Bringing the outside in: Nature therapy for indoor sessions

The beneficial connection between nature and mental health has gained significant attention in recent years. While many studies on the therapeutic benefits of nature focus on outside spaces, not all therapists have easy access to the outdoors.

Fortunately, there are plenty of ways to bring the benefits of nature into therapy without leaving the room.

Room layout

A seminal 1984 hospital study found that patients who had a window view of a natural scene needed less post-operative time in the hospital and less pain relief, suggesting a connection between nature and the limbic system (the part of the brain where emotions are processed and regulated). So, when planning your therapy room layout, consider positioning your client’s chair so they can see out of the window. 

Research indicates that having plants in therapy rooms can enhance comfort and lower cortisol levels. I frequently incorporate plants into sessions, particularly using a mindfulness technique that benefits clients with social anxiety. I encourage them to closely observe a nearby plant, noting its details and characteristics, which helps ground them and shift their focus away from anxious thoughts.

Initially, they might notice that it’s green and has leaves. Then, I encourage them to look more closely— to notice the colours, textures, patterns, and even the life and death of the leaves. They can also engage other senses by smelling and touching the plant. This deeper observation often helps ground them and distract them from anxious thoughts. 

Nature through art

Nature-based art therapy can be particularly effective for those dealing with anxiety. Clients can create their own nature-inspired art to express emotions, such as painting scenes or using nature objects like leaves to create patterns that reflect their thoughts and feelings.

Keeping a collection of postcards or photos of nature scenes can be useful—sometimes I ask clients to choose one at the start of the session to represent how they’re feeling that day. 

Nature metaphors

Nature metaphors can be an effective way for us to communicate difficult concepts and help anxious clients verbalise their feelings, both in and out of the therapy room.

A popular nature metaphor used in ACT is "Urge Surfing," where the image of a wave building and then crashing, represents the growth of an urge and its eventual passing, this is a great tool to help clients struggling with addiction, OCD, anger and anxiety.

Other metaphor ideas include:

• plant/garden imagery to symbolise nourishment and the importance of self-care
• paths, rivers, or streams to represent life journeys
• mountains to reflect challenges
• clouds to represent the movement and passing of thoughts
• weather imagery to depict moods and emotions

Guided imagery

Numerous studies have established a link between Guided Imagery (GI) and its effectiveness in managing anxiety symptoms. 

One popular GI intervention is "Leaves on a Stream," where clients imagine themselves standing by a stream, observing leaves floating past. They’re encouraged to place their thoughts on the leaves and watch them drift away, helping them see thoughts as mere events of the mind rather than reflections of reality.

In the “Safe Space” Guided Imagery exercise, we can lead the client through a calming process to create somewhere they feel safe whenever they need to feel calm and grounded. The space can be unique to the individual, a quiet beach with gentle waves, a forest, a lake, and high in the mountains are all places my clients have used to evoke a feeling of safety, relaxation and grounding.

The “Tree of Life” is a guided imagery exercise where clients visualise themselves as a sturdy, deeply rooted tree. They sense the grounding stability of their roots firmly anchored in the earth, while their branches stretch confidently toward the sky. This exercise is great for clients looking to build resilience and boost confidence.

Scripts for these and other guided imagery exercises can be found online. 

Nature objects

Keeping a collection of natural objects like conkers, acorns, leaves, and twigs in the therapy room can be incredibly useful. In addition to their role in art therapy, these objects have been shown to reduce anxiety when used as tools of association. During guided meditation, ask clients to notice the shape, weight, and texture of a natural object. They can take these items home as "anchor tools" (reminders of the calm moments experienced in therapy) whenever they feel anxious or overwhelmed.

Leaves and acorns can also be used symbolically to represent life cycles. For example, a green leaf might symbolise growth, a colourful autumn leaf might represent change, and a dried leaf could signify letting go or endings. A small acorn can serve as a metaphor for growth, illustrating the client's potential to grow into a strong oak tree.

Soothing sounds and smells

Studies have shown that sounds of nature can lower anxiety levels and improve physiological responses. Incorporate sounds like rain, forest ambience, or ocean waves during sessions, especially during art therapy or relaxation exercises. If a client wants to improve their sleep hygiene, suggest adding nature sounds to their bedtime routine.

Nature sounds can also help clients express their emotions through metaphors and similes—such as comparing happiness to birds singing, or thunder to a sense of dread.

Room sprays and essential oils can be a subtle way to bring the scents of nature in. Lots of nature smells have calming associations such as lavender, sandalwood, and cedarwood, some are associated with being energising and uplifting such as citrus scents, pine and eucalyptus. However, be aware that clients may carry associations with the smells – what we can find soothing may have a different meaning to a client. 

Technology

I sometimes have a screen playing forest or ocean scenes from YouTube in the background. Clients often comment on how much they appreciate it, and many ask me to share the links so they can use the same videos at home. 

Apps are great resources for nature meditations and there are some exciting studies around the evolving use of nature-inspired virtual reality as a form of nature therapy, where clients can lower stress levels by wearing a VR headset and engaging in some virtual reality. 

Homework with a nature twist

If your client responds well to nature-based interventions, consider suggesting nature exposure as homework, such as taking a mindful walk outside. Numerous smartphone apps play nature sounds and meditations, many of which can be found on YouTube. I'm a huge fan of The Honest Guys' material and often recommend them to clients struggling with sleep, anxiety, or simply in need of a relaxation break.

Clients may also enjoy reflective journaling. You could give them a nature object to take home and invite them to reflect on the session by writing about the object, what it symbolises, and how it relates to their journey. Another idea is to suggest they keep a gratitude jar, placing nature objects that represent things they’re grateful for inside, and watching the jar fill up over time.

Conclusion

By bringing nature into therapy we are inviting our clients to sense a connection to the natural world. Of course, we have to be aware that some clients will feel resistance to nature-based interventions and we must remain respectful of this. But for the many clients who will benefit, we can bring nature to them by simply positioning a chair so that they can look out of a window, or placing a few houseplants nearby and with a bit of preparation, you can easily incorporate nature into with art, technology, meditation, and metaphors into your sessions.

References and further reading

Atkins, S. S., & Snyder, M. A. (2018). Nature-based expressive arts therapy : integrating the expressive arts and ecotherapy. Jessica Kingsley Publishers.

Kamitis, I., & Francis, A. (2013). Spirituality mediates the relationship between engagement with nature and psychological wellbeing. Journal of Environmental Psychology, 36, 136–143

Nguyen,J, Brymer,E, (2018), Nature-Based Guided Imagery as an Intervention for State Anxiety

Chang, C., & Chen, P. (2005). Human Response to Window Views and Indoor Plants in the Workplace. HortScience HortSci, 40(5), 1354-1359. Retrieved Aug 9, 2024, 

White MP, Yeo NL, Vassiljev P, Lundstedt R, Wallergård M, Albin M, Lõhmus M. A prescription for "nature" - the potential of using virtual nature in therapeutics. Neuropsychiatr Dis Treat. 2018 Nov 8;14:3001-3013. doi: 10.2147/NDT.S179038. PMID: 30510422; PMCID: PMC6231506.

Ulrich, Roger. (1984). View Through a Window May Influence Recovery from Surgery. Science (New York, N.Y.). 224. 420-1. 10.1126/science.6143402.