Rationale for Research
The need for the present study emerged from the researcher’s observations of people whom they guided in the mountains during hikes and treks as a mountain leader and scout leader. The majority of individuals coming to the natural setting complain of having chronic stress in the environment where they work and live. Therefore, most of them report escaping to the open nature to relieve stress, change the settings, and enjoy the rural freedom unattainable in the urban context. Their primary motivation is to leave the accustomed surroundings full of haste and distraction for the sake of restoring the peace of mind amid the natural serenity. The common outcomes of mountain hikes and treks are less anxiety and stress, alleviated depression, and an overall state of improved well-being.
These observations have made the researcher think of a more structured approach to studying the impact of outdoor activities on people. The literature review presented in this assignment focuses on numerous domains of human health, such as physical, mental, and spiritual wellness, to show the intricate connections between outdoor pastimes and positive health outcomes. As Harper and Dobud (2020) pointed out, there is scarce attention currently paid to the importance of human interactions with the outdoor and nature-based settings in the public health domain. However, these interactions lay a significant foundation for people’s physical and mental well-being, with numerous health promotion tools available at no cost in the open nature. In addition, nature offers a powerful healing space for therapy and counseling of people with various mental health issues. Therefore, it is not necessary to confine therapy to indoor facilities, using the richness of natural sources for more balanced mental health promotion instead.
The nuanced understanding of the relationship between people and nature is at the core of using nature-based settings for health promotion and mental health therapy. This relationship shapes the human experience and enhances the bonds between individuals and their planet amid the urban chaos and fuss. In addition, the literature review uncovered the systemic failures of indoor, formal therapies with specific populations, such as children and youth. Therefore, integrating therapeutic and counseling efforts into outdoor activities has recently acquired popularity. This approach takes advantage of the unconscious human longing for connectedness with nature and reconceptualizes therapy in a more patient-friendly format.
Given the considered evidence of nature-based therapy’s universal positive effect on people, this literature review aimed to form the basis for a therapeutically focused outdoor intervention. The anticipated intervention is aimed to close the gaps of a medical-clinical-pharmaceutical model of healthcare that deprives people of meaningful practices and natural ways of illness management (Harper and Dobud, 2020). It may fit specific population groups with particular mental health problems or target broad health promotion aims. The outcomes of this literature review are expected to advance the researcher’s professional practice as a scout leader, enabling a more informed therapeutic component of their activities.
Research Objectives
Based on the identified rationale for the study and the researcher’s personal assumptions about the value of outdoor activities for people’s health in numerous domains, I have formulated the specific research objectives as follows.
- To identify the range of effects that outdoor activities produce on people.
- To focus on the therapeutic value of outdoor activities for human mental health and well-being.
- To identify the available academic evidence on the use of outdoor activities as a mental health intervention for different population groups and conditions.
Literature Review
People have relied on herbal, spiritual, and community-oriented approaches to physical and mental health promotion for many centuries. That approach used to be holistic, integral, and all-encompassing, with the healing practices and legacy, passed down from generation to generation. However, the 19th and 20th centuries witnessed the rise of traditional medicine and the emergence of a medical-clinical-pharmaceutical model of illness that isolated a sick individual from their natural surroundings (Harper and Dobud, 2020). In some cases, these measures were justified, such as surgery or emergency help. Still, in many other situations, people’s healing potential has eroded with the rise of the medical model of illness and treatment, disconnecting individuals from the natural world and inhibiting their ecological knowledge. The resulting unhealthy relationship of the modern community with the environment has aggravated many problems, including eco-friendly living and in-depth connectivity with the planet.
The contemporary global society is amid a large-scale public health crisis resulting from chronic stress, work overload, sedentary lifestyle, and social isolation in urban settings. Diabetes, cardiovascular diseases, and obesity plague the world due to sedentary habits and an absence of a culture of outdoor activity. North Americans are reported to spend 90% of their time indoors, 5% of their free time in their vehicles, and only 5% – outdoors (Harper and Dobud, 2020). The stress coming from a fast pace of change and rapid technological advancements aggravates these health crises, causing environmental estrangement among urban residents. The outcomes of such processes are the developing nature-deficit disorder, eco-anxiety, and unsustainable living concerns shared by many inhabitants of megapolises (Harper and Dobud, 2020). In these conditions, reconnecting people with their natural roots and returning them to a natural environment promises a large-scale healing effect reflected in better well-being, internal balance, resilience, and immunity.
General Effects of Outdoor Activities
Research suggests that physical activity and spending time in the open nature come with a range of health benefits. For instance, Eigenschenk et al. (2019) reviewed the literature on outdoor interventions in seven European countries and discovered the recognized social impact of such activities in six categories. The latter included physical health, mental health, well-being, active citizenship, lifelong learning and productive education, crime and deviant behavior reduction, and additional benefits. However, the researchers pointed out a significant research gap in terms of identifying the long-term effects of outdoor activities on people’s personal and social development.
Regular pastime outdoors has pronounced effects on people’s immunity and severe disease resilience. Harper and Dobud (2020) reported a positive impact of walking in old-growth forests on people’s immune function and cancer-fighting abilities, thus showing that exposure to nature is universally beneficial for health. Numerous clinical studies discovered the comparative effectiveness of outdoor health and fitness exercise (Manferdelli, La Torre and Codella, 2019). In addition, research suggests that outdoor leisure activities can be an effective social inclusion and physique improvement tool for people with disabilities (Labbé, Miller and Ng, 2019). These facts point to the importance of outdoor pastime for all populations regardless of age and physical condition.
The outdoor settings are also regarded as an ideal place for inner and outer landscape learning. As Harper, Rose and Segal (2019) pointed out, clients’ sensory awareness increases in the outdoor settings, and people reveal better physiological and emotional regulation in the open nature. These outcomes are explained by the fact that NBIs are usually a dynamic process. People’s eyes need to adjust to the changing light, breath changes are experienced during hiking and rest, and the sense of bodily balance is continually trained during nature-based activities. However, the researchers also pointed out that the intensity of NBIs should be adjusted with respect to individual clients’ goals and physical preparation (Harper, Rose and Segal, 2019). Covering difficult terrains in bad weather or walking to excessively remote places may fail to achieve the intended therapeutic goal for specific clients.
Mental Health Effects of Outdoor Therapy
The demand for mental health services is rising in all parts of the world, contributing to an active search for alternative mental health interventions with proven therapeutic effects. One of such approaches is nature-based recreation, associated with measurable improvements in patients’ psychological health and well-being. Lackey et al. (2019) conducted a systematic review of the therapeutic benefits of NBIs, focusing on mental health outcomes. Their review findings suggest a visible effect of NBIs on affect, cognition, restoration, anxiety and depression relief, as well as well-being. Marselle et al. (2019) confirmed those findings by showing that interactions with nature can improve people’s resilience, serving as a buffer for stressful life events and mental health challenges. The researcher suggested introducing group walking schemes as an effective health promotion intervention for mental health improvement. Therefore, one can see that the positive effect of nature-based activities is pronounced for people with different psycho-emotional issues due to the extensive curing effect of nature.
Though outdoor therapy is not a panacea for all mental health problems, its introduction in mainstream mental health can help improve mental health in large populations. As Buckley, Brough, and Westaway (2018) observed, outdoor activities positively impact chronic disease syndrome, depression, and dementia. Nature-based activities were also found to alleviate chronic pain and produce positive effects on people of all ages, from children to senior adults. In addition, these interventions are low-cost and easily accessible, requiring broader popularization in the healthcare field (Trøstrup et al., 2019). These findings suggest a universal value of nature-based activities regardless of the individuals’ nature and severity of clinical symptoms.
The overall positive influence of nature tourism on mental health has been recognized worldwide. According to Buckley (2020), these findings increase the perceived value of national parks across the globe, with the governments investing trillions of dollars in this new health promotion asset. The researcher interviewed the attendees of subtropical national parks in Queensland, Australia, and discovered that people experience improved well-being and become happier after visiting these sites. The respondents reported short-term emotional benefits and medium-term recovery from stress, while 20% of the sample even acknowledged long-term changes in their worldviews (Buckley, 2020). This evidence suggests that nature tourism indeed comes with numerous health benefits of varying duration and magnitude.
Nature-based health interventions (NBIs) are associated with a positive behavioral change in individuals suffering from a range of physical and psychological challenges. Shanahan et al. (2019) conducted a Delphi expert elicitation process to identify effective NBIs and arrived at a list of 27 interventions. The selected NBIs targeted a change in the person’s environment (for example, the creation of gardens and parks in hospitals and cities) and organized programs targeting a behavior change. The researchers also pointed out that a range of socio-economic factors shaping every individual’s situation strongly impact the intervention’s success (Shanahan et al., 2019). Therefore, the process of NBI planning and assessment of its outcomes should be done with respect to the person’s individual socio-demographic characteristics.
There is also a rich body of evidence suggesting the positive impact of NBIs on stress recovery. Corazon et al. (2019) conducted a systematic review of 36 studies from 2010 to 2018 related to the impact of NBIs on stress. They discovered unanimous evidence of NBIs’ significance for emotional and psychological healing. Natural environments were found to contribute to stress relief and emotional well-being improvement, but findings on their effects on physiological health were inconclusive (Corazon et al., 2019). Therefore, one may conclude that the power of NBIs to affect the psychological and emotional health of people is more pronounced than a physical therapeutic effect.
Exposure to natural environments can amplify the effect of other mental health interventions, contributing to better health outcomes among patients. As Choe, Jorgensen, and Sheffield (2020) observed, the outcomes of Mindfulness-Based Stress Reduction (MBSR) therapy are better when performed in a natural outdoor environment. Their study participants reported sustainable improvements in their mental health even one month after MBSR completion. Therefore, the power of natural settings to enhance the impact of stress reduction therapy should be applied for the benefit of patients.
NBIs have been found effective in treating serious mental health issues. The study of Greer and Vin-Raviv (2019) shared the promising outcomes of outdoor-based therapeutic recreation (TR) programs for military veterans with PTSD. The researchers conducted a systematic review on the subject and identified 13 studies observing significant short-term psychosocial improvements in the patients’ condition. The improvements included reduced depression symptoms, lower PTSD severity, less pronounced stress, and improved quality of veterans’ lives (Greer and Vin-Raviv, 2019). These findings suggest that even severe mental problems can be managed with NBIs and result in pronounced symptom alleviation.
However, for the NBIs to be effective, they must comply with a set of criteria inherent in well-organized, evidence-based outdoor therapy. According to Harper and Dobud (2020), outdoor therapies should be place-based, meaning that clients and therapists should meet outdoor, as natural settings improve cognition and affect for depressed individuals. Besides, a natural setting is associated with positive attention, memory, and mood changes. In addition, outdoor therapy should incorporate a component of active body engagement with the natural environment (Harper and Dobud, 2020). For example, clients can be invited to structured adventure activities, expeditions to remote places, or some other form of experiential education. Finally, NBIs should focus on the enhancement of nature-human kinship to restore the holism of that primeval relationship and move people closer to themselves. With these components, the effectiveness of NBIs rises exponentially, giving them a strong therapeutic component.
Nature-Based Interventions for the Elderly
Millions of elderly people across the globe suffer from dementia at an advanced age, but their need for outdoor activity remains high. Older adults can also benefit from NBIs specifically formatted for this age group with its specific mental health needs. Motealleh et al. (2019) hypothesized that creating a dementia-friendly environment (DFE) for residents of long-term care facilities can positively affect elderly patients’ health. The researchers reviewed the existing evidence on the ability of DFEs to produce positive effects on dementia patients’ agitation, apathy, and engagement. Taheri et al. (2021) confirmed the value of therapeutic landscapes for mental health, showing that they add a social and mental dimension to people’s experiences of interaction with nature. These findings confirm the importance of creating therapeutic landscapes for the elderly due to their sizable health effects.
Overall, the significance of inclusive and accessible outdoor environments for the elderly is pronounced for healthy aging. Levinger et al. (2019) created an exercise intervention outdoor project in the community for older people (ENJOY) to exemplify the benefits of such environments. The researchers suggested that such natural settings help older adults to continue their physical activity and improve their social interactions, which is vital for their quality of life. They proposed the senior exercise park design aimed to help older adults improve their muscle strength, balance, and joint movements with regular outdoor exercise. The subsequent research of Levinger et al. (2020) revealed improved life mobility and self-care, reduction in fear of falls and falls risks, and higher general activity levels among participants. Therefore, the Seniors Exercise Park proved to be an effective therapeutic intervention for physical functioning and well-being improvement among older adults.
Impact of Nature Therapy on Children
The use of NBIs to address children’s health is also a workable mental health tactic. According to Bang et al. (2018), forest therapy is an effective intervention for increasing elementary schoolchildren’s self-esteem and well-being. The researchers held a quasi-experimental 10-week study with 52 upper-grade elementary students from five community centers offering after-school child education. The study involved forest therapy (60 minutes of forest activities) combined with 30 minutes of daily health education by nursing student mentors. The intervention outcome revealed a sizable improvement in children’s self-esteem and a reduction in depressive symptoms (Bang et al., 2018). The study thus proved the healing power of the forest in combination with essential health literacy.
NBIs can also serve as a vital source of healthy physical activity for modern children. As Wray et al. (2020) pointed out, the growing prevalence of a sedentary lifestyle among children and youth exacerbates the mental health problems of young people across the globe. Therefore, returning to the outdoor spaces can boost physical activity and social connectedness, giving effective solutions to the health problems of young people (Wray et al., 2020). These findings were supported by the conclusions of Bélanger et al. (2019) about the mediating effect of physical activity on outdoor time and mental health. Therefore, it is possible to promote the positive impact of outdoor time on young people’s mental health by introducing more physical activity into that pastime.
Wilderness therapy is considered an effective intervention for treating mental health problems in adolescents. Gabrielsen et al. (2018) studied the impact of a Norwegian wilderness therapy program, Friluftsterapi, provided to adolescents in a specialized mental health care organization. Their findings suggest that the program takes up to three months to internalize experiences and achieve improvements in young people’s daily functioning. However, the researchers arrived at a conclusion that the program is valuable and effective, resulting in mental health improvements for the majority of participants. Besides, such programs may become additionally valuable for patients non-responsive to traditional treatment methods.
Research Problems and Potential Limitations
The literature review provided enough evidence to substantiate the planned study of a therapeutically focused mental health intervention. However, one should keep specific limitations of such research in mind. First, the researcher will hardly attain a homogeneous study sample, as people’s psychological problems differ in scale and intensity. What works for a person with mild depression will hardly be effective for an individual with intense anxiety. Thus, it is vital to keep the individual nature of participants’ mental health conditions in mind when evaluating the intervention’s outcomes. The results are likely to differ from participant to participant, suggesting the varying degree of outdoor interventions’ impact on mental health.
Another potential weakness of the planned study is the low level of its generalizability to broader populations. The intervention needs to be tested with different population groups with various mental health issues to achieve a considerable degree of results’ reliability. One study with a small sample of participants will likely yield valuable findings, but they will be limited in validity and reliability. Therefore, their interpretation should be approached with caution and performed with reference to a specific sample and study context.
Reference List
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