Nature-Based Therapy: Healing the Body, Mind, and Spirit

Group of four children and adolescents hiking in the forest, engaging in nature-based therapy

“I go to nature to be soothed and healed and to have my senses put in order.” – John Burroughs

For those of us who spend most of our lives between four walls, a trek into the Great Outdoors — even a short one — translates into health benefits that go well beyond strong lungs and legs. Cultivating a sense of wonder about the natural world exercises not only our physical muscles, but our mental and spiritual ones as well.

The power of connection

Whether standing awestruck in front of the Grand Canyon or admiring the tenacity of a dandelion sprouting through cracks in the sidewalk, time invested in nature returns high health dividends. Spending as little as 20 minutes outdoors has been shown to reduce levels of the stress hormone cortisol and mitigate mental fatigue.

The benefits go even deeper — literally. Many gardeners claim to feel happier and more relaxed when digging in the dirt, and those feelings aren’t purely psychological. Mycobacterium vaccae, a common bacterium found in soil, has been shown in studies to reduce stress chemicals and may have long-lasting anti-inflammatory effects on the brain.

A breath of fresh air

While outdoor activities don’t come without hazards (curious wildlife, seasonal allergens, inclement weather, etc.), “green exercise,” or activities that take place outside, may offer ancillary benefits that can’t be replicated by similar activities indoors.

Exposure to Vitamin D boosts mood, supports immune health, increases muscle function, and assists in brain cell activity. Additionally, taking regular breaks from HVAC-filtered air and city pollution and spending it instead in the great outdoors can help reduce risks of chronic respiratory illnesses.

The endless playground

Outdoor play is a critical part of a child’s healthy development. From honing gross and fine motor skills to fostering creativity and a sense of connection with the natural world, exposure to outside activities from a young age can help a child grow in ways that an exclusively indoor education can’t replace. Researchers have found that children with attention-deficit hyperactivity disorder (ADHD) who walk in a park for 20 minutes can improve their symptoms as effectively as if they took a dose of prescription medication.

A case study in forest bathing

Device-free, you wander through the leaf-littered path of an old growth forest. You have no schedule, no time constraints. You listen to the birds overhead and the wind in the trees. The soil under your feet is slightly damp and smells sweet. The stream, when you find it, is cold and clear and wakes you up better than a shot of espresso.

This hypothetical walk describes the Japanese practice of shinrin-yoku, or forest bathing. Not merely a walk in the forest, shinrin-yoku is the conscious and contemplative practice of immersing oneself fully in nature’s sights, sounds, smells, textures, and other sensations.

Research into shinrin-yoku has shown that forest environments promote lower concentrations of cortisol, lower pulse rate, lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity than do city environments. Additional research found positive emotional, cognitive, and behavioral changes among forest bathing participants, with many participants discovering meaningful metaphors for their own life experiences in the ebb and flow of nature’s rhythms.

Nature as a treatment modality

In occupational therapy literature, the use of gardening as a therapeutic intervention goes as far back as 1932. It’s not difficult to see why. Gardening is a meaningful, purposeful, goal-oriented activity, often with tangible results. When leveraged as an occupation-based intervention, gardening is flexible in its implementation, translatable to various settings, cost-effective, and doesn’t require advanced training.

Although gardening as a therapeutic intervention has been around a while, nature-based interventions are generally not prevalent in most OT practices. Even so, a small but growing number of pediatric occupational therapists are beginning to incorporate the outdoors as a natural setting to facilitate the skills and abilities of children.

Jill Clancy, OTR/L, MS, CNS, a pediatric occupational therapist at a private out-patient pediatric clinic located in Massapequa, New York, has explored this idea in her “Learn Through Nature” enrichment class. In this program, she brings nature into the clinic for multi-sensory learning, motor skills development, and cultivating curiosity about the natural world.

The results of an eight-week occupational therapy intervention with 28 pre-adolescent at-risk youths embedding a nature-based intervention vs. a non-nature intervention found preliminary evidence for supporting the use of nature-based interventions in decreasing heart rate and increasing positive emotions. The inclusion of nature-based interventions in occupational therapy for at-risk youth contributes to occupational justice and engagement for this population.

The ConTiGO approach

Laura Park Figueroa, OTR, MS, developed the ConTiGO approach in 2015, out of her work with Outdoor Kids (OKOT). Located in Berkeley and Oakland, California, OKOT provides children’s OT services in small groups in nature. This approach encompasses the values of connection with family and friends (con) and transformation through therapy (t) in (i) the great outdoors (go).

The groups include 3-4 children receiving OT services addressing motor skill development, attention, social skills, or sensory processing, in addition to 1-2 “Peer Playmates.” OKOT also runs summer camps for children who can benefit from improved motor coordination, confidence, self-regulation, or social skills in a supportive outdoor environment.

The TimberNook approach

Angela Hanscom, OTR, MS, a pediatric occupational therapist, developed this approach after observing the effects of restricted movement and lack of outdoor playtime on children’s attention span, academic performance, and sensorimotor development.

TimberNook has gained international recognition as programs spread across the US, Canada, New Zealand, and Australia, with the goal of enhancing childrens’ neurological systems through outdoor play.

Each experience is unique to the location, provider, and participants, and includes free play in a sensory-rich learning environment to develop creativity, motor skills, socialization, visual skills, balance, auditory processing, attention, emotional regulation, and conflict resolution. Parents and educators have observed increased confidence, calmness, concentration, and improved sleep after engaging in TimberNook experiences.

Adventure Therapy: Taking a risk

Adventure Therapy (AT) aims to build trust, develop interpersonal or intrapersonal awareness, and develop processing skills and resiliency, and is beneficial for adolescents and adults with mental health challenges.

In practice, AT can consist of any outdoor activity that comes with a perceived degree of risk: rope courses, rock climbing, kayaking, hiking, backpacking, snowshoeing, archery, and surfing, to name a few.

Occupational therapists in particular are uniquely qualified to implement AT, as they bring to the table expertise in activity and environmental analysis, activity sequencing, group facilitation, and the focus on occupation-based activities in various settings and environments.

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