Ecotherapy, also known as nature therapy or green therapy, is an evidence-based therapeutic approach that harnesses the healing power of nature to improve mental health and overall well-being. This innovative field combines traditional psychotherapy with structured outdoor activities, offering a holistic treatment option for various mental health conditions.

Recent research demonstrates that spending as little as 10-20 minutes in nature can significantly reduce stress, anxiety, and depression symptoms. With mental health challenges affecting millions worldwide, ecotherapy provides an accessible, cost-effective complement to traditional treatments that can benefit people of all ages and backgrounds.

Table of Contents

  • What Is Ecotherapy?
  • The Science Behind Nature and Mental Health
  • Benefits of Ecotherapy
  • Common Ecotherapy Activities and Techniques
  • Who Can Benefit from Ecotherapy?
  • Finding an Ecotherapy Practitioner
  • Frequently Asked Questions
  • How Therapy Can Help / Find a Therapist

What Is Ecotherapy?

Ecotherapy is a structured, nature-based intervention that connects individuals with the natural environment to promote psychological healing and personal growth. Unlike casual outdoor activities, ecotherapy involves deliberate therapeutic techniques guided by trained professionals who integrate nature into evidence-based treatment plans.

This approach recognizes that human well-being is intrinsically linked to environmental health. Ecotherapy is a novel form of psychotherapeutic technique based on explicit environmental or ecological interventions, encompassing various activities from forest bathing to therapeutic gardening.

The practice emerged from ecopsychology, which explores the relationship between human mental health and the natural world. Ecotherapy is one of the ecosystem services that nature provides and is based on the theories of ecopsychology. Broadly speaking, it is an area of psychology that embraces ecology and aims to be holistic in theory and practice.

The Science Behind Nature and Mental Health

Neurological and Physiological Effects

Research reveals that nature exposure triggers measurable changes in the brain and body. Compared to control groups, NBIs groups showed significant improvements in: diastolic blood pressure (MD -3.73 mmHg [-7.46 to −0.00], I2 = 62%) and heart rate (MD -7.44 bpm [-14.81 to −0.06], I2 = 0%) for cardiovascular conditions, fatigue (SMD -0.50 [-0.82 to −0.18], I2 = 16%) for central nervous system conditions, and body fat percentage (MD -3.61% [-5.05 to −2.17], I2 = 0%) for endocrine conditions.

Nature exposure also affects stress hormones and neurotransmitters. Studies show that interaction with therapy animals reduced cortisol levels, increased oxytocin, lowered blood pressure, and increased social engagement and emotional regulation.

Attention Restoration Theory

One key mechanism explaining ecotherapy's effectiveness is Attention Restoration Theory (ART). According to attention restoration theory, natural environments can help restore and replenish cognitive functions related to attention and reduce mental fatigue. This is particularly relevant for individuals with ADHD, where Attention Restoration Theory (ART) posits that exposure to nature can restore depleted cognitive resources, specifically attention, which is especially important in children with ADHD.

Stress Reduction Theory

Nature environments activate the parasympathetic nervous system, promoting relaxation and recovery. The most commonly mentioned theories – Attention Restoration Theory (ART) and Stress Reduction Theory (SRT) – were related to the restoring capacities pathway.

Benefits of Ecotherapy

Mental Health Improvements

A comprehensive meta-analysis found that "How does nature exposure affect adults with symptoms of mental illness? A meta-analysis. International Journal of Mental Health Nursing. 2024a;33(6):1889–1907. doi: 10.1111/inm.13400," demonstrating significant positive effects across various conditions.

Specific mental health benefits include:

  • Depression reduction: The effect sizes (Cohen's d) of NBT compared to the control group were medium to large: depression (0.583), anxiety (0.728), daily activity (1.002), life satisfaction (0.786), mindfulness (0.645), stress (0.903), and loneliness (0.695).
  • Anxiety management: The results indicate that exposure to virtual natural environments effectively reduces anxiety levels (SMD = 0.82, p < 0.001, large effect), stress levels (SMD = 0.577, p = 0.003, moderate effect), and depression levels (SMD = 0.621, p < 0.001, moderate effect) in healthy adults.
  • Stress reduction: Horticultural therapy has been increasingly accepted as a non-pharmacological stress reduction treatment. Previous studies have demonstrated its therapeutic effects, with the effect varying according to the populations, settings, and interventions of horticultural therapy. This study aimed to provide a comprehensive review of the current literature regarding the effectiveness of horticultural therapy in reducing stress.

Physical Health Benefits

Beyond mental health, ecotherapy provides numerous physical benefits:

  • Improved cardiovascular health
  • Enhanced immune function
  • Better sleep quality
  • Increased physical activity levels
  • Reduced inflammation markers

Social and Cognitive Benefits

Evidence indicates that ecotherapy can improve conditions like depression and anxiety, promote social cohesion, and encourage pro-environmental worldviews. Additional benefits include:

  • Enhanced social connections
  • Improved cognitive function
  • Increased self-esteem
  • Better emotional regulation
  • Greater sense of purpose and meaning

Common Ecotherapy Activities and Techniques

Nature Meditation and Mindfulness

Nature meditation involves mindful observation and connection with natural elements. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals' connectedness to nature. We hypothesized that nature-based therapy has a positive impact on individual mental health and connectedness to nature.

Techniques include:

  • Guided forest meditation sessions
  • Mindful walking in natural settings
  • Sensory awareness exercises outdoors
  • Nature-based breathing practices

Horticultural Therapy

First, the quantitative results indicated that horticultural therapy made a positive impact on mental well-being. This is supported by a significant change in the mental well-being scores of the treatment group when compared with the comparison group. Participants said that horticultural activities help them stay calm, develop patience, relieve stress, stay focused on tasks, and use their brains more. They also shared their experience with friends and family more, which all could contribute to their psychosocial well-being.

Activities include:

  • Therapeutic gardening programs
  • Plant care and cultivation
  • Community garden participation
  • Indoor plant activities for those with limited mobility

Research shows the purpose of this meta-analysis of randomized controlled trials (RCTs) was to explore the effect of HT on mental health. This study is the first meta-analysis of RCTs to provide critical evidence that HT has a positive effect on mental health. The effect size of HT on mental health was medium (0.55).

Animal-Assisted Ecotherapy

Combining nature settings with animal interactions enhances therapeutic outcomes. Additionally, support for AAT was evident from 4 studies comparing it with established interventions, demonstrating that AAT was equally or more effective. These compelling findings indicate that AAT is a robust intervention deserving of further exploration and use.

Common approaches:

  • Equine-assisted therapy in natural settings
  • Dog-walking therapy in parks
  • Farm-based therapeutic programs
  • Wildlife observation activities

Forest Bathing (Shinrin-Yoku)

Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis... While most of the existing studies have focused on physical health, this systematic review and meta-analysis examined the mental health impacts of shinrin-yoku, using the PRISMA guidelines (PROSPERO registry: BLINDED). While noting a need for more rigorous research and extensive follow-up assessments, the findings indicate that shinrin-yoku can be effective in reducing mental health symptoms in the short term, particularly anxiety.

Key elements:

  • Slow, mindful walks through forests
  • Multi-sensory engagement with nature
  • Breathing exercises among trees
  • Silent observation periods

Green Exercise

Physical activity in natural environments multiplies health benefits. The interest in and evidence supporting the positive impact of outdoor activities and spending time in nature on both physical and mental health have been steadily increasing (Gladwell et al., Citation2013; Moreton et al., Citation2021; A. Roberts et al., Citation2020; Rosa et al., Citation2021), and recent research suggests that effective health interventions should incorporate elements of 'being' and 'doing' in nature.

Examples include:

  • Nature-based yoga or tai chi
  • Trail running or hiking therapy
  • Outdoor fitness classes
  • Adventure-based counseling

Conservation and Environmental Activities

Since deforestation and biodiversity loss are considered to be facilitators of zoonoses (diseases transmitted from animals to humans), long-term ecological solutions including nature conservation, prevention of deforestation, bans on wildlife trade and live animal markets need to be a part of public-health surveillance, strategies and policies.

Activities include:

  • Habitat restoration projects
  • Environmental stewardship programs
  • Beach or trail cleanup initiatives
  • Native plant propagation

Who Can Benefit from Ecotherapy?

Children with ADHD

Research strongly supports ecotherapy for children with attention challenges. The exploration of how best to manage and treat ADHD in children is ongoing; therefore, the findings reviewed here about the benefits of nature regarding ADHD symptoms are relevant and encouraging. While further research should be conducted to support a causal effect and provide better insight into the mechanisms behind this, there is strong enough evidence to begin implementing this approach into practice for use alongside already established treatments for ADHD.

Studies show that in a key study, she found a 20-minute walk through a park was as effective for children with ADHD as methylphenidate — a common stimulant medication used to treat the condition — to temporarily improve concentration.

Adults with Depression and Anxiety

Depression and anxiety are the two most common mental health conditions, which often co-exist and relapse over time. There is a need for sustainable treatment options to address increasing rates of depression and anxiety and reduce the strain on health systems. Social and Therapeutic Horticulture (STH) is a nature-based health intervention that can reduce symptoms of depression and anxiety; however, synthesized evidence of its effectiveness is required to inform commissioning.

Individuals with PTSD

Nature therapy shows promise for trauma recovery. Coping with post-traumatic stress disorder (PTSD): A 2023 study emphasizes the potential benefits of nature therapy for veterans with PTSD, particularly when other treatment programs or trauma-focused therapies have not worked.

Older Adults

Our findings suggest that engaging in indoor horticultural activities, such as watering houseplants for 10 minutes, can reduce mental and physical stress levels in older adults.

General Population

Evidence suggests that health and wellbeing can be improved from relatively short bursts of nature-based activity from as little as 10 min a day.

Finding an Ecotherapy Practitioner

Qualifications to Look For

When seeking an ecotherapy practitioner, consider:

  • Licensed mental health credentials (counselor, therapist, psychologist)
  • Specialized ecotherapy training or certification
  • Experience with nature-based interventions
  • Knowledge of safety protocols for outdoor settings

Types of Programs Available

  • Individual ecotherapy sessions
  • Group nature-based therapy
  • Intensive wilderness therapy programs
  • Day programs at therapeutic farms or gardens
  • Virtual nature therapy options

Questions to Ask Potential Therapists

  • What ecotherapy training have you completed?
  • How do you integrate nature into treatment plans?
  • What types of outdoor settings do you use?
  • How do you handle weather or accessibility concerns?
  • Can you provide references or outcome data?

Frequently Asked Questions

How long does ecotherapy take to show results?

Research indicates that benefits can occur quickly. "Sometimes people say, 'Well, I went to the park, and I didn't feel any better while I was there, so it didn't work.' But the research shows it's more of an after effect; you're resting and recovering while you're there and afterward, your focus improves," Taylor said. "I think the most practical takeaway is that even short exposures to nature can be beneficial."

Can ecotherapy replace traditional therapy or medication?

Ecotherapy works best as a complement to, not a replacement for, conventional treatments. NBIs are promising therapies that healthcare professionals can consider integrating into clinical practice. NBIs are positioned to be useful for hard-to-manage chronic conditions and symptoms and may have a multiplying effect for patients with comorbid conditions that all benefit from NBIs.

What if I don't have access to wilderness areas?

Urban nature works too! In general, incorporating elements of nature in the design of built environments, such as indoor plants, water features, large windows with natural light, etc., would allow children who live in urban areas to receive the benefits of exposure to nature that they otherwise would not have.

Is ecotherapy covered by insurance?

Coverage varies by provider and location. Many licensed therapists who incorporate ecotherapy can bill insurance for psychotherapy services. Check with your insurance provider about outdoor therapy coverage.

How Therapy Can Help / Find a Therapist

Ecotherapy offers a powerful, evidence-based approach to mental health treatment that complements traditional therapeutic interventions. Whether you're dealing with anxiety, depression, ADHD, or simply seeking to enhance your well-being, connecting with nature through structured therapeutic activities can provide significant benefits.

If you're interested in exploring ecotherapy, consider reaching out to a qualified mental health professional who incorporates nature-based interventions into their practice. The GoodTherapy directory can help you find therapists in your area who offer ecotherapy or are open to incorporating outdoor sessions into treatment.

Remember, healing happens in many forms, and for many people, nature provides a supportive environment for growth, restoration, and transformation. Take the first step toward experiencing the therapeutic benefits of nature by connecting with a qualified professional today.

References:

  1. American Psychiatric Association. (2024). Connecting children with nature to improve mental well-being. Psychiatry.org. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/connecting-children-with-nature-to-improve-mental
  2. Armitt, H. A., Kingsley, E., Attwell, L., White, P., Woolley, K., Garside, M., & Coventry, P. (2024). Co-production of a nature-based intervention for children with ADHD study (CONIFAS): Creating a home-based intervention with children and families with lived experience of ADHD. Children and Youth Services Review, 159, 107603. https://doi.org/10.1016/j.childyouth.2024.107603
  3. Bettmann, J. E., Speelman, E., Blumenthal, E., Couch, S., & McArthur, T. (2024). How does nature exposure affect adults with symptoms of mental illness? A meta-analysis. International Journal of Mental Health Nursing, 33(6), 1889–1907. https://doi.org/10.1111/inm.13400
  4. Donovan, G. H., Michael, Y. L., Gatziolis, D., & Hoyer, J. L. (2024). Nurturing attention through nature. Environmental Research, 252, 119024. https://doi.org/10.1016/j.envres.2024.119024
  5. Hartfiel, N., Smyth, H., Gruffydd, K., Wilberforce, M., Wainwright, E., & Stathi, A. (2021). The cost effectiveness of ecotherapy as a healthcare intervention, separating the wood from the trees. International Journal of Environmental Research and Public Health, 18(21), 11599. https://doi.org/10.3390/ijerph182111599
  6. Hood, M., & Baumann, O. (2024). Could nature contribute to the management of ADHD in children? A systematic review. International Journal of Environmental Research and Public Health, 21(6), 736. https://doi.org/10.3390/ijerph21060736
  7. Isham, A., Jefferies, L., Blackburn, J., Fisher, Z., & Kemp, A. H. (2025). Green healing: Ecotherapy as a transformative model of health and social care. Current Opinion in Psychology, 62, 102005. https://doi.org/10.1016/j.copsyc.2025.102005
  8. Joschko, L., Pálsdóttir, A. M., Grahn, P., & Hinse, M. (2023). Nature-based therapy in individuals with mental health disorders, with a focus on mental well-being and connectedness to nature—A pilot study. International Journal of Environmental Research and Public Health, 20(3), 2167. https://doi.org/10.3390/ijerph20032167
  9. Joubert, A., Jankowski-Cherrier, B., Rossi, A., et al. (2024). Impact of horticultural therapy on patients admitted to psychiatric wards, a randomized, controlled and open trial. Scientific Reports, 14, 14378. https://doi.org/10.1038/s41598-024-65168-0
  10. Kaleta, B., Campbell, S., O'Keeffe, J., & Burke, J. (2025). Nature-based interventions: A systematic review of reviews. Frontiers in Psychology, 16, 1625294. https://doi.org/10.3389/fpsyg.2025.1625294
  11. Kim, S., Lee, H., Shin, B., Oh, J., Hwang, H., Lee, H., Lee, K., Ko, J., Park, S., Kim, S. A., Song, J., Park, Y., & Song, C. (2023). The effectiveness of nature-based therapy for community psychological distress and well-being during COVID-19: A multi-site trial. Scientific Reports, 13, 22418. https://doi.org/10.1038/s41598-023-49702-0
  12. Kotera, Y., Richardson, M., & Sheffield, D. (2020). Effects of Shinrin-Yoku (forest bathing) and nature therapy on mental health: A systematic review and meta-analysis. International Journal of Mental Health and Addiction, 20, 337–361. https://doi.org/10.1007/s11469-020-00363-4
  13. Li, H., Wei, T., Petersen, J. D., Zhou, J., & Lu, X. (2023). Biological effects of negative air ions on human health and integrated multiomics to identify biomarkers: A literature review. Environmental Science and Pollution Research, 30(27), 69824–69836. https://doi.org/10.1007/s11356-023-27133-8
  14. Lu, S., Liu, J., Xu, M., & Xu, F. (2023). Horticultural therapy for stress reduction: A systematic review and meta-analysis. Frontiers in Psychology, 14, 1086121. https://doi.org/10.3389/fpsyg.2023.1086121
  15. Meredith, G. R., Rakow, D. A., Eldermire, E. R. B., Madsen, C. G., Shelley, S. P., & Sachs, N. A. (2020). Minimum time dose in nature to positively impact the mental health of college-aged students, and how to measure it: A scoping review. Environment and Behavior, 52(10), 1125-1167. https://doi.org/10.1177/0013916518812561
  16. National Institute of Mental Health and Neurosciences (NIMHANS). (2020). Recovering with nature: A review of ecotherapy and implications for the COVID-19 pandemic. Frontiers in Public Health, 8, 604440. https://doi.org/10.3389/fpubh.2020.604440
  17. Pandey, R. P., Himanshu, Gunjan, Mukherjee, R., & Chang, C. M. (2024). The role of animal-assisted therapy in enhancing patients' well-being: Systematic study of the qualitative and quantitative evidence. JMIRx Med, 5, e51787. https://doi.org/10.2196/51787
  18. Paredes-Céspedes, D. M., Vélez, N., Parada-López, A., Toloza-Pérez, Y. G., Téllez, E. M., Portilla, C., González, C., Blandón, L., Santacruz, J. C., & Malagón-Rojas, J. (2024). The effects of nature exposure therapies on stress, depression, and anxiety levels: A systematic review. European Journal of Investigation in Health, Psychology and Education, 14(3), 609-622. https://doi.org/10.3390/ejihpe14030040
  19. Rodríguez-Redondo, Y., Denche-Zamorano, A., Muñoz-Bermejo, L., Rojo-Ramos, J., & Adsuar, J. C. (2023). Bibliometric analysis of nature-based therapy research. Healthcare, 11(9), 1249. https://doi.org/10.3390/healthcare11091249
  20. Struthers, N. A., Guluzade, N. A., Zecevic, A. A., Walton, D. M., & Gunz, A. (2024). Nature-based interventions for physical health conditions: A systematic review and meta-analysis. Environmental Research, 258, 119421. https://doi.org/10.1016/j.envres.2024.119421
  21. Summers, J. K., & Vivian, D. N. (2018). Ecotherapy – A forgotten ecosystem service: A review. Frontiers in Psychology, 9, 1389. https://doi.org/10.3389/fpsyg.2018.01389
  22. Taylor, E. M., Robertson, N., Lightfoot, C. J., Smith, A. C., & Jones, C. R. (2022). Nature-based interventions for psychological wellbeing in long-term conditions: A systematic review. International Journal of Environmental Research and Public Health, 19(6), 3214. https://doi.org/10.3390/ijerph19063214
  23. Tu, H. M., & Chiu, P. Y. (2022). Effect of horticultural therapy on mental health: A meta-analysis of randomized controlled trials. Journal of Psychiatric and Mental Health Nursing, 29(5), 603-615. https://doi.org/10.1111/jpm.12818
  24. Wen, Y., Shen, X., & Shen, Y. (2024). Virtual nature, real relief: How exposure to virtual natural environments reduces anxiety, stress, and depression in healthy adults. npj Digital Medicine, 7, Article 342. https://doi.org/10.1038/s41746-025-02057-4
  25. Wood, C. J., & Wicks, C. L. (2024). Effectiveness of social and therapeutic horticulture for reducing symptoms of depression and anxiety: A systematic review and meta-analysis. Frontiers in Psychiatry, 15, 1507354. https://doi.org/10.3389/fpsyt.2024.1507354