What Is Ecotherapy? A Detailed Scientific Guide on the Healing Power of Nature

How do you feel when you walk through the woods, sit on a park bench, listen to birds chirp, spend time at the beach, or watch the sunset? Chances are, you might experience a sense of peace, relaxation, and calm.

There's a good reason these experiences in nature elicit such positive feelings. Science supports what many people have known for centuries: There’s a strong connection between mental health and engagement with our natural world.

And there’s an emerging type of therapy called ecotherapy, or nature therapy, which relies on this principle to help people cope with mental stressors and improve their quality of life. Read on to learn more about the types of ecotherapy, the many health benefits of nature exposure, and what you may want to know if you’re interested in giving outdoor therapy a try.

A Definition of Ecotherapy, or Nature Therapy

“Ecotherapy, also called nature therapy or green therapy, is the practice of being in nature to improve psychological and physiological health,” explains Valerie Smith, a licensed master social worker and certified forest guide in New York state.

“Ecotherapy” is an umbrella term that encompasses nature-based activities and nature therapy programs that aim to improve mental and overall health.

It’s important to note there’s a difference between ecotherapy and simply spending time in nature (though of course you can still get a mental health boost from the latter).

Patricia Hasbach, PhD, an Oregon-based licensed professional counselor and clinical psychotherapist with expertise in ecopsychology, says nature therapy involves:

• A trained professional, such as a therapist, counselor, or guide
• A connection with the natural world

“Taking a walk in nature, going outside to play with your dog, or sitting by the river can be very therapeutic and beneficial,” she says. “But I’d call that a therapeutic or wonderful nature experience. I wouldn't call it ecotherapy.”

Ecotherapy is an emerging field with a growing body of research backing its many potential health benefits, according to the American Psychological Association (APA).

But the concept of nature as a healer has been around for millennia. In India, the ancient and traditional medical system of ayurveda relies on “natural” or nature-based approaches (such as local, seasonal foods) for physical and mental ailments, notes the National Center for Complementary and Integrative Health (NCCIH).

Similarly, traditional Chinese medicine is based on the belief that humans are interconnected to nature and are profoundly affected by its forces, per Johns Hopkins.

Researchers began studying the impacts of nature on human health in the 1970s, when studies showed that scenes of nature were associated with positive feelings of friendliness, affection, and joy, according to a research review published in Frontiers in Psychology in 2018. Since then, study after study has found similar benefits of nature on mental health.

The principles of ecotherapy are rather simple. “It’s essentially incorporating nature into some kind of mental health or therapeutic practice,” says Derrick Sebree Jr., PsyD, a clinical psychologist who specializes in ecopsychology and multicultural identity counseling at the Michigan School of Psychology in Farmington Hills, Michigan.

One way to engage in ecotherapy is to meet with a therapist outdoors, rather than have a session in the office. This might be at a local park, in a wooded area, or by a body of water. Dr. Hasbach says sometimes she takes mindful walks with her patients, while other times she finds a quiet spot to sit and talk.

Ecotherapy can also be practiced in an office setting by observing nature through a window, bringing nature, such as plants, inside, and using metaphors or visualization techniques.

Nature therapy also includes modalities like animal-assisted therapy, wilderness experiences, forest bathing, and horticulture therapy, among others.

There currently isn’t an accrediting body for ecotherapists that offers a nature therapy certification. Some organizations, such as the Association of Nature and Forest Therapy, offer certification for specific modalities, such as forest therapy.

Ecotherapy can take a number of different forms, from mindful gardening to walking or sitting in lush green spaces to spending time with animals.

Here’s a closer look at some different types of nature therapy.

Horticultural Therapy

Horticultural therapy usually involves some form of gardening, but can also include caring for, watering, or simply spending time with plants indoors.

Forest Therapy

Forest therapy is based on the Japanese art of shinrin-yoku, meaning forest bathing. According to the International Nature and Forest Therapy Alliance (INFTA), it’s a research-supported practice of guided immersions in forests to promote mental and physical health while you relax and enjoy the forest. Possible forest bathing benefits include improved relaxation, reduced stress, and increased physical activity, per the Cleveland Clinic.

Wilderness Therapy

Wilderness therapy involves immersing oneself in nature by camping and hiking in the wilderness while taking part in survival-skills trainings and exercises.

“Through a therapist, people doing wilderness therapy have [the opportunity] to confront their maladaptive behaviors through primitive-skills training and team-building exercises in risky [but supervised by the therapist] outdoor environments,” Smith explains. “This can help build self-confidence, overcome negative beliefs, improve communication skills, and gain trust.”

This type of therapy is often aimed at teenagers or young adults dealing with difficult situations, Dr. Sebree notes.

Animal-Assisted Therapy

Animal-assisted therapy involves spending time with an animal or animals. This can be done outside in a farm setting or inside with therapy pets like dogs. Equine-assisted therapy brings horses into the therapeutic process.

A session can involve petting, feeding, or grooming animals under the supervision of a professional therapist.

Green Exercise

Green exercise simply means partaking in physical activity while exposing yourself to nature. This may include any kind of exercise in nature, including gardening, walking, cycling, running, or horse riding, to name a few. While green exercise is not necessarily supervised by a therapist or medical professional, and therefore may not be ecotherapy, per se, it may offer therapeutic benefits or experiences, and can happen at home or on a wellness trip.

Ecotherapy (and other forms of nature interactions) have been tied to a number of possible health benefits in hundreds of scientific studies for various physical and mental illnesses, per a research review published in August 2018 in Frontiers in Psychology. These may range from improved mental health to physical benefits like pain management. Here are a handful of ways getting outside (in a therapeutic environment or otherwise) may be worth it.

May Boost Your Mood and Relieve Stress

Numerous studies have examined the effects of nature on mental health. According to a research review published in July 2019 in Science Advances, the possible psychological benefits of being in nature include positive attitudes, emotions, and feelings. Essentially, interacting with nature may put you in a better mood and reduce stress. Here are a few more potential perks, according to science.

May Ease Depression and Anxiety

Since engaging with nature often leads to a lifted mood, it may be no surprise that ecotherapy has been linked to a reduction in symptoms of depression and anxiety.

Some research has shown that access to green and blue spaces (being around water, such as lakes, rivers, or the ocean) is associated with a lower risk of anxiety and mood disorders, as well as higher instances of self-reported good mental and overall health.

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May Help Post-Traumatic Stress Disorder (PTSD) Symptoms

Several forms of ecotherapy, including wilderness therapy, adventure therapy, and green-space-based therapy, have been shown to be effective for veterans living with PTSD.

One small study published in September 2021 in BMJ Open looked at the effects of hiking in nature on 26 veterans with PTSD in the Pacific Northwest. Over the course of 12 weeks, half of the participants went on six nature hikes, while the other group participated in six urban hikes. At the end of this period, those who partook in the nature hikes reported more improvement in PTSD symptoms than those who went on the urban hikes.

For many veterans, being immersed in nature has a calming effect, helping them manage negative emotions. It may allow them to see past their traumatic military experiences and injuries to a greater purpose for themselves.

May Enhance Well-Being and Quality of Life

For many people, being outside simply helps them feel good, and some research has shown that engagement with our natural environment has been linked to improved well-being and greater life satisfaction.

May Improve Management of ADHD

Regular exposure to nature and green outdoor activities has been linked to a reduction in ADHD symptoms in children, according to research. This benefit has been found among both boys and girls from all income groups.

Pain Relief

Exposure to nature or nature images has been linked with reduced pain and pain perception in people undergoing medical procedures and during recovery.

A study of 61 individuals with chronic pain found that those in the experimental group who completed a two-day forest therapy program reported significant decreases in pain and depression, compared with a control group that didn’t participate in the forest program.

While ecotherapy is generally considered safe, there are some things to consider before you try nature-based therapy.

Before your first ecotherapy session, your therapist will review with you what to expect and any safety precautions you should take.

“Any responsible ecotherapist has a waiver that explains potential health risks, such as falls or outdoor allergies,” Smith says. “These waivers must be signed first and should be reviewed before the activity happens.”

When it comes to possible side effects, experts say it’s important to keep in mind that in nature-based environments, you’ll be in a less controlled setting than in an office.

“When you have encounters with nature directly, there is an element of unpredictability,” Sebree says. “So you just have to be aware that there may always be some risks.”

While your therapist will work to minimize risks, these may include:

• Bee stings
• Insect bites
• Contact with poisonous plants
• Sunburn
• Falls
• Seasonal allergies

Before heading outdoors for therapy in nature consider the following advice, from Hasbach.

• Have a conversation with your therapist that sets expectations for where in nature you’ll be and how long you’ll be outside.
• Dress for the weather and wear appropriate, comfortable footwear.
• Wear sunscreen.
• Protect yourself from ticks and insects by wearing long clothing and insect repellent if you will be in a grassy or wooded area.
• Pack water and stay hydrated.

For immersive forms of ecotherapy, like wilderness therapy, you may need to take more precautions. Your therapist and instructor should let you know ahead of time what to bring and what will be provided for the duration of your session or program.

Ecotherapy is generally considered safe for most people. Still, it may not be right for everyone and there are a few things to consider before trying ecotherapy.

Who Ecotherapy / Nature Therapy Is For

Connie L. Habash, a licensed marriage and family therapist who practices ecotherapy in Menlo Park, California, says most people can benefit from nature therapy.

“Certainly, anyone who is naturally drawn to the outdoors would probably resonate with ecotherapy, but it is also especially helpful for people experiencing high stress and burnout,” she says. “In our technological age, we’re often on our devices all day long, and suffer from a sense of disconnection and agitation that being in natural spaces can greatly transform.”

People with depression or anxiety may want to consider ecotherapy to help ease their symptoms. Veterans or anyone with PTSD, as well as children with ADHD, may also benefit from nature therapy.

Ecotherapy may also be used as a complementary therapy approach along with more traditional in-office psychological and trauma therapy.

Who Should Avoid Ecotherapy and Nature Therapy

Of course, not everyone is comfortable being in nature, and that is certainly something to think about when considering the different types of ecotherapy and whether it’s right for you.

“If we think of ecotherapy as a gradient of how much direct, intensive interaction you have with nature, obviously wilderness therapy will be on the stronger side of that gradient,” Sebree says. “That’s very different from a walk or a therapy session in a local park.”

It’s a good idea to research the different types of ecotherapy and consider what you may be comfortable with, and then search for a qualified therapist in that type of approach. Once you find a therapist, be sure to discuss your medical history with them before your first session, so they can adapt the program to fit your needs.

For example, people who have had traumatic experiences in nature may also want to proceed with caution, Hasbach says. “If someone had a traumatic experience in a wooded area, that’s not the type of location I would choose to bring them,” she says.

But if someone feels ready to heal a fear or past trauma outdoors, working with an ecotherapist might help. “That’s a discussion to have together [as patient and therapist] and mindfully consider,” Habash says.

Ecotherapy may not be the best option for people with severe mental illness experiencing delusions or hallucinations. “I would be cautious about taking a client who has active psychosis,” Habash says. “You would want to have an ecotherapist very experienced in those kinds of mental disorders, and it may not be appropriate.”

Finally, if someone has privacy concerns about receiving therapy, ecotherapy might not be the best option if you might encounter someone you know outside during a session.

“This is a conversation I have with my clients in the office before we bring the practice outside,” Hasbach says. “I ask them what they want to do if we run into somebody that they know or that I know. We talk about that and come to a decision and I document that in the client chart.”

Nature therapy will look different depending on which type of approach you’re engaging with and where you’re physically located. Nature therapy can take place in parks, in a forest, in the mountains, on the beach, in the wilderness, on a farm, or just about any place in nature you can imagine. It can also be experienced inside while looking through a window or bringing elements of nature like plants or animals inside.

While each session may be different, here’s what you can expect, in general, before, during, and after ecotherapy.

Before

Before engaging with nature therapy, your therapist will discuss what you hope to achieve, whether that’s to calm stress or anxiety or to gain insight into a relationship or challenge in your life, Habash says.

“They will probably also explore with you any past experiences you have had in nature, how you feel about the outdoors, how comfortable you are outside, and any past traumas that may have occurred in the outdoors,” she notes.

Your therapist will prepare you for any safety concerns, like critters or plants to watch out for, and what you will need to bring with you, like a water bottle. You’ll also discuss privacy and what you would like to do should you encounter anyone you know during an outdoor session.

During

At the start of the session, your ecotherapist may begin with some mindful breathing and ask you to pay attention to your senses. This may offer a sense of grounding so you can begin to connect with nature.

“I ask people to notice what they’re hearing, the sound of the wind or the birds chirping or what visuals draw them in,” Hasbach says. “Maybe it’s the trees or some flowers or a squirrel nearby. It's a way of bringing the whole body into the therapeutic process.”

The rest of the session will look different depending on the type of ecotherapy you’re engaging with. In any scenario, you will have support and guidance from your therapist.

“Sessions may take place in just one spot, sitting still, breathing, and receiving what comes, or can involve more hiking and exploration,” Habash says. “You may be encouraged to move your body in spontaneous and novel ways.”

Ecotherapy can also be helpful if you appreciate symbolism and metaphor. “Nature provides ample reflections of our personal processes and relationships,” Habash says.

Remember, you always have the choice of how much or how little you wish to engage with nature during an ecotherapy session.

After

After a nature therapy session, you’ll take some time to reflect and process the experience.

“With your therapist, you can process any emotions that may have arisen,” Habash explains.

Your therapist may also write you “nature prescriptions,” or instructions to spend time in nature on your own.

“We find that people really follow through when you hand them a piece of paper that says go outdoors, find a favorite spot in your yard or in a park,” Hasbach says. “Nature prescriptions can be a vital part of ecotherapy.”

The cost of nature therapy varies depending on type and therapist. Note that the expertise of practitioners will vary depending what region of the country you’re in.

For therapy sessions that are brought outdoors, Habash notes the cost is typically the same as an in-office session.

“Some insurance may cover it — that can be discussed with your ecotherapist and how they bill insurance,” she says.

If you’re concerned about the cost of ecotherapy, Habash advises asking your therapist if they have a sliding scale or if they have a referral for a newly graduated ecotherapist for a lower fee.

Favorite Orgs for Essential Info on Ecotherapy

American Psychological Association (APA)

The APA is an excellent source for all things mental health and if you want to learn more about psychotherapy in general. The organization also provides tons of information on nature therapy, as well as a deep dive into the scientific research on its possible health benefits.

Association of Nature and Forest Therapy

The Association of Nature and Forest Therapy is a global leader in the development and practice of forest therapy. Check out their website to learn more about the science behind forest therapy, recommended books to dive deeper into the practice, and a library of resources on forest therapy from magazine articles to podcasts.

American Horticultural Therapy Association

The American Horticultural Therapy Association is a nonprofit organization focused on promoting the practice of utilizing plants and gardening activities to improve mental and physical health. The organization publishes a digital magazine with relevant articles on horticultural therapy, holds an annual conference on topics of interest in the field, and sends a monthly newsletter.

Favorite Blogs About Nature Therapy

Nature Connection Guide

This organization offers forest bathing walks in Vermont, as well as guided online programs. Its site also has a blog dedicated to all things forest bathing. We love the practical advice it offers, from what to wear while forest bathing in the winter to simple practices to try if you’re feeling a bit disconnected from nature. There’s also tons of helpful information if you’re interested in becoming a forest therapy guide.

Healing Hooves

The blog of this Canadian-based equine and animal-assisted therapy program is filled with useful information about getting started with equine therapy, the healing power of animals, and sweet stories of lessons learned from working with the farm’s animals.

Garden Therapy

Stephanie Rose has a passion for gardening and she wants to share it with everyone. In her blog, she shares how transforming her backyard to a vegetable garden helped her cope with years of chronic pain. She offers many practical tips in her posts, from a guide to watering houseplants, the cheapest vegetables to grow at home, and how to get rid of pests in the garden.

Favorite Apps

NatureDose

The NatureDose app tracks the amount of time you spend outdoors so you can compare your nature exposure day by day and week to week. You can set a weekly goal and get helpful tips and suggestions to optimize your time outside. NatureDose is free on the Apple App store and Google Play.

Roots: Connect With Nature

The Roots app provides walking meditations meant to be done outdoors so you can reap the benefits of both nature and mindfulness. These guided meditations can be done in backyards, neighborhoods, hiking trails, beaches, or forests in the rain or shine. When you’re unable to get outside, enjoy immersive soundscapes and bring the sounds of nature to your home or office. Roots is free on the Apple App store with options for in-app purchase.

Favorite Retreat

True North Counseling

True North, based in Traverse City, Michigan, offers adventure-based counseling retreats for people of all ages. The retreat programs combine therapeutic techniques with challenging experiences in an outdoor environment that engage the participants' ability to connect with nature, each other, and themselves. These adventure retreats take place throughout the country from the mountains of Wyoming to the Alaskan wilderness.