Ecotherapy (Nature Therapy): How It Works, Activities, & What to Expect

What Is Ecotherapy?

Ecotherapy (also known as nature therapy or green therapy) involves intentional therapeutic interventions and activities in nature led by licensed psychotherapists.¹ The American Psychological Association describes it as the integration of outdoor activities into mental health counseling.² It’s about connecting people with the outdoors, often incorporating mindfulness, in order to promote healing and mental health.³

Ecotherapy vs. Just Being Outdoors

Being in nature, whether actively engaging in ecotherapy or simply spending time outside, offers many mental health benefits. The difference between nature therapy and simply being outdoors is akin to the difference between working with a mental health therapist and talking to a friend. Like any type of therapy, ecotherapy is more formal than just being outdoors. It’s structured and involves targeted interventions done to achieve a specific goal.

Who Can Benefit from Ecotherapy?

“All people can participate in ecotherapy but an ecotherapist must screen clients. Not all people have positive relationships with the natural world or feel safe in nature. It is important to be intentional about why and how you are incorporating nature into your practice and be clear with your clients about those intentions. Equine assisted therapy, for example, is very effective with veterans of all abilities and can be adapted for wheelchairs. Just sitting in a natural space, in as little as 5 minutes, reaps rewards.” – Megan Delaney, PhD, LPC professor in the Professional Counseling Department at Monmouth University

Why Is Nature Therapeutic?

“As of now I have never seen a study that didn’t show a measurable, robust positive effect of human contact with any aspect of the rest of nature, including pictures of nature on a wall! People have wondered why this is so, but it seems obvious to me. We are human primates that evolved over millennia with daily immersion in nature. Fairly recently, in evolutionary terms, we started to live in a more nature-deprived way (what author Richard Louv calls “nature deficit disorder”) so perhaps we’ve been like the frogs not noticing that the water they live in is heating up to boiling. And when we return humans or other animals to their natural evolutionary habitat conditions, physical and mental health improve dramatically, which shouldn’t surprise us.” – Linda Buzzell, MA, LMFT, Adjunct Faculty at Pacifica Graduate Institute and facilitator of the Canadian Ecopsychology Network

How Does Nature Therapy Work?

Ecotherapy, nature therapy, and green therapy are broad terms referring to any type of purposeful activity involving the natural world. While different in their approach, all types of nature therapy work by getting people actively in touch with nature. The focus is on the outdoor encounter and the activity rather than on problems and challenges.¹ Perhaps ironically, when focusing on the experience of nature rather than on themselves and their difficulties, people actually increase their awareness of themselves, others, and their surroundings.⁶

Nature therapy can serve as a stand-alone therapy or be combined with other, more traditional, types of mental health therapy such as cognitive-behavioral therapy (CBT).^1,3,6 When doing dedicated nature-based therapy, people are actively involved in nature, whether that is completing a project, moving their bodies mindfully outdoors, or sitting in stillness appreciating beauty.

When ecotherapy is included in traditional talk therapy, the therapist may:

• Incorporate natural indoor elements (such as plants, aquariums, or fountains), making them prominent features of the office
• Hold sessions in an outdoor space if the client is comfortable doing so
• Include walking or tending to a garden as part of the sessions

What Can Nature Help With?

Engaging in nature has numerous mental health benefits and can reduce stress and induce inner calm, improve mood, generate positive emotions and thoughts, create a sense of life balance, foster empathy and a sense of connection, increase attention span and concentration, and boost feelings of contentment and well-being.

Nature therapy has been demonstrated in studies to help with mental health conditions and experiences such as:^3,4,8,9

• Anger
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Depression
• Fatigue
• Memory
• Mood (general)
• Mood disorders
• Post-traumatic stress disorder (PTSD)
• Self-esteem
• Stress
• Substance use and addiction
• Climate anxiety or other existential related anxieties

Rather than focusing on problems and symptoms, ecotherapy actively connects people with nature. This has been shown to facilitate brain waves similar to those seen in meditative states and boost the production of serotonin and other feel-good neurochemicals.³ Nature therapy done in groups also fosters social connection and reduces loneliness and isolation, as well as connect people back to nature if they’re experiencing eco-anxiety.⁶

Who Might Want to Avoid Nature Therapy?

While nature therapy may sound enticing to many, it is certainly not for everyone. Not everyone has a positive relationship with nature, and some people with nature-related phobias may not want to begin their healing journey with eco-therapy. It is also important to consider the physical demands of engaging in nature therapy. While mobility isn’t required to spend time in nature, many eco-therapy activities do involve physically strenuous movement, so consult with your doctor and eco-therapist before beginning treatment if you have any medical conditions. Severe allergies or photosensitivity are also things to discuss with a medical provider before engaging in nature therapy treatment.

Ecotherapy Activities

Ecotherapy and nature therapy are general terms for mental health therapy involving elements of the outdoors and/or structured activities in nature.

Here are 10 popular types of ecotherapy or nature therapy activities you might encounter:

1. Nature Meditation

Meditation is the practice of focusing attention on something (breath, sight, sound, smell, texture, bodily sensation, word or phrase, etc.) in order to turn your concentration away from negative thoughts and emotions. Nature meditation involves meditating outdoors among elements like plants, trees, grass, or water. Whether it involves sitting or lying in stillness or moving activities like walking or yoga, it more easily allows people to tune in to their senses.¹³

As with any other type of meditation, nature meditation can be done alone or as part of a group and led by a teacher. Sometimes, when people can’t get outside, meditation with a soundtrack offering nature sounds can substitute for an actual outdoor experience. Many meditation apps offer this feature.

2. Horticultural Therapy

Also called garden therapy, this type of ecotherapy involves dedicated time spent working in gardens. People cultivate and care for flowers, fruits, vegetables, and herbs, remove weeds, and add aesthetic elements to a garden area. Done individually or as part of a structured group therapy program, horticultural therapy has been shown to lower symptoms of depression and stress as well as decrease loneliness and isolation for all ages (when done in groups) and improve behavioral and attention problems in children.^3,4

3. Animal-Assisted Therapy

As its name implies, animal-assisted therapy involves animals in the process of healing. It can be a structured group program involving caring for animals on a farm or ranch or it can be incorporated into individual therapy and someone’s treatment plan. Perhaps they care for a pet or have a therapy animal with them at all times for emotional support.¹⁴ This type of nature therapy is helpful for people with autism, depression, schizophrenia, and substance use disorders.¹⁴

4. Nature Conservation

This type of therapy involves participation in conservation projects like:

• Caring for endangered animals
• Cultivating wildlife gardens
• Planting grasses, flowers, shrubs, and trees
• Litter clean-up and restoration projects

In caring for nature, participants also care for their own mental health and well-being, reducing stress and fostering a sense of purpose and meaning. Conservation programs are particularly useful for decreasing loneliness and isolation as they are typically done in structured groups.¹⁵

5. Exercise in a Natural Environment or “Green Exercise”

Also known as green exercise or blue exercise, this involves any type of exercise done outdoors. Green exercise refers to exercising in green spaces like parks or trails through woodlands, mountains, or prairies, while blue exercise refers to activities done in or near any type of water.^16,17 Done individually or in groups and involving structured programs or a stroll with a therapist, outdoor exercise of any duration or type has been found to relax and energize, boost overall well-being, and reduce symptoms of stress and mental health disorders like depression.^3,4

6. Forest Bathing

A tradition known as Shinrin-Yoku in Japan and China, forest bathing has become a form of nature therapy that involves immersing yourself in nature mindfully, experiencing it with all your senses.¹⁸ Similar to nature meditation, forest bathing involves concentrating on the experience of being in the forest rather than simply walking through the forest (or elsewhere in nature) while talking or engaging in simultaneous activities (like conservation or adventure). A review of 127 academic papers published between 2007 and 2017 found that forest bathing reduces heart rate and blood pressure, induces relaxation and feelings of calm, increases feelings of safety and connectedness, and decreases symptoms of depression.¹⁸

7. Wilderness & Adventure-Based Therapy

Structured wilderness therapy and adventure therapy programs are typically offered as treatment programs and camps. While not exclusively for adolescents, many programs exist to serve teens and young adults dealing with a wide variety of challenges, including adjustment disorders, emotional and behavioral difficulties, addiction, anxiety, depression, mood disorders, anger issues, family issues, and difficulty with social- or coping skills.^3,19 Such programs often incorporate conservation work as well as outdoor adventure activities like whitewater rafting, mountain biking, and other such rigorous activities.

8. Therapeutic Farming

In therapeutic farming, clients participate in working on a farm in order to receive the benefits of physical work in connection with nature and animals. The term “multifunctional agriculture” was coined at the 1992 UN Conference on the environment and development in Rio de Janeiro. Multifunctional agriculture refers to the additional benefits of farming beyond production, including therapeutic benefits.²³

9. “Park Prescriptions”

Park prescriptions have been utilized in recent years by both health and mental health practitioners to encourage patients to reap the many health benefits of spending more time outdoors. A park prescription is a written recommendation to spend time outside in nature, usually for a prescribed amount of time.²⁴

10. Nature Arts & Crafts

Nature arts and crafts involves the therapeutic use of writing, painting, journaling, photography, and craft project creation using natural materials.⁴ With the intention of mental health improvement, this type of ecotherapy is often incorporated into traditional talk therapy or in-patient settings, assigned as homework, in-session activity, or both.

Potential Benefits of Nature Therapy

Studies show that there are many benefits to spending time in nature. Here are a few proven benefits of nature therapy:^25,26,27,28

• Improved attention
• Psychological and social well being
• Mindfulness
• Reduced stress
• Decrease in aggressive behavior for children who spend time around animals
• Coping skills
• Self-efficacy
• Increase motivation to exercise

Ecotherapy Safety Risks & Limitations

The safety risks involved in nature therapy vary greatly depending on the activity. While things like sun exposure and insect bites are a common inconvenience of spending time outdoors and are easily mitigated through protective clothing, more physically-demanding activities may come with some risk. Ensure that you are physically capable of safely engaging in nature-based activities before beginning, and discuss any risks specific to the activity with your therapist beforehand. Wear proper clothing and shoes, and educate yourself on your surroundings.

It is also important to note that animals can be unpredictable, and though therapy animals are thoroughly screened and trained to do their job well, it is important to work with a therapist who is also prepared to maintain safety in a client’s work with therapy animals. Your therapist will guide you in interacting with the animals safely and respectfully.

Is Ecotherapy Effective?

Many studies have examined the effectiveness of ecotherapy, and the evidence is overwhelmingly positive.⁹

Here are several highlights regarding the efficacy of ecotherapy:

• In 2017, the Journal of Public Mental Health examined existing scientific papers investigating the effect of nature therapy on veterans with PTSD. Across the studies, a variety of nature-based interventions were used and all showed ecotherapy as effective in reducing PTSD symptoms, fostering hope, and increasing the quality of life of veterans. No negative impacts of ecotherapy were reported in any of the studies analyzed.¹⁰
• In 2018, a study in Frontiers in Psychology showed support for the effectiveness of various types of nature therapy for veterans living with PTSD. Outdoor adventure therapy, wilderness therapy, green space-based therapy, and simple outdoor experiences were all found to calm emotions, improve positive management of symptoms, foster a sense of meaning and purpose, and build strengths.³
• Scientific evidence has shown a possible association between exposure to nature and onset of ADHD, and several studies support these findings. Ecotherapy shows promising results for children, teens, and adults with ADHD.^3,21,22
• In a meta-analysis of 31 randomized studies, almost all showed support for attention restoration theory (the idea that the ability to concentrate can be boosted or restored with exposure to natural environments).⁵
• Nature therapy in the form of gardening improved the mental health of inpatients in a psychiatric hospital according to a 2018 study in the journal Archives of Psychiatric Nursing. Patients tending to hospital gardens as part of an ecotherapy intervention experienced greater calm, improved mood, a sense of belonging and community, and a distraction from negative thoughts and emotions.¹¹
• An analysis of 10 studies in the UK involving 1,252 participants explored the effectiveness of nature therapy in the form of green and blue exercise. Exercising outdoors improved participants’ self-esteem and mood. Surprisingly, short durations of exercise yielded the greatest benefits, with only five minutes of exercising in nature boosting mental health and well-being.¹²

Criticisms of Ecotherapy

While ecotherapy is research-backed, well-received, and widely accepted as a legitimate approach to mental health treatment, it isn’t free of skepticism.

Some common criticisms of ecotherapy include:⁴

• Many studies are flawed because it is difficult to design standardized blind, randomly controlled clinical trials of nature therapy.
• More research is needed into exactly how and to what degree ecotherapy helps specific mental disorders.
• Green therapy isn’t appropriate for everyone, as some people have physical or mental health limitations (such as phobias) that make outdoor therapy prohibitive.
• Weather conditions may be disruptive and interfere in certain types of ecotherapy.

Delaney states, “It is important to note that nature is still wild and must be respected and treated with deference. As with all relationships, one must know their own strengths and limitations and be as prepared as possible for the unknown. In addition to the unpredictable aspect of nature, a counselor must have conversations about specific medical conditions that may be triggered and carry necessary items (for example, a simple first aid kit, cell phone, emergency contact information and water). An ecotherapist MUST know where they are going and be very familiar with the area. Furthermore, all therapists and clients should talk about possible limitations of confidentiality.”

How to Find an Ecotherapist

While dedicated ecotherapists are relatively rare, a growing number of therapists specialize in ecotherapy, and some universities are beginning to offer dedicated programs. As such, it is gradually becoming easier to find an ecotherapist. Typically, therapists who use nature therapy specify on their websites, brochures, and online therapist directories. When you are choosing a therapist, call a therapist’s office to learn more information and ask if they use ecotherapy.

Finding wilderness therapy programs is a bit more straightforward than locating a therapist who uses ecotherapy. You can find dedicated nature programs at The Association of Nature & Forest Therapy. Also, there are more than 100 official Outdoor Behavioral Healthcare programs in the U.S. offering wilderness therapy for adolescents.

How Much Does Ecotherapy Cost?

When a therapist uses ecotherapy, it is typically covered as part of their rate. The cost of therapy varies per region of the country, setting (a public health center versus a private office, for example), and the education and credentials of the therapist. The average cost ranges from $100 to $200 per session. Some therapists offer sliding fee scales, meaning the fee is determined by the client’s income.

Wilderness therapy programs carry an average cost of $558 per day with an average enrollment fee of $3194.²⁰ Some components of wilderness programs may be covered by some insurance companies. Your own insurance company will be able to tell you what your policy covers.

Does Insurance Cover Ecotherapy?

Sometimes insurance covers therapy, but each insurance company differs in what they do and do not cover. Usually, insurance will cover approved treatment approaches for specific mental health diagnoses made by a doctor. Despite positive research behind it, because ecotherapy is so new, it often isn’t covered by insurance as a stand-alone therapy; however, when a therapist integrates it into another treatment, such as CBT, it’s often included by default.

What to Expect at Your First Ecotherapy Session

If your therapist incorporates ecotherapy into other treatment approaches, your first therapy session may not dive right into outdoor experiences. Instead, you’ll likely talk with your therapist and explain what brought you in. Your therapist will get to know you and begin to develop an understanding of your unique personality, challenges, and goals before creating interventions that include outdoor activities.

In more structured, group ecotherapy programs, you’ll dive right into the activity after initial introductions are made and instructions are provided. These focus on nature and the activity rather than personal difficulties, so your nature experience will begin immediately. Healing and growth happen naturally as you engage with nature.

Techniques & Practices From Ecotherapy You Can Try Yourself

Ecotherapy is a formal approach to mental health that is structured and done with a mental health professional; however, being in nature in any way (formally or informally, structured or unstructured, individually or in groups) has mental health benefits. As long as you’re safe and do activities that align with your physical abilities, there is no right or wrong way to experience nature.

Here is a partial list of ecotherapy techniques and practices you can try on your own:

• Make a commitment to do something small outside every day
• Sit outside and enjoy the scenery
• When you’re outdoors, experience it mindfully rather than rushing, lost in thought, from point A to point B
• Walk outside or hike locally
• Ride a bike
• Make or buy a bird feeder and hang it outside a prominent window
• Decorate your home with plants, flowers, fountains, and even pictures of nature
• Step outside to take slow, deep breaths and pause to appreciate the beauty around you
• Start a garden in your yard or in a community garden area
• Volunteer at your local humane society
• Volunteer for local park projects
• Gather some friends or neighbors for a clean-up/litter pick-up day
• Attend local outdoor festivals
• Join a local walking, biking, or hiking group (check your local newspaper, community center, or online services like MeetUp to find them)
• Try some “dark nature” activities, like star gazing or taking a night walk

Final Thoughts on Ecotherapy

The challenges you are facing are personal and unique to you, but you are not alone. If you are dealing with stress, anxiety, depression, or any other mental health diagnosis or challenge that prevents you from living the life you desire and deserve, talking to a therapist who uses ecotherapy or participates in a nature therapy program can make a positive difference.