(An interview with Dr. Paul Deal, a nationally certified counselor, co-chair of Counseling and Clinical Services Department and associate professor of Clinical Mental Health Counseling at SUNY Plattsburgh — and two of his students — served as the backdrop for this column. The students included Raneem Kurzum, who is working on his PhD in Counseling Psychology at the University of Albany, and Taylor Scott, who just completed her MS in August 2022. Dr. Deal provided a number of research studies to review. This column relies greatly on “Recovering With Nature: A Review of Ecotherapy and Implications for the COVID-19 Pandemic,” by Chaudhury, et al.)

Living in the North Country brings the lovely ambience of lakes and mountains into our daily lives. If there seems to be something sacred about nature, this might be related to historical Indian philosophy and the belief that man and nature are not radically distinct entities. The Indian philosophy views man as being an integral part of nature, and believes that there is a bilateral nourishing existence between nature and man.

Western culture, however, has been infiltrated with globalization and urbanization, and technology has eviscerated this sacred relationship. This has resulted in a decrease in exposure to nature and an increase in the global prevalence of mental illness. Unlike in Indian philosophy, which emphasized restraint in using ecological resources, Western philosophy views nature as a commodity, and as something to consume 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 viewed as distinct entities with humans given complete power to exploit and use these resources for personal and collective gain.

Eco-therapy 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 helpful for addressing depression, ADHD, adjustment disorders and PTSD. There are benefits to integration with nature for medical issues as well. These include post-surgical recovery, obesity and hypertension.

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

As James Hillman notes: “Psychology, so dedicated to awakening human consciousness, needs to wake itself up to one of the most ancient human truths: We cannot be studied or cured apart from the planet.”

Eco-psychology and eco-therapy proposes a holistic relationship between man and nature. This generally refers to therapeutic interventions that relate to animals, plant and nature. Eco-therapy, however, integrates meaningful and healthy interactions with the earth and helps humans to form a reciprocal relationship with nature. It serves as an umbrella word for green care, and it includes therapeutic activities that incorporate animals, plants and nature.

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

Biophilia implies that human fulfillment, and even identity, are dependent upon a human relationship with nature. This refers to an emotional and deep connection between people and the non-natural world. The term biophilia refers to a love of life, and some philosophers note that it is in effect the essence of humanitarian ethics and humankind as a whole. This instinct and attachment to the nonhuman world is integral to emotion, cognition, and even art, and both consciously and unconsciously relates to experiences from early childhood and beyond.

Stress reduction theory (SRT), proffers that natural environments trump artificial environments in the restorative value that they provide. According to this theory, connection to nature mitigates the flight and fight response of what is known as the sympathetic nervous system, and enhances the neurophysiology of the parasympathetic system, helping to decrease the effect of emotion laden signals. Ulrich, et al., notes that there are increased feelings of joy, playfulness, and affection when viewing natural scenes. On the other hand, watching urban scenes can produce anger and sadness.

Serotonin production increases when unstressed adults are shown images of natural landscapes. Serotonin reuptake inhibition, and increases in the concentration of serotonin in the pre-frontal cortex and limbic system, are the purported mechanisms of action of antidepressants such as Zoloft, Prozac, Celexa, and Lexapro. The pre-frontal 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 demonstrated that surgical recovery times are improved with windows and nature versus viewing urban scenes such as walls or concrete.

Attention restorative theory (ART) states that a conscious and voluntary focus is required to differentiate relevant from irrelevant exogenous stimuli. Since this is a voluntary process, cognitive resources can be more readily depleted. This results in a decrease in ability to focus and to pay attention. In nature, however, there is an involuntary process of bonding with nature, repleting cognitive resources and restoring both cognitive and attentional capabilities, and potentially able to improve memory measures and attentional strength.

The Eco-existential Positive Psychology Perspective supports the hypothesis that embracing the innate biophilic tendencies that all humans have can improve well-being. It accomplishes this by helping people to manage existential anxieties that can occur with loneliness, isolation, boredom and alienation. Writer Leo Tolstoy noted that existential anxieties can occur potentially in everyone, relating 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 emptiness. Alternatively the structure of Jungian psychotherapy enables us to engage with our dreams and their interpretations as a guidepost to our future. Embracing nature, while not perhaps completely replacing doing inner psychological work, can catalyze the process and improve our own inner connections to ourselves.

Given the data that supports a connection to nature, it is natural to ask what role the environment might play in producing 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 has been known for years that just being in the same room with an animal or pet can induce a drop in blood pressure. These interventions can help to emotionally stabilize children and improve their alertness and attention capabilities. Therefore the utilization of animals in psychotherapy can help children to calm aggression.

Another green based intervention includes social and therapeutic horticulture. Although it can help decrease loneliness and isolation and depressive symptoms in adults, it has been noted in children to increase capacity to maintain attention.

Criticisms to these green based approaches include the simplistic structure that might lead some patients to be resistant to adhering or accepting this treatment. This would be interesting to test in children since they may be less resistant to a nature based interventions, regardless of its simplicity.

Another criticism is that it is not feasible to standardize green environments, and because of this any large scale research would like be prohibited.

Using pets and dogs as the core part of therapy may not be accepted by all demographics and may create a barrier to uptake in a specific patient or population.

Trauma can create severe mental illness or, alternatively, serve as an ingredient for post traumatic resilience. The pandemic proved to be highly traumatizing. Heinz Kohut described the need for optimally frustrating experiences in children to help them to build the internal resources necessary to cope and survive. Parents should watch over their children, but also allow them to fall and get up, and learn how to deal with adversity. The role of greenery in psychotherapy should continue to be researched and explored. More studies should be conducted to explore the differences between how children vary from adults when treated with ecological interventions. Ultimately, the outdoors is the best marking of all, serving to encourage adults and children to spend time outdoors. Fortunately, these enjoyable activities help to provide protection and healing for demographics of all ages.