In the last couple of months I've spent a LOT of time reading literature about nature based interventions. Both within occupational therapy, and beyond (waaay beyond) the profession of occupational therapy.

The 'outdoor sector'

The 'outdoor sector' as I've come to call it in my mind is really diverse. There are many exciting services being provided to increase contact with nature in education, health and social services. My role as a voluntary Board member with the organisation Outdoor Health Australia (formerly the Australian Association of Bush & Adventure Therapy) has provided opportunities to cross paths and have conversations with many passionate service providers, researchers and authors. This has led me to reflect on where my profession of occupational therapy 'sits' within the sector, and how we could define nature based occupational therapy in a way that reflects our full scope of practice.

Occupational therapy, nature and 'the outdoors'

I absolutely LOVE delving into the literature and get excited about a good scoping or systematic review or meta-analysis as a juicy analysis of literature. During my recent reading adventure I read these occupational therapy review articles about ways of working with nature;

1)  Burke, H.,  Burke, L., Hacker, C & Lane, S, (2023): Nature-Based Pediatric Occupational Therapy: A Scoping Review, Physical & Occupational Therapy In Pediatrics, DOI: 10.1080/01942638.2023.2204924

https://pubmed.ncbi.nlm.nih.gov/37125675/

2)  Firby, H & Raine, R 2022, ‘Engaging with nature and the outdoors: A scoping review of therapeutic applications in contemporary occupational therapy’, British Journal of Occupational Therapy vol.86, no. 2 pp101-115.

3) Bonham-Corcoran, M., Armstrong, A., O’Briain, A., Cassidy, A., & Turner, N. (2022). The benefits of nature-based therapy for the individual and the environment: an integrative review. Irish Journal of Occupational Therapy, 50(1), 16-27.

What is nature based occupational therapy?

I think it can be many things, and the definitions in the literature vary.

Bonham-Corcoran et al (2022) describe the broad concept of nature-based therapy as 'an approach to intervention that uses the natural environment as a facilitator during the therapeutic process'. They describe modalities including horticulture-based activities, being in a natural environment and engaging in nature-related crafts or green exercise.  The integrative review methodology aimed to identify literature about nature-based therapies and their benefits for the individual and the environment. They reported a 'paucity' of relevant occupational therapy papers, so searched beyond the profession-specific literature. There were 25 papers included for full review. Categories of nature-based therapies identified included - forest therapy, horticultural therapy (including indoor), virtual reality nature-based images, yoga, meditation, mindfulness, support groups, wilderness camps, nature-based crafts and incorporating nature into indoor environments.

Firby & Raine (2022) focus on outdoor interventions in their scoping review of therapeutic application of 'engaging with nature and the outdoors' in contemporary occupational therapy. They searched for literature to establish both the extent and the type of applications of engaging with the natural outdoors in occupational therapy. The criteria for inclusion included interventions where the environmental context was a ‘natural and outdoor environment’, even if the participant couldn’t actually be present in the environment, e.g., by viewing through a window. The type of applications could be either occupation-based or occupation-focused, where the latter includes interventions enabling people to engage with the natural outdoors. The review of 64 articles found occupational therapy interventions included therapeutic groups which were mostly horticultural groups or vocational rehabilitation programs and also included groups engaging in outdoor adventure, green walking and exploration outdoors. The occupation-focused interventions identified were design of restorative natural spaces and gardens.

Burke et al (2023) completed a scoping review of nature-based pediatric occupational therapy services with nature as a ‘primary context and treatment modality’. Studies were excluded if they only described animal-assisted therapies or human-made structures. Twelve articles were include and the authors reported ‘no clear conceptualization of nature-based pediatric occupational therapy’ and a range of terms used to describe nature-based interventions, including eco-therapy and nature therapy. The authors suggest that horticultural therapy, animal-assisted therapy and adventure therapy are specifically relevant to occupational therapy. Modalities identified in the reviewed literature include outdoor play, gardening and farm-based intervention, water-based interventions (surfing, windsurfing and adaptive hiking.

How do we define nature based occupational therapy?

I have a particular passion for valuing nature connection for all people, including people who have limited ability to physically be outdoors. This could be due to physical, psychological, social capacity, deprivation (institutional living), poor health (especially in palliative care), or their socio-economic situation and ability access safe and healthy nature. I had a really moving conversation once with Dr Robert Zarr, founder and medical advisor for Park Rx America about the concept of self as nature. The awareness that we ARE nature and that we always have the ability to connect with OUR nature – our breath, our heartbeat. As I’ve explored sensory processing and interoception I feel really drawn to this idea of self as nature.

This has brought me to my current thinking about what nature actually is, and therefore what nature based occupational therapy is.

This is MY definition -  

The concept of nature will be another blog, and for now this is my current definition of what nature based occupational therapy is;

Nature based occupational therapy is the intentional evidence-based application of the therapeutic benefit of nature contact, nature connection and nature-based occupation to enable people to participate in the activities of everyday life.

Nature based occupational therapy takes place indoors, virtually and in outdoor environments and includes working with the environment, people and occupation to support meaningful occupational engagement.

What does nature-based occupational therapy look like for you?

Let me know at [email protected]