A Portfolio of Research Work

Including an investigation of

Spending Time in Nature: Restorative Effects of Mood Amongst Depressed Individuals

By

Michael Eko

Submitted to the University of Surrey for the degree of

Practitioner Doctorate (PsychD) in

Psychotherapeutic and Counselling Psychology

Department of Psychology

Faculty of Arts and Human Sciences

University of Surrey

2015

Statement of Copyright1

No aspect of this portfolio may be reproduced in any form without written permission from

the author, with the exception of the librarians of the University of Surrey who may

reproduce this portfolio by photocopy, or otherwise, and lend copies to institutions or

individuals for academic purposes.

©Michael Eko, 2015

2

Statement of Anonymity and Confidentiality

To preserve the anonymity and confidentiality of clients, research participants, supervisors,

and placements, all names and identifying markers have either been omitted or replaced with

pseudonyms throughout the portfolio.

3

Acknowledgements

I would like to dedicate this accomplishment to Michael John Harper Brade: Thank you for

your unconditional love, your mischievous spirit, for inspiring me and believing in me, and

for helping me see life with new eyes.

To all the helpful individuals who have made the last three and a half years easier: Dr

Ricarrdo Draghi-Lorenz, Pierre Cachia, Maureen Luden, Tommy Raisanen; my supportive

and inspirational supervisors, Dr Martin Milton and Dr Birgitta Gatersleben; and the

wonderful administration staff who have always been very helpful to me. I thank you and

value your help and support.

To all my placement supervisors—all of whom, in their own inimitable ways, have taught

and influenced me over the course of my training: Thank you for your guidance, acceptance,

and flexibility, and for taking a giant leap into the unknown so that I may follow in your giant

footsteps.

To all the wonderful, complex, and gracious people who have worked together with me:

Thank you for allowing me to see you and for seeing me. You will always be my greatest

teachers.

To Peter Wilton: Thank you for generously proofreading my work during the last six years.

To all the participants who generously gave their time and volunteered to take part in the

research: Your contribution is appreciated and valued.

To all the wonderful colleagues and people I have met whilst studying at the university and at

placements: It has been the greatest pleasure—talking with you, laughing with you, and

learning with you.

Thank you one, thank you all.

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Contents

A General Abstract 6

Introduction to Research Dossier 8

Literature Review:

Spending time with nature: Exploring the relationship between ecopsychology and mental health problems

10

Research Project (Year 2):

Almost like an old friend: An exploration of depressed individuals’ relationship with nature

55

Research Project (Year 3):

Spending time in nature: Restorative effects of mood amongst depressed individuals

107

5

A General Abstract

This portfolio contains a collection of work written and submitted for the Practitioner

Doctorate in Psychotherapeutic and Counselling Psychology at the University of Surrey. It

consist the research dossier, all of which have been reworked and amended according to the

feedback that was received at the time. The research dossier includes my literature review,

one qualitative study and a quantitative study. The literature explores the relationship

between ecopsychology and mental health problems such as depression, stress and

psychological trauma. This is then followed by a study which explores depressed individuals’

relationship with nature. The final piece of research investigates the restorative effects of

spending time in nature on the mood of depressed individuals.

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Research Dossier

7

Introduction to Research Dossier

This research dossier consists of a literature review which I carried out in my first year, and

two empirical studies that I conducted in my second and final year as a trainee counselling

psychologist. My area of research relates to the beneficial impact of nature on depressed

individuals. Overall, I have found this effort has been fascinating and has produced new

insight. I have also found that it fuels my interest in the application of research knowledge.

Indeed, as discussed in my final clinical paper, it has also been reflected in my clinical work

with a few clients who presented with depression. Although this area of research is not new,

the use of nature as a therapy for those with mental health problems is a relatively new and

developing area. It is my hope, therefore, that my effort, as well as that of others, will

continue to help shed much needed attention on the importance of nature in promoting mental

health and well-being, not only for people who are depressed, but also for non-depressed

individuals too.

My literature review explores the relationship between the natural world and mental health

problems such as depression, stress and psychological trauma. The review considers relevant

ecopsychological and theoretical perspectives of the human-nature relationship. The review

further explores mental health and well-being from an ecopsychological viewpoint. Overall,

it shows that whilst there is plenty of positivistic research evidence suggesting that there is a

relationship between interaction with nature and positive mental well-being, there is a lack of

research into individuals’ subjective experience of nature. In addition, research has neglected

exploring the impact of spending time in nature on individuals with mental health problems.

Following on from my literature review, my 2nd year research examined depressed

individuals’ relationship with nature. I adopted an Interpretative Phenomenological Analysis

in order to capture and explore participants’ subjective experience of nature. This study

provided rich and in-depth data which shed some insight on depressed individuals’

relationship with nature, their experience of connection with it, as well as the impact upon

them of being in nature. I chose to conduct qualitative research because previous studies have

largely been quantitative; therefore, I felt that a subjectivist understanding might do more to

advance current knowledge.

My final research investigated the effect of nature on the mood of depressed individuals. The

study adopted a positivistic understanding in order to consider the research hypothesis. I

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chose a quantitative approach, because, since this area is still only just emerging, there is a

lack of research exploring the effect of nature on the mood of depressed individuals.

Therefore, having conducted a qualitative research in the previous year, I felt that a more

experimental approach, taking research into the field, might lend greater depth to what I had

learnt from my previous research.

9

Spending time in nature: Exploring the relationship between

ecopsychology and mental health problems

Abstract

Ecopsychology focuses on diverse issues such as climate change, the development

of sustainable behaviour, the psychological effects of the natural world, the

mutually-beneficial relationship between mankind and the planet, the impact of

separation from nature, etc. Literature suggests that spending time in (and with)

nature is fundamental to our mental health and well-being. This paper explores

the relationship between the natural world and three mental health problems:

depression, stress, and psychological trauma. Applicable theories and evidence

are examined in order to understand what effect interacting with nature has on

these conditions, and how they may be approached from an ecopsychological

perspective. This paper gives an overview of ecopsychology, examines what

constitutes mental well-being in ecopsychology, and explores the psychological

benefits of the natural world on depression, stress, and psychological trauma. The

limitations of current research, gaps in available literature, implications, and

possible future directions for research are also discussed.

Keywords: ecopsychology; depression; nature; psychological trauma; stress.

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Introduction

The field of ecopsychology focuses on diverse issues such as climate change, the

development of sustainable behaviour, the psychological effects of the natural world, the

mutually-beneficial relationship between mankind and the planet, the impact of separation

from nature, etc. Conversely, mental well-being and mental health problems are thought to be

shaped by the interplay of biological, psychological, and social determinants (WHO, 2012).

Currently, in healthcare settings, there are a wide range of theoretical frameworks concerning

mental health issues put forward by competing schools of thoughts, each attempting to

explain the development and management of these problems (Dooher, 2008; Gross, 2005;

Kring, Davison, Neale & Johnson, 2007). However, all these theories tend to ignore the

ecopsychological notion that the human mind is framed within a larger context (that of the

physical world).

As ecopsychology and mental health problems encompass very broad subject areas, it is

essential to touch upon a range of relevant subjects in both fields. Nonetheless, the key focus

of this article regards the question of what literature tells us about the relationship between

ecopsychology, mental health, and well-being. In that a growing body of evidence suggests

that there is a link between mental health and interaction with nature, an understanding of this

relationship may provide deeper insight into how mental distress can be approached from an

ecopsychological perspective. In order to consider this issue in depth, this review will be

broken down into three sections: firstly, a general overview of ecopsychology; secondly, an

exploration of the literature of ecopsychology to examine what constitutes ‘well-being’; and

finally, a focus on how ecopsychological work can help provide a more holistic approach to

three specific mental health difficulties: depression, stress, and trauma.

General Overview of Ecopsychology

By definition, ecopsychology is the study of the relationship between mankind and nature;

one of its central tenets being that the human psyche is deeply connected to the earth in which

it is bonded and nourished. Ecopsychology scholars have long argued that separation from

nature has led to a widespread disconnection from that which is important to our mental

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health, and that it is increasingly contributing to environmentally-damaging behaviours

(Boston, 1996; Searles, 1960; Shepard & McKinley, 1969). It appears that empirical research

is only just beginning to understand some of the impact (and ramifications) of this separation.

Ecopsychology aims to understand and advance the relationship between humanity and the

planet, and to understand the reasons behind environmentally-harmful behaviours, as well as

to explore ways to stimulate sustainable, environmentally-friendly behaviour to the mutual

benefit of humans and the planet (Roszak, 1992). Fisher (2002) states that ecopsychology has

four interrelated tasks: firstly, to re-establish connection with the natural world, and to move

away from the conventional concept of the dualism of body and mind, which dominates

scientific and psychological discourse. Secondly, to carry out social enquiry and activism.

Thirdly, to challenge anthropocentrism by facilitating an understanding that we are all part of

the same ecosystem and thus equal – rather than superior to other lifeforms. And fourthly, to

“develop therapeutic and recollective practices toward an ecological society” (Fisher, 2002:

p. 12). There has since been a burgeoning collection of literature regarding the therapeutic

uses of horticulture, vegetation, wilderness and ‘green exercises’, in what Clinebell (1996)

terms ‘ecotherapy’. Some of these tasks are directly related to the biophilia hypothesis, a

concept that will be discussed next. Afterwards, three additional concepts will be addressed,

due to their pertinence, to understanding ecopsychology: dualism, ecological consciousness,

and environmentally-damaging behaviours.

The Biophilia Hypothesis

According to Wilson (1984), who developed the biophilia hypothesis, humans have an

“innate emotional affiliation… to other living organisms” (Wilson, 1993: p. 31), such as

plants, trees, animals, wildlife, etc. Kellert (1997) describes this inherent affiliation as a

fondness for nature and a sense or need to be ‘at one’ with it. Thus, our connection within the

ecosystem is essential in determining our individual identities and level of life satisfaction

(Wilson, 1984). This relationship also maintains our self-esteem and well-being by

engendering a sense of belonging in the world (Kellert & Wilson, 1993). This is significant,

considering that studies have consistently found a link between self-esteem and mental-health

problems like depression, anxiety, and eating disorders (Silverstone & Salsali, 2003;

Silverstone, 1990; Battle, 1978; Taylor & Pilar, 1992; Gual et al., 2002). Accordingly, this

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provokes the question: If nature is vital to our sense of self-worth, can it then be beneficial in

alleviating some symptoms of mental distress? In other words, what is the relationship

between mental distress and being in contact with nature? This question will be explored later

in some detail.

Wilson (1984) further states that our biophilic instinct to connection with other living things

evolved as a survival mechanism, to ensure that mankind is never far from what Maslow

(1943) called our basic physiological and safety needs (i.e. food, water, and shelter). This

innate instinct connects us with nature by helping us develop an awareness of our shared

existence, but at the same time, serves to remind us of our evolutionary root; when our

ancestors scavenged as hunter-gatherers, and were more sensorially aware of (and attuned to)

the natural world (Wilson, 1993). This evolutionary link is believed to be important (Conesa-

Sevilla, 2010; Metzer, 1999), particularly since it is in direct contrast with the current trend

towards separation from nature. One of the implications of the biophilia hypothesis is,

therefore, that humans and other living things (plants, trees, animals, wildlife, etc.) are all

interconnected, and our efforts to be independent hurt not only ourselves, but other living

things. This position is supported by authorities representing diverse but related fields such as

agriculture (food production – McNeely & Scherr, 2003; Pretty, 2002), horticulture (Relf,

1998), and ecology (O2 production – Archibold, 1995; Keddy, 2007). Another implication of

the theory is that it suggests that human well-being is intrinsically linked with the natural

world. This is one of the strengths of the theory, in that it may explain why some individuals

have a preference for natural environments, rather than built environments (Hartig et al.,

2011; Kaplan 1987; Ulrich et al., 1993). However, some studies also suggest that museums

(Kaplan, Bardwell & Slakter, 1993) and monasteries (Ouellette et al., 2005) in some cultures

can have cognitive restorative effects on individuals. This point is contrary to one of the

biophilia hypothesis assumption that humans have an inherent need or preference for nature.

Empirical evidence supports some aspects of the biophilia hypothesis. Research demonstrates

that humans tend to have a preferences for savanna grassland landscape (Dutton, 2003; Falk

& Balling, 2010; Han, 2007; Orians & Heerwagen, 1992), which is considered to be the

typical environment that the early humans (the hominins) inhabited in East Africa over two

million years ago (Cerling et al., 2011; Plummer et al., 2009). Studies consistently

demonstrate that interaction with nature is associated with cognitive well-being: improved

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attentional capacity (Kaplan & Kaplan, 1989; Berman et al., 2008; Berto, 2005), improved

productivity/efficiency (Fjeld et al., 1998; Leather et al., 1998), and reduction in cognitive

fatigue (Berman et al., 1989; Pearson & Craig, 2014). Studies also show that connection with

nature is linked with improved emotional well-being: reduced physiological indicators of

stress and increased positive effect (Alvarsson, Wiens & Nilsson, 2010; Hartig, 1991; Ulrich

et al., 2002). Furthermore, others have found that human contact with animals stimulates

emotional well-being (Frumkin, 2001; Vining, 2003). For example, Katcher et al. (1983) and

Katcher, Segal and Beck (1984) demonstrated that viewing an aquarium with live fish is

linked with reduced blood pressure and increased state of relaxation in individuals before

undergoing oral surgery. This seems to support the biophilia hypothesis assumption that there

is a relationship between human well-being and interacting with nature.

Whilst the biophilia hypothesis has some strength, as discussed above, in evaluating some of

its claims and assumptions further, it is clear that there are several weaknesses, and this will

now be expanded upon. Firstly, it is important to note that the biophilia hypothesis takes an

evolutionary psychology approach towards social behaviour. Therefore, similar to the way

that evolutionary psychology views human physical traits as evolving over time due to

natural selection, the biophilia theory considers the act of interacting with nature as a

behaviour that is passed down from generation to generation. This is problematic because it is

directly assumed that engagement with nature is genetically determined. Whilst there is

evidence that demonstrates that some social behaviours are genetically defined in some

animals like worms, bees, wasps and ants (Aamodt, 1998; Bolton et al., 2006; Ferreira et al.,

2013; Kocher et al., 2013; Park et al., 2015: Yan et al., 2014), there has been no evidence to

indicate that this may also be the case for humans. Furthermore, it is a big jump to argue,

based on evidence that shows that certain animal behaviours are genetically fixed to inferring,

based on those same evidence, that certain human behaviour that are nature activity related

are genetically modified. Since there is no evidence in support of this contention or this

aspect of the biophilia theory, it would seem that there is a gap between this particular claim

and relevant evidence. This is another notable weakness of the theory.

A third weakness of the theory concerns the idea that, while it accounts for positive affiliation

with nature, this is countered by observation and evidence that some individuals have a

negative affiliation with nature. That is, some individuals perceive nature to be unlikeable,

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hostile and threatening (Dunn, 2010; White & Heerwagen, 2013). In some sense, it is likely

that some people fear or are weary of nature because of the association that nature is

unpredictable and is far likely to be inhabited by a variety of animals, some of which can be

harmful and dangerous (e.g. false widow spiders, jellyfish, badgers, snakes, and wasps and

bees.) It is also notable that individuals can have different levels of phobia of plants/trees

(botanophobia/hylophobia), the sea, (thalassophobia), as well as animals such as snakes

(ophidiophobia), dogs (cynophobia), birds (ornithophobia), and insects like spiders, bees and

ants (Agras, Sylvester & Oliveau, 1969; Torgersen, 1979). This would seem to contradict the

biophilia hypothesis assumption that humans have an inherent instinct to connect with nature.

Though some individuals may have a deep connection to nature, it is also probable that rather

than this behaviour being genetically determined, it may simply be a learnt behaviour that

individuals like and are used to, similar to the way that some individuals may show a

preference for living in a city rather than a rural setting. Other factors such as individual

experience, attitude, culture, personal beliefs and beliefs about environment functionality

may also play a role in preference for nature. Therefore, such actions or behaviour may elicit

positive bias response. Furthermore, it suggests that not everyone actually has a positive

affiliation of nature, which also implies that perhaps not everyone experiences positive

psychological benefit from spending time in nature.

Cartesian Dualism

The second concept relevant to ecopsychology is Cartesian Dualism (the dominant paradigm

of modern empirical science), which is in distinct contrast with the perspective forwarded by

the biophilia hypothesis. Cartesian Dualism (rooted in Greek philosophy) maintains that the

immaterial mind and the material body are two completely distinct and separate types of

substances that simply interact with each other (Chalmers, 1997, Mohrhoff, 1999). This

contention has been supported by arguing that, while the human body can be physically

divided (exemplified by severing a limb), the mind (or soul) were indivisible (Fisher, 2002).

A weakness of this idea is that it is reductionist, in that it reduces phenomena into mere

mechanisms (Fisher, 2002). Similarly, various other phenomena are reduced to their

constituent parts: mankind and nature, good and evil, nature and nurture, subject and object,

self and other, and so on. As Higley and Milton (2008) note:

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“With the dawning of the industrialisation and enlightenment period, the

concept of self and what was important for one’s well-being narrowed. In

order to exploit the earth’s natural resources and to foster the importance of

economic progress, some sense of disconnection from that which was being

exploited needed to occur in the cultural psyche, a collective dissociation of

sorts.” (Higley & Milton, 2008: p. 11).

Thus, with the assertion of a separation between the body and mind by Cartesian philosophy,

a separation of self from the natural world emerged, which modern psychology has been

complicit in maintaining (Sneep, 2007; Vining, Merrick & Price, 2008). As a result, the focus

became what Lamb (1996) described as ‘anthropocentric’, whereby humans have come to see

themselves as distinct and supreme. Lamb contrasts this with the ‘biocentric’ view (similar to

the biophilia hypothesis argument), whereby all life-systems are seen as equal, arguing that

the way we perceive nature affects our bond and relationship with it. This assertion now rings

true more than ever in that, due to modern technological advances, an increasing number of

people willingly become dependent on technological tools (particularly the Internet and

social media for communication), thereby effectively reducing the opportunity to experience

nature. As a consequence, the disconnection between man and nature has never been wider.

Some scholars have observed that the current generation of children are growing up with no

personal experiential connection with nature (Louv, 2005; Frumpkin, 2001). Louv (2011)

termed this the ‘nature deficit disorder’, believing that disconnection from nature explains

conditions such as attention deficit disorder and depression, increasing in both children and

adults.

The Ecological Unconscious and Environmentally-Damaging Behaviour

The third concept relevant to ecopsychology is that of the so-called ‘ecological unconscious’,

a term Roszak (1992) adapted from Jung’s theory of ‘collective unconscious’ (Jung, 1959) to

argue that, within the human mind, an ecological unconscious exists that can pave the way to

ecological sanity. Roszak describes this phenomenon as our inborn connection to the earth

and as our deep, natural understanding of it, both of which are rooted in cosmic and

biological evolution. Roszak also argues that the human mind is situated within a wider

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intelligence (the earth), and that we depend on this intelligence and other lifeforms for

nourishment and sustenance, just as much as they depend on us. Therefore, it is essential to

recognise the reciprocal interaction between both (McCallum & Milton, 2008; Greenway,

2010). This view is echoed by Higley and Milton (2008) who voice the concern that

‘counselling’ psychology, like the rest of psychology, may be in danger of becoming

anthropocentric and, as a result, further perpetuating the division between humans and nature.

While this observation is a valid one, this paper contends that it may be easier for us to adopt

an environmentally-friendly behaviour if we understand how vital the planet is to our mental

health and overall well-being.

The fourth and final concept imperative to ecopsychology is that of environmentally-

damaging behaviours. Some ecopsychologists have reasoned that, rather than investigating

the sources of environmentally-damaging behaviours, it makes more sense in the long term to

look into the benefits of spending time in nature, and how the impact of this on one’s mental

well-being may be useful in modifying such behaviours (Fisher, 2002; Sneep, 2007). This

seems particularly important in light of recent evidence indicating that public opinion

concerning climate change has shifted in the last few years, with fewer people believing in

this phenomenon, and less than 30 per cent believing that humans are the cause of climate

change (Gray, 2012). Conversely, some authors maintain that human inventiveness (via

technology) will eventually allow us to resolve the current environmental issues without

having to alter our ecological behaviour and practices (Simon, 1981; Suzuki & Dressel,

2002). This paper argues, as others have noted, that the environmental crisis we are presently

experiencing, and our disconnection from nature, are likely directly linked (Macy, 1983).

Therefore, it is vital to re-frame the human mind back to its natural ecological context,

because:

“Spending time outside, whether it be in our back gardens or in the wilds of

nature, is profoundly healing, and this can be a powerful ally in helping us to

recover a relationship with our nature. It also makes us aware of our need to

take care of our environment, as part of healthy development.” (Rust, 2008:

pp. 77–78).

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What constitutes mental health and well-being in ecopsychology literature?

Thus far, this paper has attempted to define ecopsychology and outline a few concepts that

are significant in this field. This section will now examine the literature of ecopsychology in

order to ascertain what constitutes ‘psychological well-being’. To achieve this, it is necessary

to first look at the definition of mental health and well-being, and explore the concept of

‘nature connectedness’, which has been described as “the proxy concept for the hypothetical

biophilia” (Hegarty, 2010: p. 1). This section will also examine relevant theories and

evidence, demonstrating the restorative effect of connecting with nature.

According to the World Health Organization (WHO), one way of viewing mental health is:

“… a state of well-being in which the individual realizes his or her own

abilities, can cope with the normal stresses of life, can work productively and

fruitfully, and is able to make a contribution to his or her community.” (2004b:

p. 11).

Moreover, mental health and well-being may also be understood through a term that

originates from ‘positive’ psychology: ‘flourishing’ (Keyes, 2002), characterised as a state in

which individuals “feel good”, “function effectively”, and “perceive that their life is going

well” (Huppert & So, 2009: p. 1). Evidence from positive psychology suggests that

individuals who are flourishing experience greater psychological well-being (self-esteem, a

sense of meaningfulness and purpose, optimism and resilience), emotional well-being (high

positive emotions, low negative emotions, and life satisfaction), as well as social well-being

(social esteem and positive relationships with others) (Barry, 2009; Fredrickson & Losada,

2005; Huppert & So, 2009; Keyes, 2007). In effect, good mental health is important for good

functioning in all aspects of human life and interaction.

It can be argued that good mental health is also related to the extent to which we are in touch

with nature. Schultz (2002), whilst recognising that bonding with nature is an innate human

quality, nonetheless asserts that individuals vary in the degree to which they embrace nature

within their personal identity; therefore, it makes sense that those who feel that they are a part

of their environment are more likely to care for it. In environmental and health psychology,

this is known as ‘connectedness with nature’ (CN) or ‘nature-relatedness’. Nisbet, Zelenski

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and Murphy (2009) define CN as “the affective, cognitive, and experiential aspects of human-

nature relationships” (2009: p. 1). Conn (1998) and others (Kahn, 1997; Kellert, 1997)

contend that CN is an essential aspect of human physical and mental health; therefore, not

being in touch with nature may have some negative impact on individuals’ sense of well-

being and life satisfaction. For example, Vining, Merrick and Price (2008) found that a

majority of the participants who took part in their study saw themselves as being part of

nature, whilst the others saw themselves as separate. Those who described themselves as ‘part

of nature’ reported having contact with it, carrying out nature-related activities, and

experiencing a level of positive emotion (e.g. pleasure, compassion, and affection) associated

with nature. Those who described themselves as ‘separate from nature’ reported having

minimal contact with the natural environment. This is significant because it implies that the

more in touch with nature we are, the more clearly-defined the relationship is for people.

However, a critique of Vining et al.’s (2008) study is that it does not explain in what way both

groups experience nature and how these may differ from each other. This is a matter that

might be taken into consideration in future research.

Nature-connectedness has also been linked to positive psychological effects. Mayer and

Frantz (2004) found that connection to nature is a good indicator of psychological well-being.

Cervinka, Roderer and Hefler (2012) suggest that there is a relationship between connection

to nature, mental well-being, and having a sense of personal meaning. Mayer, Frantz,

Burehlman-Senecal and Dolliver (2009) investigated the mediating role of connectedness to

nature on nature experiences and positive emotions of 232 undergraduate psychology

students, the results of which showed that CN strongly predicts the relationship between

experiences with nature and emotional well-being. More recently, Howell, Dopko, Passmore

and Buro (2011) examined the nature-connectedness, the social, emotional and psychological

well-being, as well as the degree of mindfulness (moment-to-moment awareness) of 452

undergraduate students, with results suggesting that feeling connected to nature is associated

with feelings of wonder, liveliness, direction in life, and positive moods. Students who felt

connected to nature also tended to show more mindful moment-to-moment awareness.

However, it is important to note that these studies have several limitations, one of which was

the use of standardised questionnaires to collect the data. Thus, inherently, some degree of

insight may have been lost due to the researchers’ limitations in probing deeper into the

participants’ answers. Secondly, quantitative research designs like those mentioned above

19

take a ‘positivist’ stance, which considers ‘truth’ and ‘knowledge’ as objective rather than

social constructs. This means that, from an ontological perspective, these studies may be

reductionist. Thirdly, these studies tend to rely on undergraduate psychology students as

subjects, which suggest that the research may not be representative of other populations.

In a recent study that adopted a social-constructivist research approach, Hegarty (2010)

examined counselling students’ experience of nature-connectedness using a qualitative

research method. The researcher found that participants experienced “positive emotional

effects of being in contact with nature, contrasted by the feelings of isolation, sadness and

other negative consequences of being disconnected from nature” (2010: p. 1). Overall,

evidence consistently demonstrates that there is a measurable relationship between

connectedness to nature and psychological well-being – regardless of the research method

used. However, an important criticism of Hegarty’s (2010) study concerns the use of

‘counselling’ students as participants, since it can be argued that those students may maintain

a certain bias in their view of this subject, in that they may have more interest in the subject

than laypersons; therefore, the credibility of the study may be in doubt. Given this, future

research using qualitative methodology might consider the use of participants from outside

the fields of counselling and psychology in order to garner credibility (and possibly,

additional insight).

Theorists and researchers from a wide range of fields have attempted to investigate the

processes that underlie connectedness to nature and its subsequent psychological effects (see

Frumkin, 2001; Ulrich, et al., 1993). This work may be coalesced in two theories: the

attention restoration theory, and the stress recovery theory. While this paper focuses on these,

it is worth bearing in mind, as Getersleben points out, that “although there is a lot we know,

there is also a lot we don’t know” (Getersleben, 2008: p. 24).

The attention restoration theory (ART) (Kaplan, 1995) asserts that humans have a preference

for nature because it is filled with “soft fascinations” (i.e. the sound of water, trees rustling,

the intricate patterns of plant life, etc.) that “effortlessly” grabs attention and boost direct

attention capacity. Based on the work of William James (1892), who described two kinds of

attention, ART outlines that (a) directed attention is when some effort, intent and energy are

required to focus attention on something (e.g. a task at work, crossing a busy road,

20

completing a form), (b) ‘involuntary’ attention occurs in situations where attention is

passively and effortlessly drawn towards something without any conscious intent (e.g. when

walking in nature, in survival-related incidents) (Kaplan & Kaplan, 1989). ART states that

our capacity to direct attention tends to become depleted and fatigued quickly in stressful,

everyday life and in urban environments, due to the effort required to remain attentive

(Kaplan, 1995). Therefore, an important way of helping recovery from such mental fatigue is

through sleep. Alternatively, another strategy for recovery is considered to be interaction with

nature, which is characteristically rich in “soft fascinations” rather than “hard fascination”

(i.e. unpleasant loud noise, traffic), typical of urban environments (Kaplan, 1992). It is

thought that this is because when, one is interacting with nature rich in “soft fascination” or

“qualities of restorativeness” (fascination, being away, coherence and compatibility), directed

attention relinquishes and involuntary attention takes control. As a result of this process,

direction attention becomes restored.

There is well-documented evidence for different aspects of ART (see review by Kaplan &

Berman, 2010). Research suggests that depletion of directed attention is linked with poor

executive functioning and reduced cognitive performance (Berto et al., 2010; Driver, 2001;

Van der Linden et al., 2003), whilst natural settings in comparison with urban ones has

consistently been shown to help recover from direct attention fatigue, resulting in improved

executive functioning and cognitive performance (Berman, Jonides & Kaplan, 2008; Berto,

2005; Hartig, Mang & Evans, 1991). Some studies also show that individuals tend to be

drawn to natural environment and landscapes, rather than urban or built environments

(Gullone, 2000; Kahn, 1997; Kaplan, 1992), and that focusing on landscapes, plants, and

trees aids recovery from mental fatigue, while stimulating concentration in stressful

environments (Kaplan & Kaplan, 1990; Leather et al., 1998; Kaplan & Berman, 2010).

Furthermore, it appears that people generally perceive natural environments as having

positive psychological benefits on directed attention (Herzog et al., 1998; Laumann, Garling

& Stormark, 2001) and are likely to recommend it to friends and family who may be feeling

stressed (Grahn & Stigsdotter, 2003). Some studies have also found that those who are

feeling mentally fatigued are more inclined to prefer natural environment to urban ones as a

place to recover (Hartig & Staats, 2006; Kaplan, 1992). In addition, it has been demonstrated

that those who visited a “preferred place” reported greater recovery from cognitive fatigue

21

than those who did not (Korpela et al., 2009; Van den Berg, Frese & Meijman, 2003). The

later findings are interesting because they also suggest that personal beliefs and preferences

about an environment may play a role in the restoration reported in nature, rather than the

“soft fascination” of nature itself. This then seems to be a weakness of the theory in that it

assumes that nature itself is fully the cause of the psychological effects that individuals

reported when it is possible that nature’s role may be mediated by other several other

influences.

A further weakness of the ART concerns evidence that suggest that other types of

environment (i.e. museums, monasteries) can also be experienced as restorative (Kaplan,

Bardwell & Slakter, 1993; Ouellette et al., 2005), implying that nature is perhaps not

particularly special in doing this. For example, in cultures where monasteries are often

viewed as holy places, it is likely that individuals tend to hold beliefs about this type of

environment as restorative. This is one possible explanation for the findings. Thus, this

suggests that people of different cultures may find other types of environment just as

restorative as nature if not more. The ART does not really take this into consideration. In

addition, museums can often be busy and crowded, and yet it seems that people can find them

restorative (Ouellette et al., 2005). This would seem to contradict ART assumption that

natural environment is restoratively superior to other types of settings. However, no current

study as far as I am aware has tested the theory. This may be an interesting question for future

research to explore; how do natural environments compare with other types of environments

like museums and monasteries that are similarly perceived as restorative.

Two other factors that are further worth noting are individual differences and individual

experience of natural and urban settings. There is some possibility that individuals’ personal

experience of both environments may directly or indirectly influence their perception of these

settings. For example, one person who was raised in a busy city may have grown up

perceiving it as restorative in times of stress, while another may not. Both of these persons,

based on their own individual differences, experiences and possible numerous other factors,

may grow up with different preferences, and ART does not really address or explain this.

In contrast to ART, which espouses the cognitive benefits of being in contact with nature, the

stress recovery theory (SRT) (Ulrich, 1983) asserts that experiences with nature elicit positive

22

emotional responses, which improve our mood, and may act as a buffer that shields us from

negative moods. The work of Roger Ulrich, one of the leading researchers in this field of

study (see Ulrich, 1991), has provided much insight into the impact of the natural world on

our physiological state. For example, Ulrich (1984) found that after surgery, gallbladder

patients with a window view of nature spent less time in hospital recovering than those

without such a view. Ulrich (1991) demonstrated this phenomenon by exposing 120 stressed

participants to one of two videos: either a view of vegetation, or a view of an urban setting.

The result of the physiological measures showed that the participants who viewed the video

of the vegetation recovered at a quicker rate than those who viewed the urban space. The

researcher also noted that “the quickness of nature-induced restoration was manifested as

significant changes in all physiological measures within about three minutes” (Ulrich, 2002,

p. 4), implying that nature’s recuperative effect on the sympathetic nervous systems is

actualized by a reduction in physiological arousal levels. Ulrich (1983) argues that this is

indicative that humans are fundamentally predisposed to connect with the natural world in all

its shapes and forms.

Ulrich, Lunden and Eltinge (1993) found that, by showing images of trees and water to post-

operative heart surgery patients, and by comparing them with a control group who did not see

the images, the images markedly aided the recovery of those who viewed them. It was also

found that patients who viewed the natural images experienced less post-operative anxiety,

and that it was also possible to reduce the strength of their pain regimen, the latter suggesting

that nature may decrease the perception of pain by stimulating positive emotions and

reducing stress. Similarly, Hartig (1991) found that participants who were exposed to rural

landscapes recovered faster than those who viewed urban landscapes after exposure to stress

stimuli (e.g. urban traffic during rush hours). This is consistent with another study, which

found that nature (i.e. plants and trees) reduces intense emotions (e.g. fear and anger) while

increasing positive emotions (Ulrich, Simons, Lositio, Fiorito, Miles, Zelson, 1991),

suggesting that nature helps lower the sense of threat or danger. In another study (Heerwagen,

1990), in which participants’ heart rates were monitored, it was shown that nature effectively

reduces levels of anxiety and stress in individuals visiting the dentist if they can view murals

depicting nature on the wall. Those able to see only a blank brick wall did not experience the

same effect. Together, these studies imply that a connection with nature is linked to reduction

in negative moods (as well as fear, anger, and anxiety).

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Many of the supporting studies for ART and SRT (mentioned above) have advanced the

literature regarding ecopsychology by demonstrating the powerful effect nature has on well-

being. Conversely, when evaluated, it becomes clear that their reliance on controlled

experiments means their findings are dependent on a correlation between factors, which, as

Sagarin and Pauchard argue “does not imply causation” (Sagarin & Pauchard, 2012: p. 4).

Therefore, the dualistic assumptions (separating one part from another) maintained by

experimental approaches may be too restrictive in understanding the interrelationship

between the mind and the natural world. Several ecopsychologists have made this argument

(Norton, 2008; Scull, 2009). For example, Kerr and Key note that the “positivist methods

which dominate the biomedical and natural sciences have no way of studying this

interconnected self” (Kerr & Key, 2011: p. 1). However, given the current debate in

ecopsychology, with some factions arguing that the field needs to root itself in science, others

finding the confines of academia limiting (Conesa-Sevilla, 2010; Greenway, 2010; Kerr &

Key, 2011), ecopsychology admittedly has some way to go in establishing its identity and

validity, and the methodology most conducive to capturing the interrelationship between

humankind and nature.

An ecopsychological view of mental health problems: depression, stress, and

psychological trauma

Thus far, this paper has examined several relevant concepts in ecopsychology, as well as the

ecopsychological view of mental health and well-being. In this section, the focus will be on

the conceptualization of three mental health problems (depression, stress, and psychological

trauma) and the way in which ecopsychological work may help to advance how they are

approached in mental health practice. In England alone, people who suffer from co-morbid

health conditions and mental health problems (i.e. depression and anxiety) cost the National

Health Service around £13 billion a year (Department of Health, 2009; Naylor et al., 2012).

Independent statistics suggest that “one-in-six adults have mental health problems at any one

time” in the UK (Forest Research, 2010: p. 16). Estimates also show that roughly 10 per cent

of children aged 1-15 years’ experience mental health problems at any given time (Mental

Health Foundation, 2005b) and that this percentage rises as children reach adolescence

(National Statistics Online, 2004).

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Depression

According to the World Health Organization, by the year 2020, “depression will be the

second largest single cause of ill health” (WHO, 2001: p. 44). Even more troubling, the

prescribing of antidepressants continues to rise yearly, with government records showing that

GPs issued almost 10 million antidepressants in 1999 and 25 million in 2005 (Office for

National Statistics, 2005). By 2009, that number was found to have nearly doubled (Office

for National Statistics, 2011). This figure is even more alarming when research findings

suggest that the majority of people with depression do not seek professional help is taken into

account (Bland, Newman & Orn, 1997; Roy-Bryne, Stand, Wittchen, Ustun, Walters &

Kessler, 2000). Demographically, studies show that men are less likely to seek professional

help due to the social stigma associated with depression (Addis & Mahalik, 2003; Rochlen,

Whilde & Hoyer, 2005). Moreover, depression is linked with “a high risk of suicide and

suicide attempts” (European Commission, 2004: p. 18).

The Center for Disease Control and Prevention (CDC) (2009) states that depression is the

experience of “distress and suffering… and can lead to impairments in physical, mental, and

social functioning” (2009: p. 1). In other words, this condition can have a significant impact

on an individual’s physiology, cognition, behaviour, and emotions. Depression is also

characterized by various symptoms, including persistent feelings of sadness, guilt, irritability,

loss of pleasure and interest, low mood, poor concentration, mental fatigue and reduced

activity, social withdrawal, feelings of hopelessness, and changes in appetite and sleep

patterns (Gilbert, 1989; 1992; Nolen-Hoeksema et al., 2008). Although there are several

theoretical and therapeutic approaches to treating depression – from the existential school of

thought to ecotherapy (Ottens & Hanna, 1998) – the biomedical approach dominates the

treatment of depression within standard healthcare practice today, in spite of criticisms and

limitations put forward by numerous authorities (Jackson, 2012; Mendels, 1970). As a result,

there are few clinical options for those interested in more naturalistic (or holistic)

alternatives.

Some have argued that the biomedical approach to treating mental health problems makes

scientific sense and is meaningful (Kendell, 1975; Schwartz & Wiggins, 1985; 1986). And

25

whilst it is true that this model has advantages, it is also true that it has considerable

drawbacks that may seriously affect the degree to which clients actually improve or recover.

For example, the model’s advocacy of (and dependence on, to a large extent) classification

systems (e.g. DSM-IV), which views mental health problems as illnesses/disorders to be

categorised and measured in order to be treated, is effectively reductionist because it fails to

consider the role of social factors and individual subjectivity regarding mental health

problems (Milton, Craven & Coyle, 2010). Thus, this model is limiting and restrictive. This

paper contends that the dominance of the biomedical model in mental health practice may be

to the detriment of clients because the model promotes the attitude that mental health

professionals are the ‘experts’ and therefore know what is best for their clients. This attitude

may not only serve to reduce client autonomy, it may unwittingly encourage reliance on the

experts, rather than on taking personal responsibility. This makes sense, in light of findings,

that the biomedical model may enhance people’s sense of helplessness (Farina et al., 1978).

Therefore, as counselling psychologists whose training emphasizes the “phenomenological

base and humanistic value system – which views human beings as free and autonomous yet

inherently relational” (Milton, Craven & Coyle, 2010: p. 65). Therefore, to help understand

mental health conditions such as depression, stress, and trauma, and their connection to the

relationship between humanity and nature, it may be a role we are especially suited to fulfill

because of our training.

The biomedical conceptualization of depression assumes that psychological and behavioural

indicators of depression have biological origins that may involve varying factors: genetic,

infective or environmental, or a chemical imbalance of the brain (Spitzer et al., 1975).

Theories such as the monoamine and serotonin hypotheses of depression (Heninger, Delgado,

Charney & Harbour, 1996) dominate science and psychology literature, perpetuating a culture

in which individuals that experience depression are taught to rely on anti-depressants, rather

than encouraged to explore the possible root causes of the problem, or attempt to discover

how they arrived there. In a review, Lacasse and Leo (2005) examined evidence for the

monoamine and serotonin theories of depression and concluded that there was not enough

evidence to support the theories. In light of this, it is difficult to understand the dominance of

these counterintuitive approaches in mental healthcare practice today. Even more so, within

popular culture, the social media have helped propagate so-called ‘chemical imbalance’

theories of depression, which suggest that medications can lower or increase mood (Lacasse

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& Leo, 2005). It is therefore not surprising that government records show that the number of

people routinely prescribed antidepressants increases yearly. However, the efficacy of

dependence on medication is not supported by the evidence. For example, a recent meta-

analysis found that, whilst medication may be effective for patients with severe or chronic

depression, its benefit to those with mild to moderate depression is minimal, or even non-

existent, and in some cases, only slightly more effective than placebos (Fournier et al., 2010).

Research has shown that a majority of GPs acknowledge they have prescribed anti-

depressants primarily because there is no alternative (Hairon, 2006; Layard, 2006), and that

the biomedical model effectively reduces help-seeking behaviour, reduces an individual’s

effort to resolve problems long-term, and leads to an increased sense of hopelessness about

relieving mental health problems (Lam et al., 2006; Lam & Salkovskis, 2007), making it clear

that an effective alternative is both needed and well-advised. And in view of the recent

economic crisis and budget cuts in the NHS, there seems to be an obvious need to explore

alternative, efficient and easily-accessible options for reducing the symptoms of depression.

With this in mind, this paper argues for an ecopsychological approach to depression, because

(a) disconnection from nature has been shown to affect our well-being and explains the recent

increase in this condition, and (b) evidence points to the positive effects of nature on

depression. Simply stated: spending time in nature is a fundamental aspect of improving

one’s self-esteem and sense of belonging in the ecological system. Ecopsychological theories

such as the biophilia hypothesis, A.R.T. and S.R.T., according to which attachment to the

natural world affects our mental health and well-being, constitute a potentially viable

alternative that warrants deeper exploration.

Recent studies consistently indicate that there is a close link between reduction in depressive

symptoms and one’s interaction with nature. Berman et al. (2012) examined the impact of

walking and observing nature on people suffering episodes of depression. They found that

participants experienced an increased level of concentration and a positive mood after contact

with nature – even after being asked to think of distressing experiences whilst walking in a

natural setting. The authors also found that depressed participants experienced greater

psychological benefits after walking in a natural setting than non-depressed individuals

(Berman et al., 2008), indicating that a connection with nature may be even more

fundamentally important for those suffering depression than those who do not. This finding is

27

further supported by evidence showing a relationship between urban environments and an

increase in levels of depression (Weich, Blanchard, Prince, Burton, Erens & Sproston, 2002).

Although these findings suggest both – that there is a link between nature and a reduction in

depressive symptoms, as well as a link between urban settings and an increase in depression –

a general limitation of these findings is that they heavily rely on quantitative methodologies.

Therefore, little is known about the lived, subjective experience of individuals dealing with

depression and their relationship with nature.

Research results demonstrate clearly that physical activity is beneficial to general health and

psychological well-being (Laumann, Garling & Stormark, 2003; DoH, 2004). Researchers

have taken this finding one step further, addressing the issue of whether the positive effect of

walking in a natural environment is caused by the exercise itself, rather than the environment

in which the exercise is taken. To test this issue, Pretty et al. (2005) exposed several groups of

participants to various combinations of exercise, in pleasant and unpleasant scenes of natural

and urban settings, taking measure of the participants’ blood pressure, self-esteem, and mood

before and after the experiment. The authors found that the so-called ‘green exercise’ (the

combination of nature and exercise) was more effective in increasing positive mood and self-

esteem, as well as in lowering blood pressure. This is noteworthy in that it suggests that the

natural environment itself is as beneficial as the physical activities undertaken in it.

In another study, where the impact on those experiencing depression and involved in various

activities in a natural setting (i.e. horse-riding, walking, and cycling) was examined, it was

found that the combination of these activities and nature both significantly increased the

participants’ level of self-esteem and reduced their levels of depression. Participants of this

study reported that these activities, undertaken within the natural environment, gave them a

sense of accomplishment, escapism, relaxation, confidence, happiness, and feeling better able

to cope. This further supports the biophilia hypothesis and reinforces the link between time

spent in nature and mental health and well-being. Conversely, it also shows that lack of

contact with nature is linked to mental health problems (such as depression). Therefore, it

makes sense to adopt an ecopsychological approach in the treatment of depression, and to

encourage and promote the value of spending time within a natural setting; particularly since

nature is often easily accessible, is natural and safe with no side-effects, is supported by an

extensive body of research, and it is less costly than other methods.

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In spite of evidence that demonstrates that there is a relationship between connecting with

nature and increased psychological well-being, it does not hold, however, that disconnecting

from nature results in depression because there is very little direct evidence to support this

claim. Indeed, current research indicates that depression is likely caused by a combination of

factors such as negative life events and negative thinking (Beck et al., 1990; Keely et al.,

2009; Kendler, Karkowski & Prescott, 1999; Mitchell et al., 2003), an overly self-critical

personality trait, low self-esteem (Kotov et al., 2010), a familial history of depression

(Monroe et al., 2014) and low socio-economic status (CDC, 2009). It is also likely that the

rise of depression in urban areas is linked with a global urbanization trend, which shows that

there is a significant increase in the proportion of people moving from rural settings to cities

and towns (Hondula et al., 2014; Seto et al., 2011). For example, the United Nations recently

reported that almost half of the world’s populations now live in urban areas, and it is

projected that this will continue to increase (UN, 2014). This is important as it suggests that

the rising rate of depression in urban areas may partly owe to the growing number of people

migrating from more rural areas. This migration trend is considered to be the result of factors,

such as shortage of resources and employment opportunities in urban areas, as well as beliefs

that the standard of living in urban areas is better (Brakmana et al., 2015). In addition, some

research also suggest that the growing rate of depression may be due to several factors like

increasing rates of chronic diseases, declining social capital, greater inequality and loneliness

(Hidaka, 2012; Kappeler et al., 2015; McPherson, Smith-Lovin & Brashears, 2006).

Stress

According to the Stress Management Society (SMS), “… we live in a stressful era, possibly

the most stressful period humans have experienced” (SMS, 2012; p. 1). This observation is

no exaggeration when one considers that almost 80 per cent of visits to doctors concern

stress-related complaints (Sebelius, Frieden, Sondik, 2011), and that of over a million work-

related illnesses reported in the UK between 2011 and 2012, almost half were attributable to

workplace stress (Labour Force Survey, 2012), costing billions of pounds per year (Health

and Safety Commission, 2012). This indicates that the cost of stress to society, individuals,

and families is alarmingly high, that stress is a major problem in modern society, and that

29

stress is a condition most of us are likely to experience at one point or another. And

considering the current climate of economic difficulties, it is more important than ever to

provide readily-accessible and effective options for relieving stress. Although several theories

on stress have been proposed, this paper will focus on two widely-used theories on stress

(biological and cognitive appraisal), will contrast them with the perspective of ecopsychology

– to what ecopsychology literature tells us about stress, and will present a persuasive

argument as to why it makes sense to approach stress management from the ecopsychology

perspective.

Before considering theories on stress, it is necessary to look at what stress is and what some

of the signs are. However, neither task is simple because stress has been defined in numerous

ways. Hans Selye, for example, who borrowed the term from physics and engineering, and is

still very much influential in this area (1936), defined stress as the “non-specific response of

the body to any demand for change” (1936: p. 32), and later as “a state manifested by a

specific syndrome which consists of all the non-specifically induced changes within the

biological system” (Selye, 1976b: p. 64). Although this definition is relatively vague, one

thing that is clear is that, as with any mental health problem, stress—like pain––is a

subjective experience.

Furthermore, there are many indicators associated with stress, and these can be broken down

into four domains: the emotional domain (feeling anxious, low, lonely, angry, guilty, and

ashamed), the physical domain (high blood pressure, nausea, fatigue, muscular tension, aches

and pain in the body), the cognitive domain (loss of concentration, inability to make

decisions, increased sensitivity to criticism, and self-critical thoughts), and the organisational

domain (reduced productivity, poor relations at work, and job dissatisfaction) (Powell, 2009).

In terms of human biology, stress is the process by which potential threats (stressors) directly

disturb the body’s homeostasis (constancy in the internal environment), triggering stress

hormones and activating the stress response of “fight, flight, freeze, or friend” (Cannon,

1929; Powell, 2009). When stress responses are triggered, we instinctively react by being

aggressive, being avoidant, or by befriending (seeking support, etc.) Thus, environmental

stressors are believed to determine biological responses directly, which then activate

behavioural strategies. A fundamental understanding of this process has been crucial to

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understanding the role stress plays on our physical well-being. For example, Seyle’s (1950)

pioneering experiments demonstrate that persistent stress can eventually lead to the

development of ulcers, hypertension, and even heart attacks (in humans as well as other

animals). This suggests that chronic stress can make us susceptible to physical and

physiological illness. Therefore, readily-accessible and effective ways of managing stress are

critical to our health and ability to function. However, one limitation of the biological theory

of stress is that it ignores the importance of cognition, which Lazarus and Folkman (1984)

address in their theory on stress.

In Lazarus and Folkman’s (1984) cognitive appraisal model, stress is considered either

physical or psychological, and seen as the connection between the individual and the

stressor(s) assessed as being beyond the individual’s toleration level. According to the

researchers, an appraisal of the demands of environmental stressors on well-being and the

capacity to tolerate the demands of the stressors are important factors, and it is this appraisal

process that determines whether we experience stress or not. For the cognitive appraisal

model, in contrast to the biological model, it is this process that results in the emotional

experience of stress.

There are many stress management options available today in mental healthcare practice,

including medication, exercise, meditation (mindfulness-based stress reduction), relaxation

techniques (progressive muscle relaxation), and psychotherapy (CBT, person-centred

approach, etc. – see review, Schafer, 1996), several of which have also proved effective in

managing stress for individuals suffering various other conditions. For example, Lutgendorf

et al., (1998) found that CBSM (cognitive behavioural stress management) was effective at

modifying the cognitive coping skills of gay men diagnosed with HIV, while others (Cruess

et al., 2000) have demonstrated that it can reduce physiological stress and increase perceived

ability to relax and lower serum cortisol in early-stage breast cancer patients. Lopez et al.

(2011) also reported that CBSM is helpful in alleviating distress and enhancing general well-

being in patients with chronic fatigue syndrome. Additionally, Dolbier and Rush (2012) found

that progressive muscle relaxation technique is effective in addressing levels of severe stress

amongst college students. Thus, overall, there is a range of effective stress management

options for various problems. However, there are very few nature-based interventions

available at this time for stress management. This is surprising, considering that nature-based

31

management of stress may be less expensive and ultimately healthier than medication.

From the ecopsychological perspective, three theories discussed earlier in this paper clearly

indicate a link between low levels of stress and a connection to nature. Firstly, according to

the biophilia hypothesis, an environment lacking natural features such as plants, trees, and

water may have unfavourable consequences on mental and emotional well-being (Kellert &

Wilson, 1994). Secondly, the attention restoration theory (Kaplan & Kaplan, 1989) outlines

that our fondness for natural features is related to the restorative effect they have on our

ability to focus, as well as their capacity to make us feel less fatigued, and hence, relieve

some of the symptoms of stress. Empirical evidence consistently supports this notion (Larsen

et al., 1998; Suh & Gallo, 1997; Kaplan, 2001). Thirdly, the stress recovery theory asserts that

nature safeguards us against negative feelings, whilst increasing our sense of ‘belonging’ by

generating positive emotions (Ulrich, 1983). This positive feeling then acts as a buffer against

symptoms of stress (and stress-related disease).

Research findings pertaining to nature-based therapy for stress and other mental health

conditions is slowly beginning to accumulate, with studies showing that exposure to

allotments, gardens, trees, and landscapes can significantly reduce stress levels (Hartig et al.,

1999; Bird, 2007; Mind, 2007) and that ‘green exercise’ (exercising in a natural environment)

has a restorative effect on the symptoms of stress (Pretty et al., 2005; Pretty et al., 2007; Hine

et al., 2008b). The aforementioned theories and research effectively provide a theoretical

underpinning, supporting the use of nature-based therapy in stress management. However,

one limitation of most of these studies is that they were not carried out with individuals who

were directly reported as experiencing high levels of stress. Therefore, this review contends

that further direct research is needed to explore the experience of nature-based therapy on

those who are reported as subject to high levels of stress.

Psychological Trauma

A psychologically traumatic event is defined as a frightening (single or repeating) experience

that can lead to an intense feeling of shock, threat, and vulnerability, as well as feelings of

being unable to cope mentally and emotionally (Lodrick, 2007; Corbett & Milton, 2011).

Examples of such distressing events may include witnessing or being the victim of abuse,

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bullying, rape, violence, accident, war, etc. Accordingly, there are a number of symptoms

associated with psychological trauma including: intrusive recall of the incident(s),

nightmares, so-called ‘flashbacks’, avoidance (phobias) of anything that acts as a

reminder/trigger, panic attacks, hypervigilance to signs of potential danger, the use of

disruptive and self-destructive coping strategies, and self-medication (substance

misuse/abuse, etc.) (Rothschild, 2000). Moreover, individuals experiencing trauma may have

difficulty differentiating between the past and the present – known as “re-experiencing the

traumatic incident” (Herman, 1992; Lodrick, 2007; van der Kolk & Ducey (1989) – meaning

past traumatic events are re-lived in the present, as if they are occurring now (in real time).

Scientific literature has documented the psychological impact of traumatic events such as war

(Van de Put & Eisenbruch, 2002), violence (Gorst-Unsworth & Goldenberg, 1998), child

abuse (Silverman, Reinherz & Giaconia, 1996) and torture (Granville-Chapman, 2004) on an

individual’s sense of self (and worldview), as well as on physical health (Kendall-Tackett,

2009). Evidence suggests that the experience of trauma is not only disabling but can

dramatically affect the way individuals see others and the world around them. Recently,

trauma related to catastrophic events has been highlighted, especially now that researchers

have had the opportunity to investigate the experiences of survivors of the Japanese

earthquake and tsunami of 2011 (Procter & Crowley, 2011), and of those who lived through

the Atlantic Hurricane Katrina in 2005 (Weems et al., 2007), and the negative impact these

events have had on the victims’ sense of self and perception of the world as a whole. It is now

recognised that these types of traumatic experiences may also have lasting and enduring

consequences for survivors, especially children, who are still developing, and therefore even

more psycho-emotionally vulnerable (Taylor, Weems, Costa & Carrion, 2009). Additionally,

research demonstrates that early traumatic events are strong predictors of depression in

adulthood (Chapman et al., 2004). These findings all clearly show that the experience of

psychological trauma can have devastating consequences for individuals’ lives. Therefore, the

importance of readily-accessible, effective interventions is crucial.

Practitioners working with traumatised individuals use a wide range of therapeutic

approaches, including trauma-focused cognitive-behavioural therapy (trCBT), eye-movement

desensitisation and reprocessing (EDMR), family therapy, and medication. The first two

approaches are particularly recommended by NICE – the National Institute of Clinical

33

Excellence (NICE, 2005). Empirical evidence widely supports the efficacy of both TRCBT

and EDMR in helping individuals with PTSD cope and adjust (Karlin et al., 2010; Resick et

al., 2008), although it has been argued that treatment options for people experiencing trauma

and/or PTSD should not be limited to one or two interventions, since an intervention that

works for one individual may not work for another (Herman, 1992). Thus, it seems only

prudent to continue to develop and advance intervention options. With this perspective in

mind, this paper will now focus on looking at what ecopsychology can potentially add to

trauma intervention.

In view of the need for more, readily-accessible intervention options for psychological

trauma, coupled with extensive evidence suggesting that nature has a positive effect on

physical health and mental well-being (Ulrich, 1983, Kaplan, 2001), it is clear that

ecopsychological interventions (or ecotherapy) is a viable alternative, which may prove

effective on its own, or beneficial as a complementary treatment to some interventions

already available. This is because, as it has been demonstrated, spending time in nature can

provide traumatised individuals (who may already feel disconnected from their surroundings

and those around them) with a containing space for healing and reflection. Also,

ecopsychological interventions “could be incorporated as a beneficial therapeutic approach”

(Corbett & Milton, 2011; p. 1) for children, given that emerging evidence indicates that

nature plays an important role in healthy childhood development and in generating a sense of

safety and well-being (Chawla, 1998b; Hart, 1997; Louv, 2005). For example, qualitative

research shows that “natural areas, when safe and accessible, hold special meaning to

children and adolescents” (Chawla, 2001; p. 458), suggesting that connecting with nature is a

fundamental aspect of healthy childhood development.

From a theoretical perspective, both the attention restoration theory and the stress recovery

theory (discussed earlier) illustrate that experiences with nature induce positive moods,

reduce fatigue by enhancing mental acuity, and protect individuals from negative moods

(Ulrich 1985; Kaplan & Kaplan, 1989). These would seem to be important benefits that can

help ground and contain those experiencing symptoms of psychological trauma.

Despite the fact that studies investigating the impact of experiences with nature on

psychological trauma are sparse, emerging research shows real promise. Tristan and Nguyen-

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Hong-Nhiem (1989) found that horticultural therapeutic activities (i.e. gardening, tending a

greenhouse) had healing effects on Asian refugees who had been displaced. Linden and Grut

(2002) found that the use of psychotherapy, in conjunction with horticultural therapeutic

activities (i.e. allotment gardening), was an effective way of alleviating the symptoms of

distress in torture victims. Ottoson and Grahn (2008) examined whether there is a link

between levels of crisis and contact with nature, and reported that the greater the crisis

participants had experienced, the more they benefited from nature’s recuperative effect.

Furthermore, it was found that social interaction and walking are two of the most important

aspects of contact with nature for individuals experiencing a time of crisis (or in warding off

the effects of an oncoming crisis). This body of work is supported by a number of other

studies, which show that trauma can be addressed effectively from an ecopsychological

viewpoint (Ottoson, 2001; Gerlach-Spriggs, Kaufman & Warner, 1998). However, more

research is needed to achieve a deeper understanding of the role that connection may play in

alleviating traumatic distress.

Conclusion

With the aim of exploring the link between ecopsychology and mental health problems, this

review explored several ecopsychological ideas and argued that, whilst some aspect of the

biophilia hypothesis is supported by evidence, others such as its assumption that humans are

genetically adapted to seek deep connection with nature is not. Likewise, it argues that the

biophilia theory is contradicted by evidence that demonstrates that people can have an

adverse reaction to nature. The review also explored and evaluated pertinent concept like the

attention restoration (ART) and the stress recovery theory (SRT). It maintained that, in spite

of robust evidence, which suggests that spending time in nature aids attention restoration, it is

also clear that other type of environments are equally able to aid restoration.

The review also demonstrated that spending time in (with) nature can enhance our cognitive

and emotional well-being by reducing the symptoms of stress and fatigue, inducing relaxation

and improving concentration. Since sensitivity to stress, fatigue and reduced productivity is a

common symptom in many mental health problems, it may be a fruitful endeavor to explore

nature’s role in facilitating and promoting well-being in people with different forms of mental

health problems.

35

Furthermore, several quantitative studies seem to suggest that spending time in nature can be

helpful in alleviating some aspects of depression (i.e. reduced positive mood and increased

negative mood), stress, and trauma. However, there is very little research into personal

subjective experiences of nature. In view of this, some qualitative research will be useful in

order to fully understand the individuals’ experiences and to further advance treatment of

these problems. In addition, more evidence is needed to better understand how exposure to

the natural world may be useful in managing mental health problems.

This review has demonstrated the need for alternative therapeutic interventions within the

current mental healthcare practice (currently dominated by the biomedical model), and that

ecopsychological interventions (or ecotherapy) may be beneficial as co-therapy. However,

there is a decided need for concerted research to explore the lived experiences of individuals

suffering mental health problems and their relationship with nature.

36

References

Aamodt, S. (1998). The genetics of social behavior in worms. Nature Neuroscience, 1, 6,

439.

Addis, M. & Mahalik, J. (2003). Men, masculinity, and the contexts of help

seeking. American Psychologist, Vol. 58, 1, p5–14

Agras, S., Sylvester, D. & Oliveau, D. (1969). The epidemiology of common fears and

phobias. Comprehensive Psychiatry, (10) 2.

Alvarsson, J. J., Wiens, S., & Nilsson. M. E. (2010). Stress Recovery during Exposure to

Nature Sound and Environmental Noise. International Journal of Environmental

Research and Public Health, 7(3), 1036-1046.

Anderegg, W. R. L., Prall, J. W., Harold. J. & Schneider, S. H. (2010). Expert credibility in

climate change. Proceedings of the National Academy of Sciences. 8: 93–105.

Araya, R. I, Montgomery, A., Rojas, G., Fritsch, R., Solis, J., Signorelli, A., & Lewis, G.

(2007). Common mental disorders and the built environment in Santiago, Chile.

British Journal of Psychiatry, 190: 394-401.

Archibold, O. W. (1995). Ecology of World Vegetation. London: Chapman and Hall.

Barry, M. (2009). Addressing the Determinants of Positive Mental Health: Concepts,

Evidence and Practice. International Journal of Mental Health Promotion, 11: pp. 3,

4–17.

Battle, J. (1978). Relationship between self-esteem and depression. Psychology Report, 42:

745–746.

Berman, M., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with

nature. Psychological Science, 19, 1207–1212.

Berman, M. G., Kross, E., Kirpan, K. M., Askren, M., Burson, A., Deldin, P. J., Kaplan, S.,

Sherdell, M., Gotlib, I. H., & Jonides, J. (2012). Interacting with nature improves

cognition and affect for individuals with depression. Journal of Affective Disorder,

12, 48–56.

Berto, R., Baroni, M., Zainaghi, A. & Bettella, S. (2010). An exploratory study of the effect

of high and low fascination environments on attentional fatigue. Journal of

Environmental Psychology, 30, 494–500.37

Berto, R. (2005). Exposure to restorative environments helps restore attentional capacity.

Journal of Environmental Psychology, 25, 249–259.

Bird, W. (2007). Investigating the links between the Natural Environment, Biodiversity and

Mental Health. The Royal Society for the Protection of Birds.

Bland, R. C., Newman, S. C., & Orn, H. (1997). Help-seeking for psychiatric disorders.

Canadian Journal of Psychiatry, 42, 935 –942.

Bolton, A., Sumner, S., Shreeves, G., Maurizio, C., & Field, J. (2006). Colony genetic

structure in a facultatively eusocial hover wasp. Behavioral Ecology, 17 (6), 873-884.

Boston, T. (1996). Ecopsychology: An Earth-psyche bond. Trumpeter 13(2). Accessed 21st of

September 2012 from

http:///trumpeter.athabascau.ca/index.php/trumpet/article/viewArticle/269/402

Brakmana, S., Garretsena, K & Marrewijkb, C. V. (2015). Cambridge Journal of Regions,

Economy and Society, 8 (2): 225-240.

Canon, W. B. (1929). Bodily Changes in Pain, Hunger, Fear and Rage. New

York: Appleton.

Centers for Disease Control and Prevention and National Association of Chronic Disease

Directors. (2009). The State of Mental Health and Aging in America Issue Brief 1:

Addressing Depression in Older Adults: Selected Evidence-Based Programs. Atlanta,

GA: National Association of Chronic Disease Directors.

Cerling, T. E., Wynn, J., Andanje, M., Bird, M., Levin, N., & Remien, C. H. (2011). Woody

cover and hominin environments in the past 6 million years. Nature, 476,51–56.

Cervinka, R. R., Roderer, K, K., & Hefler, E. (2012). Are nature lovers happy? On various

indicators of well-being and connectedness with nature. Journal of Health

Psychology, 17(3), 379–388.

Chalmers, D. (1997). The Conscious Mind. London: Oxford University Press.

Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F.

(2004). Adverse childhood experiences and the risk of depressive disorders in

adulthood. J. Affect. Disord. 82, 217–225.

Chawla, L. (1998b) Significant life experiences revisited: a review of research on sources of

environmental sensitivity, Environmental Education Research, 4(4), pp. 369–382.

Chawla, L. (Ed.) 2001. Growing Up in an Urbanising World. UNESCO/Earthscan: London.38

Clinebell, H. (1996). Ecotherapy: Healing ourselves, healing the earth. New York: Haworth

Press.

Conesa-Sevilla, J. (2010). Evolutionary ecopsychology. European Journal of Ecopsychology,

1: 37–51.

Conn, S. A. (1998). Living in the earth: Ecopsychology, health and psychotherapy. The

Humanistic Psychologist, 26, 179–198.

Corbett, L. & Milton, M. (2011). ‘Ecopsychology: A Perspective on Trauma’. European

Journal of Ecopsychology, 2: 28–47.

Cruess, D. G., Antoni, M. H., McGregor, B. A. S., Kilbourn, K. M., & Boyers, A. E. (2000).

Cognitive behavioral stress management reduces serum cortisol by enhancing

benefit finding among women being treated for early-stage breast cancer.

Psychosomatic Medicine, 62, 304–308.

Demyttenaere, K., Fruyt, J., & Stahl, S. M. (2004). The many faces of fatigue in major

depressive disorder. International Journal of Neuropharmacology, 8: 93–105

Department of Health. (2004). On the state of the public health. Access 10 June 2012 from

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/

DH_4080936

Department of Health. (2009). Tackling health inequalities: 10 years on – a review of

developments in tackling health inequalities in England over the last 10 years.

Department of Health, London.

Dolbier, C. L., & Rush, T. E. (2012) Efficacy of Abbreviated Progressive Muscle Relaxation

in a High-Stress College Sample. International Journal of Stress Management, Vol.

19, No. 1, 48–68.

Dooher, J. (2008). Fundamental aspects of mental health nursing. Wiltshire: Quay Books

Drake, R. E., Szmukler, G., Mueser, K.T., & Thornicroft, G. (2011). Oxford test of

community mental health. London: Oxford University Press.

Driver, J. (2001). A selective review of selective attention research from the past century.

British Journal of Psychology, 92, 53–78.

Dunn, R. (2010). “Global Mapping of Ecosystem Disservices: The Unspoken Reality That

Nature Sometimes Kills Us”. Biotropica, 42(5), 555–557.

Dutton, D. (2003). Aesthetics and evolutionary psychology. In J. Levison (Ed.), The Oxford

handbook for aesthetics. New York: Oxford University Press.39

Emsle, C., Ridge, D., Ziebland, S. & Hunt, K. (2006). Men’s accounts of depression:

reconstructing or resisting hegemonic masculinity. Social Science and Medicine, 62:

2246–57.

Emsle, C., Ridge, D., Ziebland, S. & Hunt, K. (2007). Exploring men's and women's

experiences of depression and engagement with health professionals: more

similarities than differences? A qualitative interview study. BMC Family Practice, 8,

43.

European Commission. (2004). Actions against depression Improving mental and well-being

by combating the adverse health, social and economic consequences of depression.

Accessed 6 May 2012 from

http://ec.europa.eu/health/archive/ph_determinants/life_style/mental/docs/depression_

en.pdf

Farina, A., Fisher, J. D., Getter, H., & Fischer, E. H. (1978). Some consequences of

changing people's views regarding the nature of mental illness. Journal of Abnormal

Psychology, 87:272–279.

Falk, J. H. & Balling, J. D. (2010). Evolutionary Influence on Human Landscape

Preference. Environment and Behavior, 42(4), 479–493.

Ferreira, P. G., Patalano, S., Chauhan, R., French-Constant, R., Gabaldon, T., Guigo, T., &

Sumner, S. (2013). Transcriptome analyses of primitively eusocial wasps reveal novel

insights into the evolution of sociality and the origin of alternative phenotypes.

Genome Biology, 11, 14-27.

Fisher, A. (2002). Radical ecopsychology: Psychology in the service of life. New York:

SUNY Press.

Fjeld, T., Veiersted, B., & Sandvik, L. (1998). The effect of indoor foliage plants on health

and discomfort symptoms among office workers. Indoor+Built Environment 7:204–

206. Fredrickson, B. L., & Losada, M. F. (2005). Positive affect and complex

dynamics of human flourishing. American Psychologist, 60: 678–686.

Forest Research. (2010). Benefits of green infrastructure. Final report for Forestry

Commission Scotland. Forest Research, Farnham.

Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R.

C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: A

40

patient-level meta-analysis. Journal of the American Medical Association, 303, 47–

53.

Frumkin, H. (2001). Beyond toxicity human: health and the natural environment. American

Journal of Preventative Medicine, 20, 234–240.

Gatersleben, B. (2008). Humans and nature; Ten useful findings from Environmental

Psychology research, Counselling Psychology Review, 23, 2, 24–34.

Gerlach-Spriggs, Nancy, R. E. Kaufman, & S. B. Warner. (1998). Restorative gardens:

The healing landscape. New Haven: Yale University Press.

Gilbert, P. (1989). Human Nature and Suffering. Lawrence Erlbaum Associates: Hove.

Gilbert, P. (1992). Depression: The Evolution of Powerlessness. Lawrence Erlbaum

Associates: Hove.

Gorst-Unsworth, C. & Goldenberg, E. (1998) Psychological sequelae of torture and

organised violence suffered by refugees from Iraq. British Journal of Psychiatry, 172,

90–94.

Grahn, P., & Stigsdotter, U. (2003). Landscape planning and stress. Urban Forestry and

Urban Greening, 2, 1–18.

Granville-Chapman, C. (2004). Rape and other torture in the Chechnya conflict: Documented

evidence from asylum seekers arriving in the United Kingdom. London: Medical

Foundation for the Care of Victims of Torture.

Greenway, R. (2010). What is ecopsychology? Gatherings: Journal of the International

Community for Ecopsychology. Accessed 27 June 2012 from

http://www.ecopsychology.org/journal/gatherings/what.htm

Gross, R. D. (2005). Psychology: The Science of Mind and Behaviour. Hove: Hodder.

Gray, R. (2012). Climate scientists are losing the public debate on global warming. Accessed

online on the 12 June 2012. http://www.telegraph.co.uk/earth/environment/climate

change/9192494/Climate-scientists-are-losing-the-public-debate-on-global-

warming.html#

Gual, P., Perez-Gaspar, M., Martinez-Gonzalez, M. A., Lahortiga, F., de Irala-Estevez, J., &

Cervera-Enguix, S. (2002). Self-esteem, personality, and eating disorders: baseline

assessment of a prospective population-based cohort. International Journal of Eating

Disorder, 31: 261–273.

41

Gullone, E. (2000). “The biophilia hypothesis and life in the 21st century: increasing mental

health or increasing pathology?”. Journal of Happiness Studies, 34, 293–321.

Hairon, N. (2006). Survey exposes GP frustration at dire access to depression services. Pulse,

2, 14–15.

Han, K. (2007). Responses to Six Major Terrestrial Biomes in Terms of Scenic Beauty,

Preference, and Restorativeness. Environment and Behavior, 39: 529-538.

Hart, R. (1997). Children’s Participation: the theory and practice of involving young citizens

in community development and environmental care. Earthscan: London.

Hartig, T. & Staats, H. (2006). The need for psychological restoration as a determinant of

environmental preferences. Journal of Environmental Psychology, 26, 215–226.

Hartig, T., Mang, M., & Evans, G., (1991). Restorative Effects of natural environment

experiences. Environment and Behavior, 23, 3–26.

Hartig, T. (1991). Testing restorative environments theory. Unpublished doctoral

dissertation, Program in Social Ecology, University of California, Irvine.

Hartig, T. (2011). Health benefits of nature experience: Psychological, social and

cultural processes. In Nilsson, K. et al. (Eds.), Forests, trees, and human health (pp.

127–168). Dordrecht: Springer.

Health and Safety Commission. (2012). Health. Accessed 20 October 2012 from

http://www.hse.gov.uk/statistics/overall/hssh1011.pdf

Heerwagen, J. H. & Orians, G. H. (1986). Adaptations to windowless: The use of visual

décor in windowed and windowless offices. Environment and Behavior. 18(5): 623–

629.

Heerwagen, J. H. & Orians, G. H. (1993). Humans, habitats, and aesthetics. In Kellert, S. R.

& Wilson, E. O. (eds) The Biophilia Hypothesis. Shearwater Books/Island Press,

Washington, DC, 138–172.

Hegarty, J. R. (2010). Out of the consulting room and into the woods? Experiences of nature

connectedness and self-healing.  European Journal of Ecopsychology 1: 64–84.

42

Heninger, G. R., Delgado, P, & Charney, D. S. (1996). The revised monoamine theory of

depression: a modulatory role for monoamines, based on new findings from

monoamine depletion experiments in humans. Pharmacopsychiatry, 29(1): 2–11.

Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.

Herzog, T., Black, A., Fountaine, K., & Knotts, D. (1998). Reflection and attentional

recovery as distinctive benefits of restorative environments. Journal of Environmental

Psychology, 17, 165–176.

Hidaka, B. H. (2012). Depression as a disease of modernity: explanations for increasing

prevalence. Journal of Affective Disorder. 140(3): 205-214.

Higley, N, & Milton, M. (2008). Our connection to the earth – a neglected relationship in

counselling psychology? Counselling Psychology Review, 23: 2.

Hine, R., Peacock, J. & Pretty, J. (2008b). Green Spaces: Measuring the Benefits. Report for

the National Trust. Accessed on 21 September 2012 from

http://www.nationaltrust.org.uk/main/w-green-lung-1a2.pdf

Hondula, M., Georgescu, M., & Balling, R. C. (2014). Challenges associated with projecting

urbanization-induced heat-related mortality. Science of The Total Environment, 47,

490: 538.

Howell, A. J., Dopko, R., Passmore, H. A., & Buro, K. (2011). Nature connectedness:

Associations with well-being and mindfulness. Personality and Individual

Differences, 12: 49–61.

Huppert F. A. & So, T. (2009). What percentage of people in Europe are flourishing and

what characterises them? The Well-being Institute University of Cambridge

Measuring subjective well-being: an opportunity for NS O's. Florence. (Briefing

Document for ECD/SQOLS meeting, 23-24 July).

Jackson, J. (2012). Depression: Un-medicalising misery. In M. Milton. Diagnosis and

beyond. Herefordshire: PCCS Books.

Jung, C. G. (1959). The Archetypes and the Collective Unconscious, Collected Works,

Volume 9, Princeton: Princeton University Press.

Kahn, P. H. (1997). Developmental psychology and the biophilia hypothesis: Children’s

affiliation with nature. Developmental Review, 17: 51–61.

Kaplan, S. (1987). Aesthetics, affect, and cognition: Environmental preferences from an

evolutionary perspective. Environment and Behavior, 19, 3–32.

43

Kaplan, R. & Kaplan, S. (1990). Restorative experience: The healing power of nearby

nature. In M. Francis and R. T. Hester, Jr. (Eds.). The meaning of gardens.

Cambridge: MIT Press. Pp. 238–243.

Kaplan, S. (1992). Environmental preference in a knowledge-seeking, knowledge-using

organism. In. J. H. Barkow, L. Cosmides, & J. Tooby (Eds.), The adapted mind:

Evolutionary psychology and the generation of culture (pp. 581–598). New York:

Oxford University Press.

Kaplan, S. (1995). Review of S. R. Kellert and E. O. Wilson (Eds.), The biophilia hypothesis.

Environment and Behavior, 27, 801–804.

Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective.

Cambridge: Cambridge University Press.

Kaplan, S. (2001). Meditation, Restoration and the Management of Mental Fatigue.

Environment and Behavior, 33, 480–506.

Kaplan, S., & Berman, M. G. (2010). Directed attention as a common resource for

executive functioning and self-regulation. Perspectives on Psychological Science,

5(1), 43–57.

Kappeler, P. M., Jones, L., Fielden, S., Sondik, P. (2015). Sociality and health: impacts of

sociality on disease susceptibility and transmission in animal and human societies.

Philosophical Transactions of Royal Society B Biological Science, 370(1669-88).

Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., & Hembree, E. A.

(2010). Dissemination of evidence-based psychological treatments for

posttraumatic stress disorder in the Veterans Health Administration. Journal of

Traumatic Stress, 23, 663–673.

Katcher, A., Friedmann, E., Beck, A., & Lynch, J. (1983). Looking, talking, and blood

pressure: The physiological consequences of interaction with the living environment.

In A. Katcher & A. Beck (Eds.), New perspectives on our lives with companion

animals. Philadelphia: University of Pennsylvania Press.

Katcher, A., Segal, H., & Beck, A. (1984). Comparison of contemplation and hypnosis for

the reduction of anxiety and discomfort during dental surgery. American Journal of

Clinical Hypnosis, 27, 14–21.

Keddy, P. A. (2007). Plants and Vegetation. Cambridge: Cambridge University Press.

Kellert, S. (1997). Kinship to Mastery: Biophilia in Human Evolution and Development.

Washington, DC: Island Press.

44

Kellert, S. & E. O. Wilson. (1993). The Biophilia Hypothesis. Washington, DC: Island

Press.

Kendall-Tackett, K. A. (2009). Psychological trauma and physical health: A

psychoneuroimmunology approach to etiology of negative health effects and

possible interventions. Psychological Trauma, 1, 35–48.

Kendell, R. E. (1975). The concept of disease and its implications for psychiatry. British

Journal of Psychiatry, 127, 305–315.

Kessler, R. C., Berglund, P. A., Demler, O., Jin, R. & Walters, E. (2005). Lifetime

prevalence and age-of-onset distributions of DSM-IV disorders in the National

Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6):

593–602.

Kessler, R. C., Chiu, W. T., Demler, O. & Walters, E. (2005). Prevalence, severity, and

comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey

Replication (NCS-R). Archives of General Psychiatry, 62(6): 617–27.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J.,

Walters, E. & Wang, P. S. (2003). The epidemiology of major depressive disorder:

results from the National Comorbidity Survey Replication (NCS-R). Journal of the

American Medical Association, 289(3): 3095–3105.

Kerr, M, & Key, D. (2011). The Ouroboros (Part 1): Towards an ontology connectedness in

ecopsychology research. European Journal of Ecopsychology, 2: 48–60.

Keyes. C. L. M. (2007). Promoting and Protecting Mental Health as Flourishing, American

Psychologist, 95–98.

Kocher, S. D., Li, C., Yang, W., Tan, H., Yi S. V., Yang, X., Hoekstra, H. E., Zhang, G.,

Pierce, N. E., & Yu, D. W. (2013). The draft genome of a socially polymorphic

halictid bee, Lasioglossum albipes. BMC Genomics, 32, 122-141.

Korpela, K., Evan, & Ylén, M., (2009). Effectiveness of favorite-place prescriptions: a field

experiment. American Journal of Preventive Medicine, 36, 435–438.

Kring, A. M., Davison, G. C., Neale, J. M., & Johnson, S. L. (2007). Abnormal psychology

(10th ed.). Hoboken, N. J.: John Wiley & Sons.

Lacasse, J. R, & Leo, J. (2005). Serotonin and depression: A disconnect between the

advertisements and the scientific literature. PLoS Med, 2(12): e392.

45

Lader, M. H. (1988). The psychopharmacology of addiction. Oxford: Oxford Medical

Publications.

Lamb, K. L. (1996). The problem of defining nature first: A philosophical critique of

environmental ethics. Social Science Journal 3, 475–486.

Larsen, L., Adams, J., Deal, B., Kweon, B. & Tyler, E. (1998). Plants in the workplace: the

effects of plant density on productivity, attitudes, and perceptions. Environment and

Behaviour, 30, 261–282.

Laumann, K., Gärling, T., & Stormark, K. M. (2001). Rating scale measures of

restorative components of environments. Journal of Environmental Psychology,

21 (1), 31–44.

Layard, R. (2006). The case for psychological treatment centres. BMJ, 332, 1030–1032.

Lazarus, R. S & Folkman, S, (1984). Stress, Appraisal, and Coping. New York: Springer.

Leather, P., Pyrgas, M., Beale, D. & Lawrence, C. (1998). Windows in the workplace.

London: Sage.

Linden, S. & Grut, J. (2002). The healing fields; Working with psychotherapy and nature to

rebuild shattered lives. Published in Association with the Medical Foundation for the

Care of Victims of Torture. London: Frances Lincoln.

Lodrick, Z. (2007). Psychological trauma – what every trauma worker should know. The

British Journal of Psychotherapy Integration 4(2): 1–19.

Lopez, C., Antoni, M., Penedo, F., Weiss, L., Cruess, S., Segotas, M., Siegel, S., Klimas, N.,

& Fletcher, M. (2011). A pilot study of cognitive behavioral stress management

effects on stress, quality of life, and symptoms in persons with chronic fatigue

syndrome. Journal of psychosomatic research, 70(4): 328–34.

Louv, R. (2011). The Nature Principle: Human Restoration and the End of Nature-Deficit

Disorder. Washington: Algonquin Books.

Louv, R. (2005). Last Child in the Woods: Saving Our Children from Nature-Deficit

Disorder. Washington: Algonquin Books.

Lutgendorf, S. K., Antoni, M. H., Ironson, G., Starr, K., Costello, N., & Zuckerman, M.

(1998). Changes in cognitive coping skills and social support during cognitive

behavioral stress management intervention and distress outcomes in symptomatic

human immunodeficiency virus (HIV)-seropositive gay men. Psychosomatic

Medicine, 60, 204–214.

46

Niemz, K., Griffiths, M. & Banyard, P. (2005). Prevalence of Pathological Internet Use

among University Students and Correlations with Self-Esteem, the General Health

Questionnaire (GHQ), and Disinhibition. CyberPsychology and Behavior, 8(6): 562–

570.

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., & Galea, A. (2012). Long-

term conditions and mental health: the cost of co-morbidities. The King's Fund,

London, UK.

McCallum, I. & Milton, M. (2008). In conversation: Ian McCallum, Jungian analyst,

ecopsychologists and author in conversation with Martin Milton. Counselling

Psychology Review, 23 (2): 62–67.

McNeely, J. A. & Scherr, S. J. (2003). Ecoagriculture. Washington, DC: Island Press.

McPherson, M., Smith-Lovin, L., & Brashears, M. (2006). Social isolation in America:

changes in core discussion networks over two decades. American Sociological

Review, 71: 353.

Macy, J. (1983). Despair and Personal Power in the Nuclear Age. New Society Publishers:

New York.

Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50, 370–96.

Mayer, S. F. & Frantz, C. M. (2004). The connectedness to nature scale: A measure of

individuals’ feeling in community with nature. Journal of Environmental Psychology,

24, 503–515.

Mayer, F. S., Frantz, C. M., Bruehlman-Senecal, E., & Dolliver, K. (2009). Why Is Nature

Beneficial? The Role of Connectedness to Nature.  Environment and Behavior, 41,

607–643.

Mendels, J. (1970). Concepts of Depression. New York: Wiley.

Mental Health Foundation (2005b) Lifetime Impacts. Report of a seminar organised by the

Office of Health Economics and the Mental Health Foundation. London: Mental

Health Foundation.

Metzer, R. (1999). Green psychology: Transforming our relationship to the Earth. Rochester,

Vermont: Park Street Press.

Mind (2007). Ecotherapy – the green agenda for mental health. Accessed 10 May 2012 from

http://www.mind.org.uk/mindweek/

47

Milton, M., Craven, M. & Coyle, A. (2010). Understanding human distress: Moving beyond

the concept of psychopathology. In M. Milton (Ed.), Therapy and beyond:

Counselling psychology contributions to therapeutic and social issues (pp.57–72).

London: Wiley-Blackwell.

Mohrhoff, U. (1999). “The physics of interaction.” In B. Libet, A. Freeman, & K. Sutherland

(Eds.), The Volitional Brain (pp. 165–184). Thorverton, UK: Imprint Academic.

National Statistics Online. (2004). Mental Disorder More Common In Boys. Accessed online

on 15 September 2012 from

http://www.statistics.gov.uk/hub/health-social-care/specialist-health-services/mental-

health-services

National Institute for Clinical Excellence. (2005). Post-traumatic stress disorder. London:

NICE

Nisbet, E. K., J. M. Zelenski & S. A. Murphy. (2009) ‘The nature relatedness scale:

Linking individuals’ connection with nature to environmental concern and behavior.’

Environment and Behavior, 41, 715–740.

Nolen-Hoeksema, S., Wisco, B. E. & Lyubomirsky, S. (2008). Rethinking rumination.

Perspectives on Psychological Science, 3, 400–424.

Norton, B. G. (2008). Beyond positivist ecology: Toward an integrated ecological ethics.

Science and Engineering Ethics 14(4): 581–592.

Office for National Statistics. (2005). Health. Accessed online on 15 September 2012 from

www.ons.gov.uk/ons/rel/social-trends-rd/social...41/health.pdf

Office for National Statistics. (2011). Economic review. Accessed online on 15 September

2012 from http://www.ons.gov.uk/ons/dcp171766_263951.pdf

Orians, G. H. & Heerwagen, J. H. (1992). Evolved responses to landscapes. In J. H. Barkow,

L. Cosmides & J. Tooby (Eds.), The adapted mind: Evolutionary psychology and the

generation of culture (pp. 555–579). New York: Oxford University Press.

Ottens, A. J. & Hanna, F. J. (1998) Cognitive and existential therapies: Toward an

integration. Psychotherapy: Theory, Research, Practice, Training, 35(3), 312–324.

Ottosson, J. (2001). The Importance of Nature in Coping with a Crisis. Landscape

Research, 26, 165–172.

Ottosson, J. & Grahn, P. (2008). ‘The role of natural settings in crisis rehabilitation: how

48

does the level of crisis influence the response to experiences of nature with regard to

measures of rehabilitation?’, Landscape Research, 33 (1): 51–70.

Park, D., Jung, J. W., Choi, B. S., Jayakodi, M., Lee, J., Lim, J., Yu, Y., Choi, Y. S., Lee, M.

L., Park, Y., Choi, I. Y., Yang, T. J., Edwards, O. R., Nah, G., & Kwon, H. W. (2015).

Uncovering the novel characteristics of Asian honey bee, Apis cerana, by whole

genome sequencing. BMC Genomics, 42, 92-118.

Pearson, D. G. & Craig, T. (2014). The great outdoors? Exploring the mental health benefits

of natural environments. Frontier in Psychology, 5, 1178-1192.

Plummer, T. W., Güneralp, B., & Reilly, M. K. (2009). Oldest evidence of toolmaking

hominins in a grassland-dominated ecosystem. PLoS ONE 4, 12, 31-39.

Powell. T. (2009). The mental health handbook: a cognitive behavioural approach. London:

Speechmark Publishing.

Pretty, J. (2002). Agri-Culture: Reconnecting People, Land and Nature. Earthscan: London.

Pretty, J., Peacock, J., Sellens, M., & Griffen, M. (2005). The mental and physical health

outcomes of green exercise. International Journal of Environmental Health Research,

15, 319–337.

Pretty, J., Peacock, J., Hine, R., Sellens, M., South, N. & Griffen, M. (2007). Green exercise

in the UK countryside: Effects on health and psychological well-being, and

implications for policy and planning. Journal of Environmental Planning and

Management, 50, 211–231.

Procter, N. G, & Crowley, T. (2011). A mental health trauma response to the Japanese

earthquake and tsunami. Holistic Nursing Practice, 25: 162–164.

Relf, P. D. (1998). Human issues in horticulture. In: J. Stoneham and T. Kendle. (eds.).

Plants and human well-being. The Sensory Trust, Bath, England. p. 1–17.

Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z. & Goodwin,

F. K. (1993). The de facto US mental and addictive disorders service system:

Epidemiologic catchment area prospective 1-year prevalence rates of disorders and

services. Archive of General Psychiatry. 2: 85–94.

Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A. & Young-Xu,

Y. (2008). A randomized clinical trial to dismantle components of cognitive

49

processing therapy for posttraumatic stress disorder in female victims of interpersonal

violence. Journal of Consulting and Clinical Psychology, 76, 243-258.

Rochlen, A. B, Whilde, M. R. & Hoyer, W. D. (2005). The Real Men. Real Depression

campaign: Overview, theoretical implications, and research considerations.

Psychology of Men and Masculinity, 6, 186–194.

Roszak. T. (1992). The Voice of the Earth: An exploration of ecopsychology. NY: Simon &

Schuster.

Roszak, T., Gomes, M. E. & Kanner, A. D. (Eds.). 1995 . Ecopsychology: Restoring the

earth, healing the mind. San Francisco: Sierra Club Books.

Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma

treatment. New York: Norton.

Roy-Byrne, P. P., Stang, P., Wittchen, H. U., Ustun, B., Walters, E. E. & Kessler, R. C.

(2000). Lifetime panic-depression comorbidity in the National Comorbidity Survey:

Association with symptoms, impairment, course and help-seeking. British Journal of

Psychiatry. 176, 229–235.

Rust, M. J. (2008). Climate on the couch: Unconscious processes in relation to our

environmental crisis. Psychotherapy and Politics International, 6, 157–170.

Sagarin, R. & A. Pauchard. 2012. Observation and ecology: broadening the scope of

science to understand a complex world. Washington: Island Press.

Schafer, W. (1996). Stress management for wellness (3rd ed.). New York: Harcourt Brace

College Publishers.

Schultz, P. W. (2002). Inclusion with nature: The psychology of human-nature relations. In P.

W. Schmuck & W. P. Schultz (Eds.), Psychology of sustainable development. (pp.

62–78). Norwell, M. A.: Kluwer Academic.

Schwartz, M. A., Wiggins, O. P. (1985). Science, humanism, and the nature of medical

practice. Perspective Biology Medicine, 28: 331–361.

Schwartz, M. A. & Wiggins, O. P. (1986). Logical empiricism and psychiatric

classification. Comprehensive Psychiatry, 27: 101–114.

Schildkraut, J. J. (1965). The catecholamine hypothesis of affective disorders: A review of

supporting evidence. Journal of Neuropsychiatry Clinical Neuroscience, 7: 524–533.

Schore, A. N. (2003). Early relational trauma, disorganized attachment, and the development

of a predisposition to violence. In M. F. Solomon & D. J. Siegel (Eds.), Healing

trauma: Attachment, mind, body, and brain. New York, NY: Norton.

50

Scull, J. (2009). Ecopsychology: Where does it fit in psychology in 2009? Trumpeter 24(3).

Accessed 11 October 2012 from

http://trumpeter.athabascau.ca/index.php/trumpet/article/view/1100/1429

Searles, H. (1960). The non-human environment in normal development and in

schizophrenia. New York: International Universities Press.

Sebelius, K., Frieden, T., M. D., & Sondik, E. J. (2011). Health Status of the Nation, Center

for Disease Control and Prevention & National Center for Statistics, United States

Government, Washington, D.C.: Department of Health and Human Services. Access

on the 10 September 2012 from www.cdc.gov/nchs/data/hus/hus09.pdf

Selye, H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138, 32.

Selye, H. (1950). Forty years of stress research: Principal remaining problems and

misconceptions. CMA Journal, 115, 53–55.

Selye, H. (1976b). The stress of life (Rev. ed.). New York, NY: McGraw-Hill.

Seto, K., Fragkias, M., Güneralp, B., & Reilly, M. K. (2011). A Meta-Analysis of Global

Urban Land Expansion. PLoS ONE, 6 (8): 23-34.

Shepard, P. & McKinley, D. (1969). The subversive science: Essays toward an ecology of

Man. Boston: Houghton-Mifflin.

Silverman, A. B., Reinherz, H. Z. & Giaconia, R. M. (1996). The long-term sequelae of

child and adolescent abuse: A longitudinal community study. Child Abuse and

Neglect, 20(8), 709–723.

Silverstone, P. H. (1990). Low self-esteem in eating disordered patients in the absence of

depression. Psychology Report, 67: 276–278.

Silverstone, P. H. & Salsali, M. (2003). Low self-esteem and psychiatric patients: Part I –

The relationship between low self-esteem and psychiatric diagnosis. The Annuals of

General Psychiatry, 2: 2.

Singleton, N., Lee, A., Meltzer, H. & Lewis, G. (2003). Better or worse: a longitudinal

study of the mental health of adults in private households in Great Britain . HMSO:

London.

Sneep, J. (2007). Ecopsychology: An introduction and Christian critique. Journal of

Psychology and Christianity, 26, 166–175.

Spitzer, R. L., Endicott, J. & Robins, E. (1975). Research Diagnostic Criteria. Biometrics

Research, New York State Psychiatric Institute, New York.

51

Stress Management Society. (2012). About stress. Access on 2 September 2012 from

http://www.stress.org.uk/About-stress.aspx

Suh, T. & Gallo, J. J. (1997). Symptom profiles of depression among general medical

service users compared with speciality mental health service users. Journal of

Psychology Medical, 27: 1051–1063.

Suzuki, D. & Dressel, H. (2002). Good news for a change: How everyday people are helping

the planet. Toronto, ON: Stoddart Publishing.

Tylee, A. T., Freeling, P. & Kerry, S. (1993). Why do general practitioners recognize major

depression in one woman patient yet miss it in another? British Journal of General

Practitioner, 43: 327–330.

Taylor, D. N. & Pilar, J. D. (1992). Self-esteem, anxiety, and drug use. Psychology Report,

71: 896–898.

Taylor, L. K., Weems, C. F., Costa, N. M. & Carrión, V. G. (2009). Loss and the experience

of emotional distress in childhood. Journal of Loss and Trauma, 14, 1-16.Ulrich, R. S.

(1993). Biophilia, biophobia, and natural landscapes. In S. R. Kellert & E. O. Wilson

(Eds.), The biophilia hypothesis (pp. 73–137). Washington, D.C: Island Press.

Torgersen, S. (1979). The Nature and Origin of Common Phobic Fears. British Journal of

Psychiatry, 134, 343–351.

Tristan, J. & Nguyen-Hong-Nhiem, L. (1989). Horticultural therapy and Asian refugee

resettlement. Journal of Therapeutic Horticulture, 4: 15–20.

Ulrich, R. S. (1983). Aesthetic and affective response to natural environment. In I. Altman &

J. F. Wohlwill (Eds.), Behavior and the natural environment (pp. 85–125). New York:

Plenum Press.

Ulrich, R. S. (1984). View through a window may influence recovery from surgery.

Science, 224: 42-421.

Ulrich, R. S. (1985). The role of trees in well-being and health. In: Rodbell, P. D. (ed.), Proc.

4th Urban Forestry Conf., pp. 15–9. Stlonis: Missouir.

Ulrich, R. S. (1991). Effects of health facility interior design on wellness: Theory and

recent scientific research. Journal of Health Care Design, 3: 97–109. Reprinted in:

Marberry, S. O. (Ed.) 1995. Innovations in Healthcare Design. New York: Van

Nostrand Reinhold, pp. 88–104.

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A. & Zelson, M. (1991).

52

Stress recovery during exposure to natural and urban environments. Journal of

Environmental Psychology, 11: 201–230.

Ulrich, R. S., Lunden. O. & Etinge, J. L. (1993). Effects of exposure to nature and abstract

pictures on patients recovery from heart surgery. Psychophysiology, 1: 7–18.

Ulrich, R. S. (2002). Communicating with the healthcare community about plant benefits.

In C. Shoemaker (Ed.) Proceedings of the Sixth International People Plant

Symposium. Chicago: Chicago Botanic Garden.

United Nations. (2014). World Urbanization Prospects: The 2003 Revision. New York: UN.

Van der Linden, D., Frese, M. & Meijman, T. (2003). Mental fatigue and the control of

cognitive processes: effects on perseveration and planning. Acta Psychologia, 113,

45–65.

Van der Kolk, B. A. & Ducey, C. P. (1989). The psychological processing of traumatic

experience: Rorschach patterns in PTSD. Journal of Traumatic Stress, 2, 259–274.

van de Put, W. & Eisenbruch, M. C. (2002). The Cambodian Experience. Chapter 2. In:

(de Jong, J. T. V. M., ed). Trauma, War and Violence: Public Mental Health in

Socio-Cultural Context. New York: Kluwer Academic/Plenum Publishers. pp. 93–

156.

Vining, J., Merrick, M. & Price, E. (2008). The Distinction between Humans and Nature:

Human Perceptions of Connectedness to Nature and Elements of the Natural and

Unnatural. Human Ecology Review, 15(1), 1–11.

Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M. & Cannon, M. F.

(2007). The psychosocial impact of Hurricane Katrina: Contextual differences in

psychological symptoms, social support, and discrimination. Behaviour Research and

Therapy, 45, 2295–2306.

Weich, S., Blanchard, M., Prince, M., Burton, E., Erens, B. & Sproston, K. (2002). ‘Mental

health and the built environment: a cross-sectional survey of individual and

contextual risk factors for depression’, British Journal Of Psychiatry, 180, 428– 443.

White, R. & Heerwagen, J. (2013). “Nature and Mental Health; Biophilia and Biophobia” in

Lundberg, A, (eds) “The Environmental and Mental Health: A Guide for Clinicians”.

US: Psychology Press.

Wilson, E. O. (1984). Biophilia. Cambridge: Harvard University Press.

53

Wilson, E.O. (1993). Biophilia and the conservation ethic. In S. R. Kellert & E. O. Wilson

(Eds.), The biophilia hypothesis. Washington DC: Island Press: Shearwater Books.

Woolfe, R., Strawbridge, S., Douglas, B. & Dryden, W. (2010). Handbook of Counselling

Psychology London: Sage.

World Health Organisation. (2001). Mental health and new hope. Accessed online on 9 July

2012 from http://www.who.int/whr/2001/en/whr01_en.pdf

WHO (2004b). Promoting mental health: concepts, emerging evidence, practice: summary

report. Geneva, World Health Organization.

World Health Organisation. (2012). Depression. Accessed online on 12 June 2012.

http://www.who.int/mental_health/management/depression/definition/en/

Yan., H., Jones, F., Small, K., June, G. M., & Braid, M. (2014). “Eusocial insects as

emerging models for behavioural epigenetics”, Nature Reviews Genetics, 15: 677-

688.

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Almost like an old friend: An exploration of depressed individuals’ relationship with

nature

Abstract

Existing literature has to-date only focused on healthy individuals’ relationship with

nature and the effect of nature on cognitive functions and moods of depressed and

non-depressed individuals. The present study, however, aims to explore how

depressed individuals experience their relationship with nature. Semi-structured in-

depth interviews were conducted with eleven participants (five men and six women)

and analysed using interpretative phenomenological analysis (I.P.A.). The findings

have shed light on depressed individuals’ relationship and experiences of nature.

Implications and limitations are considered within the scope of this research,

identifying future areas for research.

Keywords: depression; nature; ecotherapy; mental health

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Introduction

Extant literature has only focused on healthy individuals’ relationship with nature. They have

further focused on examining the effect of nature on cognitive functions and mood of

depressed and non-depressed individuals’. Many of these studies have relied on quantitative

approaches which does not fully illustrate or shed light on depressed individuals’ experience

of nature. Therefore, the present study explores relationship with nature from the perspective

of individuals’ with depression, using Interpretative Phenomenological Analysis (IPA). In the

following overview, I will first explore what depression is and why there is a need to examine

alternative intervention to help individuals’ cope with depression. Secondly, I will discuss

why nature may be an alternative remedy and outline theoretical understanding of human-

nature connection. Finally, I will discuss literature on the effects of nature on depressed

individuals as well as rationale and aims of the study.

Depression

Depression has been described as the experience of ‘distress and suffering….which can lead

to impairment in physical, mental and social functioning’ (CDC, 2009: p. 1). It is

characterized by a persistent negative mood including feelings of sadness, guilt, hopelessness,

anxiety and low self-esteem. Other characteristics of depression might involve loss of

interest, pleasure and changes in appetite and sleep patterns (Nolen-Hoeksema et al., 2008). It

is also considered that individuals with depression might experience poor concentration,

physical and mental fatigue and significant sensitivity to daily stress (Gilbert, 1992; Nolen-

Hoeksema et al., 2008). These symptoms can become enduring or recurrent, and may differ

from one person to another.

Official government figures have shown that approximately 4.7 million people were

diagnosed with depression in England in 2011, an increase of 11 per cent from three years

earlier (SSentif, 2012). Research further suggests that about 40% of those diagnosed with

depression tend to experience their first episode of depression around the age of 20 (Eaton et

al., 2008), and that depression is associated with a high rate of suicide (Ustun et al., 2004).

Similarly, it is well known that depression can have a negative impact on sufferers work life

as well as lead to difficulties or breakdown in relationships. People who are depressed tend to

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withdraw from social activities (Nolen-Hoeksema et al., 2008) and might rely on self-

medication (i.e. alcohol, drugs) as a coping strategy to relive distress (Norman et al., 2013).

A key issue regarding depression is the increasing rate of depression across the globe

(Mathers & Loncar, 2006; WHO, 2012) and projections for 2020 predict that depression will

become the biggest “cause of disability” (WHO, 2012, p. 23). Further reinforcing this is the

huge burden to society in terms of financial cost. Recently, psychologists have been called to

action by researchers who suggest that more research exploration of effective, simple and

accessible approaches to managing depression are urgently needed (Kazdin & Blasé, 20011;

Barton, Hine & Pretty, 2009; Wild & Horsford, 2012). This call has also been echoed by mental

health organisations who advocate the relevance of more new treatments that are effective,

accessible and low cost. This is primarily based on the belief that some people do not find

current treatment beneficial whilst many others simply do not have access to treatment

(MIND, 2012; SCMH, 2013). This is significant because it suggests that there might be many

people in the UK suffering with depression who have no alternative way of coping, because

they have no access to treatment or because they are reluctant to engage with services. In fact,

we know from research evidence that half of the depressed individuals’ tend to drop out of

both psychological and pharmaceutical therapies, (See review by Cuijpers et al, 2013) which

further strengthens the notion that there are many people out there who feel that they have no

alternative approach to help them cope and manage depression. In view of this, having an

effective intervention that is simple yet effective and perhaps more easily accessed than the

current interventions, may hold some value for some individuals. Having such an intervention

may also seem palatable if the intervention has no serious side-effects as anti-depressants

often do (Khawam et al., 2006). Such an intervention may also provide an alternative for

those who for a variety of reasons may refuse or drop out of psychological or pharmaceutical

therapy. For this to be successful, research exploration needs to be conducted to understand

some of this alternative interventions and their impact on depressed individuals.

Looking to nature as an alternative remedy

A worthwhile approach currently gaining some attention is nature-focused intervention which

is based on the concept that interacting with the natural environment or nature (i.e. plants,

trees, wildlife etc.) has restorative effects on our mental health. This concept has garnered

active research exploration from environmental psychologists and ecopsychologists in the last

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few decades. There is also ongoing debate about the importance and value of promoting the

positive impact of nature on mental well-being, particularly for those with mental health

problems (MIND, 2007; Barton et al., 2009; Relf, 2012). It is argued here, that, this is an

important endeavour if taken into account that (a) urban environments are associated with

high rates of stress and mental health problems (see review by Peen, Schoevers, Beekman and

Dekker, 2010) and (b) being in nature helps to relieve stress and generate positive mood (See

review by Frumkin, 2001). However, it is important to explicitly note that the link between

urban settings and mental health problems like depression in no way indicate causality since

there is a strong possibility that this link may be because of the upward trend in urbanisation.

In other words, it is likely that the proportion of people with mental health issues becomes

more concentrated in cities and towns as more and more people leave rural settings in search

of better work opportunities and prosperity.

It is further argued that if nature proves to be beneficial in helping to reduce symptoms of

depression, nature may be simpler and more easily accessible than psychological and

pharmaceutical therapies, since some people may readily have access to parks, fields, woods

and gardens unlike other interventions which may be harder to access. Likewise, nature

based intervention which involves spending time (i.e. walking, sitting) in nature may be more

cost-effective than current approaches used to manage depression as it requires little or no

money to access. Some studies have indeed suggested that individuals with mental health

problems generally perceive nature based intervention and activities as fun, helping people

socialise and readily accessible (Pretty et al., 2005; 2007). Spending time in nature does not

involve having to tell anyone about how one is feeling, which for men in particular, may be a

source of shame and stigma. In view of these points, it is of value to explore the role of nature

in promoting psychological well-being amongst depressed individuals. Having given reasons

as to why it is worthwhile to explore nature’s role in promoting well-being, I will now give

an overview of three theories regarding human-nature relationship.

Theoretical understanding of the human-nature relationship

According to the biophilia hypothesis (Wilson, 1984), humans have an ‘innate emotional

affiliation….to other living organisms’ (Wilson 1993: p. 31) such as plants, trees, animals,

wildlife etc. This affiliation is described as a fondness for nature and a need to be connected

with nature and nature-like processes. Kellert and Wilson (1993) asserts that our relationship

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and emotional connection with nature is important for human identity and well-being because

closeness to help us maintain a sense of self-esteem, well-being and belonging. The theory

further argues that our inherent biophilic instinct connects us with nature, not only by helping

to generate an awareness of our shared existence in the web of life, but at the same time

serving as a reminder of our evolutionary roots of when our ancestors scavenged as hunter-

gatherers, and were more aware of the natural world. This evolutionary link is believed to be

important (Conesa-Sevilla, 2010) since it is in contrast to our current disconnection from

nature which some psychologists believe to be rooted in the dualistic paradigm propagated by

positivism (Higley and Milton, 2008; Higley, 2008; Fisher, 2006). The implication of the

biophilia hypothesis, therefore, is that our relationship to nature is important as it has relevant

consequences for our mental health and emotional well-being.

Studies that were conducted amongst healthy non-clinical populations largely support the

biophilia hypothesis. For instance, Vining, Merrick and Price (2008) found that a majority of

the participants who took part in their study saw themselves as being part of nature, whilst the

others saw themselves as separate from nature. Those who described themselves as part of

nature reported having contact with it, carrying out nature-related activities and experiencing

a level of positive emotion (e.g. pleasure, compassion and affection) associated with nature.

Those who described themselves as separate, reported having minimal contact with the

natural environment. This is important because it implies that the more in touch we are, the

clearer the relationship is for people. Higley and Martin (2008) also found that those with a

close relationship with nature experienced ‘felt-connectedness’, an ‘ecologically connected

sense of self’ and psychological benefits from connection to nature. Other studies have shown

that feeling connected to nature is associated with feelings of wonder, liveliness, positive

moods and mindful awareness (Cervinka, Roderer & Hefler, 2012; Howell et al. 2011; Mayer

& Frantz, 2004; Mayer et al. 2009).

Furthermore, research on healthy non-clinical population indicate that people have a

preference for the natural environment consisting of trees, plants, landscapes and vegetation

rather than a built environment (Hartig et al., 2011; Kaplan 1987; Ulrich et al., 1993). Some

studies have found that human contact with animals stimulates emotional well-being (see

review, Frumkin, 2001) and that individuals with access to a nearby natural environment or to

a window with a view of trees, plants and grass are healthier, experience greater life

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satisfaction and greater levels of well-being than their counterparts who have no access to

nature (Kaplan and Kaplan, 1989; Kaplan, 2001). Several studies further support the idea that

being in nature improves self-esteem (Martin, 1998; Pretty et al, 2005) and generate a sense

of belonging (Maller et al., 2008) in healthy non-depressed individuals. Together, these

findings suggest that our relationship with nature is important because nature has beneficial

effects on our psychological well-being. Whilst these findings expand the quality of extant

literature, they have tended to rely on correlation studies which mean that individuals’

subjective experience about their relationship with nature or their experience of nature is yet

to be fully understood.

Furthermore, there are several important flaws to the biophilia hypothesis that warrant

highlighting. Firstly, the theory stemming from a sociobiological perspective assumes that

human preference for nature through evolution is genetically determined. Though some

evidence has suggested that certain animal behaviours (i.e. sterile individuals working to

advance others’ generative prospect) are genetically adapted (Bolton et al., 2006; Yan et al.,

2014), thus far, there is no empirical evidence to support the idea that preference for nature is

hardwired in humans. Secondly, despite findings that show humans tend to have a preference

for nature, there is also clear evidence of individuals with a negative affiliation with nature.

This is demonstrated by reports of people who find nature unpleasant and frightening (White

& Heerwagen, 2013). This is also displayed by people who show a fear of animals/ insects

(i.e. spiders, snakes, bees) generally associated with nature (ref; ref). Indeed, there is a term

for this phenomenon, which is known by the name, biophobia (Torgersen, 1979).

Consequently, this reinforces the argument that not all humans have a preference for nature.

In addition, other types of environment (museum and monasteries) have also been shown to

be as restorative as nature (Kaplan et al., 1993; Ouellette et al., 2005), which implies that

nature’s effect could be due to an individual belief about a particular type of environment.

However, two critiques of the theory are, first, that it assumes that the human preference for

nature is genetically determined, though there is little evidence to support this; second, it

accounts for people with a positive view of nature, but not for those with a negative view of

it.

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Two other theories, attention restoration theory (ART) and stress recovery theory (SRT) have

been put forward to explain the processes that underlie connectedness to nature and its

consequent psychological effects. ART (Kaplan, 1995), a cognitive psychology perspective,

asserts that humans have a preference for the natural environment as they are filled with

fascinating attractions that tend to grab one’s attention effortlessly. Therefore, the

psychological effect of nature is considered to lie in the way that nature appears to restore the

brain’s capacity to attend to information. According to ART, when directed attention

(capacity to direct one’s attention towards different tasks) becomes fatigued due to repeated

use or stress, nature’s power to fascinate and effortlessly draw ones attention can help to

restore fatigued attentional capacity.

Experimental research findings in support of ART consistently confirms that viewing a

picture or a clip of nature such landscapes, plants, vegetation and trees, aids recovery from

mental fatigue, stimulates concentration and restores working memory capacity (Berman and

2008; Kaplan, 1995; Leather et al., 1998). Many other studies have also supported these

findings (See review in Kaplan and Berman, 2010). This is important as they indicate that

nature has a positive impact on our cognitive functioning. Whilst these studies largely

increase knowledge about cognitive effects of nature, they (a) have mainly focused on

healthy individuals, and (b) they do not provide an in-depth insight into people’s perception

of the benefits of spending time in nature, owing to the quantitative approach the studies

adopted.

Similar to the previous critic of the biophilia hypothesis, a shortcoming of ART is its failure

to take into account that nature itself may not fully be responsible for the psychological effect

reported; rather it is probable that nature’s impact is mediated by several other factors, such

as individual beliefs about nature and personal preferences. A good way of testing this theory

can be to use individuals with negative belief about nature or individuals who are neutral

about nature’s beneficial effect as a control in some of the studies. This may shed more light

on the extent of nature’s role in stimulating attention and reducing mental fatigue. Moreover,

in view of findings that suggest that individuals also find other types of environments

restorative (Kaplan, Bardwell & Slakter, 1993; Ouellette et al., 2005), it would appear that

nature is not particularly superior in this respect. This is important since it suggests there may

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well be many other types of settings that are equally as restorative as nature. This is

problematic because it contradicts the assertion that humans have a preference for nature, and

that nature is superior to other types of environment in its ability to restorative attention.

In contrast to ART, which espouses the cognitive benefits of interacting with nature, SRT

(Ulrich, 1983) maintains that nature experiences stimulate positive emotional responses

which improve our mood, and may act as a buffer shielding us from negative moods in times

of stress. Experimental studies have shown that nature related murals on the wall effectively

reduces anxiety and stress in individuals when visiting the dentist (Heerwagen & Orians,

2005). Gallbladder patients with a window view of nature spent less time in hospital post-

surgery, compared to those without a view of nature because they experience less stress

(Ulrich, 1984). Other findings have also found that walking in nature (i.e. plants and trees)

reduces intense emotions (e.g. fear and anger) thus increasing positive emotions (Hartig et al.,

2011; Ulrich et al., 1991). Together, these studies indicate that connection with nature is

directly linked to a reduction in stress and negative moods, and to an increase in positive

moods. Notably, persistent negative and low positive moods are common symptoms of

depression. This highlights that the possibility that spending time in nature may be just as

beneficial in reducing negative mood in depressed individuals’ as it is for non-depressed

ones. As such, it makes sense to explore depressed individuals’ relationship with nature as

well as their perception of the impact of interacting with nature.

In summary, research evidence in support of biophilia hypothesis, ART and SRT indicates

that walking in nature is beneficial for; (a) reducing negative mood (Ulrich et al., 1991); (b)

increasing positive mood (Frunkin, 2001); (c) relieving stress (Ulrich, 1983); (d) improving

concentration (Berman et al, 2008); (e) improving self-esteem (Pretty et al., 2007) and (f)

promoting positive outlook in healthy non-depressed individuals (Barton et al, 2009). These

findings have been particularly important in providing some insight about nature’s

therapeutic effect on human beings. They have also provided some understanding into

nature’s role in promoting positive mental health and wellbeing in healthy non-depressed

individuals. Moreover, , they have been useful in guiding healthy architectural designs which

incorporate parks and natural spaces into the community and therefore making it easier for

both children and adults to benefit from access to natural environments (Wells, Evans &

Yang, 2010; Wigle, 2003). Conversely, a criticism of existing literature concerns the fact that

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they have largely been quantitative with very little focus on individuals’ relationship or their

experience of interacting in nature.

Literature on the effect of nature on depressed individuals

Given that people with mental health difficulties often present with pervasive negative mood,

stress, low self-esteem and concentration difficulties (APA, 2000) and that evidence shows

connection with nature to have therapeutic effects on healthy individuals’ functioning

(Berman et al., 2008); there has been very little research investigation into furthering current

knowledge into how spending time in nature may be beneficial for depressed individuals. As

others (Kazdin & Blasé, 20011; Wild & Horsford, 2012) have noted, more research

exploration is indeed needed, to shed some light on whether interacting with nature is

beneficial for those with depression or not.

Recently, a few quantitative studies have explored the effects of nature on those with mental

health difficulties. Roe and Aspinall (2011) compared the benefits of walking in a rural and

urban setting between two groups of adults; one with good mental health and the other with

mental health problems (i.e. depression, bipolar, psychosis and stress). They found that

cognitive (i.e. concentration) and emotional (i.e. mood) benefits of nature for both groups

were more pronounced when walking in a rural environment. More importantly, those with

mental health problems reported more pronounced improvement in positive moods and

reduction in negative moods compared to those with good mental health. This indeed

suggests that nature may be even more useful in helping those with mental health difficulties

recover more quickly and fully from low moods. In the only study focused on people with

depression, (Berman et al., 2012) has found that depressed individuals who interacted with

nature reported a reduced negative mood, increased positive and improved concentration

levels even after being primed to ruminate on stress life events. The findings of these studies

is significant as it supports the idea that nature is beneficial for depressed individuals’ and

may offer another means of alleviating distress and promoting well-being for those who may

not benefit from psychological and pharmaceutical therapy. Conversely, these studies do not

help us understand or provide an in-depth insight into depressed individuals’ perception or

subjective experience of their relationship with nature. Given this, the present study aims at

exploring the relationship of depressed individuals’ with nature.

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Rationale

Existing literature has only focused on healthy individuals’ relationship with nature and its

effect on cognitive functions and mood, amongst depressed and non-depressed individuals’.

Many of these studies have relied on quantitative approaches which does not fully illustrate

or shed light on depressed individuals’ experience of nature. This signifies a need to gain a

better understanding of depressed individuals’ relationship with nature, particularly because

some people may not favour the current inventions for managing depression. A more in-depth

understanding of depressed individuals’ relationship with nature is, however needed, to

understand nature’s impact on mood and cognitive functioning.

Research aims

Relationship with nature from the perception or account of individuals’ with depression will

be examined; the research question that is of interest is:

How do individuals’ with depression experience their relationship with nature?

The aims of the study are firstly, to explore depressed individuals’ understanding of their

bond with nature, and secondly, to explore their lived experience with the impact and benefits

of spending time in nature.

Given the aims of the research, a qualitative research design was deemed appropriate as it

facilitates the emergence of rich and in-depth data. More specifically, it was decided that an

Interpretative Phenomenological Analysis (IPA) would be adopted because it facilitates the

aim of capturing participants’ personal lived or phenomenological experience (Smith, Jarman

& Osborn, 1999). Furthermore, IPA is underpinned by hermeneutics and symbolic-

interactionism understandings, which signifies its emphasis on the meanings that individuals

assign to their phenomenological experiences and the interpretative process involved in

making sense of these meanings (Smith & Osborn, 2007). As such, the interpretative process

involves the researcher making sense of participants’ experiences.

Method

Epistemology

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It was considered that IPA’s strength involves its emphasis and priority on how people make

sense of, or make meaning from, the subjective experiences. This is a strength that is

sometimes believed (seen to) to be absent from other qualitative approaches (Smith, 1996).

IPA’s phenomelogical and hermeneutics aspects are also grounded on the ontological

position of relativism which takes into account individuals’ historical and social context

(Smith and Osborn, 2007). IPA places some significance on the use of language as reflective

of participants’ experiences and meaning. Moreover, the researchers’ reflexivity and

interaction with the text is considered to be of importance. In essence, it makes transparent

the researchers role in the research/interview and analysis and further suspends (brackets off)

interpretation at least until later on in the analysis (it is not suspended entirely) (Smith,

Flowers & Larkin, 2009). Through the exercise of this ‘double hermeneutic’ (the inclusion of

the subjective world of the researcher and respondent), and through the suspension of

interpretation until later in the process of analysis, it is hoped that the ‘cognitive inner world’

of the subject can be accessed (Smith & Osborn, 2007).

Sample and recruitment

Since the aim of the study was to capture experiences or perceptions of participants,

purposive sampling was employed to select individuals who had been diagnosed with

depression for the purposes of this research. . Depressed individuals were recruited through

branches of the MIND Charity (mental health organisation) in High Wycombe and Reading

as they frequently provide access to nature activities for its members and runs green projects,

in which, some members participate throughout the year. Furthermore, it made sense to

recruit participants through the organization since MIND had itself carried out several studies

into the impact of the natural environment on mental health problems, and also advocated the

use of nature-based interventions in mental health practice. However, it is important to

highlight that by focusing on a group of individuals who probably have a preference for

nature; it is very possible that the result of the study is biased, since these individuals are far

more likely to say positive things about their experience of nature. In addition, this means

that the opportunity to interview those with an experience of nature is reduced, and this

further impacted on the result presented because it indicates that not all aspects of this issue

are represented.

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MIND local managers were contacted by email, and they arranged for the researcher to put

up posters at their offices and speak directly with members with a multi-pronged purpose (a)

to inform them about the research and its aims, and (b) to check if anyone wanted to

volunteer to participate. Eleven participants were recruited. This was considered to be an

adequate number to provide a rich insight pertinent to the research question. The sample is

also consistent with the idiographic approach of IPA, and indeed it is in the high range for a

study of this type (Smith & Osborn, 2007). The idiographic approach of IPA is aimed at

understanding single cases or a sample that is small and homogenous (Smith & Eataugh,

2006). Hence, it does not seek to prove representativeness.

Inclusion criteria required that participants needed to have been either diagnosed with

depression in the past or recently diagnosed with depression. This is to ascertain that the data

collected is relevant to the research question. Exclusion criteria involved individuals who

referred to themselves as psychotic or suicidal; none of the participants matched this.

The sample size consisting of eleven participants (n=11), included five men (45%) and six

women (55%). Eight respondents described themselves as ‘White - British’, whilst others

specified that they were of Polish, Japanese, Egyptian and English Romany Gypsy

backgrounds. The mean age of the participants was 34 years (range 23-54; 14.2). Two

(18.2%) had a PhD degree, one (9.1%) had a Master’s degree, one (9.1%) had a BA degree,

one (9.1%) had a BTEC, three (27.3%) had A-levels and three (27.3%) had no qualifications.

Six of the participants (54.5%) reported that they were currently experiencing symptoms of

depression, whilst five (45.1%) reported that they had previously experienced several

episodes of depression. The names of all the participants have been changed to protect

participants’ confidentiality and anonymity.

Procedure

A week before each interview was arranged, participants were presented with an information

sheet (Appendix-B) detailing the purpose of the research, what they were required to do,

confidentiality and their right to withdraw at any time. Before the interview, participants were

asked to complete a brief demographic information sheet, and to read and sign a consent form

(Appendix-C). Individual face-to-face interviews were then conducted with participants at

MIND’s offices in a room allocated to the researcher.

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Interview process

As per Smith and Osborne (2008), a semi-structured interview is conducted with the purpose

of enabling the participants to express their experience of their relationship with nature and to

help capture rich and in-depth data. The interview schedule (Appendix-D) was pre-designed

in lieu of the research aims and relevant literature. The schedule was also designed in

advance because the researcher had no previous experience in conducting an IPA interview.

Therefore, the researcher felt slightly more confident having some pre-designed questions

that could be asked to set the interview off. The schedule consisted of one main question and

ten prompts which invited the interviewees to reflect on their relationship with nature as

someone who has been depressed or is currently depressed. The prompts explored the

feelings and actions of participants while they interacted with nature as well as benefits they

experienced from spending time in nature. The interviews lasted from fifty to seventy

minutes and were recorded with an audio digital recorder to be later transcribed verbatim.

The first interview conducted was a pilot, to judge strength of the questions and prompts, and

determine their ability to capture context-rich data. However, as no changes arose based on

feedback, it was decided to include it in the final analysis. As outlined by Smith, Flowers &

Larkin, (2009), the questions designed were open-ended and impartial.

Ethical Considerations

The research was given a favourable ethical opinion by the Faculty of Arts and Human

Sciences Ethics Committee (Appendix-E). Ethical codes of conduct by the BPS (2009) and

HCPC (2012) were adhered to throughout the research. All participants were above 18 years

of age, and the researcher made sure that they fully understood that the research involved a

semi-structured interview which would be recorded. All the participants were informed that

they can stop the interview at any point should they feel distressed with no obligation to

continue. They were further informed that all information will be kept in the strictest of

confidence and destroyed on completion of the Doctorate. At the end of the interview,

participants were debriefed and provided with support service information in case they felt

distressed. Participants were given the name of a local MIND co-ordinator whom they can

contact should they feel distressed after the interview. They were also invited to contact the

researcher should they have any questions about the research.

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Analytic procedure

The transcripts were analysed based on the steps that were outlined by Smith, Jarman and

Osborn (1999), in which the researcher followed a four-stage coding process.

In the first stage of the analysis, a line-by-line coding was adhered to (Smith, Jarman &

Osborn, 1999). This is to say that the initial transcript was read several times before being

coded, with the aim of deciphering the open or hidden emotions, thoughts, and so forth of the

participant. The researcher attempted to detect meaningful information in the data. In-vivo

codes and gerunds deciphered subtle processes, whilst at the same time, staying as closely as

possible to the data (Smith et al., 1996). Another method that was used was focusing on the

researchers’ own subjectivity in response to the transcript (Charmaz, 2012). The researcher

also committed early to take steps to interpret the data even at this stage, since IPA focuses

specifically on the co-construction of meaning between the researcher and the participant, as

well as the researcher being able to enter the participants’ inner world in order to make sense

of it (Smith, Jarman & Osborn, 1999).

In the second stage, the researcher listed and clustered themes from the transcript, as well as

checked in a constant iterative process that the emergent themes fitted the transcript (Smith,

Jarman & Osborn, 1999). For example, themes concerning “nature’s positive aspect” were

consistently expressed, whilst some such as “nature’s negative aspect” were expressed less.

During this stage, which is also known as focused coding, the categories that were thought to

be meaningful and pertinent to the research question were chosen and pooled together.

Throughout this sorting process, themes to keep and discard were identified and sorted. The

themes were then ordered in a table.

The third coding stage continued with the other transcripts, which were examined and coded

from the standpoint of bracketing (Charmaz, 2006). Thus, the other cases were analysed as

separate cases, rather than from the standpoint of the first set of themes from the first

transcript. In essence, this coding stage reiterates the first and second coding stages in order

to decipher the remaining transcripts and list and cluster themes for each transcript.

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In the fourth coding stage, the researcher decided which themes to prioritise. The researcher

not only focused on frequency but also on whether a theme can shed some light on a critical

connection in the work. For example, in the analysis, only one participant spoke directly

about spirituality, but it made such a critical point that it seemed as if it needed to be included

in the final analysis. Subsequently, the emergent themes were organised within a table.

Reflexivity

In accordance with the double hermeneutic process of IPA, it was recognised that the

researchers’ knowledge on the subject coupled with the personal love of nature may have

contributed to and influenced the research and the analysis process in general. Moreover, the

researcher recognises that his previous literature review (Eko and Martin, 2012) work might

also have affected his interpretation of the data. Therefore, his reactions might be

indistinguishable from that of the participants. This can be seen as subjective, and perhaps

calling into question the credibility of the interpretation. However, it is argued here that this

is in fact the strength of IPA, in that it allows the researcher access to the participants’ inner

world. This process takes places through the researcher making sense of participants’

experiences (Smith and Osborne, 2008). Further reflection on the process can be gained in

his personal reflection (Appendix-A)

Analysis

The research question focussed on how individuals’ with depression experience their

relationship with nature. Three master themes emerged regarding depressed individuals’

experience of nature, as a result of the analysis. The emerging themes are: (a) ‘perception of

relationship with nature’, (b) ‘perception of the benefits of relationship with nature’, and (c)

‘perception of nature as transcending everyday experiences’ (See Table 1 below). The sub-

ordinate and sub-themes are considered to answer the research question and are discussed in

more depth below.

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Table 1: List of super-ordinate and sub-themes.

Super-ordinate themes Sub-themes

Perception of relationship

with nature

Attached relationship with nature

Detached relationship with nature

Desire to be closer to nature

Perception of the benefits of

interacting with nature

Positive mood benefits

Cognitive benefits

Physical benefits

Perception of nature as

transcending everyday

experiences

Childhood

Something bigger than self

Spirituality

Perception of relationship with nature

This super-ordinate theme characterizes a variety of relationships that participants’

experience with the natural world. Most participants seem to experience a sense of

connection with nature, whilst a few, felt disconnected from nature at different points in their

lives. Some participants also seem to have a desire to feel more connected with nature. These

different relationship experiences suggest that participants experience connection with nature

in different ways, and indeed, they seem to experience nature differently at different times in

their lives. This theme consists of three sub-themes as illustrated in the Table 1.

Attached relationship with nature70

When asked what their relationship with nature is, the majority of participants described

themselves as having a close bond with nature. This bond is alluded to in a variety of ways.

Tom referred to it as a sense of ‘personification’ and ‘feeling tied to’ nature, which seems to

suggest a strong emotional bond, as if nature was a living thing. Indeed, the extent of his bond

seems so strong that being separated elicits in him a sense of disconnection and displacement.

This communicates a deep-felt experience of attachment with nature that holds important

value and act as a secure base through which he can explore the world:

‘It’s almost personified for me in that when I was in a city full of

people, I almost felt as if I was away from a person that I wanted to be

with. I mean, certain trees, for example, on a walk are almost like an

old friend….and a landscape and a place. There’s a place that I feel

very tied to, and taken out of that environment I’ve sometimes felt

completely cut off from and so much out of my natural environment

that I couldn’t relate to the people who were around in a city stuffed

full of people’.

For Chris, the experience of closeness to nature seems to change depending on whether he is

feeling depressed or not. His closeness to nature or relationship with nature can also be

interpreted as one that he associates with feeling safe, hence his making contact with nature

when feeling depressed:

‘I find I often want to be in a natural environment because there’s a

feeling of safety there and also that way I get away from people. I do

that all the time anyway, but I tend to do that more when I am feeling

depressed’.

Furthermore, Chris’s comment is also somewhat surprising because, on the one hand, his

narrative can be interpreted to mean that he feels protected in nature when he is feeling

depressed, but at the same time, it seems to imply that there may be, for him, some

significance to getting away from people and nature perhaps serves this purpose, rather than

being directly beneficial in itself. This is interesting therefore as it suggests that nature may

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simply act as a haven to escape to and get away from others who may be seen as unsafe and

adding to depression in some way.

Sarah alludes to her relationship with nature starting through physical activity in nature and

the impact that the growing relationship had on her. This paints a picture of a bond which

slowly developed through a combination of physical activity and being in nature. Her

narrative illustrates the experience of forming and developing a close connection with nature:

‘So my relationship with nature started when the doctor recommended

weekly exercises. I went running, by chance, as we lived near a river

bank. So rather than go to a gym, I just ran down by the river. And it

was in running there and in the park and seeing the trees and flowers,

and the many lovely natural places around me to run, I think it was

running in those beautiful natural places that I started to feel much

better’.

For some, nature’s ability to appear non-judgemental seems to help, while others feel more

connected with nature. Jackie described how she feels unashamed and not judged in nature

as opposed to feeling ‘ashamed’ and ‘judged’ in her normal environment where there are

people:

‘Generally when I am feeling very depressed, I try to avoid people

because I feel ashamed of what I look like. Looking around at others,

they are always busy going somewhere. They are doing things and I

am not, so that doesn’t help, but being in nature I feel a part of it. I

feel connected. I am ok and I can just be myself’.

Jackie’s sense of feeling ‘a part of it’ seems connected to Tom’s experience of ‘feeling tied

to’ nature. They are capturing participants’ experience of being in a relationship with nature

and holding that relationship as meaningful and significant. Generally, it appears that all of

the supporting quotes abovementioned are describing the experience of feeling attached to

nature because nature provides a sense a safety and security. This experience seems to offer

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support for the biophilia hypothesis which indicates that we have an emotional bond with

nature as it has an impact on our mental well-being.

Detached relationship from nature

While most of the participants’ described a sense of feeling attached to nature, a few

participants’ perceived their relationship with nature as disconnected. Takeshi’s narrative

intimates how his relationship with nature has changed from one of closeness to one of

distance. This implies a sense of loss that is alluded to, and that, he may be unaware of. In the

following extract, it can be noted that he seems to struggle to convey the sense of detachment

he feels:

‘I do not have a close relationship with nature. But I suppose that’s –

it’s a bit difficult to explain. Let’s say that I don’t do it now, but I

used to enjoying drawing and painting and things. And particularly I

was interested in drawing small insects, for example…. Or very

detailed drawings of plants. Wilds. Although I don’t do that

anymore’.

Notably, Takeshi’s answer is further interesting because of what it indicates about preferred

response in these interviews with these particular participants. Since the participants are

people with a generally positive view of nature, it somewhat reveals a bias in the way that

they see nature, which probably means that their responses are generally pro-nature. This

unfortunately suggests that the result of this study therefore does not provide a balanced

picture of how a diverse range of people actually experience nature. Moreover, it can be

argued that Takeshi’s comment reveals a tendency, similar to some of the other participants,

to simply skim the surface, rather than relate their deep-lived experiences of nature.

Anne also struggled to make sense of her previous detachment from nature. This struggle

seems to generate a feeling of confusion because she ‘can’t understand’ how she could be

near nature without paying any attention to it:

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‘I find it so healing and so important that I can’t understand how I

used to walk around completely blind to it. I used to walk past trees,

walk past flowers. The seasons, I didn’t even notice the change in

the seasons’.

The disconnection from nature may also be related to the experience of feeling too depressed.

Jennifer communicates a sense of how she was ‘cut off from nature’ and how this meant she

‘suffered greatly’ because she was focused on social concerns. Implicit in this account is the

notion that focusing on social issues was an experience filled with pressure, which in turn

affected how she felt. This suggests that in contrast, nature provides the opposite of feeling

pressured:

‘I think I have a very very good relationship with nature now…….

But when I was too depressed I don’t think I felt like that. I think it is

probably because I didn’t feel like that that I was very depressed;

very cut off from nature and very much more thinking about people

and concentrating on relationships and society and all that kind of

things. When you are cut off from it you suffer greatly.’

Desire to be closer to nature

Throughout most of the participants’ accounts, the longing to feel closer to nature seems to be

a part of their experience of nature. Underlying this seems to be a desire for peace and

solitude, and a need to remove the self as much as possible from the stress of modern life. For

example, Keith described how it would be a dream to live in isolation completely

‘surrounded by nature’ and away from people:

‘If there was a way where I could isolate myself completely and

basically live almost, it’s not so much about solitude; it’s about the

environment as well. If I could find a way of living completely

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surrounded by nature and not having contact with anybody then that

would be the perfect world.’

The wish to form a deeper alliance with nature runs through Jennifer’s narrative in

which she conveys a longing for a more natural lifestyle. She also seems to be

suggesting that modern society has resulted in separation from nature which is a

view that existing literature supports (Higley and Martin, 2008). The implication

here seems to be a lack of option or choice, and that modern living has an impact

on the human-nature relationship. Indeed, this lack of option narrative is similar to

that of this study which argues that nature based therapy may provide an effective,

simpler and more accessible alternative for those with depression:

‘I am quite interested in those old….farming culture where they …

live in houses but they have a very outdoor lifestyle. I am envious of

that kind of outdoor, very simply lifestyle. You are very much in

contact with nature but you know, I think this society has become so

artificial and losing contact with the earth, which is the most important

thing’.

The desire to be closer to nature seems to mean living in the countryside for a few of the

participants. In Chris’s narrative, this desire appears to be related to the participant’s belief

about the positive experiences that being in the countryside generates. Implicit in this, is the

importance of feeling at peace and experiencing less stress that makes him wish to have a

closer relationship with nature:

‘There’s something about, there’s an uplifting feeling about being in

the open air in the country. I’ve always enjoyed it really. If I had my

way I’d actually be living in the country as opposed to living in the

town, in a rural cut-off place; obviously not completely away from

civilisation but just in a tranquil setting, because I just prefer more of a

laid back life’.

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Rashida captures her desire to feel closer to nature as a longing to live in a house with a

meadow so that she can ‘see’ and ‘run into ‘the horizon’. This seems to encapsulate a deep-

felt longing for space and freedom which she appears to believe that nature can provide:

‘I’ve always imagined like when I grow old there’ll be a house where

in spring you see all these different kinds of colours of flowers and all

these kind of shapes of trees and things like that. I have always liked

that.….. A meadow where you can see the horizon and you can just

keep running. And it’s a liberating kind of feeling’.

In summary, the main theme of ‘perception of relationship with nature’ encapsulates

participants’ experience of connection or lack of it with nature. This highlights the knowledge

for many of the participants that there is a significant value in feeling connected with and

having a relationship with nature. This in fact connects to the essence of the biophilia theory

which espouses the importance of our relationship and emotional bond with nature (Wilson,

1993).

Perception of the benefits of interacting with nature

This super-ordinate theme characterizes the participants’ perception of the payoff or outcome

of having a relationship with nature. Three sub-themes emerged from all the participants’

accounts: (a) ‘positive emotional experiences’, (b) ‘cognitive benefits’, and (c) ‘physical

benefits’).

Positive mood benefits

Most of the participants communicated a sense of experiencing a change in mood from being

in nature. Their change of mood appears to be based on a sense of ‘uplifting’ feeling which

they experience as well as a feeling which they seem to experience as overwhelmingly

positive. It strongly implies that the positive moods that nature elicits in them, is in contrast

with their experience of negative moods. This is illustrated in Andrew’s account below:

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‘It doesn’t affect me as much as it used to, but, when I was very

depressed I used to get quite an uplift by taking myself into a peaceful

natural environment [The Chilterns; nearby woods and a local forest],

even if it was just lying there in the sun or whatever and I would

always come back lifted’.

This sense of ‘uplift’ is also connected to the participants’ sense of feeling ‘better’ than they

did before being in nature. Anne illustrates this point in the following excerpt which suggests

that nature stimulates positive feelings in her and perhaps, helps her recover from a sense of

fatigue which is often common in those with depression (Berman et al., 2012):

‘I just feel much better, much more, I think it blows out the cobwebs

and makes me feel happier again’.

Moreover, this seems to support previous studies that show that interaction with nature is

beneficial in reducing mental fatigue amongst those with depression (Berman et al., 2012).

The significance of positive emotional experiences is also highlighted by Jackie who

described being in nature as ‘comforting’, and liberating. This seems to be coupled with a

feeling of security in nature which many of the participants also hinted at. The feeling of

security seems to make sense in view of participants’ sense of attachment to nature:

‘It’s comforting. It’s a relief. It makes me feel that I don’t have to try

so hard. I do like the fact that it doesn’t change, that it’s very reliable.

And it will always be there’.

The feeling of security is also mentioned by Jennifer who compared ‘love for nature’ with

loving a person. This is also connected to the sub-theme of ‘attached relationship with nature’

in which participants conveyed a sense of closeness with nature. In the excerpt below,

Jennifer seems to imply that this closeness to nature provides a sense of stability. The

implication here, seems to be that humans may let her down but nature won’t:

‘I think it’s kind of having a love for something that is always there. I

mean you can have love for a person and they can disappear or they

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don’t love you back, but, I suppose having a love for nature is

something you can always rely on. It is there even if it is like, every

tree, and you can’t get rid of the sky very easily and the stars so it’s

something which is always there for you’.

Keith believes that the experience of interacting with nature when feeling low, helps him to

relieve stress, reduce negative mood and anxiety. In the following account he seems to have a

theory about how this effect occurs:

‘It helps me unwind if I’m feeling stressed. It helps me put a

perspective on things and those combined generally help me lift the

mood. The depression seems to improve; the anxiety seems to

improve. This doesn’t happen immediately, they take time, but, once

I’m outside I slowly start to feel better, less anxious and then these

feelings continue when I return even to work or back indoors with the

family. It generally just helps’.

The participants experiences seems to support previous findings which demonstrated that

nature is beneficial for alleviating stress, reducing negative mood and increasing positive

mood in both depressed and non-depressed individuals (Berman et al., 2012; Hartig, et al.,

2011; Ulrich, 1983; Ulrich, 1991).

Cognitive benefits

Much of the participants’ narratives also captured the sense that they derived some cognitive

benefits from spending time in nature, such as improved concentration, a shift in the focus of

attention, and feeling the ability to think clearly again. This is connected with existing

literature which indicates that interaction with nature is beneficial for cognitive functioning

(Berman et al, 2008; Kaplan & Kaplan, 1989). This is illustrated in Keith’s narrative,

suggesting that time in nature helps him feel more able to focus and solve problems:

‘It helps me; I attach with the depression. I get quite anxious, paranoid

about things and it just helps me, that environment helps me to think

clearer and sort things out in my own mind’.

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Rashida seems to describe an experience similar to that of Keith. In the following quotation,

she paints a picture of how nature appears to help her with stress and mental fatigue:

‘So if you had a particularly hard day and you just feel like there are

things in your head that shouldn’t be there…..like a clouding kind of

effect, you can just take a moment and you sit outside in the garden

and it’s quiet and you close your eyes and just breathe in and out. That

helps’.

For Anne, spending time in nature when feeling depressed generates a sense of distraction by

taking her attention away from current problems:

‘When I was depressed I would think about my problems again and

again and again and analyse them over and over…. Often when I’m in

walking…I’d be distracted by the lovely view a tree or some flower.

So I could be walking across the field and I’d notice rows of trees….

It often felt like the problems were…they often seemed less important

because of the distraction’.

A few participants further imply that nature’s ability to sooth and relieve stress helps them

gain ‘control’ over their attention and thoughts. In the following extract, Takeshi’s narrative

conveys this idea and offers a theory about how he believes this works:

‘I seem to gain more control over my thoughts, because although I

said there were more things that I notice in nature, but it seems to kind

of shift my attention from a stressful thing to less stressful things, such

as the features of nature, and in doing so, then, I suppose it has a

calming effect. And I can remain sort of more control over my

thoughts. That’s something I like’.

This illustrations of the cognitive benefits that participants’ experience in nature,

seem to be in line with existing research evidence, which suggests that interacting

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with nature assists in restoring attentional capacity and relieving mental fatigue, as

well as boost concentration (Kaplan, 1995; Kaplan & Berman, 2010).

Physical benefits

Two of the participants also communicate a sense that whilst being in nature, there is a

physical aspect to interaction which seems helpful. Tom illustrates this idea in his experience

of walking and how it appears to help reduce anxiety and tension:

‘You can just pass the time when things are not working, until your

emotions settle down again. So spending the time away like that and

just perhaps, walking and using up some energy helps. The actual

physical movement seems helpful. It makes me sleep better’.

This suggests that, nature seems to facilitate physical activity which perhaps itself

has an impact on sleep pattern. This is significant, as it indicates that physical

aspect of nature may play an important role in helping Tom ‘sleep better’. This

connects with existing studies that have demonstrated that interaction with nature,

facilitates physical activities, which, seems to have a positive effect on emotional

and physiological systems (Herwageen & Oran, 2005; Ulrich, 1993). In the

following excerpt, Tom further expands on this aspect of interacting with nature:

‘When the moments are sublime it’s a sort of – the physical feelings

associated with emotion are all in this part of the body [stomach]. The

knots of unhappiness and the release of tension of elation. I notice that

there are physical feelings that should correspond to those emotional

states, and they are to do with muscular tension and release’.

Though Eva believes that an on-going challenge for her seems to be motivating herself to go

outdoors, once she is outdoors, however, she seems to perceive herself ‘much better’. This

seems to imply that walking in nature helps her feel physically better and generally better.

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‘It is difficult to motivate myself but when I do, I always feel much

better after that walk. Also, physically, the symptoms of depression

always eases’.

To summarize, the main theme of ‘perception of the benefits of interacting with nature’

suggests that the participants close connection with nature may be influenced by the positive

benefits gained from spending time in the natural environment. It further suggests, that

overall, participants’ experience cognitive, emotional and physical benefits from connecting

with nature. This is also supported by extant literature which suggests that interaction with

nature helps reduce negative mood, aids concentration, reduces mental fatigue and has a

calming effect on attention (See literature review by Eko & Martin, 2012).

Perception of nature as transcending everyday experiences

This super-ordinate theme illustrates many of the participants’ perception of how nature

seems to be able to elicit a sense of awe and inspiration. Underlying this seems to be the

notion, that, nature symbolizes something that is expansive, divine, and the ultimate force for

good. Amongst the participants’ narratives, four underlying sub themes have emerged:

‘childhood’, ‘something bigger than self’, ‘openness and spaciousness’, and ‘spirituality’

Childhood

Many of the participants’ narratives capture how they relate some of their experiences of

being in nature with their childhood. Implicit within this is the idea, that, childhood seems to

be an important time during which people develop their love of nature. Memories of

childhood nature-experiences seemed to bring back a time when life was simpler and less

complicated; a time of innocence when they had been carefree, with less fears and worries.

The following quotation from Anne’s account encapsulates this:

‘Actually you know when I was very very depressed; one of my

strategies to get out of it was to smell pear. This particular pear, the

yellow one is linked with my childhood and it smells absolutely

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fantastic. It is a very beautiful smell. It makes me feel closer to nature

and life.’

Similarly, Sarah believes, that an aspect of nature for which she has a preference is linked to

her childhood experiences. In her narrative, she alludes to how this link seems to be present in

other people’s preference for certain kinds of natural environment than for others:

‘My favourite nature are hills and green..and it’s amazing how many

people will say “sea”. And I’m not sea. I’m hills. And I do often

wonder if that is because that’s where I grew up....and people that I

know that love sea more than hills, it’s because they have childhood

memories of seaside times’.

The idea that interacting with nature can trigger positive memories of childhood and perhaps

a sense of nostalgia, is an interesting insight, which to my knowledge, has not come up in my

literature search thus far. It makes one wonder how people affected by depression make sense

of their memories; and whether it is possible to trigger depressive symptoms such as

excessive rumination or perhaps give depressed individuals’ a sense of belonging?

Something bigger than self

Some of the participants’ feel a sense that nature is something that is bigger than oneself;

implying, that connecting with nature has the power to transcend ordinary daily concerns. For

Eva, nature seems to include ‘mountains’ whose ‘vastness’ renders her daily concerns

‘insignificant’:

‘When I saw those big mountains in the dales…. that was a moment.

You just see how little you are compared to them and how little and

insignificant your problems are in the universe. So obviously during

depression you sort of become egocentric but when you see the

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natural world around you; it is vast and it is beautiful and it is so

beneficial’.

Sarah further illustrates this by describing how she was initially preoccupied with doing well,

only to ‘suddenly’ feel ‘a sense of something bigger’ than herself. The implication in her

narrative seems to be that being in nature gave her a new perspective on life; something that

transcended ordinary daily concerns:

‘I remember…. I’d been in my little bubble of, ‘I need to succeed…. I

need to be something magnificent and great’. Then I suddenly felt the

sense of something bigger. There’s this big expanse of nature.

Suddenly all that stuff had mattered and now it didn’t matter’.

Takeshi, in his narrative, further paints a picture of nature as something that is bigger than

one self, which communicates his perception that nature gives a sense of space. Underlying

this, seems to be that, nature is expansive and unrestrictive in comparison to his normal

environment:

‘If I go out to the countryside I do feel kind of, I suppose, that sense of

space is different from where I am normally. So I enjoy that. That is

sort of how I relate to nature. I don’t feel as confined. I feel there is

more space and I feel less oppressed’.

Spirituality

A few of the participants spoke about their perception of nature as helping them to connect

with their spiritual aspect. Sarah believes this is important in the way she experiences nature.

Implicit, in this sense of spirituality, seems to be the sense of something that is bigger than

one self or something divine. This theme is connected to the previous theme, which suggests

that some participants perceived nature as having the ability to transcend into everyday life

and concerns. This meaning seems to be communicated in Sarah’s narrative:

‘I think there’s a religious aspect…..I’m at a stage now where I..feel

I’m not a strong Christian any more, but I have a spiritual side of me

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and that is really important in my understanding of nature… and my

connection with nature. And….when I’m in nature it helps me to

connect with the spiritual side of things, which I think is fundamental

to my happiness’.

Similarly, Anne further expands on this by suggesting that ‘God’ and ‘nature’ are one and the

same. This is interesting to note as it highlights the importance of nature not only in

individuals’ lives but also in their mental and emotional well-being:

‘I believe in God and that is also a part of getting out of depression; so

nature for me is also the presence of God…..it is not separate’.

In summary, the final theme ‘perception of nature as transcending everyday experiences’

suggests the significance of nature in helping some depressed individuals’ rise above their

daily human concerns. This is relevant as it adds a new dimension to existing literature.

Discussion

This research sought to advance existing literature by exploring relationship with nature from

the perception or experience of individuals’ with depression. It aimed to facilitate the

emergence of rich and in-depth understanding of depressed individuals’ bond with nature,

and to explore their lived experiences of the impact and benefits of spending time in nature.

The findings provide some insights into the complex contexts and relational patterns that is

involved in participants’ relationship with nature. The findings also provide some

understanding into the many benefits of interacting with nature. In the following sections, the

findings of the present study will be further explored with regards to existing literature. The

limitations of the study, implications, as well as propositions future research will be

discussed.

Evaluation of present findings

Although there has not been any previous research exploration into depressed individuals’

relationship with nature, the present findings is consistent with the findings of a previous

84

study carried out amongst non-depressed individuals’ suggested that the majority of

participants reported feeling close to nature while only a small number of respondents

reported feeling separated from nature (Vining et al., 2008). Moreover, those who felt close

to nature often interacted with nature and derived a general sense of well-being from being in

nature whilst those who felt separated from nature did not spend much time in nature.

Similarly, in the current study, the few participants who felt disconnected from nature seemed

to convey the sense that they did not spend as much time interacting with nature as they once

did. This is a significant insight indicating that the more in touch the participants were, the

clearer the relationship is for them.

There seem to be several reasons why depressed individuals’ experience a close relationship

with nature. One reason is that the natural world seems to provide a sense of safety and a

sense of belonging. This is reflected in the participants’ experiences of feeling ‘tied to’ nature

and feeling themselves to be ‘a part’ of nature. This also materialized when participants

sought out the natural environment in order to escape from their problems and other people

for some time. Another reason pointed out why participants experience a close relationship

with nature appears to be that nature provides a sense of security which allows people to feel

safe. This is reminiscent of the attachment theory (Bowlby, 1958), in which an emotional

bond with a care-giver is believed to provide a safe environment from which infants can

explore their surroundings. In the same way, nature seems to provide a secure base where

some of the participants felt safe to retreat into.

Furthermore, the sense of security that is implied in the participants experience in nature,

seems to add further insight to the theory of biophilia, which maintains that connection with

nature stimulates self-esteem and belonging (Pretty et al., 2005; Maller et al., 2008). It makes

sense that if people feel secure and safe in nature they may then experience a feeling of

esteem and belonging. Further reinforcing the biophilia theory is the emergent findings that

interacting with nature has psychological benefits which participants appeared to experience

as promoting their general mental well-being.

Consistent with existing research evidence, depressed individuals’ seemingly experienced

cognitive, mood, and physical benefits by spending time in nature. Interaction with nature has

also proved to be beneficial for reducing negative mood, increasing positive mood, restoring

85

concentration and relieving mental fatigue in depressed and non-depressed individuals

(Berman et al., 2012; Kaplan, 2001; Saarloos et al., 2011). It is also consistent with other

studies (Pretty et al., 2005; 2007) that have found that interacting with nature facilitates

physical activity which in turn is beneficial for reducing stress.

Another aspect of the participants’ experience concerns the benefits that they have derived

from interacting with the natural environment. Participants reported that the positive feelings

that nature elicits in them seem to help change their mood. This is consistent with the stress

recovery theory (Ulrich, 1983), according to which, contact with nature stimulates positive

emotions which can protect us against negative moods. It is also consistent with quantitative

research concerning the impact of nature on symptoms of depression (e.g. Berman et al.,

Berman et al., 2012; Pretty et al., 2007). However, what the current study uniquely identifies

is that a feeling of security is an especially important factor in the participants’ experience of

nature. The participants also felt that interaction with nature produces cognitive and physical

benefits which have helped to alleviate symptoms of depression.

Another important finding that supports previous research, is the role childhood plays in

developing a fondness for nature and how early experiences of nature seems to be carried out

in adult life. A previous study by Higley and Martin, (2008) suggests that childhood seems to

have been a ‘key time’ in which the some people might have developed a ‘connected

relationship with nature’ (Higley and Martin, 2008: 137). This is connected with the overall

idea that nature seems to help some depressed individuals transcend their everyday

experiences.

Limitation of the study and future research

Even though care has been taken to be rigorous throughout; it acknowledged that this study

predictably will have some limitations. An important limitation is that the sample consists of

only those participants who spend time in nature, and who either currently feel they have felt

connected to nature. This means that the experience of people who are depressed and do not

spend time in nature is not represented. This may be one fruitful area for further research to

explore. Another area of research to be considered might be to focus more directly on the

experience of feeling attached to and/or feeling detached from nature. This might contribute

86

to more insight towards our understanding of our relationship with nature. Alternatively,

future research might explore ways that interaction with nature may be designed and

implemented to best help those with symptoms of depression. Furthermore, as is true of all

qualitative research, (Smith and Osborne, 2008) care needs to be taken before drawing any

definite conclusions from the findings of the study since it was carried out in a specific

context.

A further limitation regards the extent that the study has accessed experience of

phenomenology versus a discourse about it. Considering some of the participants’ narrative

and language (i.e. Takeshi, Chris), it can be argued that, rather than revealing lived

experiences, the results showed more about how participants construct ideas about nature.

Whilst this is interesting and useful in some sense, it is also problematic because it may not

tell us much about the participants’ actual experience. Given this, future research may want to

consider taking a more objective/positivist approach in order to minimise some of the bias of

the present study, as well as to advance current knowledge about nature’s impact on those

with depression.

Implication for counselling psychology and the wider world

The present findings have relevant implications for those with depression who may not

favour psychological or pharmaceutical interventions which are the two main approaches for

managing depression. It may offer an alternative way of coping with depression. This insight

from the study helps to understand the importance of connection to nature amongst depressed

individuals. In addition, advances in psychological knowledge by demonstrating depressed

individuals’ experience of connection with nature as well as nature’s ability to promote

positive mental health. Similarly, the results shed further insight into relevant and important

areas that clinicians working with depressed individuals’ have a close relationship with

nature, may consider exploring in therapy when appropriate.

The findings of this study also have implications for counselling psychology which advocates

for a pluralistic approach towards therapy (Cooper & McLeod, 2007). Given that, preliminary

research exploration suggests that connection to nature has psychological impact on

depressed individuals’ well-being and helps to reduce negative mood thus generating a

87

positive outlook. This would seem congruent to promote the importance of the concept of

spending time in nature for those with depression.

In conclusion, this study has revealed different aspects of participants’ perception and

experience of nature. It also shed some light into how people who are depressed perceive

their relationship with nature. The findings further suggest that depressed individuals’

perceive nature as having many psychological benefits, which implies that spending time in

nature or nature based intervention/ therapy may offer an alternative approach for promoting

mental and emotional wellbeing in those who are depressed.

88

Acknowledgement

I would like to thank all the participants’ who took part in the research and the MIND staff

members who were very supportive throughout the recruiting process. In addition, I would

like to thank my supervisor, Dr Martin Milton for his support and feedback.

89

Reference

Barton, J., Hine, R., & Pretty, J. (2009). The health benefits of walking in greenspaces of

high natural and heritage value. Journal of Integrative Environmental Sciences, 6(4),

1-18.

Berman, M. G., Kross, E., Kirpan, K. M., Askren, M., Burson, A., Deldin, P. J., Kaplan, S.,

Sherdell, M., Gotlib, I. H., & Jonides, J. (2012). Interacting with nature improves

cognition and affect for individuals with depression. Journal of Affective Disorder, 12,

48-56.

Berman, M., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with

nature. Psychological Science, 19, 1207-1212.

Bolton, A., Sumner, S., Shreeves, G., Maurizio, C., & Field, J. (2006). Colony genetic

structure in a facultatively eusocial hover wasp. Behavioral Ecology, 17 (6), 873-884.

Bowlby, J. (1958), The nature of the child’s tie to his mother. International Journal of

Psycho-Analysis, XXXIX, 1-23.

British Psychological Society. (2009). Code of ethics and conduct. Leicester: British

Psychological Society.

Centers for Disease Control and Prevention and National Association of Chronic Disease

Directors. (2009). The State of Mental Health and Aging in America Issue Brief 1:

Addressing Depression in Older Adults: Selected Evidence-Based Programs. Atlanta,

GA: National Association of Chronic Disease Directors.

Cervinka, R. R., Roderer, K, K., & Hefler, E. (2012). Are nature loves happy? On various

indicators of well-being and connectedness with nature. Journal of Health

Psychology, 17(3), 379-388.

Charmaz , K. (2012). Mixing or Adding Methods?: An Exploration and Critique, in N. K.

Denzin and M. Giardina (eds.), Qualitative Inquiry and the Politics of Advocacy,

Walnut Creek, CA: Left Coast Press.

Conesa-Sevilla, J. (2010). Evolutionary ecopsychology. European Journal of Ecopsychology,

1: 37-51.

Conn, S. A. (1998). Living in the earth: Ecopsychology, health and psychotherapy. The

Humanistic Psychologist, 26, 179-198.

90

Cooper, M & McLeod, J. (2007). A pluralistic framework for counselling and psychotherapy:

Implications for research. Counselling and Psychotherapy Research, 7 (3). pp. 135-

143.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. R.

(2013). The Efficacy of Psychotherapy and Pharmacotherapy in Treating Depressive

and Anxiety Disorders: a Meta-analysis of Direct Comparisons. World Psychiatry:

Official Journal of the World Psychiatric Association, 12(2): 137–48.

Duncan, D. T., Gianfranco, P., Dunn, E. C., Johnson, R. M., Melly, S. J., & Molnar, B. E.

(2013). The built environment and depressive symptoms among urban youth: A

spatial regression study. Spatial and Spatio-temporal Epidemiology, 5, 11-25.

Eaton, W., Shao, H., Nesdadt, G., Lee, B., Bienvenu, O., & Zandi, P. (2008). Population

based study of first onset and chroncity in major depressive disorder. Archives of

General Psychiatry, 65, 513–520.

Eko, M & Martin, M. (2012). Spending time with nature: Exploring the relationship between

ecopsychology and mental health problems. Unpublished doctoral manuscript,

University of Surrey. Guildford, UK.

Fisher, A. (2006). To Praise Again: Phenomenology and the Project of Ecopsychology.

Spring Journal, 75: 153-174.

Frumkin, H. (2001). Beyond toxicity human: health and the natural environment. American

Journal of Preventative Medicine, 20, 234–240.

Gilbert, P. (1992). Depression: The Evolution of Powerlessness. Lawrence Erlbaum

Associates: Hove; Guilford: New York.

Hairon, N. (2006). Survey exposes GP frustration at dire access to depression services. Pulse,

2 March, 14-15.

Hartig, T., Berg, A. E., Hagerhall, C. M., Tomalak, M., Bauer, N., & Hansmann, R. (2011).

Health benefits of nature experience: psychological, social and cultural processes. In

K. Nilsson, M. Sangster, C. Gallis, T. Hartig, S. de Vries, K. Seeland, et al. (Eds.),

Forests, trees and human health (pp. 127-168). Netherlands: Springer.

Heerwagen, J. H. & Orians, G. H. (2005). Humans, habitats, and aesthetics. In Kellert, S. R.

and Wilson, E. O. (eds) The Biophilia Hypothesis, pp. 138–172. Washington, DC:

Shearwater Books/Island Press

91

Higley, N, & Milton, M. (2008). Our connection to the earth – a neglected relationship in

counselling psychology? Counselling Psychology Review, 23: 2.

Higley, N. (2008). Beyond the notion of the de-natured self: An interpretative

phenomenological analysis of participants’ felt-connectedness with nature.

Unpublished doctoral dissertation, University of Surrey. Guildford, UK.

Howell, A. J., Dopko, R., Passmore, H.-A., & Buro, K. (2011). Nature connectedness:

Associations with well-being and mindfulness. Personality and Individual

Differences, 12: 49–61.

Health and Care Professions Council (HCPC). (2012). Standards of Proficiency: Practitioner

Psychologists. London, UK: Health and Care Professions Council.

Kaplan, S., Bardwell, L, & Slakter, D. A. (1993). The restorative experience as a museum

benefit. Journal of Museum Education, 18, 3, 15-18.

Kaplan, S., & Berman, M. G. (2010). Directed attention as a common resource for

executive functioning and self-regulation. Perspectives on Psychological Science,

5(1), 43-57.

Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective.

Cambridge: Cambridge University Press.

Kaplan, S. (2001). Meditation, Restoration and the Management of Mental Fatigue.

Environment and Behavior, 33, 480-506.

Kaplan, S. (1995). Review of S. R. Kellert and E. O. Wilson (Eds.), The biophilia hypothesis.

Environment and Behavior, 27, 801–804.

Kaplan, S. (1987). Aesthetics, affect, and cognition: Environmental preferences from an

evolutionary perspective. Environment and Behavior, 19, 3–32.

Kazdin, A. E. & Blasé, S. L. (2011). Rebooting psychotherapy research and practice to

reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21-37.

Kellert, S. R. & Wilson, E. O. (1993). The biophilia hypothesis. Washington, DC: Island

Press.

Khawam, E., Laurencic, G., & Malone, D. J. (2006). Side effects of antidepressants: an

overview. Cleveland Clinic Journal of Medicine, 73(4), 351-3, 356-61.

Langride, D. (2007). Phenomenological Psychology: theory, research and method. Harlow:

Pearson.

Layard, R. (2006). The case for psychological treatment centres. BMJ, 332, 1030–1032.

92

Leather, P., Pyrgas, M., Beale, D., & Lawrence, C. (1998). Windows in the workplace.

London: Sage Publications.

Maller, C., Townsend, M., Brown, P. & Leger, L. (2008). Healthy Parks, Healthy People:

The Health Benefits of Contact with Nature in a Park Context. Melbourne: Deakin

University.

Martin, P. (1998). New perspectives of self, nature and others. Australian Journal of Outdoor

Education, 1, 3–9.

Mayer, F. S., Frantz, C. M., Bruehlman-Senecal, E., & Dolliver, K.  (2009). Why Is Nature

Beneficial? The Role of Connectedness to Nature.  Environment and Behavior, 41,

607-643.

MIND. (2012). The future of mental health: a vision for 2015. London: MIND.

MIND. (2007). Ecotherapy – the green agenda for mental health. Accessed 20 March 2013

from http://www.mind.org.uk/mindweek/

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.

Perspectives on Psychological Science, 3, 400-424.

Norman, R., Somerville, A. J., Baxter A, J., Patten, S. B., & Vos, T. (2013). Global variation

in the prevalence and incidence of major depressive disorder: a systematic review of

the epidemiological literature. Psychological Medicine, 43, 471-81.

Office for National Statistics. (2005). Health. Accessed online on 15 April 2013 from

www.ons.gov.uk/ons/rel/social-trends-rd/social...41/health.pdf

Office for National Statistics. (2011). Economic review. Accessed online on 15 April

2013 from http://www.ons.gov.uk/ons/dcp171766_263951.pdf

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?’. Landscape Research, 33 (1): 51-70.

Ouellette P., Kaplan R., & Kaplan S. (2005). The monastery as a restorative environment.

Journal of Environmental Psychology, 25, 175–188.

Peen, J., Schoevers, R. A., Beekman, A. T., & Dekker, J. (2010). The current status of urban-

rural differences in psychiatric disorders. Acta Psychiatrica Scandinavica, 121(2), 84-

93.

93

Pretty, J., Peacock J, Hine, R., Sellens, M., South, N. & Griffin, M. (2007). Green exercise in

the UK countryside: effects on health and psychological well-being. Journal of

Environmental Planning and Management 50(2), 211-231

Pretty, J., Peacock, J., Sellens, M. & Griffin, M. (2005). The mental and physical health

outcomes of green exercise. International Journal of Environmental Health Research,

15(5), 319-337

Relf, D. (2012). The role of horticulture in human well being and social development. New

York: Timber Press.

Reynolds, V. (2002). Wellbeing comes naturally: an evaluation of the BTCV Green Gym at

Portslade, East Sussex, Rep 17, Oxford Brookes University, School of Health and

Social Care.

Roe, J. & Aspinall, P. (2011): The restorative benefits of walking in urban and rural settings

in adults with good and poor mental health, Health & Place, 17, 103-113.

Saarloos, D., Alfonso, H., Giles-Corti, B., Middleton, N. & Almeida, O. P. (2011). The built

environment and depression in later life: the health in men study. American Journal of

Geriatric Psychiatry, 19, 461–470.

Schultz, P. W. (2002). Inclusion with nature: The psychology of human-nature relations. In P.

W. Schmuck & W. P. Schultz (Eds.), Psychology of sustainable development. (pp.

62–78). Norwell, MA: Kluwer Academic

SCMH. (2013). Briefing 26: The Supporting People programme and mental health. London:

The Sainsbury Centre for Mental Health.

SSentif (2012). The great depression: Is the UK facing a mental health crisis? Access online

on 02 December 2014 from: http://www.ssentif.com/archive/12_oct2012.shtml

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis:

Theory, Method, Research. London: Sage.

Smith, J. A, & Eatough, V. (2006). Interpretative phenomenological analysis. In: Breakwell

GM, Hammond S, Fife-Schaw C, Smith JA (eds) Research methods in psychology,

pp322 - 341. London, Sage.

Smith, J.A. & Osborn, M. (2007). Interpretative phenomenological analysis. In J.A. Smith

(Ed) Qualitative Psychology: a practical guide to research methods. London: Sage.

94

Smith, J. A., Jarman, M., & Osborn, M. (1999). Doing interpretative phenomenological

analysis. In M. Murray & K. Chamberlain (Eds.). Qualitative health psychology (pp.

218–240). London: Sage.

Smith, J. A. (1996). Beyond the divide between cognition and discourse: Using interpretative

phenomenological analysis in health psychology. Psychology & Health, 11, 261–271

Ulrich, R. S., Lunden. O. & Etinge, J. L. (1993). Effects of exposure to nature and abstract

pictures on patients’ recovery from heart surgery. Psychophysiology, 1: 7-18.

Torgersen, S. (1979). The Nature and Origin of Common Phobic Fears. British Journal of

Psychiatry, 134, 343–351.

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991).

Stress recovery during exposure to natural and urban environments. Journal of

Environmental Psychology, 11: 201-230.

Ulrich, R. S. (1984). View through a window may influence recovery from surgery.

Science, 224: 42-421.

Ulrich, R. S. (1983). Aesthetic and affective response to natural environment. In I. Altman, &

J. F. Wohlwill (Eds.), Behavior and the natural environment (pp. 85–125). New York:

Plenum Press.

Ustun, T., Ayuso-Mateos, J., Chatterji, S., Mathers, C., & Murray, C. (2004). Global burden

of depressive disorders in the year 2000þ. British Journal of Psychiatry, 184, 386–

392.

Vining, J., Merrick, M. & Price, E. (2008). The Distinction between Humans and Nature:

Human Perceptions of Connectedness to Nature and Elements of the Natural and

Unnatural. Human Ecology Review, 15(1), 1-11.

Wells, N. M., Evans, G. W. & Yang, Y. (2010). Environments and health: Planning decisions

as public-health decisions, Journal of Architectural and Planning Research, 27 (2),

124–143.

White, R. & Heerwagen, J. (2013). “Nature and Mental Health; Biophilia and Biophobia” in

Lundberg, A, (eds) “The Environmental and Mental Health: A Guide for Clinicians”.

US: Psychology Press.

Wigle, D. T. (2003). Child Health and the Environment. New York: Oxford University Press.

Wild, A. & Horsford, J. (2012). The Branching Out Project. (2012). Access 11 April 2013.

http://217.33.237.40/userfiles/file/Andy%20Wild%20Nw%20innovation%20fund

%20Case%20Study_Project%20Overview%202012_13.pdf

95

Wilson, E. O. (1993). Biophilia and the Conservation Ethic. In: Kellert S. a Wilson E. O

(eds): The Biophilia Hypothesis. Shearwater Books: Washington, DC., pp.31-40.

Wilson, E. O. (1984). Biophilia, the human bond with other species. Cambridge: Harvard

University Press.

Yan., H., Jones, F., Small, K., June, G. M., & Braid, M. (2014). “Eusocial insects as

emerging models for behavioural epigenetics”, Nature Reviews Genetics, 15: 677-688.

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APPENDIX-B

Information Sheet for Participants

1. What is the study about? Given that research shows that interaction with nature can be beneficial for those experiencing depression, this study aims to gain some insight into depressed individuals’ relationship with nature.

2. What do I have to do? You will be asked to take part in a face-to-face audio-recorded interview in which the researcher will explore with you your relationship with nature. The interview will be carried out at a convenient location for you and may last approximately forty minutes to an hour.

3. How confidential is it?Interviews will be audio-recorded and transcribed. At all times, your information will be anonymised and kept strictly confidential. Any identifying information will be disguised in the transcripts to safeguard your privacy and identity. Transcribed interviews will be analysed using Interpretative Phenomenological Analysis, which will attempt to gain insight into individuals’ relationship with nature. The results will be written up as part of my Practitioner Doctorate in Psychotherapeutic and Counselling Psychology. In addition, audio recordings will be destroyed once they have served their research purpose.

4. What if I want to withdraw from taking part?

You may withdraw from the study at any time without having to give a reason and you may also ask for your information to be excluded from the analysis until 12th of May 2013, when data analysis will begin, by contacting me on the contact details below.

5. Who can I contact if I feel distressed after taking part?If you feel distressed during and/or after taking part, please contact either your local MIND, the researcher or one of the helpline numbers provided below.

Depression Alliance Helpline providing information and advice on mental healthTelephone:0845 767 8000 Email: info@depressionalliance.org

SaneProvides practical help and emotional supportHelpline: 0845 767 8000 SANEmail: sanemail@sane.org.ukSupport Forum: www.sane.org.uk/DB

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APPENDIX-C

Consent Form

Ethics Committee

I the undersigned voluntarily agree to take part in the study examining how individuals with depression experience their relationship with nature.

I have read and understood the Information Sheet provided. I have been given a full explanation by the investigators of the nature, purpose and likely duration of the study, and of what I will be expected to do. I have been advised about any discomfort or distress which may result. I have been given the opportunity to ask questions on all aspects of the study and have understood the advice and information given as a result.

I understand that all personal data relating to volunteers is held and processed in the strictest confidence, and in accordance with the Data Protection Act (1998). I agree that I will not seek to restrict the use of the results of the study on the understanding that my anonymity is preserved.

I understand that I am free to withdraw from the study at any time without needing to justify my decision and without prejudice.

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study.

Name of volunteer (BLOCK CAPITALS) ........................................................

Signed ........................................................

Date ......................................

Name of researcher (BLOCK CAPITALS) ........................................................

Signed ........................................................

Date ......................................

APPENDIX-D

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Interview Schedule

Question:

As someone who is experiencing depression/ who has been depressed, what is your relationship with

nature?

Prompts:

What is nature to you?

What type of nature do you have access to?

How much access do you have to nature?

How do you feel when you interact with nature?

What types of things do you think about when you are interacting with nature?

What do you experience physically when you interact with nature?

What do you do when you interact with nature?

What types of things do you notice when you are interacting with nature?

What do you like about being with nature?

What do you dislike about being with nature?

Does nature help or hinder or does it have no impact at all? Would you please explain?

APPENDIX-E

99

Professor Bertram OpitzChair: Faculty of Arts and Human Sciences Ethics Faculty of Committee Arts and Human SciencesUniversity of Surrey

Guildford, Surrey GU2 7XH UK

T: +44 (0)1483 689445 F: +44 (0)1483 689550

www.surrey.ac.uk

Michael EkoTrainee Psychotherapeutic and Counselling PsychologistSchool of PsychologyUniversity of Surrey

10th April 2013 Dear Michael

Reference: 872-PSY-13 RSTitle of Project: A Qualitative Study of Depressed Individuals’ Relationship with Nature

Thank you for your re-submission of the above proposal.

The Faculty of Arts and Human Sciences Ethics Committee has now been given a favourable ethical opinion.

If there are any significant changes to your proposal which require further scrutiny, please contact the Faculty Ethics Committee before proceeding with your Project.

Yours sincerely

Professor Bertram Opitz

Chair

Appendix-F Themes and a sample of supporting quotes

Perception of relationship with nature100

Attached relationship with nature

Tom: ‘It’s almost personified for me in that when I was in a city full of people, I almost felt

as if I was away from a person that I wanted to be with... I mean, certain trees, for example,

on a walk are almost like an old friend….and a landscape and a place. There’s a place that I

feel very tied to, and taken out of that environment I’ve sometimes felt completely cut off

from and so much out of my natural environment that I couldn’t relate to the people who

were around in a city stuffed full of people.’

Chris: ‘I find I often want to be in a natural environment because there’s a feeling of safety

there and also that way I get away from people. I do that all the time anyway, but I tend to do

that more when I am feeling depressed.’

Sarah: ‘So my relationship with nature started when the doctor recommended weekly

exercises. I went running, by chance, as we lived near a river bank. So rather than go to a

gym, I just ran down by the river. And it was in running there and in the park and seeing the

trees and flowers, and the many lovely natural places around me to run, I think it was running

in those beautiful natural places that I started to feel much better’.

Jackie: ‘Generally when I am feeling very depressed, I try to avoid people because I feel

ashamed of what I look like. Looking around at others, they are always busy going

somewhere. They are doing things and I am not, so that doesn’t help, but being in nature I

feel a part of it. I feel connected. I am ok and I can just be myself’.

Detached relationship from nature

Takeshi: ‘I do not have a close relationship with nature. But I suppose that’s – it’s a bit

difficult to explain. Let’s say that I don’t do it now, but I used to enjoying drawing and

painting and things. And particularly I was interested in drawing small insects, for

example…. Or very detailed drawings of plants. Wilds. Although I don’t do that anymore’.

Anne: ‘I find it so healing and so important that I can’t understand how I used to walk around

completely blind to it. I used to walk past trees, walk past flowers. The seasons, I didn’t even

notice the change in the seasons’. 101

Jennifer: ‘I think I have a very very good relationship with nature now……. But when I was

too depressed I don’t think I felt like that. I think it is probably because I didn’t feel like that

that I was very depressed; very cut off from nature and very much more thinking about

people and concentrating on relationships and society and all that kind of things. When you

are cut off from it you suffer greatly.’

Desire to be closer to nature

Keith: ‘If there was a way where I could isolate myself completely and basically live almost,

it’s not so much about solitude; it’s about the environment as well. If I could find a way of

living completely surrounded by nature and not having contact with anybody then that would

be the perfect world.’

Jennifer: ‘I am quite interested in those old….farming culture where they … live in houses

but they have a very outdoor lifestyle. I am envious of that kind of outdoor, very simply

lifestyle. You are very much in contact with nature but you know, I think this society has

become so artificial and losing contact with the earth, which is the most important thing’.

Chris: ‘There’s something about, there’s an uplifting feeling about being in the open air in the

country. I’ve always enjoyed it really. If I had my way I’d actually be living in the country as

opposed to living in the town, in a rural cut-off place; obviously not completely away from

civilisation but just in a tranquil setting, because I just prefer more of a laid back life’.

Rashida: ‘I’ve always imagined like when I grow old there’ll be a house where in spring you

see all these different kinds of colours of flowers and all these kind of shapes of trees and

things like that. I have always liked that.….. A meadow where you can see the horizon and

you can just keep running. And it’s a liberating kind of feeling’.

Perception of the benefits of interacting with nature

Positive mood benefits

102

Andrew: ‘It doesn’t affect me as much as it used to, but, when I was very depressed I used to

get quite an uplift by taking myself into a peaceful natural environment [The Chilterns;

nearby woods and a local forest], even if it was just lying there in the sun or whatever and I

would always come back lifted’.

Anne: ‘I just feel much better, much more, I think it blows out the cobwebs and makes me

feel happier again’.

Jackie: ‘It’s comforting. It’s a relief. It makes me feel that I don’t have to try so hard. I do

like the fact that it doesn’t change, that it’s very reliable. And it will always be there’.

Jennifer: ‘I think it’s kind of having a love for something that is always there. I mean you can

have love for a person and they can disappear or they don’t love you back, but, I suppose

having a love for nature is something you can always rely on. It is there even if it is like,

every tree, and you can’t get rid of the sky very easily and the stars so it’s something which is

always there for you’.

Keith: ‘It helps me unwind if I’m feeling stressed. It helps me put a perspective on things and

those combined generally help me lift the mood. The depression seems to improve; the

anxiety seems to improve. This doesn’t happen immediately, they take time, but, once I’m

outside I slowly start to feel better, less anxious and then these feelings continue when I

return even to work or back indoors with the family. It generally just helps’.

Cognitive benefits

Keith: ‘It helps me; I attach with the depression. I get quite anxious, paranoid about things

and it just helps me, that environment helps me to think clearer and sort things out in my own

mind’.

Rashida: ‘So if you had a particularly hard day and you just feel like there are things in your

head that shouldn’t be there…..like a clouding kind of effect, you can just take a moment and

you sit outside in the garden and it’s quiet and you close your eyes and just breathe in and

out. That helps’.

Anne: ‘When I was depressed I would think about my problems again and again and again

and analyse them over and over…. Often when I’m in walking…I’d be distracted by the 103

lovely view a tree or some flower. So I could be walking across the field and I’d notice rows

of trees…. It often felt like the problems were…they often seemed less important because of

the distraction’.

Takeshi: ‘I seem to gain more control over my thoughts, because although I said there were

more things that I notice in nature, but it seems to kind of shift my attention from a stressful

thing to less stressful things, such as the features of nature, and in doing so, then, I suppose it

has a calming effect. And I can remain sort of more control over my thoughts. That’s

something I like’.

Physical benefits

Tom: ‘You can just pass the time when things are not working, until your emotions settle

down again. So spending the time away like that and just perhaps, walking and using up some

energy helps. The actual physical movement seems helpful. It makes me sleep better’.

Tom: ‘When the moments are sublime it’s a sort of – the physical feelings associated with

emotion are all in this part of the body [stomach]. The knots of unhappiness and the release of

tension of elation. I notice that there are physical feelings that should correspond to those

emotional states, and they are to do with muscular tension and release’.

Eva: ‘It is difficult to motivate myself but when I do, I always feel much better after that

walk. Also, physically, the symptoms of depression always eases’.

Perception of nature as transcending everyday experiences

Childhood

104

Anne: ‘Actually you know when I was very very depressed; one of my strategies to get out of

it was to smell pear. This particular pear, the yellow one is linked with my childhood and it

smells absolutely fantastic. It is a very beautiful smell. It makes me feel closer to nature and

life.’

Sarah: ‘My favourite nature are hills and green…..and it’s amazing how many people will say

“sea”. And I’m not sea. I’m hills….And I do often wonder if that is because that’s where I

grew up......and people that I know that love sea more than hills, it’s because they have

childhood memories of seaside times’.

Something bigger than self

Eva: ‘When I saw those big mountains in the dales…. that was a moment. You just see how

little you are compared to them and how little and insignificant your problems are in the

universe. So obviously during depression you sort of become egocentric but when you see the

natural world around you; it is vast and it is beautiful and it is so beneficial’.

Sarah: ‘I remember…. I’d been in my little bubble of, ‘I need to succeed…. I need to be

something magnificent and great’. Then I suddenly felt the sense of something bigger.

There’s this big expanse of nature. Suddenly all that stuff had mattered and now it didn’t

matter’.

Takeshi: ‘If I go out to the countryside I do feel kind of, I suppose, that sense of space is

different from where I am normally. So I enjoy that. That is sort of how I relate to nature. I

don’t feel as confined. I feel there is more space and I feel less oppressed’.

Spirituality

Jackie: ‘I think there’s a religious aspect…..I’m at a stage now where I..feel I’m not a strong

Christian any more, but I have a spiritual side of me and that is really important in my

understanding of nature… and my connection with nature. And….when I’m in nature it helps

me to connect with the spiritual side of things, which I think is fundamental to my happiness’.

105

Anne: ‘I believe in God and that is also a part of getting out of depression; so nature for me is

also the presence of God…..it is not separate’.

Spending time in nature: restorative effects of mood amongst depressed individuals

Abstract

106

Studies have shown that walking in nature increases positive mood and helps healthy

individuals recover more quickly from negative mood. This study aimed to examine whether

spending time in a natural environment has restorative effects on the mood of people with

depression. 24 individuals (mean age = 30.38yrs) with moderate to severe depression

participated in the study. Participants’ positive and negative mood was measured pre-

intervention using PANAS. They were then asked to sit alone in either nature or an urban

environment for 30 minutes. Post-intervention, participants’ positive and negative mood was

measured again with the PANAS. Participants also completed the PRS in order to assess

whether the environmental setting was perceived to have restorative effects. The data showed

that participants who were exposed to nature reported a greater increase in positive mood

relative to those exposed to an urban environment (p < 0.001). Although the nature group

reported a greater reduction, there was no difference in the negative mood score of the two

groups. Participants also perceived the natural environment to have greater restorative

effects than the urban environment (p < 0.001). The findings demonstrate that nature has

restorative effects on depressed individuals’ mood. This has implications for individuals with

depression as well as general mental health practices.

Keywords: nature, depression, nature-based therapy, restoration

Introduction

There is significant evidence that exposure to natural environments helps healthy individuals

recover quickly from negative mood (Ulrich et al., 1993), mental fatigue (Berman et al.,

2008) and stress (Heerwagen, 1990). Moreover, research suggests that people who suffer

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from depression are more likely to suffer from increased negative mood (Scherrer et al.,

2014), mental fatigue (Targum & Fava, 2011) and are more sensitive to stressors (Muscatell

et al., 2009). Given this, the aim of this study is to investigate whether spending time in a

natural environment has restorative effects on the mood of people with depression.

Depression

Depression (also known as a mood disorder) is the experience of intense distress

characterised by persistent negative mood, low positive mood and low self-esteem

(Chepenik, Cornew & Farah, 2007; Nolen-Hoeksema et al., 2008; Scherrer, Dobson &

Quigley, 2014). According to literature, one feature of depression involves changes in mood

with pervasive feelings of guilt, anger, shame, sadness, anxiety and overall negative mood

(APA, 2000; NICE, 2009). Another feature is thought to relate to changes in cognitive

evaluation pattern; people who are depressed are generally considered to hold negative

beliefs about themselves, others and the world (Beck et al., 1997). For example, one person

may perceive themself as “inadequate,” others as “critical” and the world as “dangerous”

whilst another may see themself as “weak,” others as “strong” and the world as “unfair.” In

addition, those with depression tend to see the future as hopeless (Beck et al., 1997). Another

feature of depression is anhedonia which is conceptualised as a combination of a feeling of

emptiness and reduced positive mood or the inability to find pleasure in everyday interests

and activities which one might have enjoyed before (Abrahamson et al., 1989; Klinger,

1993). Other characteristics of depression include poor concentration, mental fatigue,

sensitivity to daily stress, irritability and reduced vigour (APA, 2000).

Depression affects approximately 350 million people worldwide at any one time (WHO,

2012). It can considerably reduce one’s quality of life and life expectancy (Ferrari et al.,

2013; Penninx et al., 2013). Depression is often believed to start in childhood and

adolescence (NCCMH, 2005; NIMH, 2013), with a tendency to reoccur later once a major

episode has been developed (NICE, 2004). Furthermore, it is more prevalent in women than

men (WHO, 2012) with symptoms lasting for months and sometimes years if professional

help is not sought (Ferrari et al., 2013).

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The experience of depression can lead to a number of consequences which can vary from

person to person. Firstly, it can interfere with individuals’ cognitive processes (i.e.

perception, working memory, and attention) by reducing concentration, the ability to perform

tasks and productivity (Austin, Mitchell & Goodwin, 2001; Berman et al., 2012; Glied &

Daniel, 2002; Perez et al., 1999). Secondly, depression can affect people behaviourally,

leading to reduced physical and social activity as well as social withdrawal (Feldman &

Gotlib, 1993; Segrin & Abramson, 1994). Thirdly, it can increase the risk of suicide and in

some cases directly lead to suicide (MIND, 2007; WHO, 2004b). Finally, it is clear that

depression is a condition which has a devastating impact on family life and on society in

terms of financial cost (ONS, 2011). There have also been suggestions that depression can

lead to reckless behaviour, addiction to drugs and substances, relationship difficulties and

health problems (Dinan, 1999; WHO, 2004b; WHO, 2012). As such, depression can have a

significant impact on individuals’ psychological, physical and social functioning as well as

interfering with day-to-day life.

Currently, it believed that there is no single cause of depression. Instead, individuals are

thought to develop symptoms of depression due to a wide range of factors (APA, 2000).

People can develop depression as a result of stressful life events, including divorce,

bereavement, loss of employment, relationship breakdown, serious health problems,

retirement and abuse etc. (Keely et al., 2009; Kendler, Karkowski & Prescott, 1999; Mitchell

et al., 2003). Some people may be susceptible to depression due to having certain personality

traits (i.e. a low self-esteem trait or an overly self-critical trait) (Kotov et al., 2010). Some

individuals are considered to be more vulnerable to depression due to a familial history of

depression (Kovacs et al., 1997; Monroe, Slavich & Gotlib, 2014). Other risk factors which

can contribute to feeling depressed include sensitivity to stress, lack of social support,

loneliness, age (elderly people), addiction problems and low socio-economic status (APA,

2000; Gilbert, 2007; Jaremka et al. 2012; CDC, 2009). However, it is widely believed that for

many people with depression, it is a combination or variety of some of these factors which

leads to developing symptoms of depression (NICE, 20011).

Usual treatment for depression

The usual treatments for depression are pharmaceutical and psychological therapies.

Pharmaceutical therapy typically involves different types of anti-depressant drugs such as

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selective serotonin reuptake inhibitors (i.e. Fluoxetine, Citalopram, Sertraline), and

Serotonin-noradrenaline reuptake inhibitors (Venlafaxine and Duloxetine) (NICE, 2004). UK

government statistics show that in the UK alone, anti-depressants are being prescribed in

record numbers, increasing from 20 million in 2005 to 53 million in 2010 (Office for

National Statistics, 2005; 2011). This indicates that the number of people with depression and

/ or those who are probably dependent on anti-depressants may be rising. Psychological

therapies for depression include cognitive behavioural therapy (CBT), online CBT,

interpersonal therapy (IPT), and psychodynamic psychotherapy (NICE, 2009). By all

account, most of these services are struggling to cope with public demand in addition to being

underfunded (Mental Health Collaborative, 2013; MIND, 2014).

Efficacy research suggests that a combination of medication and psychological therapy (i.e.

CBT, interpersonal therapy and psychodynamic therapy) is the most effective intervention for

depression (NCCMH, 2010; NICE, 2009). Studies have also shown that both pharmaceutical

and psychological therapies are effective at reducing the severity of depressive symptoms,

although half of all clients tend to drop out from both therapies (see Cuijpers et al., 2013 for a

meta-analytic review). Meta-analytic reviews consistently indicate that whilst anti-

depressants are very effective for people with severe depression, their effect on those with

mild to moderate depression is minimal to non-exist and often no better than placebo

(Fournier et al., 2010; Khin et al., 2011; Kirsch et al., 2008). These findings therefore suggest

that there is a need for an alternative remedy because for some people the benefits of taking

anti-depressants which are the frontline treatment for depression are very little, if any.

Moreover, the increasing cost of anti-depressants is a huge burden on society, with these

drugs costing the UK public £270 million in 2011 which was a 23% rise on the previous year

(NHS, 2012). As this may not be sustainable in the future, it is crucial that an alternative

invention is explored.

Why is there a need for an alternative?

Apart from anti-depressants’ lack of benefits for some people, there are several other reasons

why it is important to find an alternative way of intervening with depression: (a) research

evidence suggests that half of all students/ clients usually drop out of both pharmaceutical

and psychological therapies, therefore it is possible that some of those who drop out from

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these interventions may benefit from having an alternative choice; (b) there are serious

concerns about potential withdrawal symptoms and side effects of anti-depressants (i.e.

nausea, agitation, stomach pain, weight gain, sedation, blurred vision and sexual related

difficulties) (Khawam, Laurencic & Malone, 2006); (c) with government statistics suggesting

a huge rise in the number of people now relying on anti-depressants to function day-to-day, it

is possible that this trend may be unsustainable in the future if alternative remedies are not

explored or available; (d) we now know that over 90% of general practitioners prescribe

anti-depressants as they reported that they lacked other choices for students (Hairon, 2006;

Layard, 2006); (e) access to psychological resources are limited with long waiting lists

reported at many services; (f) in view of recent NHS cuts and the rising cost of maintaining

current interventions (MIND, 2013), there is an urgent need for an intervention which is less

costly and is more easily accessible to people with mental health difficulties. Given this, it

makes sense to consider an alternative approach to promoting mental health and well-being

for people who suffer from depression.

Nature as an alternative: Why would it work?

Nature (i.e. plants, vegetation, trees, wildlife) may provide an alternative way of managing

symptoms of depression; environmental psychologists have focused extensively on the

restorative effects of the natural environment on the psychological well-being of healthy

individuals. Their research evidence suggests that nature has a wide range of benefits for

healthy individuals which may also be helpful for those with depression.

In a study investigating the impact of nature and the urban environment on cognitive

performance, Berman, Jonides and Kaplan (2008) found that, in comparison to those who

walked in an urban environment, undergraduate students who walked in nature demonstrated

a significantly improved level of concentration and working memory capacity; both cognitive

functions which are typically dysfunctional in individuals with depression (Hartlage et al.,

1993; Rose & Ebmeier, 2006). This is supported by studies which showed that walking in

nature or viewing pictures of natural landscapes, plants and trees helps people recover from

mental fatigue (Bratman et al., 2012; Fan et al., 2002; Kaplan, 1995; Leather el al., 1998;

Shibata & Suzuki, 2001), improves their ability to perform tasks (Shibata & Suzuki, 2002)

and improves productivity (Fjeld et al., 1998). In addition to this, many other studies have

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also demonstrated that exposure to nature has positive effects on individuals’ cognitive

processes such as attention and working memories (Berto, 2005; Hartig, Evans, Jamner &

Davis, 2003; Felsten, 2009; Kaplan, 2001; Tennessen & Cimprich, 1995). Overall, these

studies suggest that nature has important cognitive benefits for the general population.

Indeed, this is one reason why it may provide an alternative choice for depressed individuals,

given that deficits in cognitive functioning such as low level of concentration, inability to

perform tasks, mental fatigue and working memory dysfunction are common among those

with depression (Demyttenaere, Fruyt & Stahl, 2004; Ortiz et al., 2003; Pelosi et al., 2000;

Targum & Fava, 2011).

Research also supports the idea that nature-experiences can help to reduce levels of stress.

Ulrich (1991) showed that participants who viewed clips of vegetation showed signs of a

decline in heart rate, reduced muscular tension and lower blood pressure in comparison to

those who viewed a clip of an urban setting. This suggests that those who were exposed to

clips of nature recovered from stress at a quicker pace than their counterparts. Heerwagen

(1990) found that seeing murals depicting nature on the wall effectively reduces levels of

anxiety and stress in individuals visiting the dentist. However, those able to see only a blank

brick wall did not exhibit the same improvement. Other evidence further supports these

findings (Grinde & Patil, 2009; Van den Berg, Hartig and Staats, 2007) as well the idea that

nature helps to reduce blood pressure and physiological arousal (Bennett, Cardone & Jarczyk,

1999; Ulrich, 1981). Complementing these are recent social neuroscience findings which

suggest that people who live in or grew up in the city display high amygdala activation and

do not handle stress as well as those who live in or grew up in rural environments. The latter

showed higher activation in the perigenual anterior cingulate cortex, an area that regulates

amygdala activity, negative mood and stress (Lederbogen et al., 2011). Together, these

studies imply that interaction with nature is associated with recovery from stress.

Interestingly, research has long shown that people who are depressed are more sensitive to

daily stress (Austin, Mitchell & Goodwin, 2006; Kessler, 1997; Muscatell et al., 2009;

Williams et al., 1997). Therefore, this is another reason why nature may be a useful

alternative to pharmaceutical therapy.

Some studies have found that exposure to nature increases positive emotions whilst at the

same time reduces negative emotions such as fear and anger (Keddy, 2007; Katcher et al.,

1983; Ulrich, Lunden & Etinge, 1993). This is reinforced by other findings which suggest

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that nature can help to reduce feelings of anger and frustration (Kuo & Sullivan, 2001; White

& Dolan, 2009) and anxiety (Chang & Chen, 2005; Pretty et al., 2005) in healthy adults.

Some studies have also shown that interacting with and carrying out activities (i.e. walking,

cycling, horse riding) in nature can help improve self-esteem (Kahn, 1999; Pretty et al.,

2005), reduce levels of negative mood like anger, anxiety and confusion (Barton, Hine &

Pretty, 2009; Maller, 2009; Peacock et al., 2007) as well as boost overall mood (Kaplan,

1974; Ulrich, 1993) in both healthy adults and children. Overall, these studies imply that

interaction with nature is associated with both a reduction in negative mood and improvement

in positive mood. This has particular relevance for those with depression whom we know

persistently experience increased negative mood, low positive mood and low self-esteem.

Therefore, it is likely that when those with depression interact with nature they experience the

same benefits as healthy individuals.

Furthermore, with the rise of urbanisation, globalisation and modern technology, it seems that

our ability to relate and engage with the natural world is decreasing (Buzzell and Chalquist,

2009; Higley and Milton, 2008; Louv, 2005). This disconnection from nature may have

implications for our mental wellbeing. Emerging studies suggest that living closer to natural

environments has psychological benefits which can last for years, even after people move

away (Alcock et al., 2014; White et al., 2013); whilst living in urban environments

considerably increases the risk of mental health disorders like anxiety and depression (see

review by Peen, Schoevers, Beekman and Dekker, 2010). Some studies have also found that

there is a greater prevalence of depression among people who reside in built environments

(Galea et al., 2005; Paykel et al., 2003; Weich et al., 2002). In contrast, evidence indicates

that those with access to a nearby natural environment are healthier and experience greater

life satisfaction than their counterparts who have no such access (Frumkin, 2001;

Nieuwenhuijsen, 2014). Overall, these findings point to the importance of connecting with

nature and the benefits of nature on individuals’ mental health and well-being. This is another

reason why exposure to nature may provide a beneficial alternative to anti-depressants.

Research indicates that being outdoors in nature not only improves people’s mood, but also

influences a general positive outlook (Barnicle & Midden, 2003; Bernstein et al., 2009;

Grinde & Patil, 2009; Kohlleppel et al., 2002; McFarland, Waliczek & Zajicek, 2010). Other

studies found that those who spend time nurturing plants experience less mental distress than

those who do not (PLNA, 2009; Park and Mattson, 2009). Taken together, these findings

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imply that contact with nature can relieve feelings of distress in healthy non-depressed

individuals. It is well known that those with depression generally have a negative outlook on

life and typically feel hopeless about the future (Beck et al., 1990; Gilbert, 1989).

Furthermore, depressed individuals characteristically feel distress because they perceive

themselves in critical and negative terms (i.e. I am “inadequate” “weak” “worthless”). Given

this, it makes sense to examine the impact of nature on those with depression as spending

time in nature may help them feel less distress.

Theoretical understanding of the effect of nature on mental health and well-being

Two theories have been proposed to explain why nature seems to have all kind of positive

effects on human functioning. The first theory, which is known as the attention restoration

theory (ART), states that the most advantageous environment is one where (a) fewer demands

are made on attention and (b) fatigued mental capacities caused by everyday stress are easily

replenished (Kaplan & Kaplan, 1989). The theory postulates that natural environments have

more restorative qualities which distinguish them from other types of settings (i.e. urban

environment) (Kaplan & Kaplan, 1990; Staats, Kievet & Hartig, 2003). Kaplan (1992) points

out four restorative qualities that are present in nature which underlie nature’s ability to affect

human cognitive functioning. Firstly, nature helps us escape from normal everyday routines

which may be stressful and monotonous; this restorative quality is referred to as “being

away”. Secondly, nature has the ability to effortlessly fascinate and capture our involuntary

attention (when attention is sustained without much exertion) without making a demand on it

as would be required in voluntary attention (when attention is directed towards a task). This is

known as the restorative quality of “fascination”. Thirdly, the extent to which nature can

provide stimulation and exploration in a way which is not demanding on attention is called

“extent / coherence”. The final restorative quality is called “compatibility”; this is nature’s

ability to meet individuals’ needs and goals. This theory which provides a cognitive

psychological perspective underpinning the restorative effects of nature has some relevance

for depressed individuals because it implies that an environment perceived to be rich in

restorative qualities will be more helpful in reducing mental fatigue, which is a common

feature of depression (Targum & Fava, 2011). It also suggests that spending time in nature

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helps improve cognitive deficits, another feature of depression. Given this, it seems crucial to

investigate how those who are depressed might perceive natural environments.

There are several criticisms of ART however. Firstly, it has been shown that other types of

environment such as museum and monasteries can be conducive to restorative attention

(Kaplan, Bardwell & Slakter, 1993; Ouellette et al., 2005). This indeed contradicts ART’s

assumption that natural environment is superior to built and other types of environments.

Secondly, the fact that some people have a negative view of nature (i.e. people with phobia of

insects and animals) because they associate nature with dangerous and threatening animals

(Hartig & Staats, 2007) also suggests that nature is not always viewed as pleasant and non-

stressful. This also contradicts one of ART’s assumptions because it suggests that some

individuals may not consider nature to be a way of escaping from normal everyday routines.

Furthermore, it would is probable that such individuals would not find nature or some aspects

of nature fascinating. In addition, it can be argued that based on the abovementioned points,

some individuals’ are less likely to see nature as being compatible with their needs. All of

these points oppose some of the key assumptions of the theory.

The second theory, called the stress recovery theory (SRT), states that contact with non-

threatening natural environments helps to build a barrier against stress (Ulrich, 1983). This

process is thought to take place because of nature’s ability to help build a buffer by boosting

positive mood whilst at the same time calming negative mood. Through this process, SRT

states that exposure to nature helps people recover from stress, increases positive mood and

subdues negative mood. As well as having an impact on our emotional system, SRT states

that nature has a soothing effect on our physiological system (i.e. heart rate and blood

pressure). As reported earlier (in the section “nature as an alternative: why would it work?”),

an extensive body of research supports the idea that nature helps to reduce blood pressure,

relieve stress, improve positive mood as well as general mood. This theory which provides a

psycho-evolutionary viewpoint has important relevance for people who are depressed

because common features of depression include a significant increase in negative mood, low

positive mood and high sensitivity to stress. In addition, this theory has important

implications because stress is a major risk factor for depression (Muscatell et al., 2009). As

such, it is conceivable that exposure to nature may help relieve stress in depressed

individuals.

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Effect of nature on people with depression

At present, there has been very little research attention regarding the effect of nature on those

with mental health presentations such as depression. On the whole, previous studies have

focused on healthy individuals in the general population. To my knowledge, only one study

has specifically examined the effects of nature on depressed individuals. In their study,

Berman et al. (2012) examined the effects of walking in natural environments on people with

depression. They found that participants experienced an increase in concentration, increased

positive mood and reduced negative mood, even when they were asked to think about

previously distressing experiences beforehand. Conversely, depressed individuals who

walked in an urban environment showed no improvement in mood or concentration.

Furthermore, in a recent qualitative study which explored depressed individuals’ personal and

subjective experience of nature, we (Eko and Milton, 2013) found that most of the

participants perceived nature to have a positive impact on their mood because it makes them

“feel better” and it provides a feeling of “security” and makes them “feel less stressed”.

Participants also perceived nature as helping them “think clearer” and “feel calmer”.

Moreover, some depressed individuals perceived nature as transcending everyday

experiences because it makes them “good memories of childhood”, makes them feel they are

in “the presence of God” and gives them a sense that nature is “something bigger” than

themselves. Overall, this finding demonstrates that nature can have many benefits for people

who are depressed and therefore it may provide an alternative remedy for depression. These

findings are an important step towards exploring and understanding the impact of nature on

individuals with depression. They also move us a step further towards the objective of finding

a simple and more accessible option to promoting mental well-being amongst those with

depression.

To summarise, there is significant evidence that spending time in nature increases positive

mood (Keddy, 2007; Ulrich et al., 1993), helps recover from mental fatigue (Berman et al.,

2008; Felsten, 2009), and stress (Heerwagen, 1990; van den Berg et al., 2007). Studies also

suggest that depressed individuals are more likely to suffer from low mood (Nolen-Hoeksema

et al., 2008; Scherrer, Dobson & Quigley, 2014), mental fatigue (Demyttenaere, et al., 2004;

Targum & Fava, 2011) and are more sensitive to stressors (Kessler, 1997; Muscatell et al.,

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2009; Williams, et al., 1997). This suggests that nature may be beneficial in improving mood

amongst depressed individuals. However, apart from Berman et al’s (2012) study, no other

study has specifically investigated this subject. In view of this, this study aimed to investigate

whether spending time in a natural environment has restorative effects on the mood of people

with depression.

It was predicted that depressed individuals would experience greater emotional restoration in

nature compared with in an urban environment. The following hypotheses were generated:

Depressed individuals who spend 30 minutes sitting in a natural environment will:

1. Show greater emotional recovery (characterised by increased positive mood and

decreased negative mood) compared to depressed participants who spent time in an

urban environment.

2. Perceive nature to have greater restorative effects, characterised by qualities of “being

away,” “fascination,” and “extent / coherence,” “compatibility,” than those who spent

time in an urban environment.

Method

Design

The present study is a mixed design consisting of both a between- and a within-participants

variables. Participants’ mood (positive and negative affect scores) was assessed pre and post

intervention and the participants were randomly assigned to one of the two groups; natural

environment intervention group (experimental group) and urban environment intervention

group (control group). It was decided that rather than asking participants to walk in nature,

they were asked to sit alone in nature. In addition, based on previous studies (Pretty et al.,

2005; 2007), it was also decided that 30 minutes in nature would be sufficient time to

experience the positive effects of nature.

Participants

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A total of 29 participants responded to an advert to participate in this study. Participants were

excluded if they did not meet the inclusion criteria of moderate to severe depression (n=5).

The final sample involved 24 participants, including 17 females (71%) and 7 males (29%),

between the ages of 21-54 years (M = 30.38 years, SD = 4.81, Mdn = 32, IQR = 26-41), who

were recruited from the University of Surrey in Guildford and from nearby residence.

Participants were recruited through poster advertisements, which were strategically placed

around the clinic. The poster asked participants whether they felt sad or depressed and gave

some relevant information about the study. The poster also asked participants to contact the

researcher if they were interested in knowing more about the study. The volunteer

participants consisted of 14 students, 4 staff members and 6 local residents. Participants were

offered a £5 Amazon voucher as an incentive to participate.

Six of the participants reported comorbid diagnoses of other mental health disorders (e.g.

general anxiety disorder, anorexia nervosa) and health-related conditions (e.g. diabetics,

fibromyalgia). Eleven of the participants reported that they were taking anti-depressants

whilst four reported they were in therapy.

Measures

Each participant was asked to complete one unstandardised demographic form (Appendix-A),

as well as three questionnaires which are widely used and have been well validated. The form

and questionnaires were:

The Demographic form. Participants were asked to complete a demographic form

particularly designed for this research. The form collected relevant information regarding

participants’ age, gender, ethnicity, employment status, length of time they had been

experiencing depression, whether they had been diagnosed with depression and whether they

were using anti-depressant or psychological therapy to manage symptoms of depression.

Beck Depression Inventory – II (BDI-II) (Beck, Steer & Brown, 1996). The inventory

measures levels of depressive symptoms (i.e. mild, moderate, and severe). It consists of

twenty-one statements pertaining to various features of depression including sadness, loss of

pleasure, concentration difficulty, self-criticism, pessimism, past failure, loss, feelings of guilt

etc. Participants were asked to rate each feature of depression on a 0-3 point scale. For

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example, the feature of sadness can be rated 0 = I do not feel sad, 2 = I feel sad, 3 = I am sad

all the time and I can’t snap out of it, 3 = I am so sad and unhappy that I can’t stand it. The

total score for the scale is 65. The inventory is one of the most widely used assessments of

depression worldwide and has been used in many studies. The measure has internal

consistency of α = .92 in non-clinical samples and α = .92 in clinical samples (Brouwer,

Meijer & Zevalkink, 2013; Kung, 2012; Lipps, Lowe & Young, 2007; Huprich & Roberts,

2012). The inventory has a retest reliability ranging from α = .74 – .95 and has been shown to

be sensitive in measuring cognitive, affective and somatic dimensions of depression (see

review by Wang & Gorenstein, 2013).

The Positive and Negative Affect Schedule (PANAS) (Watson, Clark & Tellegan, 1988). The

scale measures positive affect and negative affect. The schedule contains twenty mood-

related adjectives such as ‘strong,’ ‘irritable,’ ‘attentive,’ ‘guilty,’ ‘afraid,’ which

participants’ were asked to rate on a 5-point Likert scale (e.g. the adjective strong; 1 = not at

all or very slightly, 5 = extremely) depending on present mood. The schedule has a

moderately good internal consistency with: Cronbach Alpha of α = .87 - .90 for Positive

Affect; α = .85 - .88 for Negative Affect; retest reliability ranging from α = .64 - .76 for

Positive Affect and α = .58 - .74 for Negative Affect (Crawford & Henry, 2004; Harmon-

Jones et al., 2009; Montpetit, 2007; Schmukle, Elgoff & Burns, 2002). It has also been shown

by previous studies to have good sensitivity in measuring Positive Affect and Negative Affect

(Berman et al., 2012; Gray and Watson, 2007). A higher positive affect and a lower negative

affect denote mood recovery. The data of the current study also found that the schedule

showed good reliability, α = .74, for the positive domain and had an acceptable reliability, α =

.65, for the negative domain.

The Perceived Restorativeness Scale (PRS) (Hartig, Evans, Korpela & Garling, 1997). This

scale assesses restorative potential in different settings and is based on the attention

restoration theory (Kaplan & Kaplan, 1989). The scale contains 26 statements assessing the

four restorative qualities of ‘being away’ (spending time here gives me a break from my day-

to-day routine), ‘fascination’ (this place has fascinating qualities), ‘coherent’ (there is a great

deal of distraction), and ‘compatibility’ (I have a sense of oneness with this setting).

Participants rated each question on a 0-6 scale (e.g. of 0 = not at all, 6 = completely). The

PRS has a high reliability for the being away, α = .91; fascination, α = .92; coherence, α

= .79, and compatibility, α = 0.82. (Cronbach Alpha of 0.87) (Tenngart & Hagerhall, 2008).

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It has also been shown by several studies to have good sensitivity (Abkar et al., 2011; Han,

2009; Hartig & Staats, 2006). The data of the current study also found that the scale showed

good reliability for restorative qualities of being away, α = .83; fascination, α = .86;

coherence, α = .63, and compatibility, α = .90.

Environmental setting

Environmental setting

The study was conducted on the grounds of the University of Surrey. The Lakeside (Figure 1)

was used as the outdoor natural environment whilst the space directly behind the Philip

Merchant building (Figure 2) was the location of the outdoor urban environment. Both

outdoor locations were specially chosen for their convenience and accessibility to

participants. These locations were also ideal since some of the participants often spend their

break time there, particularly during the summer months.

The Lakeside is a tranquil environment surrounded by trees and water structures (i.e. a

waterfall). There are also collections of ducks and geese either paddling in the lake or

roaming around with babies in tow. The space behind the Philip Merchant building is often

quiet although during lunch hours, huge numbers of students can often be heard in

conversation as they walk by. From the sitting point seen in the photograph in Figure 2, it is

surrounded by buildings from all sides.

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Figure 1: Scene of natural environment

Figure 2: Scene of urban environment

Procedure

Participants who responded to the study advert were sent an information sheet (Appendix-B)

and asked to complete a Beck Depression Inventory II (BDI-II; Beck et al., 1996) via email in

order to determine if they fitted the inclusion criteria of the study. Participants’ with self-

reported scores ranging between 21 and 30 (indicating moderate depression) and between 31

and 65 (indicating severe depression) on the BDI-II were included to participate. This same

method was used by Berman et al. (2012). Following this, each participant was asked to meet

the researcher in front of The Wellbeing Centre, a well-known location at the University of

Surrey.

Participants’ were informed that at around 15 minutes into the experiment, the researcher

would stand at a nearby location where he could be reached in case they were feeling

distressed, could not complete the research for any reason or would like to withdraw.

Participants were then asked to read and sign the consent form (Appendix-C) before they

were randomly assigned to one of the two conditions (natural environment and urban

environment). Each participant was then taken to the assigned location; both locations being

approximately one minute’s walk from The Wellbeing Centre. At the appointed location, the 121

Demographic form and the Positive and Negative Affect Schedule were administered.

Thereafter, they were asked to sit alone for 30 minutes.

Fifteen minutes into the experiment, the researcher stood at the discreet location in case

participants felt distressed. At the end of the 30 minutes the Positive and Negative Affect

Schedule was administered again. Finally, participants completed the Perceived Restorative

Scale. The whole process took approximately 45 minutes.

Ethical considerations

The study received favourable ethical opinion from Surrey University’s Faculty of Arts and

Human Sciences Ethics Committee (Appendix-D) and conformed with BPS (2009) and

HCPC (2012) Codes of Ethics and Conduct.

Since previous studies indicate that recruiting volunteers in this population group is not easy,

it was considered important to offer an appropriate incentive in order to have a chance at

recruiting enough participants. Therefore, following the lead of previous research, a £5

voucher was deemed to be a suitable incentive for students and local residents alike.

Participation in the research was thought to be a useful and informative experience which

may influence reflection about the role of different environmental settings on mood.

To ensure that participants understood the aim of the study and what participation involved,

they were provided with information sheets about the study and were given ample

opportunity to ask questions. The information sheet and consent form further informed

participants that they would be left on their own for 30 minutes during the experiment.

Participants were informed that they may withdraw at any time before and during the

experiment without needing to give a reason. It was also explained to them that they may

withdraw their data from the study by the 5th of December 2014 (start of data analysis) and

have their data destroyed without any justification. Issues regarding confidentiality and

anonymity were also elucidated as well as the research’s adherence to the Data Protection Act

(1998).

At the end of the experiment, participants were debriefed and thanked. Participants were also

given Debrief Sheets (Appendix-E) with a contact point for complaints and contact

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information about support services (e.g. The Wellbeing Centre, Depression Alliance etc.)

should they feel distress. Finally, they were encouraged to contact the researcher if they had

any questions regarding the study.

Sample size

The sample size for the study was based on findings from a previous study by Berman et al.

(2012). Using a similar intervention, study design and data collection measures, they found a

significant interaction between time and environment (effect size=1.08 (a large effect size)).

In order to allow for possible lower effect sizes, this study was powered to be able to detect

an effect size of at least .45. To detect such an effect in the interaction between time and

group with 80% power at the 5% level of significance, a sample size of 24 was required. In

the event that the effect size was as large as that observed in the Berman study, 24

participants would provide 99.9% power to detect the effect at the 5% significance level.

Statistical analysis was conducted using Stata 11 for Windows.

Result

To test whether participants who were exposed to nature showed greater emotional recovery

compared to those who spent time in an urban environment, a two-way ANOVAs was used to

explore the effect of setting (nature and urban) on mood (positive and negative).

I) Positive affect

The means estimated from an ANOVA for positive mood are shown in Table 1. Overall,

there was no difference in the mean positive mood of all participants before (M = 25.25, SD =

5.05) and after the intervention (M = 26.08, SD = 3.49), F(1,46) = 1.63, p = .22. However,

there was a significant difference by setting, with those exposed to nature (M = 27.37, SD =

4.57) reporting higher scores than those exposed to an urban environment (M = 23.97, SD =

3.52), F(1,46) = 26.61, p < .001. Further, there was a significant interaction between time and

setting, suggesting that, while the average scores were similar before and after the

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intervention in all participants, the rate of change differed by setting, F(1,46) = 5.27, p = .03.

This means that the rate of change in positive scores differed significantly between the two

environments and the null hypothesis that setting has no effect on change in mood can be

rejected.

Table 1

Estimated means from ANOVA exploring the effect of environment on positive mood

All Pre Post Difference(Post – Pre)

Mean 95% CI Mean 95% CI Mean 95% CI Mean

95% CI

All 25.67 24.99-26.34 25.25 24.33-26.16 26.08 25.18-26.99 0.83 -1.39-3.06

Setting Nature 27.37 25.83-28.90 26.20 24.03-28.37 28.53 26.37-30.70 2.33 0.82-5.48 Urban 23.97 22.43-25.50 24.30 22.13-26.47 23.63 21.46-25.80 -0.67 -3.82-2.48Difference (Nature – Urban)

3.40 1.15-5.65 1.90 1.26-5.07 4.90 1.74-8.07

Following the ANOVA, post-hoc comparisons were carried out to determine whether the

change in positive mood differed within each setting and to compare the scores in the two

settings pre intervention and post intervention.

For those exposed to nature the positive mood score was higher after the intervention (M =

26.20, SD = 3.62) than before (M = 28.53, SD = 5.26), an increase of 2.33, but this increase

was not statistically significant, t(46) = 1.49, p = .14. For those exposed to the urban

environment the positive mod score was lower after intervention (M = 23.63, SD = 3.81) than

before (M = 24.30, SD = 3.34), this was not statistically significant, t(46) = -0.43, p = .67.

Prior to the intervention there was a difference of 1.90 in the means of the Urban (M = 24.30,

SD = 3.34) and Nature (M = 26.20, SD = 3.62) groups, but this was not statistically

significant t(46)= -1.21, p =.23. However, following the intervention the mean positive score

was higher in the nature group (M = 28.53, SD = 5.26) than the urban group (M = 23.63, SD =

3.81). This difference, of 4.90, between the two groups following the intervention was

statistically significant, t(46)=3.12, p = .002.

A second ANOVA was also carried out using the change in score as the dependent variable

with the estimated marginal means summarised in Table 2. Overall there was a significant

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difference in the change in scores in the Urban and Nature groups, with the largest increases

in the Nature group, F(1, 22) = 5.60, p= .02.

Table 2

Estimated means from ANOVA exploring the effect of environment on change in positive mood

DifferenceMean 95% CI

All 0.83 -0.54-2.20

Setting Nature 2.41 0.46-4.35 Urban -0.74 -2.69-1.21Difference (Nature – Urban)

3.15 0.38-5.91

The average positive mood scores in each setting are also displayed in Figure 1. In summary

the change in positive mood was significantly greater in the nature group than in the urban

group, and the nature group were significantly more positive than the urban group at the end

of the intervention.

Figure 1: Mean (and 95% Confidence interval) positive mood before and after the intervention.

II) Negative affect

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The results of the ANOVA for negative mood are displayed in Table 3. Negative mood

decreased between the pre (M = 31.21, SD = 3.92) and post intervention (M = 29.04, SD

= 3.91) measurements across all participants , F(1,46) = 28.60, p < .001, and was also

slightly higher in urban (M = 30.87, SD = 3.40) compared to nature (M = 29.38, SD =

4.55) environments, F(1,46) = 13.21, p = .002. However, the interaction was just not

statistically significant, F(1,46) = 4.23, p = .05, and so the null hypothesis that the effect

of environment on the reduction in negative mood is the same in the two groups cannot be

rejected.

Table 3

Results of ANOVA exploring the effect of environment on negative mood

All Pre Post Differencemean 95% CI mean 95% CI mean 95% CI mean 95% CI

All 30.13 29.70-30.55 31.21 30.65-31.77 29.04 28.48-29.60 -2.17 -4.12-0.08

Setting Nature 29.38 27.83-30.94 30.88 28.69-33.07 27.88 25.69-30.07 -3.00 -6.18-0.18 Urban 30.87 29.31-32.42 31.53 29.34-33.73 30.20 28.01-32.39 -1.33 -4.52-1.85Difference (Nature – Urban)

-1.49 3.76-0.78 -0.65 -3.85-2.54 -2.32 -5.52-0.88

For the nature group, the mean negative mood score was higher before the intervention (M =

30.88, SD = 4.73) than after (M = 27.88, SD = 4.00) but this mean change of -3.00 points was

not statistically significant, t(46) = -1.90, p = .06. There was also an overall decrease in

negative mood after the intervention (M = 30.20, SD = 3.68) compared to before (M = 31.53,

SD = 3.12) in the urban group, but to a lesser extent. This mean change of -1.33 was also not

statistically significant, t(46) = -0.85, p = .40.

There was no difference between the negative moods of the urban (M = 31.53, SD = 3.12)

and nature (M = 30.88, SD = 4.73), t(46) = .41, p = .68. The difference in negative mood

following the intervention was also not statistically significant, though was lower in the

nature group (M = 27.88, SD = 4.00) than the urban group (M = 30.20, SD = 3.68), with a

mean difference of -2.3, t(46) = -1.46, p = .14.

A second ANOVA was also carried out using the change in score as the dependent variable

with the estimated marginal means summarised in Table 4. Overall the difference in the

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change in scores in the Urban and Nature groups were not significantly different, F(1, 22) =

3.73, p = .07.

Table 4

Estimated means from ANOVA exploring the effect of environment on change in negative mood

Differencemean 95% CI

All -2.17 -3.02- -1.31

Setting Nature -2.97 -4.19- -1.75 Urban -1.36 -2.58- -0.15Difference (Nature – Urban)

-1.61 -3.34- 0.12

The average negative mood scores in each setting are also displayed in Figure 4. In summary,

although the negative scores reduced in both groups, and at a faster rate in the nature group

than the urban, the difference between the two was not statistically significant. The p-value

was however only just non-significant (p = .05).

Figure 2: Mean (and 95% Confidence interval) negative mood before and after the intervention.

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III) Perceived restorative effect

T-tests were used to test whether participants who were exposed to nature showed greater

perceived restorative effects (“being away”, “fascination”, “extent/coherence”,

“compatibility”) than those who spent time in an urban environment. The average scores and

results of t-tests comparing the scores in the two groups are presented in Table 5. There were

significant differences between the two groups in: being away t(22) = 5.67, p < .001;

fascination, t(22) = 6.28, p < .001; coherence, t(22) = 5.49, p < .001 and compatibility,

t(22)=4.20, p < .001.

Table 5

Comparison of perceived restorative qualities in those exposed to nature and urban environments.

Nature Urban Unpaired t-test

Mean SD Mean SD t df P-value

Being away 26.08 3.00 18.83 3.27 5.66 22 < .001

Fascination 31.58 3.06 22.33 4.08 6.28 22 < .001

Coherence 26.75 2.99 19.08 3.80 5.49 22 < .001

Compatibility 30.37 3.94 23.25 4.67 4.20 22 < .001

The associations between change in mood following the intervention and perceived

restorative effects were explored using Pearson’s correlation and are summarised in Table 6.

All measures of perceived restorative effects were associated with r(22) > .65, p < .001. The

effect most strongly correlated with change in positive mood was perceived compatibility,

r(22) = 0.47, p = .02, followed by fascination, r(22) = .41, p = .05. Compatibility and

fascination were also the factors most strongly associated with negative, r(22) = -.39, p = .06

and , r(22) = -.39, p = .08, respectively, though the relationships were not statistically

significant.

Table 6

Correlation between post-intervention mood and perceived restorative effects.128

Being

away

Fascination Coherence Compatibil

ity

BDI Positive

mood

change

Fascination .63

(p = .001)

Coherence .74

(p < .001)

.65

(p < .001)

Compatibility .70

(p < .001)

.72

(p < .001)

.66

(p < .001)

BDI .24

(p = .25)

.33

(p = .13)

.16

(p = .46)

.02

(p = .94)

Positive mood

change

.27

(p = .20)

.41

(p = .05)

.29

(p = .16)

.47

(p = .02)

-.09

(p = .66)

Negative mood

change

-.35

(p = .10)

-.37

(p = .08)

-.17

(p = .43)

-.39

(p = .06)

-.16

(p = .46)

-.16

(p = .46)

Following intervention there was a positive correlation between positive mood and negative

mood, r(22) = .42, p = .04, suggesting that overall those who felt more positive also reported

more negative feelings (Figure 3).

2025

3035

Pos

itive

moo

d

25 30 35 40Negative mood

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Figure 3: Scatter plot showing relationship between positive and negative mood scores following intervention.

Discussion

This study sought to examine whether spending time in nature has restorative effects on

depressed individuals’ mood; the current findings will now be discussed, related to literature

and elucidated in terms of its implications for counselling psychology.

Firstly, it was hypothesised that depressed individuals who were exposed to nature would

show greater emotional recovery than the participants who were exposed to an urban

environment. The results showed that positive mood improved at a significantly greater rate

in a natural environment than in an urban one. This supports the stress recovery theory which

asserts that interacting with nature boosts positive mood, which in turn acts as a buffer

against negative mood and stress (Ulrich, 1983). It is also in line with previous studies which

suggest that contact with nature affects healthy individuals’ mood positively (Hartig et al.,

2003; Katcher et al., 1983; Pretty et al., 2007; Ulrich, Lunden & Etinge, 1993). Additionally,

it supports Berman et al’s (2012) findings that walking in nature is beneficial for improving

positive mood in people who are depressed. In Berman et al’s study participants walked in

nature, however in the current study participants sat alone in nature. This can be seen as

suggesting that both active and passive interaction in nature has therapeutic benefits for

depressed individuals.

Although there was a significant difference in the positive mood score of the nature and

urban group, it is noticeable that the positive mood score in the nature group pre-intervention

was already higher than those of the urban group (Figure 1). Essentially, this means there was

already a big difference from the start even though the difference was not statistically

significant. It is likely that the reason for this difference may be because participants’ were

already in nature although they had not spent any time there. This may suggest therefore that

at least for the nature group, being in nature resulted in an almost immediate change in mood.

This may in fact have dampened the findings somewhat.

Furthermore, the results showed that there was a tendency towards greater reduction in

negative mood in the nature group compared to the urban group although the difference

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between both groups was not significant. This is in contrast to Berman et al’s (2012) findings

which found that interacting with nature had significantly reduced negative mood in people

who were depressed. One reason why this study did not find a difference between the nature

group and the urban group may be because of the small sample size. A larger sample may be

able to detect likely differences in negative scores between the two groups. Taken together,

the results clearly indicate that nature has a greater emotional restoration on depressed

individuals than an urban environment because nature improves positive mood in depressed

participants who historically reported high negative mood and low positive mood. Moreover,

it is positive that nature’s restorative effects on depressed individuals may be immediate due

to the difference in positive mood noticed between the groups from the beginning. These

results seem to largely support the stress recovery theory that nature influences positive mood

which acts as a buffer against negative mood (Ulrich, 1981).

Secondly, based on attention restoration theory’s (Kaplan & Kaplan, 1989) assertion that

nature’s beneficial effect on human cognitive functioning lies in its capacity to provide

qualities of “being away,” “fascination,” “extent / coherent” and “compatibility,” it was

hypothesised that depressed individuals will perceive nature to have greater restorative

effects or qualities than depressed individuals who were exposed to an urban setting. The

results showed that there was a significant difference between the two groups, with the nature

group reporting greater perceived restorative effects. This indicates that the participants in the

natural environment saw nature as an environment that (a) offered escape from normal

routine, (b) was intriguing, (c) provided stimulation and (d) was compatible with their needs

at that time, whilst the urban group saw their environment as having less of these qualities. In

effect, those who spent time in nature saw more potential for restorative experiences in nature

than their counterparts. More specifically, the result suggests that fascination and

compatibility were linked to positive mood in depressed individuals who were exposed to

nature. This seems to support one of ART’s (Kaplan & Kaplan, 1990) ideas that natural

environments have in abundance “soft fascination” which grabs people’s attention in an

effortless way and in a way which allows directed attention to be replenished. This link

between increased positive mood and fascination suggests this may be one explanation of the

beneficial effect of nature. Complementing this is the association found between

compatibility and positive mood which suggests that nature may provide a kind of

“fascinating” and ”stress-free” environment which seems to meet the desired goal of the

131

depressed individuals who spent time in nature. Conversely, the linear regression analysis

further suggested that it may be something other than the restorative qualities which explains

why positive mood increases more in nature.

The above results support one of ART’s assumptions that nature tends to be perceived as

having restorative qualities more than urban environments. Previous studies have also

suggested that perceived restorative qualities are associated with improved psycho-

physiological responses (i.e. better cognitive functioning, slower heart rate, lower blood

pressure etc.), all of which seems to point towards recovery from stress (Chang and Perng,

2000; Chang, Chen, Hammitt & Machnik; 2008; Hartig, Mang & Evans, 1991; Hartig &

Staats, 2003; Hipp and Ogunseitan, 2011). This may have some implication for those who are

depressed, who tend to be very sensitive to daily stress. It suggests that spending more time in

nature may help depressed individuals enhance positive mood and perhaps develop a buffer

against negative mood and stress. In addition, evidence suggesting there is an association

between perceived restorative effects and psycho-physiological responses may imply that it is

possible that nature helps to improve some cognitive deficits which are associated with

depression in the same way that it does for healthy non-depressed individuals. Indeed Berman

et al’s (2012) findings provide strong evidence for this.

Limitations and future research

There are several limitations which should be considered before drawing any conclusion

about the findings of this study. Firstly, the sample size, although a little bigger than that of

Berman et al’s (2012) study, is still small. However, the effect size of time and location found

in the current study (0.43) is slightly larger than that found in Berman et al’s (0.29) study. A

bigger sample could not be collected due to the short time-scale of the study. Nonetheless,

some care would have to be taken before generalising the result of this group to an entire

population group. Consequently, future experiments may want to consider the need for a

bigger sample in order to be able to safely extrapolate findings to the depression population at

large. Secondly, the effect size for the negative mood score was just lower than what was

allowed for in the power calculation, and the p-value is just non-significant. Thus, a slightly

larger sample may have shown the significant difference in effect on negative mood.

Although, care was taken when the power calculations was conducted, it is possible that

132

somehow the calculation may not have been accurate. Thirdly, the exact influence of weather

conditions is not known and could not be controlled. Since all of the experiments took place

between the months of October to early December in sometimes quite cold conditions, it is

possible that this may have had some effect on participants’ mood and perception of

restoration. Particularly since those who are depressed are considered to be very sensitive to

daily stress. Given that most people do not find the cold bearable, it is possible that for

depressed individuals, the cold weather may in fact reduce mood even further. As such,

future exploration may want to consider conducting experiments in the warmer months when

the weather is more likely to be amenable. Fourthly, 58.3% of the participants were

university students. This may be representative of a sample more knowledgeable about

nature’s impact on mood and may therefore not be representative of this population group in

general. Finally, even though the study showed an increase in positive mood amongst

depressed participants who were exposed to nature, it would have been interesting to use

physiological instruments to measure heart rates and blood pressure in order to confirm

whether mood recovery is indeed associated with physiological indicators of restoration. This

is a point which future studies might want to take into account. In addition, the extent to

which the results of this study in fact demonstrate whether nature leads to genuine mood

change is not completely clear due to some of the limitations mentioned above as well as the

small sample which makes it hard to generalize from this finding. There is also a good

possibility that this study may simply engage participants in a discourse of nature rather than

actual first-hand experience of nature. Therefore, future research would be advised to

consider taking steps that can help to minimize this outcome.

Implications for counselling psychology, the wider world and the future

An important learning point of this study is that spending time in nature can increase positive

mood in people who are depressed. This is significant because it suggests that nature does

indeed have some restorative effects on mood which may be particularly helpful for

depressed individuals who tend to experience increased negative mood as well as low

positive mood. According to the stress recovery theory, nature’s ability to enhance mood also

act as a buffer which can help protect people from negative mood and stress. This may have

important value for some people who suffer from depression who might prefer alternatives to

133

anti-depressants and psychological therapies. Given that there is a need for an alternative

intervention, it is clear that nature may offer an alternative remedy which is worth exploring

further.

Nature, as an alternative choice to or in adjunct with conventional treatment, may be

considered in terms of designing and implementing programmes in which depressed

individuals can spend more time in nature, either actively (i.e. walking, cycling in nature) or

passively (sitting and observing nature). This could also take the form of providing

information to depressed individuals about how for example, 30 minutes interaction with

nature can help to increase positive mood and provide a buffer against daily stress. Psycho-

education about nature’s restorative effects could also include information about the effect

that nature can have on cognitive functioning in depressed and non-depressed people.

Counselling psychologists who favour a holistic view of human distress could play a critical

role in helping to further understand nature’s role in enhancing positive mood and reducing

negative mood through research exploration.

Beyond research exploration, the findings of this study also have implications for clinical

practice. It may be that psychologists could encourage some clients with depression to spend

some time interacting with nature. For instance, in behavioural activation work for depression

(part of CBT work), psychologists would generally try to help clients schedule pleasurable

activities which they used to enjoy but no longer actively carry out. Depressed clients who

used to enjoy spending time in nature but who no longer do so could be encouraged and

supported in doing this again.

Moreover, government statistics show that the use of anti-depressants is growing at an

alarming rate and it is clear that psychological services are overwhelmed and underfunded.

Nature is far more accessible, less costly and has no serious side effects or withdrawal

symptoms, thus seems to offer an alternative therapy which is worth serious exploration.

Conclusion

This study examined the restorative effect of spending time in nature on depressed

individuals’ mood. The data supports the hypothesis that being in nature has a greater

restorative effect on depressed individuals’ mood than being in an urban setting. Furthermore,

134

it found that depressed individuals perceive natural environments as more restorative than

urban environments. These findings have important implications for people who are

depressed as well as for mental health practice and the wider world.

References

Abkar, M., Kamal, M., Maulan, S., Mariapan, M., & Davoodi, S. D. (2011). Relationship

between the Preference and Perceived Restorative Potential of Urban Landscapes.

HortTechnology, 21, 514–519.

Alcock I., White M. P., Wheeler B. W., Fleming, L. E., & Depledge, M. H. (2014).

Longitudinal effects on mental health of moving to greener and less green urban

areas. Environmental Science & Technology, 48(2), 1247-1255.

Allen, J. J., & Coan, J. A., (Eds.) (2007). Handbook of emotion elicitation and assessment.

New York: Oxford University Press.

135

Austin, M., Gladstone, G., Parker, G., Mitchell, P., & Wilhelm, K. (2003). Severity of

stressful life events in first and subsequent episodes of depression: the relevance of

depressive subtype. Journal of Affective Disorder, 73(3), 245-52.

Austin, M., Goodwin, G., & Mitchell, P. (2006). Cognitive deficits in depression: Possible

implications for functional neuropathology. The British Journal of Psychiatry, 178,

200-206.

Austin, M. P., Mitchell, P., & Goodwin, G. M. (2001). Cognitive deficits in depression:

possible implications for functional neuropathology. British Journal of Psychiatry,

178, 200 -206.

Barnicle, T., & Midden, K. S. (2003). The effects of a horticulture activity program on the

psychological well-being of older people in a long-term care facility. HortTechnology

13(1), 81-85.

Barton, J., Hine, R., & Pretty, J. (2009). The health benefits of walking in greenspaces of

high natural and heritage value. Journal of Integrative Environmental Sciences, 6(4),

1-18.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-

II. San Antonio, TX: Psychological Corporation.

Bennett, J., Fagundes, C., Glaser, R., Jarmka, L., Kiecolt-Glaser, J., & Malarkey, W. (2013).

Loneliness predicts pain, depression and fatigue: understanding the role of immune

dysregulation. Psychoneuroendocrinology, 38(8), 1310-7.

Bennet, L. W., Cardone, S., & Jarczyk, J (1999). Effects of a therapeutic camping program on

addiction recovery. Journal of Substance Abuse Treatment, 15, 469-474.

Berman, M., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with

nature. Psychological Science, 19, 1207-1212.

Berman, M. G., Kirpan, K., K. M., Askren, M., Burson, A., Deldin, P. J., Kaplan, S.,

Sherdell, M., Gotlib, I. H., & Jonides, J. (2012). Interacting with nature improves

cognition and affect for individuals with depression. Journal of Affective Disorder,

12, 48-56.

136

Bernstein, J., Brown, K. W., Gagné, M., Mistretta, L., Ryan, R. & Weinstein, N. (2009).

Vitalizing effects of being outdoors and in nature. Journal of Environmental

Psychology, 30,159-168.

Berto, R. (2005). Exposure to restorative environments helps restore attentional capacity.

Journal of Environmental Psychology, 25, 249–259.

Blumhardt, L., Pelosi, L., Slade, T., & Sharma, V. (2000). Working memory dysfunction in

major depression: an event-related potential study. Clinical Neurophysiology, 111,

1531-43.

Bratman, G., Hamilton, J.P., & Daily G. (2012). The impacts of nature experience on human

cognitive function and mental health. Annals of the New York Academic of Science,

1249, 118-136.

British Psychological Society. (2009). Code of ethics and conduct. Leicester: British

Psychological Society.

Brouwer, D., Meijer, R. R., & Zevalkink, J. (2013). On the Factor Structure of the Beck

Depression Inventory-II: G Is the Key. Psychological Assessment, 25(1), 136-145.

Buschman, T. J., & Miller, E. K. (2007). Top-down versus bottom-up control of attention in

the prefrontal and posterior parietal cortices. Science, 315, 1860-1862.

Buzzell, L. & Chalquist, C. (2009). Ecotherapy: healing with nature in mind. San Francisco:

Sierra Club Books.

Centers for Disease Control and Prevention and National Association of Chronic Disease

Directors. (2009). The State of Mental Health and Aging in America Issue Brief 2:

Addressing Depression in Older Adults: Selected Evidence-Based Programs. Atlanta,

GA: National Association of Chronic Disease Directors.

Chang, C., & Chen, P. (2005). Human response to window views and indoor plants in the

workplace. HortScience, 40, 1354-1359.

137

Chang, C., & Perng, J. (2000). Effect of landscape on psychological and physical responses.

Journal of Therapeutic Horticulture, 46, 93-102.

Chang, C.-Y., Chen, P.-K., Hammit, W. E., Machnik, L., & Su, W.-C. (2008).

Psychophysiological responses and restorative values of natural environments in

Taiwan. Landscape and Urban Planning, 85, 78-84.

Cimprich, B., & Tennessen, C. (1995). Views to nature: Effects on attention. Journal of

Environmental Psychology, 15, 77-85.

Coullaut R, C. J., Criado, J., Fernández, A., Ortiz, T., Perez-Serrano, J., & Zaglul, C. (2003).

Deficit of cognitive event-related potentials during a working task in patients with

major depression. Actas Espanolas de Psiquiatria, 31(4),177-81.

Crawford, J. R., & Henry, J. D. (2004). The positive and negative affect schedule (PANAS):

construct validity, measurement properties and normative data in a large non-clinical

sample. British Journal of Clinical Psychology, 43, 245-265.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. R.

(2013). The Efficacy of Psychotherapy and Pharmacotherapy in Treating Depressive

and Anxiety Disorders: a Meta-analysis of Direct Comparisons. World Psychiatry:

Official Journal of the World Psychiatric Association, 12(2): 137–48.

Deacon, B., Huedo-Medina, T., Johnson, B., Kirsch, I., Moore, T., & Scoboria, A. (2008).

Initial severity and antidepressant benefits: a meta-analysis of data submitted to the

food and drug administration. Plos Medicine, 5(2), e45. doi:

10.1371/journal.pmed.0050045.

Demyttenaere, K., Fruyt, J., & Stahl, S. M. (2004). The many faces of fatigue in major

depressive disorder. International Journal of Neuropharmacology, 8, 93–105.

Devlin, B., Kovacs, M., Pollock, M., Richards, C., & Mukerji, P. . (1997). A controlled

family history stuy of childhood-onset depressive disorder. Archives of General

Psychiatry, 54(7), 613-23.

138

Eko, M & Martin, M. (2013). Almost like an old friend: An exploration of depressed

individuals’ relationship with nature. Unpublished doctoral manuscript, University of

Surrey. Guildford, UK.

Fan, J., Posner, M., McCandliss, B., Raz, A., & Sommer, T. (2002). Testing the efficiency

and independence of attentional networks. Journal of Cognitive Neuroscience, 14,

340-347.

Felsten, G. (2009). Where to take a study break on the college campus: An attention

restoration theory perspective. Journal of Environmental Psychology, 29, 160–167.

Ferrari, A. J., Somerville, A. J., Baxter A, J., Norman, R., Patten, S. B., & Vos, T. (2013).

Global variation in the prevalence and incidence of major depressive disorder: a

systematic review of the epidemiological literature. Psychological Medicine, 43, 471-

81.

Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R.

C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: A

patient-level meta-analysis. Journal of the American Medical Association, 303, 47–

53.

Frumkin, H. (2001) Beyond toxicity human: health and the natural environment. American

Journal of Preventative Medicine, 20, 234–240.

Galea, S., Ahern, J., Rudenstine, S., Wallace, Z., & Vlahov, D. (2005). Urban built

environment and depression: A multilevel analysis. Journal of Epidemiology and

Community Health, 59, 822-827.

Gilbert, P. (1989). Human Nature and Suffering. Hove: Lawrence Erlbaum Associates.

Grinde, B. & Patil. G. (2009). Biophilia: Does visual contact with nature impact on health

and well-being?. International Journal of Environmental Research and Public Health,

6(9), 2332-2343.

139

Hairon, N. (2006). Survey exposes GP frustration at dire access to depression services. Pulse,

2, 14-15.

Han, K-T. (2009). An exploration of relationships among the responses to natural scenes.

Environmental Behaviour, 42, 243–270.

Harmon-Jones, E., Harmon-Jones, C., Abramson, L. Y., & Peterson, C. K. (2009). PANAS

positive activation is associated with anger. Emotion, 9, 183-196.

Hartig, T., Evans, G. W., Jamner, L. J., Davis, D. S. & Gärling, T. (2003). Tracking

restoration in natural and urban field settings. Journal of Environmental Psychology,

23, 109-123.

Hartig, T., Kieviet, A., & Staats, H. (2003). Where to recover from attentional fatigue: An

expectancy-value analysis of environmental preference. Journal of Environmental

Psychology, 23, 147-157.

Hartig, T., Korpela, K., Evans, G. W., & Gärling, T. (1997). A Measure of Restorative

Quality in Environment. Housing & Planning Research, 14, 175-194.

Hartig, T., & Staats, H. (eds.). (2003). Restorative environments. Special Issue of Journal of

Environmental Psychology, 23(2).

Hartlage, S., Alloy, L. B., Vazquez, C. & Dykman, B. (1993). Automatic and effortful

processing in depression. Psychological Bulletin, 113, 247–278.

Hartig, T., & Staats, H. (1991). The need for psychological restoration as a determinant of

environmental preferences. Journal of Environmental Psychology, 26, 215–226.

Health and Care Professions Council (HCPC). (2012). Standards of Proficiency: Practitioner

Psychologists. London, UK: Health and Care Professions Council.

Hester, R. T., & Francis, M. (1992). The meaning of gardens: Idea, place and action.

Cambridge, Ma: MIT Press.

Higley, N. & Milton, M. (2008). Our connection to the Earth: A neglected relationship in

counselling psychology. Special Issue Counselling Psychology Review, 23.2.

140

Hipp, J. A., & Ogunseitan, O. A. (2011). Effect of environmental conditions on perceived

psychological restorativeness of coastal parks. Journal of Environmental Pyschology,

31, 421-429.

Huprich S. K., & Roberts, C. (2012). The two-week and five-week dependability and stability

of the depressive personality disorder inventory and its association with current

depressive symptoms. Journal of Personality Assessment, 94, 205-9.

Kahn, P. H. (1999). The Human Relationship with Nature: Development and Culture.

Cambridge, MA: MIT Press.

Kaplan, R. (1974). Some psychological benefits of an outdoor challenge program.

Environmental Behavior, 6, 101-116.

Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective.

Cambridge: Cambridge University Press.

Kaplan, S., Bardwell, L, & Slakter, D. A. (1993). The restorative experience as a museum

benefit. Journal of Museum Education, 18, 3, 15-18.

Kaplan, R. (2001). The nature of the view from home: Psychological benefits. Environmental

Behavior. 33, 507-542.

Kaplan, S. (1995). The restorative benefits of nature: towards an integrative framework.

Journal of Environmental Psychology, 15, 169-182.

Kaplan, S. (2001). Meditation, restoration and the management of mental fatigue.

Environment and Behaviour, 33, 480-506.

Katcher & A. Beck (Eds.). (1983). New perspectives on our lives with companion animals.

Philadelphia: University of Pennsylvania Press.

Keddy, P. A. (2007). Plants and Vegetation. Cambridge: Cambridge University Press.

141

Kendler, K., Karkowski, L., & Prescott, C. (1999). Causal relationship between stressful life

events and the onset of major depression. The American Journal of Psychiatry,

156(6), 832-41.

Kessler, R. (1997). The effects of stressful life events on depression. Annual Review of

Psychology, 48, 191-214.

Khawam, E., Laurencic, G., & Malone, D. J. (2006). Side effects of antidepressants: an

overview. Cleveland Clinic Journal of Medicine, 73(4), 351-3, 356-61.

Khin, N. A., Chen, Y. F., Yang, Y., Yang, P, & Laughren, T. P. (2011). Exploratory analyses

of efficacy data from major depressive disorder trials submitted to the US Food and

Drug Administration in support of new drug applications. Journal of Clinical

Psychiatry, 72(4), 464-72.

Kirsch, I. (2002). The Emperor's New Drugs: An Analysis of Antidepressant Medication

Data Submimtted to the US Food and Drug Administration. American Psychological

Association, 5, 23.

Kohlleppel, T.., Bradley, J. C., & Jacob, S. (2002). A walk through the garden: Can a visit to

a botanic garden reduce stress? HortTechnology, 12(3), 489-492.

Kung, S., Alarcon, R. D., Williams, M. D., Poppe, K. A., Moore, M., & Frye M. A. (2013).

Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health

Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice.

Journal of Affective Disorder, 145, 341-3.

Kuo, F. E. (2001). Aggression and violence in the inner city: effects of environment via

mental fatigue. Environmental Behavioural , 109, 522-543.

Lamers, F., Milaneschi, Y., Penninx, B., & Vogelzangs, N. (2013). Understanding the

somatic consequences of depression: biological mehcanism and the role of depression

symptom profile. BMC Medicine, 11, 129.

Layard, R. (2006). The case for psychological treatment centres. BMJ, 332, 1030– 1032.

Leather, P., Pyrgas, M., Beale, D., & Lawrence, C. (1998). Windows in the workplace.

London: Sage Publications.142

Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., Wüst, S., Pruessner,

J.C., Rietschel, M., Deuschle, M., & Meyer-Lindenberg, A. (2011). City living and

urban upbringing affect neural social stress processing in humans. Nature, 474(7352),

498-501.

Lipps, G. E., Lowe, G.A., & Young, R. (2007). Validation of the beck depression inventory-

II in a Jamaican university student cohort. West Indian Medical Journal, 56, 404-8.

Louv, R. (2005). Last Child in the Woods: Saving Our Children from Nature-Deficit

Disorder. Washington: Algonquin Books.

Maller, C. J. (2009). Promoting children’s mental, emotional and social health through

contact with nature: a model. Health Education, 109, 522-543.

McFarland, A. L., T. M. Waliczek, & J. M. Zajicek. (2010). Graduate student use of campus

green spaces and the impact on their perceptions of quality of life. HorTechnology,

20(1), 186-192.

MIND. (2007). Ecotherapy – the green agenda for mental health. Retrieved online on 10

October 2014 from MIND’s website: http://www.mind.org.uk/mindweek/

MIND. (2013). Ecotherapy Works. Retrieved online on 10 October 14 from

http://www.southsomersetmind.co.uk/pdf-files9/ecotherapy-press-launch20-1-

2014.pdf

Monroe, S. M., Slavich, G. M., & Gotlib, I. H. (2013). Life stress and family history for

depression: The moderating role of past depressive episodes. Journal of Psychiatric

Research, 49, 90-95.

Montpetit, M. A. (2007). Negative Affect and Stress: A Dynamical Systems Analysis.

University of Notre Dame: Notre Dame, Indiana.

143

Muscatell, K., Slavich, G., Monroe, S., & Gotlib, I. (2009). Stressful Life Events, Chronic

Difficulties, and the symptoms of clinical depression. Journal of Nervous and Mental

Disease, 187, 154-160.

National Collaborating Centre for Mental Health. (2005). Depression in Children and Young

People: Identification and Management in Primary, Community and Secondary Care.

The British Psychological Society and the Royal College of Psychiatrists.

National Institute for Health and Clinical Excellence (NICE). (2004). The Treatment of

Depression in Adults: Understanding NICE guidance. London: NICE.

National Mental Institute of Mental Health. (2013). Depression in Children and Adolescents.

(Factsheet). Accessed online on 10 November 2014 from National Institute of Mental

Health’s website: http://www.nimh.nih.gov/health/topics/depression/depression-in-

children-and-adolescents.shtml

Nieuwenhuijsen, M.J., Kruize, H., & Gidlow, C. (2014). Positive health effects of the natural

outdoor environment in typical populations in different regions in Europe

(PHENOTYPE): a study programme protocol. BMJ Open, 4(4), 54-61.

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.

Perspectives on Psychological Science, 3, 400-424.

Office of Public Sector Information. (2014, November). Basic Interpretative Provisions:

Data Protection Act of 1998. Retrieved November 14, 2014, from National Archive

Website: http://www.legislation.gov.uk/ukpga/1998/29/contents

Office for National Statistics (ONS). (2005). Health. Accessed online on 15 September 2014

from www.ons.gov.uk/ons/rel/social-trends-rd/social...41/health.pdf

Office for National Statistics (ONS). (2011). Economic review. Accessed online on 15

September 2014 from http://www.ons.gov.uk/ons/dcp171766_263951.pdf

Park, S. H, & Mattson, R. H. (2009). Ornamental indoor plants in hospital rooms enhanced

health outcomes of patients recovering from surgery. Journal of Alternative and

Complementary Medicine, 15(9), 975–980.

144

Ouellette P., Kaplan R., & Kaplan S. (2005). The monastery as a restorative environment.

Journal of Environmental Psychology, 25, 175–188.Peacock, J., Hine, R., & Pretty, J.

(2007). Ecotherapy: the green agenda for mental health. London: Mind, U.K.

Peen, J., Schoevers, R. A., Beekman, A. T., & Dekker, J. (2010). The current status of urban-

rural differences in psychiatric disorders. Acta Psychiatrica Scandinavica, 121(2), 84-

93.

Pretty, J., Peacock, J., Sellens, M., & Griffen, M. (2005). The mental and physical health

outcomes of green exercise. International Journal of Environmental Health

Research, 15, 319-337.

Pretty, J., Peacock, J., Hine, R., Sellens, M., South, N., & Griffen, M. (2007). Green exercise

in the UK countryside: Effects on health and psychological well-being, and

implications for policy and planning. Journal of Environmental Planning and

Management, 50, 211-231.

Relf, D. (1992). The role of horticulture in human well being and social development.

Porland, OR: Timber Press.

Rose, E. J & Ebmeier, K. P. (2006). Pattern of impaired working memory during major

depression. Journal of Affective Disorders, 90(2-3), 149-161.

Schmukle, S. C., Elgoff, B. & Burns, L. R. (2002). The relationship between positive and

negative affect in the Positive and Negative Affect Schedule. Journal of Research in

Personality, 36 (5), 463-475.

Shibata, S., & Suzuki, n. (2001). Effects of Indoor Foliage Plants on Subjects' Recovery from

Mental Fatigue. North American Journal of Psychology, 3(2), 385-395.

Shibata, S., & Suzuki, N. (2002). Effects of the foliage plant on task performance and mood.

Journal of Environmental Psychology, 22, 265-272.

Stegen D. Targum, M., & Maurizio Fava, M. (2011). Fatigue as a Residual Symptom of

Depression. Innovations in Clinical Neuroscience, 8(10), 40-43.

145

Steven D. Targum, M., & Maurizio Fava, M. (2011). Fatigue as a residual symptom of

depression. Innovations in Clinical Neuroscience, 8(10), 40-43.

Tenngart-Ivarsson, C., & Hagerhall, C. M. (2008). The perceived restorativeness of gardens -

Assessing the restorativeness of a mixed built and natural scene type. Urban Forestry

and Urban Green, 7, 107–118.

Tress, B., Tress, G., Fry, G. & Opdam, P., (Eds). (2006). From landscape research to

landscape planning: Aspects of integration, education and application. Dordrecht:

Springer.

Ulrich, R. S. (1981). Natural versus urban scenes: some psychophysiological effects.

Environment and Behavior, 13, 523-556.

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991).

Stress Recovery during Exposure to Natural and Urban Environments. Journal of

Environmental Psychology, 11(3), 201.

White M & Dolan P. (2009). Accounting for the richness of daily activities. Psychological

Science, 20, 1000-1008.

Williams, J., Watts, F., Macleod, C., & Matthews, A. (1997). Cognitive psychology and

emotional disorders . New York: Wiley.

Ulrich, R. S., Lunden. O. & Etinge, J. L. (1993). Effects of exposure to nature and abstract

pictures on patients recovery from heart surgery. Psychophysiology, 1, 7-18.

Van den Berg, A. E., Hartig, T. & Staats, H. (2007) Preference for nature in urbanised

societies: Stress, restoration and the pursuit of sustainability. Journal of Social Issues,

63, 79–96

Wang, Y. P & Gorenstein, C. (2013). Psychometric properties of the Beck Depression

Inventory-11: a comprehensive review. Revista Brasileira de Psiquiatric, 35(4), 413-

431.

146

Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their

relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97,

346-353.

Weich, S., Blanchard, C., Prince, M., Burton, E., Erens, B., & Sproston, K. (2002). Mental

health and the built environment: cross-sectional survey of individual and contextual

risk factors for depression. British Journal of Psychiatry, 180, 428-433.

White, M. P., Alcock, I., Wheeler, B. W. & Depledge, M. H. (2013). Would you be happier

living in a greener urban area? A fixed-effects analysis of panel data. Psychological

Science, 6 (24), 920-928.

World Health Organisation. (2004b). Promoting mental health: concepts, emerging evidence,

practice: summary report. Geneva: World Health Organization.

World Health Organisation. (2012). Depression. Accessed online on 12 October 2014.

http://www.who.int/mental_health/management/depression

(Appendix A) Demographic Questionnaire

(Please tick or complete appropriate box)

Nationality: ………………………….. Age:……………………….

(Country of origin)

Gender: Male Female

Marital status: Single Widowed

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Married Divorced

Cohabiting Separated

Ethnicity: Black

White

Asian

Other (please explain)………………………………………

Employment status: Employed

Unemployed

Other (please explain)……………………………

Have you been diagnosed as having depression?

Yes No

How long have you been experiencing symptoms of depression?

Years Months

What are you currently using to cope with feelings of depression?

Antidepressant Psychological Therapy 148

Other (please explain)………………………………………

(Appendix B)

Information Sheet for Participants

1. What is the study about? The study aims to look at the benefits between interacting with nature and urban environments on the mood of those experiencing depression.

2. What do I have to do? Because the study is looking for people who have fairly moderate to high levels of depression, You will first be asked to complete via email a questionnaire which assesses how low you may currently be feeling. If you meet the criteria of the study, a date and time convenient to you will be set up for the research to take place. Before the experiment starts, you will be asked to complete a very short questionnaire which will take approximately 1 minute and then asked to spend 30 minutes sitting in either a natural or urban environment on your own. Immediately afterwards, you will then be asked to complete 2 questionnaires. Each questionnaire will take about 3-4 minutes to

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complete. In addition, a short interview will be carried out in which you will be asked 6 short questions. Overall, the research will last approximately 50 minutes.

3. What is the risk of taking part in the study?As the location of the study is going to be outside, around the University of Surrey, it is likely to be cold. You will be advice to bring a jacket with you just in case. It is also possible that you may feel distressed during or after sitting outside on your own for 30 minutes. Therefore, at around 15 minutes into the experiment, the researcher would stand at a nearby location where he could be reached in case you felt upset or could not complete the research for any reason. You will also withhold the right to withdraw from the study at any point without needing to give a reason.

4. How confidential is it?In accordance with the Data Protection Act 1988, your information will be anonymised and kept strictly confidential at all times in order to safeguard your privacy and identity. The results will be analysed and written up as part of my Practitioner Doctorate in Psychotherapeutic Counselling Psychology. In addition, all the questionnaires with identifying details will be destroyed once they have served their research purpose.

5. What if I want to withdraw from taking part?You can withdraw from the study at any time without having to give a reason and you can also ask for your information to be excluded from the analysis up to the 8th of Dec 2014, when data analysis will begin.

6. How can I contact the researcher if I have a query?You can contact me using the following details:

7. Whom can I contact if I have a concern or complaint?If you have a concern or complaint, please don’t hesitate to contact

My supervisor: Dr Birgitta GaterslebenEnvironmental PsychologistDepartment of Environmental PsychologyEmail: b.gatersleben@surrey.ac.uk

8. Whom can I contact if I feel distressed after taking part?If you feel distressed after taking part, please contact the Centre for Wellbeing or other organisations listed below:

Depression Alliance Helpline providing information and advice on mental healthTelephone:

SaneProvides practical help and emotional supportHelpline: 0845 767 8000

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Researcher: Michael EkoEmail: Michael.eko@surrey.ac.uk

0845 767 8000 Email:

info@depressionalliance.org

SANEmail: sanemail@sane.org.ukSupport Forum: www.sane.org.uk/DB

Centre for Wellbeing Ground Floor Building 23 University Court University of Surrey Guildford GU2 7XH Tel: 01483 689 498

Thank you for taking part.

(Appendix C) Consent Form

Ethics Committee

I the undersigned voluntarily agree to take part in the study investigating the effect of the natural environment (nature) on those experiencing depression.

I have read and understood the Information Sheet provided. I have been given a full explanation by the investigators of the nature, purpose and likely duration of the study, and of what I will be expected to do. I have been advised about any discomfort, distress which may result. I have been given the opportunity to ask questions on all aspects of the study and have understood the advice and information given as a result.

I understand that all personal data relating to volunteers is held and processed in the strictest confidence, and in accordance with the Data Protection Act (1998). I agree that I will not seek to restrict the use of the results of the study on the understanding that my anonymity is preserved.

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I understand that I am free to withdraw from the study at any time without needing to justify my decision and without prejudice.

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study.

Please indicate below whether you would like to be sent a copy of the research findings once the study is completed:

Yes No

Name of volunteer (BLOCK CAPITALS) ........................................................

Signed ........................................................

Date ......................................

Name of researcher (BLOCK CAPITALS) ........................................................

Signed ........................................................

Date ......................................

Faculty of Arts and Human Sciences Ethics Committee(Appendix D)

Chair’s Action

Proposal Ref: 1011-PSY-14Title of Project: Investigating the restorative effects between

interacting with natural and urban environments on the mood of individuals with depression

Supervisor: Dr Birgitta Gatersleben

Date of re-submission: 30th September 2014

The above Research Project has been re-submitted to the FAHS Ethics Committee and has 152

now received a favourable ethical opinion from the Faculty of Arts and Human Sciences Ethics Committee on the basis described in the protocol and supporting documentation.The final list of documents reviewed by the Committee is as follows: Protocol Cover sheetSummary of the projectDetailed protocol for the project Participant Information sheet Consent Form

This documentation should be retained by the student/trainee in case this project is audited by the Faculty Ethics Committee.

Signed: Professor Bertram Opitz Chair

Dated:

(Appendix E) Debrief Sheet Thank you for taking part in this study. I hope you have found it interesting. As we discussed, it is my hope that the findings of this study will provide some understanding about the therapeutic effect of spending time in nature on the mood of people who feel depressed.

What happens next?I will start to analysis all the data collected from the 8th of December 2014. Once the study is fully completed, a copy of the findings will be sent to you unless you have indicated otherwise in the consent form.

Can I still withdraw from the study?You can withdraw from the study at any time without having to give a reason and you can also ask for your information to be excluded from the analysis up to the 8th of Dec 2014, when data analysis will begin.

What if I have a query about the research?Please contact either myself or my researcher at the contact details below:

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Whom can I contact if I feel distressed after taking part and need someone to talk to?If you feel upset or distressed after taking part in the study it can be helpful to talk with family and friends. Alternatively, you can speak with some of the support agencies listed below:

Centre for Wellbeing Ground Floor Building 23 University Court University of Surrey Guildford GU2 7XH Tel: 01483 689 498

SaneProvides practical help and emotional supportHelpline: 0845 767 8000 SANEmail: sanemail@sane.org.ukSupport Forum: www.sane.org.uk/DB

Depression Alliance Helpline providing information and advice on mental healthTelephone:0845 767 8000

Email: info@depressionalliance.org

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Researcher: Michael Eko Supervisor: Dr Birgitta GaterslebenEmail: Michael.eko@surrey.ac.uk Email: b.gatersleben@surrey.ac.uk