Woman with arms raised at the top of mountain.

Ecotherapy: Why Spending Time Outside Is Healing

As the research around the health benefits grows, doctors and psychologists are “prescribing nature” to their patients

If you’ve ever walked through the woods or stared up at the stars and felt a sudden wave of peace come over you, it may not take much to convince you that being outside has benefits for your mental health. But in recent years, as research has begun to back up this theory, a growing number of psychologists have started to incorporate nature-based methods into their practices.

Often referred to as ecotherapy, these methods can involve things like holding counseling sessions outdoors or “prescribing nature” as part of patients’ treatment plans. They can also be simple things like weaving earthy decorations into the office design, or adding plants and table fountains.

When explaining why ecotherapy is thought to work, practitioners often point to a concept called biophilia. The theory argues that humans are genetically hardwired to connect with nature, and when they don’t, it can create stress and imbalance in their lives.

“People have a deep need to be connected with the natural world,” explains Dr. Patricia Hasbach, a clinical psychotherapist and one of the leading experts in the field of ecotherapy. “That’s what we grew out of. That’s what we are still a part of.

When we go out into nature, when we carve out the time to do that, it’s good for us.

“None of us want to roll back the clock and give up our technology, but ecotherapy helps adjust the balance that is missing.”

Dr. Ryan Reese, a licensed professional counselor who runs EcoWellness Counseling and Consulting in Bend, Ore., points out how different our lifestyles are today compared to our ancestors. The dramatic changes, he argues, have caused a disconnect for some people that impacts their nervous systems.

“For many of us, there’s not necessarily an everyday threat,” Reese says. “There’s no ‘I could be eaten today,’ but that’s how our bodies are hardwired. So instead of having these reactions to those experiences, we react to our homework assignments. We react to our job duties, our bosses.

“Our bodies are misinterpreting what’s happening. But they don't know any better—they’re wired to help us survive.”

Even the language we use to discuss the topic is flawed, he notes, since we tend to refer to humans and nature as separate entities.

“We have an evolutionary link to nature,” Reese says. “Yet even as we talk, we’re creating this binary conversation around ‘nature versus humans.’ We say we need to ‘connect with nature.’ But we are nature.”

The duality that people think exists “isn't actually a duality,” Hasbach adds.

“We are nature, and nature is in everything we do. It’s always with us—in every breath that we’re taking. In the water we drink, the food we eat, the environment we’re in.”
Person on a paddle board on a summer day.
As the field of ecotherapy grows, an increasing number of psychologists are “prescribing” time in nature for their patients.

Partnering with nature

Hasbach says she tries to view nature as a partner in her practice, incorporating it into as many areas of her work as she can. Typically, this takes on one of three forms: taking patients outside, bringing nature inside, or assigning nature-based “homework.”

When she takes patients outside, however, it’s not just changing the scenery. She does everything with intention and relies on a number of well-thought-out exercises, often asking patients to focus on their senses.

“We’re not just human from the neck up,” Hasbach explains. “Our whole body is affected by our mental well-being, so heightening the sensory piece is really important. When I go outside with somebody, I might ask them to take some long, slow, deep breaths just to slow down. To take a few moments to breathe and ask them, ‘What do you smell? What do you hear? What does the air feel like on your skin?’

“What happens is that there’s this reconnection with the body—it gets them to be whole bodies again.”
“So often, what we’re all looking for is that sense of belonging. What’s my place in the world? … Across our lifespan, that sense of deep belonging is so important to our sense of well-being.”
~Dr. Patricia Hasbach, Owner of Northwest EcoTherapy
Reese does similar exercises with his patients, noting that being outside helps them figure out how to slow down. This is especially helpful during cognitive behavioral therapy sessions (aka “talk therapy”), where the purpose is to identify one’s irrational thoughts and beliefs in order to deconstruct them.

Slowing down helps patients poke holes in their logic and negative thinking patterns, he says, replacing them with more neutral, and even positive, thoughts.

Another outdoor method Reese practices is a program he created called Fishing for Wellness. It takes people with varying mental health conditions and teaches them to fly-fish, both in individual and group settings. The goal is to improve mindfulness skills and reduce stress levels in their lives.

“Fly-fishing is one of these sports that requires a lot of integration of movement, especially micro-movements, and being very connected with your body,” Reese says. “For individuals who’ve experienced trauma, in particular, folks can be disconnected with their bodies. Fly-fishing forces them to be aware of their body and what’s happening, and also their thoughts.”
Women stretching on a bluff. Close up of Dr. Patricia Hasbach.
Clinical psychotherapist Dr. Patricia Hasbach (right), who runs Northwest Ecotherapy in Eugene, Oregon, says that focusing on their senses often helps her patients reconnect with their bodies.

Intentional indoor spaces

Office design is another way that Reese and Hasbach, along with other ecotherapists, blend nature into their practices. In addition to incorporating nature-based colors and textures, they pay careful attention to what their patients see when they’re sitting across from them.

They point to a famous 1984 study often cited by ecotherapists that found that patients recovering from gallbladder surgery showed better improvement when their windows overlooked natural settings.

For this reason, Hasbach relocated her office a while back to one that overlooks a tree canopy. Her patients now see trees, squirrels, birds, and other aspects of nature during their therapy sessions. She also keeps a basket of natural elements that she’s collected over the years to use for various purposes.

She recalls one woman who’d been struggling with suicidal thoughts after the breakup of a relationship and was having a hard time finding her words. Hasbach handed her the basket and asked if there were any objects inside that described how she was feeling.

“She picked up this ball of natural woven vine and she said: ‘This is it. I feel empty on the inside and the rest of life is a tangled mess.’ That’s what launched her into being able to speak about what was going on.”
Close up of Dr. Ryan Reese. Miscellaneous items on a table top and a hanging sunset picture.
Dr. Ryan Reese, of EcoWellness Counseling and Consulting in Bend, Oregon, says that incorporating elements of nature into office designs is another way that mental health practitioners can bring the outdoors inside for their patients.

Prescribing time outside

Nature prescriptions are another part of Hasbach’s practice. Sometimes this means asking her patients to reflect on a specific problem they’re having in a predetermined outdoor setting.

“I might ask them to take something they’re stuck on to the land, or to the trees, or to the water,” she says.

“But I’m suggesting the part of nature that is potent to them. I’m using the language I’ve heard them use—that they have a relationship with.”

If they talk about rivers, for example, she might ask them to sit by a specific river and reflect or journal. If they’ve mentioned happy memories at the beach, she might send them to the ocean.

What she asks them to do there will usually depend on the patient. Writing can be helpful for some people, while more artistic folks might want too draw or paint. Others may prefer to sit on a park bench and think, or go for a walk.

For patients who are in transitional stages of their lives, she likes to sync these activities with correlating parts of nature such as sunrises and sunsets, or changes in the weather patterns.

A patient who just started a new job, for instance, might get an assignment to watch the sunrise while someone experiencing a death or a divorce might be asked to reflect on the sunset. Among other things, this helps patients see that these transitions are often dualities that can contain both endings and beginnings.

Making it personal

As with any other part of psychotherapy, whether it’s the types of medications they prescribe or the specific treatment plans, nature-based practices must be highly catered to the individual. Hasbach and Reese both emphasize that it doesn’t do any good to take a patient outside just for the sake of being outdoors. In fact, it can be harmful if not done with purpose.

“The first one or two sessions, I meet with folks indoors because I want to get a good sense of their connection to nature,” Reese says, “particularly any adverse nature experiences they’ve had. Some people may have experienced trauma outside, whether an assault, abuse, being attacked by a dog, or whatever. So that’s really important to screen for.”

Hasbach agrees, noting that during her intake session, she asks patients specific questions to better understand their presenting issue, their family of origin, their living situation, and their relationship with the natural world. These items, along with other information discussed, helps inform the type of treatment she pursues.

“It’s important to understand what kind of [issue] they are dealing with. What sparks it? What triggers it? For some people with anxiety, for example, going outdoors would be really challenging, so I’m careful about that. Others with anxiety need to move—in the office, they feel closed in, so going out to do walk-and-talk therapy work is great.”
Woman sitting on rock outcropping over lake.
“Psychology has traditionally only been experienced in our head,” explained Dr. Patricia Hasbach. “But how do we incorporate the heart, the spirit, and the body? How do we give people the tools to be mindful of that deeper connection with the natural world?”

The role of awe

According to some research, another reason that nature may be so powerful is its unique ability to inspire awe. In fact, this theory was the subject of a 2016 science conference at UC Berkeley where researchers discussed the “physical health benefits of feeling awe” and how they might reduce cortisol levels, among other things.

A study that same year found that people who observed nature, art, and beauty may have lower levels of pro-inflammatory cytokines. Another study, published in 2012, discovered that feelings of awe may elevate people’s moods and enhance their sense of well-being.

Reese points to work that he and some other colleagues have done with the EcoWellness conceptual framework. The model is meant to identify the various components that impact a person’s mental health.

“What we’re finding is that the biggest contributing factors within the model appear to be those that have more of these transcendent qualities,” he says.

Practicing at home

These transcendent qualities don’t have to be limited to moments of meditation or sessions with a therapist, Hasbach says. You can practice mindfulness in your own life and increase your sense of awe just by doing the things you love, whether that’s hiking, fishing, camping, kayaking, trail running, skiing, or other outdoor activities.

In addition to the mental health benefits, these habits can lead to a greater sense of purpose too.

“So often, what we’re all looking for is that sense of belonging,” she says. “What’s my place in the world? Whether we’re a young child figuring that out, or we’re older and dealing with the responsibilities that come with adulthood—across our lifespan, that sense of deep belonging is so important to our sense of well-being.

“Psychology has traditionally only been experienced in our head. But how do we incorporate the heart, the spirit, and the body? How do we give people the tools to be mindful of that deeper connection with the natural world? That sense of belonging. That sense of peace and contentment and alliance.

“The idea that nature is always with me. I have this ally beside me.”
Guide to incorporating mindfulness into your outdoor activities.
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