Using forest bathing alongside other neuropsychological therapies - meet Dr Mary Delaney
Mary from the Neurons and Nature team provides an overview how nature based interventions can be used alongside other forms of therapy.
Dr Mary Delaney is one of the team behind the Neurons and Nature festival of connection happening in May 2024. In this blog post we will take a look at how nature based interventions can be used alongside and incorporated into other therapeutic approaches within neurorehabilitation.
Evidence-based psychological therapies such as Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) are commonly used by Clinical Neuropsychologists when working with people living with long-term neurological conditions. Nature-based interventions like forest bathing may be used to complement these psychological therapies, to provide the opportunity for experiential practice of these therapeutic models. In this post, Mary highlights how some of the core principles of these two therapies can be supported by forest bathing.
ACT and Forest Therapy
At the heart of ACT are 6 key processes which support the construct of psychological flexibility, referred to as the Hexaflex. The processes are
Contact with the present moment
Values
Committed action
Self-as context
Defusion
Acceptance
Using some of the processes as examples, Mary notes how they can be supported by elements of forest bathing.
Contact with the present moment
“Contact with the present moment means consciously paying attention to the physical world around us and the psychological world within us, connecting and engaging fully with our present experience.” Mary explains. Central to this aspect of ACT is the practice of mindfulness and Mary highlights how forest bathing can assist with this. “Forest bathing offers the opportunity to slow down and connect with nature in the present moment, through a series of sensory and mindful invitations. These invitations are often done in silence, enhancing immersion in the sensory experience over the course of a session.”
In forest bathing, the focus is on mindful contact with the external natural world around us, which may be more comfortable for some people who struggle to tolerate inward focussed contact with the internal world, for example those experiencing significant trauma. Mary highlights supportive research findings .“By offering a gentler, more intuitive approach that encourages outward attentional focus, recent research by Clarke et al., found that forest bathing helped to overcome this barrier. Separate research by McEwan et al., also indicated benefits of forest bathing on reduced rumination and anxiety.”
Self-as context
Sometimes called the observing self, this is a part of us that is able to “zoom out” and observe the thoughts, feelings and actions of the internal world. How does this link into forest bathing? “Forest bathing provides the opportunity to focus attention on aspects of the natural world around us, and gives an increased awareness of our place in the world and nature”, Mary explains. “In a society where we can become focussed on the self, and pushed around by our internal struggles, our egocentricity is called into question and reduced by the awareness of being part of something much bigger than ourselves, and by the sheer scale and complexity of nature”. This can support a process of “zooming out” from our internal struggles and connecting with the observing self.
Values
“In ACT, values are desired behaviours, how you want to treat others, yourself, and the world around you”. Mary goes on to expand on how nature can help support values. “Nature connection can create a sense connection, both with nature and social connection with our fellow human beings. it can lead to values around the importance of the health of the planet, foster a desire to adopt sustainable behaviours and attitudes.”
Metaphors
Another element of ACT that can be supported by being in nature is the use of metaphors, which are used extensively in ACT. “Individuals engaging in forest bathing have been shown to develop their own metaphors” Mary says, adding, “The resilience of nature in adverse circumstances can support people to have a changed and more self-compassionate understanding towards their own resilience in the face of difficult life circumstances.”
CFT and Forest Bathing
CFT incorporates elements of neuroscience, social and evolutionary psychology to describe our “tricky brain” and how processes developed to protect us can potentially lead to problems in modern life. “As the founder of CFT Professor Paul Gilbert says, people are often trying their best in difficult circumstances, in social environments they were not adapted for, where they can become over-sensitised to threat and under-sensitised to safeness.” Mary explained, adding “We have evolved as social beings and we flourish best in caring social connections”.
The CFT model considers social connectivity through three flows of compassion, which are to others, from others and to oneself. At the heart of the model are three conceptual systems of emotional regulation, drive, threat and soothe, which are linked to several cognitive, behavioural and physiological processes. Threat is linked to the sympathetic nervous system which regulates and prepares our body to respond, the “flight or fight” response. Perhaps less well known is the soothing response regulated by the parasympathetic nervous system which supports rest and restoration.
Mary highlights the evidence from recent studies by McEwan et al., (2021) and Markwell & Gladwin (2020). “Research is showing that forest bathing actively supports the parasympathetic nervous system, resulting in reduced levels of stress hormones such as cortisol, improved mood, reductions in rumination, and increased heart rate variability.”
Physical benefits of improved immune function and cardiovascular health have also been reported, alongside increased levels of nature connectedness and compassion, with emerging evidence demonstrating that the combination of CFT and forest bathing may have a greater impact on the parasympathetic nervous system than either therapy delivered alone .
“Emotions associated with this parasympathetic regulation system tend to be experienced as settling, calming, contentment, peacefulness, and social safety.” Mary adds, “Following engagement in forest bathing sessions people report an increased sense of calm, connection to themselves, nature and others”. This can be facilitated by reflective sharing circles where people share things they have noticed in the natural environment. Mary explains how, in her experience, this “fosters a sense of emotional connection of shared experience in the environment.”
Forest bathing sessions end with a tea ceremony. “In serving participants food and drink, it provides the opportunity to engage the soothing system through a timeless ritual of sitting with others in a caring, social, mindful and restful setting, to provide caring social connection and nourishment”. In this way, the tea ceremony maps onto the soothing system in the CFT model, which centres around rest, food, safety and caring social connection.
Finally, forest bathing can create a safe environment to connect with nature and address social isolation as well as addressing potential risks. “Being alone in nature, such as in parks, can activate the threat system.” Mary explains, “Forest bathing nurtures the feeling of safety in a group, connecting with the natural surroundings, allowing people to benefit from the soothing effects of contact with nature with a sense of safety.” This may be particularly relevant to those living with long term neurological conditions, who may be experiencing increased social isolation, loss of connection with their social group, and difficulties accessing nature.
Looking ahead.
ACT and CFT have key elements that are supported by present moment awareness, the observing self, mindfulness, sensory engagement, social connection and activation of the soothing part of the nervous system. As Mary sums up “Forest bathing is a useful evidence-based approach, providing rich experiential opportunities that complement and enhance these evidence-based therapeutic approaches already being widely used by neuropsychologists.”
This is a key topic that will be discussed at the upcoming Neurons and Nature festival of connection, nature and neuropsychology in May 2024. Subscribe to hear more about the team and the speakers at the event in future posts.
Full details of the event can be found on our Eventbrite page.
References
Clarke, F. J., Kotera, Y., & McEwan, K. (2021). A qualitative study comparing mindfulness and shinrin-yoku (forest bathing): practitioners’ perspectives. Sustainability, 13(12), 6761.
McEwan, K., Collett, H., Nairn, J., Bird, J., Faghy, M. A., Pfeifer, E., ... & Bond, A. (2022). The Feasibility and Impact of Practising Online Forest Bathing to Improve Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study. International Journal of Environmental Research and Public Health, 19(22), 14905.
Markwell, N., & Gladwin, T. E. (2020). Shinrin-yoku (forest bathing) reduces stress and increases people's positive affect and well-being in comparison with its digital counterpart. Ecopsychology, 12(4), 247-256.
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McEwan,K.,Giles,D.,Clarke,F.J.,Kotera,Y.,Evans,G.,Terebenina,O.,... & Weil, D. (2021). A pragmatic controlled trial of forest bathing compared with compassionate mind training in the UK: Impacts on self-reported wellbeing and heart rate variability. Sustainability, 13(3), 1380.
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