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(An interview with Dr. Paul Deal, Nationally Certified Counselor, Co-Chair of the Counseling and Clinical Services Department, and Associate Professor of Clinical Mental Health Counseling at SUNY Plattsburgh—and two of his students—provided background to This column. Among the students were Raneem Kurzum, who is working on his doctorate in counseling psychology at the University of Albany, and Taylor Scott, who just completed his master’s degree in August 2022. Dr. Deal provided a number of research studies to review. “Recovering with Nature: A Review of Ecotherapy and Implications for the COVID-19 Pandemic”, by Chaudhury, et al.)

Living in the north of the country brings the beautiful atmosphere of lakes and mountains into our daily life. If there seems to be something sacred in nature, it could be linked to historical Indian philosophy and the belief that man and nature are not radically separate entities. Indian philosophy considers man as an integral part of nature and believes that there is a bilateral nurturing existence between nature and man.

Western culture, however, has been infiltrated by globalization and urbanization, and technology has eviscerated this sacred relationship. This has led to a decrease in exposure to nature and an increase in the global prevalence of mental illness. Unlike Indian philosophy, which emphasized moderation in the use of ecological resources, Western philosophy views nature as a commodity and as something to be consumed for human needs. In this anthropocentrism, man is considered the most important aspect of nature, even more important than animals or the existence of God. Natural resources are consumed and no longer provide a sacred and mutually beneficial relationship. Instead, man and nature are seen as separate entities, with humans having complete power to exploit and use these resources for personal and collective gain.

Ecotherapy is a type of psychotherapy that integrates nature into clinical treatment. Ecological interventions for mental health include animal-assisted interventions, wilderness therapy, environmental conservation, and green exercise. These treatments are useful for treating depression, ADHD, adjustment disorders, and PTSD. Integrating with nature also has benefits for medical issues. These include post-surgical recovery, obesity and hypertension.

Important questions to ask about eco-therapy include the role that ecology plays if structured into interventions to treat mental illness, and how this therapy can improve psychological health during the current pandemic.

As James Hillman notes: “Psychology, so devoted to awakening human consciousness, must awaken to one of the oldest human truths: we cannot be studied or cured off-planet.”

Eco-psychology and eco-therapy propose a holistic relationship between man and nature. These are usually therapeutic interventions related to animals, plants and nature. Eco-therapy, however, incorporates meaningful and healthy interactions with the earth and helps humans establish a reciprocal relationship with nature. It serves as an umbrella word for green care and includes therapeutic activities that incorporate animals, plants and nature.

Theoretical models of eco-therapy include the biophilia hypothesis, stress reduction theory (SRT), attention restoration therapy (ART), and the existential positive psychology perspective.

Biophilia implies that human flourishing, and even identity, depends on a human relationship with nature. It refers to an emotional and deep connection between people and the unnatural world. The term biophilia refers to a love of life, and some philosophers note that this is actually the essence of humanitarian ethics and of humanity as a whole. This instinct and attachment to the non-human world is integral to emotion, cognition, and even art, and relates consciously and unconsciously to experiences in early childhood and beyond.

Stress reduction theory (SRT) proposes that natural environments trump man-made environments in the restorative value they provide. According to this theory, connection to nature dampens the flight and fight response of what is known as the sympathetic nervous system and improves the neurophysiology of the parasympathetic system, helping to diminish the effect of emotionally charged signals. Ulrich, et al., note that there is an increase in feelings of joy, playfulness, and affection when viewing natural scenes. On the other hand, looking at urban scenes can produce anger and sadness.

Serotonin production increases when unstressed adults see images of natural landscapes. Inhibition of serotonin reuptake and increased serotonin concentration in the prefrontal cortex and limbic system are the purported mechanisms of action of antidepressants such as Zoloft, Prozac, Celexa and Lexapro. The prefrontal cortex modulates cognition and attention and inhibits impulsivity. The limbic system is the seat of emotions, behaviors and the flight or fight response. Viewing natural landscapes has also been shown to improve surgical recovery times with windows and nature compared to viewing urban scenes such as walls or concrete.

The restorative theory of attention (ART) states that conscious and voluntary concentration is required to differentiate relevant exogenous stimuli from irrelevant exogenous stimuli. As this is a voluntary process, cognitive resources can be more easily depleted. This results in a decrease in the ability to concentrate and pay attention. In nature, however, there is an involuntary process of bonding with nature, replenishing cognitive resources, and restoring cognitive and attentional abilities, and potentially capable of improving measures of memory and attentional strength.

The eco-existential positive psychology perspective supports the hypothesis that embracing the innate biophilic tendencies that all humans have can enhance well-being. It achieves this by helping people deal with the existential anxieties that can arise with loneliness, isolation, boredom and alienation. Writer Leo Tolstoy noted that existential anxieties can potentially arise in anyone, related to the inherent lack of meaning or purpose that many struggle with, and the ultimate realization that we are all truly alone. Tolstoy advocated rebelling against this void. Alternatively, the structure of Jungian psychotherapy allows us to engage with our dreams and their interpretations as a guidepost for our future. Embracing nature, while it may not completely replace inner psychological work, can catalyze the process and enhance our own inner connections with ourselves.

Given the data that supports a connection to nature, it is natural to ask what role the environment might play in generating resilience during the pandemic. In this column nature and resilience are integrated into this discussion, and in the next column the role of generalized stress in producing post-traumatic resilience in children and adolescents will be discussed.

Psychotherapy that includes animal-assisted interventions is an example of stabilization in children during COVID. It’s been known for years that just being in the same room with an animal or pet can lower blood pressure. These interventions can help stabilize children emotionally and improve alertness and attention skills. Therefore, the use of animals in psychotherapy can help children calm aggression.

Another green intervention includes social and therapeutic horticulture. Although it may help reduce loneliness, isolation, and depressive symptoms in adults, it has been noted in children to increase the ability to sustain attention.

Criticisms of these ecological approaches include the simplistic structure that might cause some patients to resist adhering to or accepting this treatment. It would be interesting to test in children because they may be less resistant to nature-based intervention, no matter how simple.

Another criticism is that it is not possible to standardize green environments, and therefore any large-scale research would be prohibited.

The use of companion animals and dogs as a central part of therapy may not be accepted by all demographic groups and may create a barrier to adoption in a specific patient or population.

Trauma can create serious mental illness or, alternatively, serve as an ingredient for post-traumatic resilience. The pandemic has proven to be very traumatic. Heinz Kohut has described the need for optimal frustrating experiences in children to help them build the internal resources needed to cope and survive. Parents need to watch over their children, but also allow them to fall and get up, and learn to deal with adversity. The role of greenery in psychotherapy should continue to be researched and explored. Further studies should be conducted to explore differences in how children differ from adults when treated with ecological interventions. Ultimately, the outdoors is the best branding of all, serving to encourage both adults and children to spend time outdoors. Fortunately, these enjoyable activities help protect and heal people of all ages.

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