Healing Outdoors: Using Nature-Based Occupational Therapy

Occupational therapy has always had its roots in natural, realistic environments that facilitate improvement in functional areas. While we all understand that engagement in meaningful activities helps to facilitate ability, we can very easily fall into a routine of only treating in our usual treatment settings. Clinics, homes, schools, or gyms can all become the only location we use for our therapy, but that doesn’t have to be the case! In this article, we’ll cover how nature-based occupational therapy works, and how nature-based OT can be utilized by any OT practice.

What is Nature-Based Occupational Therapy?

Put simply, nature-based occupational therapy is the practice of incorporating natural elements into occupational therapy treatment. Quite often, this is seen with pediatric treatments in either the school or home setting. However, nature-based OT is by no means limited to those settings. In fact, the principles of nature-based occupational therapy can be implemented in nearly any treatment setting and to treat nearly any condition and any age.

When we first think of nature-based OT, we might have different ideas about what is expected. While it is true that some nature-based OT treatments may involve having patients sit in nature and enjoy the serenity, it is by no means limited to that.

Nature-based OT sessions are any therapeutic session where natural elements are incorporated into the treatment. For example, simple things like outdoor walks, gardening sessions, or playing with sand can all be labeled as “nature-based.”

To be a truly nature-based treatment, though, the natural element really must be intentional. The difference between a nature-based treatment and a treatment that happens to involve nature all boils down to intention. By actively utilizing the powerful effect that nature has on patients, you can reap the benefits of nature-based OT.

The Benefits of Nature-Based Therapy

There are many powerful benefits to incorporating natural elements into an OT treatment. Natural environments have a profound calming effect, helping to lower cortisol levels, reduce anxiety, and improve overall mood (Yale, 2020). For patients dealing with stress or mood disorders, incorporating nature into therapy can offer a valuable therapeutic escape and promote relaxation. Regardless of what brings someone to occupational therapy, the underlying issues are causing some amount of stress.

Therapeutic activities in natural settings can be particularly helpful when addressing cognitive impairments or developmental disorders by providing a stimulating but less distracting environment compared to traditional indoor settings. These outdoor therapy sessions can also promote increased physical activity, maximizing performance for patients with physical disabilities, rehabilitation needs from illness or injury, or limited functional activity tolerance.

Additionally, nature-based activities can often lend themselves to activities which promote social interaction and collaboration, improving social skills and offering shared experiences without feeling like a forced therapeutic intervention.

How to Implement Nature-Based Occupational Therapy

Utilizing nature-based OT starts with assessing a patient’s interests, goals, and needs, taking into account their physical abilities, cognitive functions, and emotional state to tailor nature-based interventions effectively. For example, a client with functional mobility difficulties might benefit from a therapeutic garden with raised beds, while another might prefer group nature walks. Knowing the needs as well as the desires of patients will help to craft a therapy session that helps reach goals.

Nature-Based Occupational Therapy Interventions

While you can certainly incorporate and modify some of your more traditional occupational therapy interventions to be done outside, here are a few additional intervention ideas you can add in to your treatment toolbox. 

• Gardening: Planting, weeding, watering, watering harvesting, and maintaining a raised bed or container garden.
• Functional mobility: Walking on grass/uneven terrain, raking leaves, sweeping paths
• Animal-assisted therapy: Working with animals like horses (equine therapy), dogs, or other pets in outdoor environments
• Outdoor therapeutic exercise: Practicing yoga, Tai Chi, incorporating balance or strengthening interventions, and/or breathing exercises outdoors
• Forest bathing: Taking your patient/client on a guided walk through a forest or woods, with a focus on mindfulness and taking in the natural element for relaxation and mental health benefits
• Outdoor play therapy (for pediatric patients): Play-based activities like climbing, running, balancing on natural objects, and creative play or sensory activities in nature

 

One thing to keep in mind is that not all of our patients have easy access to outdoor spaces. While being outdoors is the best case scenario for true nature based therapy, in these cases, utilizing natural elements indoors can still be therapeutic and beneficial. Using materials like sand, water, plants, and natural textures into therapy activities can still have therapeutic benefits.

For example, sensory bins with natural items such as pebbles, leaves, or seeds can help stimulate tactile exploration, indoor planters or herb gardens can be used for therapeutic gardening, and integrating nature themes into creative arts, like painting landscapes or making collages with natural materials, can promote engagement in these nature-based treatment plans.

Adapting to Patient Needs and Preferences

Nature-based interventions require flexibility, adaptability, and creativity. Likely, we all have certain treatments that we lean towards more than others. Nature-based OT pushes us out of that familiar comfort zone, helping us to find new and exciting ways to help our clients reach their goals. By looking at the natural elements involved in our OT treatments, we can ensure that all of our treatments are goal-oriented, client-centered and beneficial for our patient.

At the same time, however, an important element of nature-based OT is simply the enjoyment our patient receives from being engaged in a natural environment.

Even something as simple as taking a patient outside during a long hospital stay can make all the difference when it comes to their attitude and perspective. Nature-based OT is a great tool to use in conjunction with our therapeutic use of self to help get our patients to open up, discuss things freely, and feel more comfortable working with us towards their goals.

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Regardless of where we treat, who we treat, or how long we have been practicing OT, we all have the potential to add nature-based occupational therapy into our practice. This can be by taking our patients into nature and having them engage with the natural elements or by bringing some of the nature inside to them.

Even if we have already been using aspects of nature-based occupational therapy in our treatments, there is incredible benefit that can be found by making the best use of the natural elements.

References

Ecopsychology: How Immersion in Nature Benefits Your Health (Yale, 2020)

This post was co-written by Michel Moniger, COTA/L and Sarah Stromsdorfer, OTR/L.