The number and type of outdoor nature-based therapeutic interventions have grown significantly in recent years. While current research provides strong support for the development and use of such interventions, the role of nature in the therapeutic process isn't clearly understood. As a result, outdoor therapies tend to operate without an explicit theory of change for their application as a clinical practice. Researchers addressed this concern by conducting an umbrella review of existing systematic and meta-analytic reviews of the literature on outdoor therapies. Their primary goal was “to identify clear expressions of nature's role in outdoor therapeutic practices” as a basis for developing a theoretical framework for practice.
Fourteen studies met the inclusion criteria. The populations served and the issues addressed varied considerably. Ten of the studies included youth participants, two included children, and eleven included adults. The studies were located in different disciplines: seven in public health; two in medicine; two in child, youth, and family studies; one in mental health and addictions; one in psychology; and one in nursing. The studies were categorized into five self-identified approaches: nature-based therapies, forest therapy, horticultural therapy, wilderness therapy, and adventure therapy. Areas of assessment included mental and physical health, specific diagnosed health issues, and wellbeing. “Clear and comprehensive descriptions of theory, program structure, and activity details with causal links to outcomes were mostly absent.” A critical appraisal checklist for systematic reviews and research synthesis was used to evaluate the quality of the included studies. While some weaknesses were identified, the included papers were generally consistent with protocols established for umbrella reviews.
The approaches used for the outdoor therapies all included direct contact with nature and generally reported positive outcomes. Lacking, however, were “clear articulations of nature's contribution to the specific therapy undertaken.” Attention Restoration Theory and Stress Reduction Theory were basically the only two theories offered as to how nature supports outdoor therapies. Most of the reviews referenced intricate links between human health and environmental health, but lacked theoretical models to guide practice and research.
The researchers concluded from this review that formulating specific recommendations for practice is premature. “In order to inform best practice guidelines, more high quality, exploratory, in-depth and theory-generating research is needed as a means to clarify the impact of different types of outdoor therapies for various populations and develop detailed theories of change.”
This review thus proved to be “unfruitful” in fulfilling its purpose, which was “to identify clear expressions of nature's role in outdoor therapeutic practices.” While the researchers call for more research, they also conclude “that it may be difficult to find what we seek: nature's role in outdoor therapies.” They suggest that, along with the research, it would be wise to focus on the fact that “our presence IN nature is that of an embodied experience AS nature—where both human and more than human are simply parts of a whole.” They propose that this understanding could serve as “a parallel expression of support for outdoor therapies while the explanatory science catches up.”
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