Nature-Based Therapeutic Interventions

  • Ulrika K. Stigsdotter
  • Anna Maria Palsdottir
  • Ambra Burls
  • Alessandra Chermaz
  • Francesco Ferrini
  • Patrik Grahn


The point of departure of this chapter is to view nature-based settings as an important asset for improvement and promotion of health. During the last decades the concepts of healthy nature-based settings and accompanying treatment programs have been referred to by many names, making the subject difficult to interpret. Here the development of the theoretical framework and the research area are described. The second part of the chapter focuses on the structure of a therapy program and the health design of the nature-based setting. From the theories and experiences, including both research as well as best practice presented, the chapter ends with recommendations for future aims of research projects within this area.


Occupational Therapy Community Garden Client Group Therapeutic Setting Landscape Architect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. AHTA (2007). 2007-10-26
  2. Aldwin C (2007) Stress, coping, and development, 2nd edn. The Guilford Press, New YorkGoogle Scholar
  3. Antonovsky A (1987) Unraveling the mystery of health: how people manage stress and stay well. Jossey-Bass, San Francisco, CAGoogle Scholar
  4. Ayres JA (1974) The development of sensory integrative theory and practice. Kendall/Hunt, DubuqueGoogle Scholar
  5. Beard C, Wilson JP (2002) The power of experiential learning. A handbook for trainers and educators. Kogan Page, LondonGoogle Scholar
  6. Ayres JA (1983) Sensory integration and the child. Western psychological services, Los Angeles, CAGoogle Scholar
  7. Berger R, McLoed J (2006) Incorporating nature into therapy: A framework for practice. J Syst Ther 25(2):80–94CrossRefGoogle Scholar
  8. Björk J, Albin M, Grahn P, Jacobsson H, Ardö J, Wadbro J, Östergren P-O, Skärbäck E (2008) Recreational values of the natural environment in relation to neighbourhood satisfaction, physical activity, obesity, and well-being. J Epidemiol Community Health 62(4):e2PubMedCrossRefGoogle Scholar
  9. Boldemann C, Blennow M, Dal H, Mårtensson F, Raustorp A, Yuen K, Wester U (2006) Impact of preschool environment upon children’s physical activity and sun exposure. Prev Med 42:301–308PubMedCrossRefGoogle Scholar
  10. Bronfenbrenner U (1979) The ecology of human development – experiments by nature and design. Harvard University Press, Cambridge, MAGoogle Scholar
  11. Bucci W (2003) Varieties of dissociative experiences. Psychoanal Psychol 20:542–557CrossRefGoogle Scholar
  12. Burls A (2005) New landscapes for mental health. Mental Health Rev 10:26–29CrossRefGoogle Scholar
  13. Burls A (2007) People and green spaces: promoting public health and mental well-being through ecotherapy. J Public Mental Health 6(3):24–39CrossRefGoogle Scholar
  14. Burls A (2008a) Seeking nature: a contemporary therapeutic environment. Int J Ther Communities 29(3), autumn 2008 – InternationalGoogle Scholar
  15. Burls A (2008b) Meanwhile wildlife gardens, with nature in mind. In: Dawe G, Millward A (eds) Statins and greenspaces: health and the urban environment. Proceedings of conference by UNESCO UK-MAB Urban Forum at University College London (UCL), 27 March 2007Google Scholar
  16. Burls A (2010) Ecotherapy. In: Sempik J, Hine R, Wilcox D (eds) A conceptual framework for green care. A report of the Working Group on the Health Benefits of Green care COST 866, Green care in Agriculture Loughborough University, CCFRGoogle Scholar
  17. Burls A, Caan W (2004) Social exclusion and embracement: a useful concept? J Prim Health Care Res Dev 5(3)Google Scholar
  18. Burls A, Caan W (2005) Editorial: human health and nature conservation: ecotherapy could be beneficial, but we need more robust evidence. BMJ 331:1221–1222PubMedCrossRefGoogle Scholar
  19. Burns GW (1998) Nature-guided therapy: brief integrative strategies for health and wellbeing. Brunner/Mazel, New YorkGoogle Scholar
  20. Butler CD, Friel S (2006) Time to regenerate: ecosystems and health promotion. PLoS Med 3(10):e394PubMedCrossRefGoogle Scholar
  21. Cavill N, Kahlmeier S, Racioppi F (eds) (2006) Physical activity and health in Europe: evidence for action. WHO, GenevaGoogle Scholar
  22. Clinebell H (1996) Ecotherapy: healing ourselves, healing the earth: a guide to ecologically grounded personality theory, spirituality, therapy, and education. Fortress Press, Minneapolis, MNGoogle Scholar
  23. Coyle K (2005) Environmental literacy in America. The National Environmental Education and Training Foundation, Washington, DC.
  24. Cooper-Marcus C, Barnes M (eds) (1999) Healing gardens: therapeutic benefits and design ­recommendations. John Wiley and Sons, New YorkGoogle Scholar
  25. Coss RG, Ruff S, Simms T (2003) All that Glistens II: the effects of reflective surface finishes and the mouthing activity of infants and toddlers. Ecol Psychol 15:197–213CrossRefGoogle Scholar
  26. Crawford C, Krebs D (1997) Handbook of evolutionary psychology: ideas, issues and applications. LEA, New YorkGoogle Scholar
  27. Dawis RV (ed) (2000) The person-environment tradition in counseling psychology. Lawrence Erlbaum, Mahwah, NJGoogle Scholar
  28. Department of Health (2004) Choosing health: making healthy choices easier. Cm 6374, Public Health White Paper, LondonGoogle Scholar
  29. Flagler J, Pincelot R (1994) People-plant relationships: setting research priorities. Haworth Press, New YorkGoogle Scholar
  30. Friedman HS, Silver RC (eds) (2007) Foundations of health psychology. Oxford University Press, New YorkGoogle Scholar
  31. Frosch J (1990) Psychodynamic psychiatry: theory and practice. International University Press, Madison, WIGoogle Scholar
  32. Frumkin H (2001) Beyond toxicity: human health and the natural environment. Am J Prev Med 20(3):234–240PubMedCrossRefGoogle Scholar
  33. Gerlach-Spriggs N, Enoch Kaufman R, Bass Warner S (1998) Restorative gardens. The healing landscape. Yale University Press, New Haven, CTGoogle Scholar
  34. Gorard S, Taylor C (2004) Combining methods in educational and social research. Open University Press, LondonGoogle Scholar
  35. Grahn P (1991) Om parkers betydelse. (diss.) Stad and Land, nr 93, AlnarpGoogle Scholar
  36. Grahn P (2005) Om trädgårdsterapi och terapeutiska trädgårdar. In: Johansson K (ed) Svensk miljöpsykologi. Studentlitteratur, Lund, pp 245–262Google Scholar
  37. Grahn P (2007) Barnet och naturen. In: Dahlgren LO, Sjölander S, Strid JP, Szczepanski A (eds) Utomhuspedagogik som kunskapskälla. Närmiljö blir lärmiljö. Studentlitteratur, Lund, pp 55–104Google Scholar
  38. Grahn P, Berggren-Bärring A-M (1995) Experiencing parks. Man’s basic underlying concepts of qualities and activities and their impact on park design. Ecological Aspects of Green Areas in Urban Environments. IFPRA World Congress Antwerp Flanders Belgium,  Chapter 5, pp 97–101, 3–8 September 1995
  39. Grahn P, Mårtensson F, Lindblad B, Nilsson P, Ekman A (2000) Børns udeleg. Betingelser og betydning. Forlaget Børn and Unge, KøbenhavnGoogle Scholar
  40. Grahn P, Stigsdotter U (2003) Landscape planning and stress. Urban Forest Urban Green 2:1–18CrossRefGoogle Scholar
  41. Grahn P, Stigsdotter UK (2010) The relation between perceived sensory dimensions of urban green space and stress restoration. Landsc Urban Plan 94:264–275CrossRefGoogle Scholar
  42. Grahn P, Tenngart Ivarsson C, Stigsdotter UK, Bengtsson I-L (2010) Using affordances as a health-promoting tool in a therapeutic garden. In: Ward Thompson C, Aspinal P, Bell S (eds) Innovative approaches to researching landscape and health. Taylor and Francis, London,  chapter 5, pp 116–154
  43. Gyllin M, Grahn P (2005) A semantic model for assessing the experience of urban biodiversity. Urban Forest Urban Green 3:149–161CrossRefGoogle Scholar
  44. Haller R (2004) Creating a sensory garden. Oral presentation. Conference proceeding. AHTA Conference “Securing Our Health and Wellness” in Atlanta, GeorgiaGoogle Scholar
  45. Hall J (2004) Conservation therapy programme. Research Report, Nr. 611, Natural EnglandGoogle Scholar
  46. Hansson LÅ (1996) Psykoneuroimmunologi. Svensk Medicin 52. SPRI, StockholmGoogle Scholar
  47. Hartig T (2007) Three steps to understanding restorative environments as health resources. In: Ward TC, Travlou P (eds) Open space: people space. Taylor and Francis, London, pp 163–179Google Scholar
  48. Hartig T, Evans GW, Jamner LD, Davis DS, Gärling T (2003) Tracking restoration in natural and urban field settings. J Environ Psychol 23:109–123CrossRefGoogle Scholar
  49. Hartig T, Cooper-Marcus C (2006) Healing gardens – places for nature in health care. Lancet 368:S36–S37CrossRefGoogle Scholar
  50. Hassan BN, Mattson RH (1993) Family income and experience influence community garden ­success. J Ther Hortic 7:9–18Google Scholar
  51. Hassink J, van Dijk M (2006) Farming for health: green-care farming across Europe and the United-States of America. Springer, New YorkGoogle Scholar
  52. Hedfors P, Grahn P (1998) Soundscapes in urban and rural planning and design. Yearbook Soundsc Stud 1:67–82Google Scholar
  53. Herzog TR (1987) A cognitive analysis of preference for natural environments: mountains, ­canyons, and deserts. Landsc J 6:140–152Google Scholar
  54. Hewson ML (1994) Horticulture as therapy. Homewood Health Centre, Guelph, ONGoogle Scholar
  55. Irons W (1998) Adaptively relevant environments versus the environment of evolutionary adaptedness. Evol Anthropol 6:194–204CrossRefGoogle Scholar
  56. Janzen JM (2002) The social fabric of health. An introduction to medical anthropology. McGraw-Hill, New YorkGoogle Scholar
  57. Jick TD (1979) Mixing qualitative and quantitative methods: triangulation in action. Admin Sci Q 24(4):602–611CrossRefGoogle Scholar
  58. Jonsson H (1998) Ernst Westerlund – A Swedish doctor of occupation. Occup Ther Int 5(2):155–171CrossRefGoogle Scholar
  59. Kamp D (1996) Design consideration for the development of therapeutic gardens. J Ther Hortic 8:6–10Google Scholar
  60. Kaplan S (1990) Parks for the future – a psychologist view. In: Sorte GJ (ed) Parks for the future. Stad and Land 85. Movium, Alnarp, pp 4–22Google Scholar
  61. Kaplan S (1995) The restorative benefits of nature: toward an integrative framework. J Environ Psychol 15:169–182CrossRefGoogle Scholar
  62. Kaplan S (2001) Meditation, restoration, and the management of mental fatigue. Environ Behav 33:480–506CrossRefGoogle Scholar
  63. Kaplan R, Kaplan S (1989) The experience of nature. Cambridge University Press, CambridgeGoogle Scholar
  64. Kavanagh JS, Musiak TA (1993) Selecting design services for therapeutic landscapes. J Ther Hortic 7:19–22Google Scholar
  65. Kellert S, Wilson EO (eds) (1993) The biophilia hypothesis. The Island Press, New YorkGoogle Scholar
  66. Kemmis S, McTaggart R (1988) The action research planner, 3rd edn. Deakin University, GeelongGoogle Scholar
  67. Kielhofner G (1997) Conceptual foundations of occupational therapy, 2nd edn. F. A. Davis, Philadelphia, PAGoogle Scholar
  68. De Kloet RE, Joels M, Holsboer F (2005) Stress and the brain: from adaptation to disease. Nat Rev Neurosci 6:463–475PubMedCrossRefGoogle Scholar
  69. Knoops KTB, de Groot LCPGM, Kromhout D, Perrin A-E, Moreiras-Varela O, Menotti A, Van Staveren WA (2004) Mediterranean diet, lifestyle factors, and10-year mortality in elderly European men and women: The HALE project. JAMA 292:1433–1439PubMedCrossRefGoogle Scholar
  70. Kuo FE, Sullivan WC (2001) Aggression and violence in the inner city: effects of environment via mental fatigue. Environ Behav 33(4):543–571CrossRefGoogle Scholar
  71. Milonis E (2004) Un asino per amico. Onoterapia ovvero attività assistita con l’asino. Lupetti, RomaGoogle Scholar
  72. Nordh H, Hartig T, Hägerhäll C, Fry G (2009) Components of small urban parks that predict the possibility for restoration. Urban Forest Urban Green 8:225–235CrossRefGoogle Scholar
  73. Norman J (ed) (2006) Living for the city – a new agenda for green cities. Think tank of the year 2006/2007. Policy exchange, LondonGoogle Scholar
  74. Ottosson J (2001) The importance of nature in coping with a crisis: a photographic essay. Landsc Res 26(2):165–172CrossRefGoogle Scholar
  75. Ottosson J, Grahn P (2005) A comparison of leisure time spent in a garden with leisure time spent indoors: on measures of restoration in residents in geriatric care. Landsc Res 30:23–55CrossRefGoogle Scholar
  76. Ottosson J, Grahn P (2008) The role of natural settings in crisis rehabilitation. How does the level of crisis influence the response to experiences of nature with regard to measures of rehabilitation? Landsc Res 33:51–70CrossRefGoogle Scholar
  77. Oxford dictionary of English (2008). Oxford University Press, OxfordGoogle Scholar
  78. Prest J (1988) The garden of Eden: the botanic garden and the recreation of paradise. Yale University Press, New Haven, CTGoogle Scholar
  79. Pretty J, Peacock J, Sellens M, Griffin M (2005) The mental and physical health outcomes of green exercise. Int J Environ Health Res 15(5):319–337PubMedCrossRefGoogle Scholar
  80. Qvarsell R, Torell U (2001) Humanistisk hälsoforskning. Ett växande forskningsfält. In: Torell Q (eds) Humanistisk hälsoforskning – en forskningsöversikt. Studentlitteratur, Lund, pp 9–22Google Scholar
  81. Relf PD (1992) Human issues in horticulture. Hort Technol 2:159–171Google Scholar
  82. Relf PD (1999) The role of horticulture in human well-being and quality of life. J Ther Hortic 10:10–14Google Scholar
  83. Relf PD, Lohr VI (2003) Human issues in horticulture. HortScience 38(5):984–993Google Scholar
  84. Reynolds V (2002) Well-being comes naturally: an evaluation of the BTCV green gym at portslade, East Sussex, Report 17. Oxford Brookes University, School of Health and Social Care, OxfordGoogle Scholar
  85. Roszak T, Gomes ME, Kanner AD (eds) (1995) Ecopsychology: restoring the earth healing the mind. Sierra Club Books, San Francisco, CAGoogle Scholar
  86. Searles HF (1960) The nonhuman environment in normal development and in schizophrenia. International University Press, Madison, CTGoogle Scholar
  87. Sempik J, Aldridge J, Becker S (2003) Social and therapeutic horticulture: evidence and messages from research. Thrive with the centre for child and family research. Loughborough University, UKGoogle Scholar
  88. Shoemaker CA (2002) The profession of horticultural therapy compared with other allied therapies. J Ther Hortic 13:74–80Google Scholar
  89. Simson S, Straus MC (1998) Horticulture as therapy: principles and practice. Food Products Press, New YorkGoogle Scholar
  90. Söderback I, Söderström M, Schälander E (2004) Horticultural therapy: the ‘healing garden’ and gardening in rehabilitation measures at Danderyd hospital rehabilitation clinic, Sweden. Pediatr Rehabil 7(4):245–260PubMedGoogle Scholar
  91. Söderström M, Mårtensson F, Grahn P, Blennow M (2004) Utomhusmiljön i förskolan – dess betydelse för barns lek och en möjlig friskfaktor. Ugeskr Laeger 166(36):3089–3092PubMedGoogle Scholar
  92. Spitzform M (2000) The ecological self: metaphor and developmental experience. J Appl Psychoanal Stud 2:265–285CrossRefGoogle Scholar
  93. Statens Folkhälsoinstitut (2005) Mål för folkhälsan ska genomsyra hela samhällspolitiken. 2005-10-20.
  94. Stern D (2000) The interpersonal world of the infant. Basic Books, New YorkGoogle Scholar
  95. Stigsdotter UK (2005) Landscape architecture and health: evidence-based health-promoting design and planning. Acta Universitatis agriculturae Sueciae nr 2005:55Google Scholar
  96. Stigsdotter U, Grahn P (2002) What makes a garden a healing garden? J Ther Hortic 13:60–69Google Scholar
  97. Stigsdotter U, Grahn P (2003) Experiencing a garden: a healing garden for people suffering from burnout diseases. J Ther Hortic 14:38–49Google Scholar
  98. Tenngart C, Abramsson K (2005) Green rehabilitation. Growthpoint J Soc Ther Hortic Spring 2005(100):25–27Google Scholar
  99. Tenngart Ivarsson C, Hagerhall CM (2008) The perceived restorativeness of gardens – assessing the restorativeness of a mixed built and natural scene type. Urban Forest Urban Green 7:107–118CrossRefGoogle Scholar
  100. Tomkins SS (1995) Exploring affect. University Press, CambridgeCrossRefGoogle Scholar
  101. Townsend M, Ebden M (2006) Feel blue, touch green. Final Report from the Healthy Parks, Healthy People-project. Deakin University, AustraliaGoogle Scholar
  102. Tranel D, Bechara A, Damasio AR (2000) Decision making and the somatic marker hypothesis. In: Gazzaniga MS (ed) The new cognitive neurosciences, Sid 1047-1061. MIT Press, Cambridge, MAGoogle Scholar
  103. Ulrich R (1984) View through a window may influence recovery from surgery. Science 24:420–421CrossRefGoogle Scholar
  104. Ulrich RS (1993) Biophilia, biophobia and natural landscapes. In: Kellert SR, Wilson EO (eds) The biophilia hypothesis., pp 73–137Google Scholar
  105. Ulrich R (1999) Effects of gardens on health outcomes, theory and research. In: Cooper-Marcus C, Barnes M (eds) Healing gardens: therapeutic benefits and design recommendations. John Wiley and Sons, New YorkGoogle Scholar
  106. Ulrich RS (2001) Effects of healthcare environmental design on medical outcomes. In: Dilani A (ed) Design and health. Svensk Byggtjänst, Stockholm, pp 49–59Google Scholar
  107. Ulrich RS, Simons RF, Losito BD, Fiorito E, Miles MA, Zelson M (1991) Stress recovery during exposure to natural and urban environments. J Environ Psychol 11:201–230CrossRefGoogle Scholar
  108. Urban parks and open spaces (1983). University of Edinburgh, Tourism and Recreation Research Unit, EdinburghGoogle Scholar
  109. Van den Berg AE, Hartig T, Staats H (2007) Preference for nature in urbanized societies: stress, restoration, and the pursuit of sustainability. J Soc Issues 63:79–96CrossRefGoogle Scholar
  110. Währborg P (2009) Stress och den nya ohälsan. Natur and Kultur, StockholmGoogle Scholar
  111. Warner SB Jr (1998) The history. In: Gerlach-Spriggs N, Kaufman RE, Warner SB (eds) Restorative gardens: the healing landscape. Yale University Press, New Haven, CT, pp 7–33Google Scholar
  112. Webb EJ, Campbell DJ, Schwartz RD, Sechrest L (1966) Unobtrusive measures: nonreactive measures in social sciences. Rand McNally, Chicago, ILGoogle Scholar
  113. WHO (1948) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100 and entered into force on 7 April 1948)Google Scholar
  114. WHO (2004) 2004-06-29. www.who.intGoogle Scholar
  115. WHO (2006) 2006-09-20. Obesity and overweight. Fact sheet No 311, September 2006.
  116. WHO (2008) 2008-07-16. Programmes and projects. Mental health: depression.
  117. Willenbring M (2002) Mutter, Vater, Zappelkind. Die Zusammenarbeit mit Eltern von hyperaktiven Kindern. Lernchancen 5. Jg. (2002) Heft 30:S. 30–S. 35Google Scholar
  118. Willis J (1999) Ecological psychotherapy. Hogrefe and Huber, Seattle, WAGoogle Scholar
  119. Wilson EO (1984) Biophilia. Harvard University Press, CambridgeGoogle Scholar
  120. Wilson FR (2004) Ecological psychotherapy. In: Conyne RK, Cook EP (eds) Ecological counseling: an innovative approach to conceptualizing person-environment interaction. American Counseling Association, Alexandria, VA, pp 143–170Google Scholar
  121. Wong JL (1997) The cultural and social values of plants and landscapes. In: Stoneham J, Kendle D (eds) Plants and human well-being. The Federation for Disabled People, GillinghamGoogle Scholar
  122. Yin RK (1994) Case study research: design and methods, 2nd edn. Sage, Thousand Oaks, CAGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Ulrika K. Stigsdotter
    • 1
  • Anna Maria Palsdottir
    • 2
  • Ambra Burls
    • 3
  • Alessandra Chermaz
    • 4
  • Francesco Ferrini
    • 5
  • Patrik Grahn
    • 2
  1. 1.Forest & Landscape DenmarkUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Work Science, Business Economics and Environmental PsychologySwedish University of Agricultural SciencesUppsalaSweden
  3. 3.Man and the Biosphere Urban ForumUNESCOLyme RegisUnited Kingdom
  4. 4.Free lanceTriesteItaly
  5. 5.Department of Plant, Soil and Environmental ScienceUniversity of FlorenceFlorenceItaly

Personalised recommendations