Therapy in Nature

Counseling and psychotherapy is becoming more socially acceptable and more commonly used in modern society. Typically, a therapy session takes place in an office with two chairs (or increasingly, online), but now there is another possibility: therapy in nature.

Currently, however, outdoor therapies have limited deployment, even in wealthy urbanized nations where they are most valued. (Buckley et al., 2018). A large issue regarding the encouragement of outdoor therapy is that it is not yet perceived as mainstream medicine, making people less likely to use it and/or have it introduced to them (Buckley et al., 2018).

Although a therapy room can provide a safe, stable, and containing space, it can also be anxiety provoking. Some clients find a more formal and clinical face-to-face encounter intimidating (Cooley et al., 2020). In this case, therapy in nature is great to try to make people feel more comfortable with therapy in general. 

[1] A Man in a Therapy Session

General benefits of exposure to nature

Exposure to nature can have positive cognitive, physiological, psychological, and physical benefits! According to research, time spent in natural outdoor spaces benefits include:

  • Reduced stress responses and improved mood (Cooley et al., 2020).
  • Decreased heart rate and blood pressure, and looking at nature had positive effects on mood, stress, concentration, and self-esteem (Cooley et al., 2020).
  • A wide range of mental health benefits, related to attention and cognition, memory, stress and anxiety, sleep, emotional stability, and self-perceived welfare or quality of life (Buckley et al., 2018).

Given these specific benefits of being outdoors, therapy that takes place in nature may be an impactful alternative to traditional therapy indoors.

Why Might Therapy Outdoors Be Effective?

  • Being in nature activates our soothing system, which endorses compassion, safety, and connection, in turn protecting our mental health (Kotera et al., 2020).
  • Participation in therapeutic recreation in outdoor nature-based settings enhances elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning (Picton et al., 2020)
  • It promotes increased levels of physical activity, greater self-esteem, and enhanced sense of identity (Picton et al., 2020).
  • Exposure to nature and outdoor activities can improve mental health for at least some symptoms, causes, patients, and circumstances. They are particularly relevant for the psychological components of chronic disease syndrome, namely depression and dementia (Buckley et al., 2018).
  • Some clients and practitioners feel they benefit from a greater sense of shared ownership of a natural space (Berger & McLeod, 2006) and that therapy outdoors offers a more existential, humanistic approach that is sometimes lost in clinical settings (Cooley et al., 2020).
  • The cerebral blood flow, which is underpinning our cognitions, is gradually reduced during prolonged periods of sitting and is increased during movement such as light walking. 

According to Cooley and associates (2021):

Walking is found to promote positive affect (Miller & Krizan, 2016) and improved cognitive performance (e.g., creativity, working memory, awareness, and problem‐solving; Mualem et al., 2018; Oppezzo & Schwartz, 2014), which are valuable components of psychological flexibility required for effective talking therapy.

[2] Happy Woman Smiling, Spreading Her Arms and Facing the Sky

The effectiveness of therapy in nature has already been identified. In the article “Nature-based outdoor activities for mental and Physical Health: Systematic Review and meta-analysis” the authors conclude that, “nature-based interventions were associated with a large and significant effect size in favor of reducing anxiety symptoms.” (Coventry et al., 2021). The article also concluded that “outdoor nature-based interventions improve mental health outcomes in adult populations in the community, including those with common mental health problems, Serious Mental Illness (SMI), and long-term conditions. Nature-based therapies, such as forest bathing, were consistently effective across all mental health outcomes” (Coventry et al., 2021). Also, recent studies of counsellors, clinical psychologists, and psychotherapists highlight positive experiences of taking therapy outdoors. The evidence suggests that mental health outcomes are at least as effective, if not more effective in certain individuals, than those obtained indoors (Cooley et al., 2020).

Examples of Nature-based Therapeutic Practices:

Shinrin-yoku (Forest Bathing)

  • Immersing oneself in nature using one’s senses
  • There are different bathing approaches: (e.g. breathing, walking, yoga)
  • Shinrin-yoku can be effective in reducing mental health symptoms in the short term, particularly anxiety


  • Connecting to nature through breathing, smelling, and thinking while in a calm and soothing environment

Green exercise

  • Exercising in forests, along paths, hiking, etc 


  • Gardening while talking can be very therapeutic as well as silently a gardening in your thoughts.
[3] Woman Walking Path in Green Countryside

It is key to remember that everyone is different! Individuals differ greatly in their psychological and physical capabilities and interests, for different outdoor activities. Some individuals may not be keen to try any outdoor therapies at all. Some patients and conditions may not respond to any outdoor therapies. For those patients and conditions that do respond, different types and intensities of outdoor therapies may prove more effective for different individuals and mental health conditions (Buckley et al., 2018).

Examples of an Outdoor Therapy Program:

Example of Therapists Who Conduct Therapy Outdoors:


Buckley, R. C., Brough, P., & Westaway, D. (2018). Bringing outdoor therapies into mainstream mental health. Frontiers in Public Health6. 

Cooley, S. J., Jones, C. R., Kurtz, A., & Robertson, N. (2020). ‘into the wild’: A meta-synthesis of talking therapy in natural outdoor spaces. Clinical Psychology Review77, 101841. 

Cooley, S. J., Jones, C. R., Moss, D., & Robertson, N. (2021). Organizational perspectives on outdoor talking therapy: Towards a position of ‘environmental safe uncertainty.’ British Journal of Clinical Psychology61(1), 132–156. 

Coventry, P. A., Brown, J. V. E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. C. L. (2021). Nature-based outdoor activities for mental and Physical Health: Systematic Review and meta-analysis. SSM – Population Health16, 100934. 

Kotera, Y., Richardson, M., & Sheffield, D. (2020). Effects of shinrin-yoku (forest bathing) and nature therapy on mental health: A systematic review and meta-analysis. International Journal of Mental Health and Addiction20(1), 337–361. 

Picton, C., Fernandez, R., Moxham, L., & Patterson, C. F. (2020). Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: A qualitative systematic review. JBI Evidence Synthesis18(9), 1820–1869. 

Photo References:

[1] Gustavo Fring. (2021, April 8). A Man in a Therapy Session. Pexels.

[2] Roman Odintsov. (2021, January 4). Happy Woman Smiling, Spreading Her Arms and Facing the Sky. Pexels.

[3] Mikkel Kvist. (2023, April 4). Woman Walking Path in Green Countryside. Pexels.

First Photo Reference:

Forest Service, USDA. Dylan VanWeelden/Travel Oregon. (2020. May 24). 2 people with face coverings, Oregon. Flickr.

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