstrated and shown to vary across the world (Carrasco et al., 2020). Further research surrounding the nuance in biophilic experiences will hopefully shed some more light on the variations found between cultures, though it is clear that the biophilia hypothesis is not limited to certain areas of the world.

SRT and ART
Two well-known theories that illustrate nature’s benefits are Stress Reduction Theory (SRT) and Attention Restoration Theory (ART). SRT, which was first introduced by Ulrich in the early 1980s, states that symptoms of stress decrease with time spent in nature due to the evocation of positive emotional responses (Carrasco et al., 2021). Stress responses are considered to be a leftover evolutionary tactic for the body to ready itself for physical dangers that would have been prevalent for humanity’s early ancestors. Yet, today’s environments leave the body vulnerable to maladaptive stress responses when faced with common stressors, such as looming deadlines (Greenberg et al., 2020). SRT proposes that natural spaces have the ability to restore the body to healthier states by reducing these physiological stress symptoms. SRT also considers the idea that natural environments are less likely to present long-lasting threats than urban environments (Calogiuri et al., 2020). Physiological signs of stress such as levels of the stress hormone cortisol, as well as heart rate and blood pressure, have gone down when the participant has spent time in natural environments rather than urban areas (Greenberg et al., 2020). The theory is largely linked to the biophilia hypothesis due to its similar effects regarding increases in positive affect and decreases in negative affect (Carrasco et al., 2021).

Attention restoration theory presents similar ideas, albeit more specific to cognitive functioning. ART focuses on the restorative capacities of the natural environment (Carrasco et al., 2021), particularly on what is known as “directed attention”. Directed attention is a limited resource that, when drained, can leave us cognitively fatigued. It is defined as the ability to simultaneously focus on a specific thing and block out other distractions (Dewitte & Joye, 2018). Focusing on a mundane task, such as writing a report or doing laundry, tends to use directed attention if the task is generally uninteresting, and according to ART, can be replenished with spontaneous fascination (Calogiuri et al., 2020). The theory posits that natural spaces are particularly good areas for restoring attention capacities, because they prompt effortless fascination and allow for an opportunity to escape the drain on directed attention (Dewitte & Joye, 2018).

Case Study: Alex is working on a big report for their biology class at university. They have been feeling pretty stressed out lately because of it, and they are struggling to focus. Rather than sitting there procrastinating, or staring out of the window, Alex decides to take a friend's advice and go outside for a break. They go for a nice, long walk, finding themselves looking at the dogs and their owners walking past, the butterflies flying about, hearing the bees buzzing, and start to feel better. When Alex returns home, they feel rejuvenated and ready to give their report another crack.

Test your knowledge!
{Nature therapy is good for people's health and wellbeing. + True - False
 * type=""}

{The biophilia hypothesis states that humanity has no connection to the natural environment. - True + False
 * type=""}

Individuals
Actively including nature and the natural environment within therapeutic practices, particularly those done through professional psychologists, is still a field of study that has much development ahead (Lollar et al., 2022). This is for a number of reasons, including:


 * Ecopsychology is a young field of psychological study (Lollar et al., 2022)
 * Empirical studies on the effects of nature within therapeutic contexts are relatively new and still being explored (Lollar et al., 2022)
 * There are some doubts surrounding nature therapy practices being useful for clinical use, because of the simplicity of nature-based activities that may be done independently, such as gardening, hiking, etc. (Banerjee & Chaudhury, 2020)

The literature on nature therapy includes articles that examine the possibility of integrating nature therapy within other therapeutic frameworks, such as those within humanistic psychology, and articles that explore the benefits of unconstrained exposure to nature on a daily basis (Banerjee & Chaudhury, 2020; Lollar et al., 2022). The existence of both perspectives on nature’s benefits means that the execution of nature therapy can be as simple as valuing, experiencing and cultivating a relationship with nature with or without a therapy element.

Research on the amalgamation of humanistic psychology and nature therapy clearly states that similar values exist across ecotherapy and person-centred practices (Tudor, 2013). The importance of a holistic approach is highly valued in all person-centred and humanistic therapy frameworks, though has usually consisted of looking at social contexts. Multiple perspectives are also considered important (Lollar et al., 2022), and both of these aspects are relevant to ecological practices and nature therapy, for both the client and the environment. Clients have given positive feedback surrounding the inclusion of nature within therapy sessions (Berger, 2009), as have psychologists. Practitioners believe the natural environment to be both an active partner and influential of the therapeutic process, by facilitating openness, instigating trust, and motivating new ways of thinking (Mayseless & Naor, 2021a).



Children and adolescents
The specific effects of nature therapy on children and adolescents have been examined in a wide variety of contexts and applied as such. Having demonstrated the extensive benefits of nature, it comes as no surprise that exposure to natural spaces and activities (see Figure 3) can increase positive emotional wellbeing in young people. But what about young people in specific and extraordinary circumstances?

The experiences that we have as children and into adolescence have lasting impacts (Craig et al., 2013). For young people dealing with various life situations, the benefits of nature can be all the more important. One particular instance would be children who have been through adverse childhood experiences, which can include abuse, neglect, family dysfunction and economic adversity. Nature therapy can be a protective factor against these types of experiences, though Barrable and Touloumakos (2020) propose that exposure to nature may actually be able to mitigate some of the consequential effects of adverse experiences in childhood.

Children with learning difficulties undergoing nature therapy programs have also shown significant results. Development of social skills, positive interactions, teamwork, and improvements in motor ability and concentration have been observed in such programs, incorporating specific activities and general play (Banerjee & Chaudhury, 2020; Berger, 2008). Nature therapy is also a relevant technique for treating chronic illness symptoms in children and adolescents. Using a virtual method of nature exposure and related therapeutic techniques, a 2020 study demonstrated the effect of nature on illness. Children and adolescents awaiting a total pancreatectomy and islet auto-transplant rated their symptoms afterwards, showing a decrease in pain, anxiety and nausea (Fischer et al., 2020). The positive results from using nature therapy with children and adolescents illustrates the wide-reaching abilities of nature, from childhood to even late adulthood (Berger, 2009).

Case study:

Ben goes to a class every week that his parents signed him up for, to help him learn how to make friends more easily. The teachers have started doing all of the activities outside at the local park, and last week they were able to make faces and figures on the ground using sticks. Ben really liked his figure that he made. When one of the other kids told him it looked good, he felt proud of himself and thanked them. Ben has really enjoyed the classes when they are outside, and his parents think he has been making good progress with his social skills.

Illness, mental health and disabilities
We have already established that nature has protective benefits, including in the case of mental health. However, the use of nature as both a setting and an active component of nature therapy can affect illness and mental health after the onset too. Veterans struggling with post-traumatic stress disorder (PTSD) have found various ecotherapy techniques to be useful in treatment programs (Banerjee & Chaudhury, 2020), as have those with symptoms of depression (Banerjee & Chaudhury, 2020; Collado et al., 2021).

Certain illnesses have also been studied for responses to natural environments. There is evidence that even just having plants in the room for recovering hospital patients enhances the recovery period and general health outcomes (Banerjee & Chaudhury, 2020). Having already discussed how nature therapy affects stress, it is no surprise that individuals with stress-related illnesses receive the same benefits through a range of nature experiences (Bondas et al., 2017). Dementia has been examined in a number of ways for the response to nature therapy too. High greenspace exposure leads to indicators of significant protection against dementia, compared to low residential greenspace (Fitzpatrick et al., 2022). Further research may narrow down optimal levels of local greenspace and which types of dementia are most affected, though there are studies examining the effect on specific dementia symptoms. Decreases in agitation, and improved sleep, cognition, mood and engagement within dementia patients are positive indicators of the effects of nature on illness and associated symptoms (Banerjee & Chaudhury, 2020).



Indigenous Australians
It is important to recognise and support the ways Aboriginal and Torres Strait Islanders connect with nature and Country in Australia (including in areas such as that of Figure 4). Their health and wellbeing depends on a number of factors that are holistically integrated with the natural environment, and the relationships they have with Country. By fostering, conserving, respecting and working with nature, Aboriginal and Torres Strait Islanders and their connections with Country are likely the strongest example of a population being so closely affected by the natural environment (Bolam et al., 2013). The holism of Indigenous Australians’ wellbeing is a significant element to consider in the context of understanding nature’s contribution to a healthy society. Further attempts to support and understand Aboriginal and Torres Strait Islander peoples’ connection to Country is critical.

Test your knowledge (again)!
{Nature therapy can be applied... - Only one or two ways - Only once per person + In many ways with many different people - In many ways, but only with adults
 * type=""}

Conclusion
Nature therapy is a significant and emerging therapeutic technique that has widespread positive benefits across a range of demographics. Thoroughly studied effects on health and wellbeing have shown nature to be consistently beneficial, affecting physical, mental, emotional and even spiritual health and wellbeing (Bolam et al., 2013; Carrasco et al., 2021). How can it be applied? In a seemingly limitless way, nature and its positive effects have been associated with individuals, groups, children and young people, older adults, Indigenous peoples, various illnesses and conditions, and more.

So, how can we incorporate nature’s benefits into our own lives? It can be as simple as taking a walk every day.

Take-home messages:
 * The natural environment is very important for humanity's health and wellbeing
 * Nature exposure and nature therapy have a range of positive benefits