Do We Need Green Therapy?: CBT in Nature

Cognitive Behavior Therapy (CBT) in Nature











If you have been in therapy, chances are it took place in an office located in a hospital, institution, clinic, or a regular office building. What if the therapy could be conducted somewhere else? Where would you choose? On the beach? In a field? In the woods?

Based upon theories of environmental psychology that (1) the human disconnect with nature causes many of our psychological and physical problems and (2) nature itself is a restorative environment—as well as research results demonstrating that merely walking through a forest lowers one’s blood pressure, muscle tension, and cortisol levels and strengthens immunity—a simple study was designed. Its purpose? To see how the results of cognitive-behavioral therapy carried out in a forest environment would compare to results of the same treatment conducted in a hospital setting. The patients were those with major depressive disorder (MDD). And the variables targeted were heart rate variability, cortisol levels (in saliva), and depressive symptoms measured by a rating scale for depression.

You can probably guess how the experiment turned out. The physiological indices for the forest group were more favorable than for the hospital group. And remission rates, based on depressive symptoms, showed incredible differences: 61% for the forest group, 21% for the hospital group, and 5% for the controls (no therapy).

Do the findings mean we should “take to the woods” and streams for psychotherapy? Not only would this measure be extremely impractical “time-wise” for therapists and clients alike with their busy schedules, but also it is generally implausible in terms of finding and obtaining usable outdoor spaces. And then there are other issues, e.g., special liability insurance. What the results do imply, however, is that we should perhaps consider what might be conveniently incorporated into an office environment (plants, fountains, wall paintings or photographs of nature) or into the therapy itself (meditation, yoga, tai chi, exercise) that add some of nature’s soothing and/or uplifting features. Although this was a small experiment with limitations (e.g., lacked comparison to a regular, non-hospital office setting), it should tell us—therapists and clients alike—to keep an open mind regarding what might work to make therapy more effective. What can you think of that might prove comforting to a highly anxious person or recuperative to a depressed individual?

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