A Natural Remedy: A Review of Ecotherapy Interventions for Mental Health Diagnoses
Alexis Petrunia
Yorkville University
PSYC 6213: Research Methods
Dr. Jeremy Enzor
August 15, 2021
Abstract
Many cultures believe that fostering a connection to nature can positively impact ones
spiritual, physical, and mental wellbeing. There has been growing interest in the psychology
community regarding nature-based interventions for addressing symptoms of mental illness.
Provided that an individual has access to facilities that allow for such therapeutic methods, a
growing body of research has supported the notion that ecotherapy may be an effective addition
to treatment options for a variety of diagnoses. Ecotherapy can be understood, in a general sense,
as the practice of connecting to nature to facilitate psychological healing. There are various subtypes of ecotherapy, such as Animal-Assisted Therapy, Forest Therapy, and Horticulture
Therapy. Ecopsychology recognizes that humans are inherently connected to an expansive
ecosystem, and the needs of both human individuals and nature are therefore entwined (Roszak,
2001). This literature review will be prefaced by information pertaining to the background of
ecopsychology, as well as the problem statement that will be addressed with recently produced
research. Relevant studies that examine the effectiveness of ecotherapy interventions for mental
illness will be considered, with a focus on specific therapeutic techniques, populations who may
benefit from ecotherapy, and a discussion of important considerations within this field.
The following literature review is focused on qualitative and quantitative studies that
examine the benefits of ecotherapy in context to improving mental health outcomes for those
navigating general, chronic, and acute mental health disorders. In recent years, psychologists
have explored the benefits and implications of nature-based interventions within and outside of
clinical settings. Ecotherapy is a broad practice that allows practitioners to apply methods in
various environments. To gain insight into the ways ecotherapy can assist in better mental health
outcomes, the included compilation of literature covers three subtypes of this therapeutic
approach: Animal-Assisted Therapy (AAT), Forest Therapy, and Horticulture Therapy (HT).
The purpose of comparing these sub-therapies is meant to clarify implications of such modalities
for the counselling profession. The aim of highlighting such research is to support the concept
that nature-based interventions should be more commonly integrated into treatment plans for
individuals with a mental health diagnosis, as it is a highly versatile approach.
It should be noted that the initial topic declared in Assignment 1 specified the use of
ecotherapy for inpatients of mental health facilities. Due to the apparent lack of research that
focuses on inpatient settings, it was decided that ecotherapy would be examined through a more
general lens. Thus, the included literature studies populations that are both within and outside of
such facilities.
Background
The use of ecotherapy (from a Western historical perspective) has been employed in
many settings for several decades. A common practice during the early days of the
psychoanalytic movement involved engaging in conversation while walking outdoors, while
outdoor therapeutic camps date back to the 1860s (Jordan & Hinds, 2016). Ecopsychology
encompasses a philosophical approach to mental wellbeing, with the intention of embracing
ecology in its theory and practice (Summers and Vivian, 2018). This holistic intervention aims to
connect people with nature, in some fashion, to support the improvement of a client’s mental
health. Ecotherapy can be approached actively, passively, or in-session (Kamitsis and
Simmonds, 2017), while using several modalities, including ‘green exercise’, ‘wilderness
therapy’, ‘forest bathing’, ‘park prescriptions’, as well as previously mentioned interventions
such as AAT.
Although the origins of nature-based therapy are not specific to one cultural or
geographic location, it is worth noting, for the sake of this review, the prominent figures
associated with the treatment known as ‘ecotherapy’. In 1992, Theodore Roszak — the former
director of the Ecopsychology Institute at California State University — authored the book The
Voice of the Earth, which expanded his concept of ecopsychology. This work was influenced by
Robert Greenway’s teachings on psychoecology in the late 1960s (a theory that melds the human
psyche with nature). Roszak has been credited with coining the term ‘ecotherapy’, which has
become a broad term to describe the therapeutic approaches informed by the mentioned
framework.
Problem Statement
This literature review addresses the benefits of ecotherapy as a treatment for poor mental
health. Although this therapeutic approach has been used by counselling practitioners for many
years, the study of ecotherapy has recently been gaining more attention within the counselling
community. By examining current literature on this topic, one may gain better insight into the
types of mental health conditions that ecotherapy can treat (using passive, active, and in-session
approaches), as well as the potential issues surrounding such interventions.
Literature Review
In the past decade, multiple studies have centred their focus on ecotherapy interventions.
Qualitative and quantitative research have produced data to support the theory that mental health
can be improved upon by incorporating some type of nature-based therapy, whether the
intervention is administered indoors or outside. The reviewed literature presents evidence that
incorporating ecotherapy into treatment plans can help both adults and children in alleviating
symptoms associated with psychosocial disorders (Tuuvas et al., 2017; Burgon et al., 2017;
Dunlop et al., 2018), PTSD (Yarborough et al., 2018; Monfort Montolio et al., 2019), general
anxiety and depression (Song et al., 2018; White et al., 2019; Wilson et al., 2010), and acute
mental illness (Stefanini et al., 2016; Calvo et al., 2016; Sahebalzamani et al., 2020; Cipriani et
al., 2018). The following sections will look at Animal-Assisted Therapy (AAT) as well as Forest
Therapy and Horticulture Therapy (HT), while highlighting the effects of such interventions, in
addition to examining ethical, social, geographic, and financial considerations.
Impacts on Improved Mental Health
It could be argued that many people feel motivated to incorporate outdoor activities into
their lives for improved health. A short walk around one’s neighborhood; a challenging hike;
visiting a park with a pet; outdoor yoga; gardening — such activities can be generally thought of
as relaxing pastimes that promote mental and physical wellbeing. How can structured programs
that incorporate ecotherapy help to alleviate poor mental health? Current research has shown that
interventions such as AAT, Forest Therapy and HT can greatly assist in improving mental health
outcomes for individuals navigating an array of diagnoses.
Qualitative studies have observed improvements to symptoms relating to psychosocial
disorders (a mental illness which can be characterized by maladjusted behavioural and cognitive
processes, which is incited by life experiences) (Jacob, 2013). One study (Tuuvas et al., 2017)
examined the long-lasting impacts of AAT, specifically equine-assisted therapy (EAT). This
research used a phenomenological approach to acquire data from a small convenience sample
who had experience with EAT (an adjunct intervention included in a comprehensive treatment
program) at least 15 years prior to being interviewed. The participants had received EAT for
disorders such as ADHD, Asperger’s Syndrome, and depression. The results from the interviews
showed that the relationship that the participants had with the horses were the most impactful
aspect to their program. Additional research, such as the qualitative psychotherapeutic case study
Hoofbeats and heartbeats: equine-assisted therapy and learning with young people with
psychosocial issues – theory and practice (Burgon et al., 2017) showed that an EAT program at a
youth treatment facility enriched inter-relationships and improved mental health symptoms of
participants over the course of two months. The researchers also concluded that the participants
experience with EAT helped to improve their confidence and self-esteem. Such observations
support the notion that a connection with nature — in this case, with animals —can positively
impact a person’s mental health, both in an immediate sense and long-term. Other studies, such
as Benefits and Challenges of Using Service Dogs for Veterans with Posttraumatic Stress
Disorder (Yarborough et al., 2018), The effect of animal-assisted therapy on emotional and
behavioral symptoms in children and adolescents hospitalized for acute mental disorders
(Stefanini et al., 2016), Animal Assisted Therapy (AAT) Program As a Useful Adjunct to
Conventional Psychosocial Rehabilitation for Patients with Schizophrenia: Results of a Smallscale Randomized Controlled Trial (Calvo et al., 2016), and Animal-Assisted Therapy in the
Residential Treatment of Dual Pathology (Monfort Montolio et al., 2019) also contribute to the
collective data that indicate that developing a bond with an animal can help improve feelings of
self-worth, trust, and can assist with improving one’s ability to self-regulate.
The concept of observing nature (i.e., natural landscapes, foliage, flowers, wildlife, etc.)
to improve symptoms of ill mental health was practically unstudied until the late 1970s
(Summers et al., 2018). Around this point in time, there began multiple examinations on the
psychological impact of scenes of nature on stress experienced by and medical recovery rates
(Ulrich, 1984, as cited in Summers et al., 2018). Data collected from these studies showed that
scenes of nature positively influenced the mental state of participants, and alleviated feelings of
tension and low mood. These initial studies have influenced further investigation into the effects
of Forest Therapy and Horticulture Therapy. More recent studies have observed the ways in
which interacting with plants and/or natural landscapes have supplemented mental health
treatments for those diagnosed with anxiety disorders and [or comorbid with] depressive
disorders.
A quantitative study conducted in Japan from 2005 to 2013, Psychological Benefits of
Walking through Forest Areas (Song et al., 2018), concluded that taking walks through forest
areas “decreased the negative moods of depression-dejection, tension-anxiety, anger-hostility,
fatigue, and confusion and improved the participants’ positive mood of vigor compared with
walking through city areas” (Song et al., 2018). Another research study concluded that spending
at least 120 minutes a week in nature was associated with good mental health and wellbeing
(White et al., 2019). Furthermore, the data showed that the intervention group was more likely to
report high well-being with contact ≥120mins (e.g., 120–179mins: Well-being=1.23 [1.08–
1.40]).
With additional studies focusing on the mental health impact of interacting or observing
natural landscapes (Wilson et al., 2010), data also suggests that therapies such as HT and Forest
Therapy help with improving memory, socialization, and physical endurance. Additional benefits
of horticulture therapy can be seen in data collected by the qualitative phenomenological study,
Uncovering the Value and Meaning of a Horticulture Therapy Program for Clients at a LongTerm Adult Inpatient Psychiatric Facility (Cipriani et al., 2018). The researchers of this study
concluded that HT helped participants in forming relationships with other clients and staff, which
ultimately encouraged clients to have higher levels of trust in others (Cipriani et al., 2018).
Ethical Considerations
There are several factors to consider regarding the use of ecotherapy as a mental health
intervention. The primary concern associated with the previously mentioned modalities relates to
the respect and care practitioners (as well as clients) must show for the ecosystem that supports
this therapeutic approach.
Specific to AAT, practitioners must also consider the ethics code of the regulating college
with which they are associated, as well as the most applicable form of AAT for the client’s
particular needs. A practitioner must also be privy to allergies and phobias, as well as the amount
of experience a client has with animals such as dogs, birds, and horses (Society for the
Advancement of Psychotherapy, n.d.).
Ecotherapy practices such as Horticulture Therapy and Forest Therapy must also be
approached with consideration to provincial and federal guidelines and ethics codes. Such
therapeutic modalities must be conducted in a way that is considerate to the sustainability of
whichever environment is being utilized.
Geographic, Financial and Sociocultural Considerations
It is worth noting that ecotherapy may have its limitations, which can be associated with
geographic location, financial accessibility, and sociocultural belief systems. Although
ecotherapy can be conducted within a metropolitan landscape, particular options for modalities
may be limited. It is less likely that equine therapy (EAT) or Forest Bathing will be available to
those in cities that are mainly void of natural landscapes and larger properties. Certain
therapeutic models might not suit the budget of some clients, as most insurance providers will
not cover alternative therapies. A practitioner must also consider a client’s cultural and social
identity — perhaps the use of animals in a therapeutic treatment setting might not feel like an
agreeable practice for those concerned with animal welfare, or a client might feel most
comfortable in an urban landscape that’s void of greenspaces.
Summary
The available literature that focuses on ecotherapy has significantly supported the
concept of improving mental health by connecting humans with nature. Relatively traditional
approaches to mental health treatment in western practices often employ psychotherapy and
medication. Alternative treatments and approaches to mental health regulation — such as
meditation, yoga, acupuncture, and music therapy — have become popular in western society in
recent decades. Although ecotherapy is a relatively new approach to alleviating symptoms of
mental illness (at least in North America), more knowledge of this intervention is being gained
through qualitative and quantitative studies. The previously mentioned research has shed light on
the benefits of modalities such as AAT, HT, and Forest Therapy for a variety of mental health
disorders.
Implications
Various studies have concluded that ecotherapy programs and approaches can be easily
incorporated into treatment for depression, anxiety, PTSD, psychosocial disorders, as well as
acute and chronic mental illness (Cipriani et al., 2018; Tuuvas et al., 2017; Yarborough et al.,
2018; Sahebalzamani et al., 2020). Modalities such as equine-assisted therapy may require a
greater commitment and allocation of funds, however, simple techniques such as outdoor
meditation and nature walks are more financially feasible to incorporate into practice (Song et
al., 2018). Animal-assisted therapy has proven to be an effective intervention in decreasing
symptoms of anxiety, depression, fear, and loneliness (Sahebalzamani et al. 2020), and as such
should be considered when forming a client’s treatment plan.
Ideas for Future Research
There is much room for growth and learning in the study of ecopsychology. While many
studies have measured and observed ecotherapeutic techniques in settings that allow for
interaction with outdoor landscapes, there is very little research focusing on ecotherapy within
inpatient settings. It would be beneficial to gain more insight into the effectiveness of ecotherapy
interventions for people residing in mental health facilities.
As social interactions have been limited on a global scale due to the covid-19 pandemic,
it would also be beneficial to acquire more data regarding the ways ecotherapy interventions can
help remedy general feelings of low mood, anxiety, and even decreased physical health. Such
research could be conducted in a variety of settings.
Moving forward, it will be of importance to develop a greater understanding of the
meaning of connecting with one’s natural environment. One could assume that future research
might employ qualitative methods (such as Phenomenology) to gather information on peoples’
experience with ecotherapy. Quantitative methods, such as Quasi-Experimental, and
Experimental Research, will allow for a more straight-forward analysis of hypotheses relating to
ecotherapy interventions. Both methodologies will be useful strategies in gaining knowledge on
the benefits of ecotherapy.
Conclusion
A growing body of research has highlighted the benefits of interventions such as AAT,
HT, and Forest Therapy. Ecotherapy is a useful approach in bettering the mental health of people
who must navigate a variety of mental health diagnoses. Connecting humans with nature,
whether passively or actively, should be a method of consideration for mental health
practitioners. Ecotherapy can be a cost-effective treatment option and offers plenty of therapeutic
subtypes that suit the needs of many.
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