Ecotherapy – Andi Smart


How can nature positively impact recovery?

Vulnerability and ‘toughness’ are considered processes, rather than states, as they flux according to how we survive, thrive and, importantly, recover. So, then: how can nature support us as humans to survive, thrive and recover? 

 Summers et al (2018: 10) define ecotherapy as “an interaction with nature that enhances healing and growth”; whereasClinebell (1996; 43) recognises ecotherapy as “healing and growth nurtured by healthy interaction with the earth”. In summary, ecotherapy is an umbrella term for nature-based methods of physical and psychological healing that support individuals to be active outdoors (Griffin, 2005). This could include gardening, walking in the woods, park or green spaces, food growing and/or environmental conservation work with the support of trained professionals. This perspective recognises that individuals are intimately connected with, embedded in, and inseparable from the rest of nature (Pretty et al, 2007).

What are the strengths of ecotherapy?

The positive effects of ecotherapy have been well researched (Davies-Berman and Berman, 1998; Harper and Russell, 2008). Hendel & Martin (1994; 22) recognise ecotherapy as “a powerful antidote to depression, anxiety, and emptiness” which reduces stress and enables mental clarity/inner calm.  I have personally witnessed these therapeutic impacts when working with a client who was experiencing extreme Obsessive Compulsive Disorder (OCD) obsessions where unwanted, intrusive and often very distressing thoughts were repeatedly entering her mind. My role was to work closely with her to find new ways to support her in her recovery. On one occasion, we decided on a calming and peaceful walk around a local green space. After about 20 minutes of walking, talking about nature, smelling the freshly-cut grass and listening to the birds sing she explained how she felt a sense of peace: the voices had lessoned and, thus, her mind was clearing. This is, nonetheless, an individual example and - it is fair to say - this may not work for everyone. However, if there is a space available near you (and your client agrees and it is safe to do so) this could potentially be worth a try as an avenue of (free) support that sits within and complements a broader holistic package.  

Further benefits that have been identified in the research include a decrease of symptoms associated with trauma such as self-esteem and depression (Reynolds, 2002; MIND, 2007). Wells and Evans (2003), for example, showed that scores for anxiety and depression were lower for those living near ‘nature’. A recent outing with another of my clients also supports this research. My client is diagnosed with General Anxiety Disorder (GAD) - a long-term condition that causes individuals to feel anxious about a wide range of situations and issues rather than one specific event. She suggested that we walked to the nearby woods to help her feel calm as she felt as though she was going to have a panic attack (a symptom she often experiences as part of her anxiety disorder). As we walked together, we focused on the woods ahead of us and directed our attention to the greenery.  We took deep breaths, slowed our pace to allow for the oxygen to enter our lungs and focused on the here and now: the sounds of the birds started to get louder and the smell of the forest got stronger. This helped us both focus on the present and appeared to help remove the threat of my client’s looming panic attack. Once at the woods, we both settled down in the sun and talked about what had helped to alleviate the anxiety. My client talked about being grounded through her senses: the smell of the woods, the sight of the tress and animals and the sense of being in nature as well as inhaling the clean oxygen away from the hustle and bustle of the city. 

Others disorders that can be supported through eco-therapeutic interventions  include Post-Traumatic Stress Disorder (PTSD) Sibthorp & Jostad (2014) which benefit from immersion in “emotionally calming” natural environments (Hawkins et al, 2016; 22). Key (2015) suggests that Hawkins et al (2016; 22) “emotionally calming” experiences are similar to peak experiences. Peak experiences are defined as “transcendent moments of pure joy and elation” (Maslow’s, 1968; 12) and are considered beneficial in treating schizophrenia (Wilson and Lipsey, 2000). According to Johnson (2002) ecotherapy facilitates ‘healing’ by directing clients’ attention towards self-reflection (Griffin et al, 2005). Ulrich (1984) proposes a genetic basis for the appreciation of nature in his Stress Recovery Theory (SRT) and this is reflected in Evolutionary perspectives (Wilson et al, 2008) which also suggests that individuals respond positively to natural environments due to genetics: a predisposition which once aided survival.

There is much research to suggest that symptoms of dementia, such as aggression, decrease (Abbott et al, 1997, Van-Loon, 2004; Chalfont, 2007) when ecotherapy activities are incorporated into care plans (Day et al, 2000; Cobley, 2002, Chalfont, 2005). This is something I fully support having worked in dementia care for 15 years and seeing how many patients become much calmer when out in the garden or on a walk in the countryside. As a way to support patients on my last dementia ward I invited local garden centre volunteers to come in and offer information and guidance on different plants and how and when these could be planted. They also offered examples of how to plant the different species so we could all work together on our ward garden. This was really successful and the residents really enjoyed the session (although we were very lucky to have a garden and outside space as I know this is not always the case). The success of such sessions of course also depends on the progression of the illness among the patients – so this needs to be taken into consideration. Nonetheless, if you feel this is something that could suit your group it is definitely worth considering and you could always speak to a senior member of your team and ask for further advice or guidance in advance.

What are the weaknesses of the ecotherapy research? 

 Whilst reading around the research, as well as trying out ecotherapy with different clients, I  came across several weaknesses.  For example, terms are used interchangeably in the research (for example Russell (2001) and Pretty et al (2007)) which I found very confusing. So I would argue that clearer definitions are needed: for example what constitutes a ‘natural environment’ and what is ‘nature’. Another issue with ecotherapy, presently, is that outcomes are not easily measured. This would suggests that it is very difficult to prove or effectively demonstrate cause and effect in nature interactions. This is due to the holistic human-nature interactions that occur - as several potential causes are possible. There is limited evidence that discusses long-term effects as well as how long these effects last once therapy ends (Pretty et al, 2007). This is because, often studies fail to complete follow up investigations to measure long-term effects (Russell, 1999; Epstein, 2004; Sempik 2007).  For me, these weaknesses mean that – without more solid data on how successful ecotherapy is – there is very limited opportunity to allow for the success of this free and ever-evolving natural-intervention to grow within services. This is because commissioners or budget holders need to understand what impact they are getting in return for their investment.

 To conclude, ecotherapy has been recognised as an interaction that can be emotionally calming and thus support recovery from several mental health challenges. However, with limited research on ecotherapy, and a lack of solid data to show how this approach is successful in both the short and long term, there is a need for researchers to develop studies that can more effectively assess outcomes and impact. Nonetheless, in the meantime, this free nature intervention could be used as a way to support clients as part of a broader package and relieve acute symptoms during their times of need. 


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Dryden, W. (2002). Handbook of individual Therapy: Sage, London.

Feltham, C., and Horton, I. (2012). The Sage Handbook of counselling and psychotherapy: London, Sage.

An experienced (c15 years) Mental Health Practitioner, Andi’s specialisms are Autism and Dementia Care, as well as having a strong interest in disability advocacy, sociology and equality.

Andi currently works in Education as a subject specialist and, as well as assessing achievement and participating in Internal and External Quality Assurance, helps to develop qualifications for Awarding Organisations.

In September 2017, Andi commenced the Master of Arts in Social Work at Sussex University.