By Jodie Skillicorn, DO

For centuries, nature has been prescribed to soothe the body and soul. Cyrus the Great, founder of the Persian Empire, created gardens for rest and relaxation 2,500 years ago. Hippocrates described nature as “the physician of diseases.” In the late 1800s, sanatoriums were established in the pine forests of Germany, Switzerland, West Wales, and the Adirondacks of New York to treat tuberculosis with the “exhalations of turpentine” from the trees.

In 1865, the landscape architect Frederick Law Olmsted, who not only created New York City’s Central Park but also played a key role in the development of the national park system, wrote that immersing oneself in nature “reduces mental and nervous excitability, moroseness, melancholy, or irascibility.” At an American Medical Association meeting in 1898, Frederic Thomas, MD, presciently linked the increasing rates of mental illness to noise, smoke, and pollution of industrialized cities.

Physicians all around the world are once again turning to the healing properties of nature. In Great Britain, physicians prescribe green gyms, where patients improve their communities by helping plant trees, sow meadows, and establish wildlife ponds instead of doing push-ups and leg lifts.

Robert Zarr, MD, of Washington, DC, founded Park Rx America, whose mission is to “decrease the burden of chronic disease, increase health and happiness, and foster environmental stewardship by virtue of prescribing Nature during the routine delivery of health care.” The U.S. National Park Service created Healthy Parks, Healthy People, which partners with medical schools, health care leaders, businesses, and scientists to use public park lands to reconnect Americans to nature for “mental, physical, and spiritual health, and social well-being and sustainability of the planet.”

My absolute favorite program is sponsored by the national health board in the Shetlands, which encourages physicians to prescribe mindful activities in nature to counteract depression, anxiety, stress, diabetes, and other chronic health conditions. This program includes a beautiful online nature prescriptions calendar that offers stunning photographs and a list of monthly ideas to mindfully connect with nature and wildlife.

In January, the brochure suggests readers step outside and “be still for three minutes and listen,” or use a magnifying glass to “really look at lichen.” A suggestion for April is to “find a bud on a tree … feel the texture.” In May, it suggests, “Bury your face in the grass,” or “Make a daisy chain.”

You may roll your eyes at how this could possibly help resolve depression, but a growing body of evidence suggests that these are not just the whimsical ideas of tree huggers. Studies from around the world demonstrate that those living more than half a mile from green space are more likely to report higher stress, anxiety, and depression, and an overall increase in diseases of all kinds. Conversely, those living closer to parks report decreased stress, depression, and anxiety as well as a decreased risk of cancer, stroke, and death.

A study at the University of Essex tracked households over a three-year period, comparing those that moved from rural areas to cities and vice versa. Researchers found that those who moved to greener areas experienced less depression and improved mental wellbeing, while those moving into urban areas had an increased risk of depression. You may be thinking, places with more greenery may just be more economically advantaged communities, and the benefits may have nothing to do with nature. To rule out that possibility, another study examined comparable inner-city neighborhoods, differing only in the amount of green space. This study arrived at the same conclusions: the presence of green spaces decreases the risk for stress, depression, and disease.

Although getting outside and interacting with nature is ideal, research suggests that just views of nature soothe our bodies and emotions. Studies have found that postsurgical hospital patients with rooms viewing nature recover more quickly and have fewer complications and a decreased need for pain medications than their unfortunate controls with views of buildings or brick walls. Prisoners with a view require fewer visits for medical care. Elementary school children with views of nature perform better in school. Office workers are more productive at work.

MRI scans show that viewing nature increases activity in the hippocampus, particularly an area dense with opioid receptors, increasing positive thoughts and decreasing the perception of stress. Views of nature also decrease the firing of the amygdala and increase activity in areas of the brain associated with empathy and altruism. Imagine the effect on our society if we all added a bit more nature to our daily lives!

In contrast, those who viewed urban scenes showed increased activity in the amygdala, leading to increased feelings of stress, fear, and anxiety. Other studies suggest urban views even shift value systems from altruistic desires for helping others to more self-centered pursuits of money, fame, and power. Clearly, we as individuals and as a society are suffering more than we know from our disconnection from nature.

For those city dwellers without access to a view or a nearby park, do not despair. It seems that even pictures of nature offer some reprieve from stress and sullen moods. One study had a group of students, fresh from college exams, view a series of pictures. Half of the students viewed nature scenes, while the other half viewed urban buildings. Those who viewed the scenes from nature reported feeling calmer and happier, while those viewing the urban scenes felt sadder.

Brain scans and labs confirmed this finding. Those viewing nature displayed more alpha waves, indicative of a calm, attentive state, as well as lower cortisol levels and heart rate, and increased serotonin levels. Why not take advantage of your body’s response to nature and tape a picture of a beautiful calming scene next to your computer, and look at it every hour or so, while taking a few deep breaths? Better yet, buy a plant. The presence of plants at work can decrease anger, anxiety, depression, and fatigue by 40 percent, and decrease stress by 50 percent.

Pictures of animals or beloved pets offer a nature reprieve as well. In fact, one study on watching cat videos online suggests that those who watch these videos report feeling more energized and positive, with decreases in anxiety, irritability, and sadness.

Even better, studies suggest pet owners may experience decreased stress and anxiety, improved mood, lower blood pressure and heart rate, less loneliness, fewer health problems, and even a longer life. In exchange for food, water, and shelter, these companions, with whom we have cohabitated over the past fourteen thousand years, offer unconditional love and acceptance, wet sloppy kisses when we are sad, and a reason to get up off the couch and go for a walk on even the dreariest and coldest of days.

Forest Bathing

Much of the research on the healing benefits of nature has come from Japan, where two-thirds of the country is filled with forests, and there is a deep spiritual attachment to the wonders of the natural world. In 1982, Japan instituted a national program for shinrin-yoku, or forest bathing. The first of over 60 forest therapy bases was created within the Akasawa Natural Reactional Forest. There, one could receive a medical consultation amongst the trees, and hike trails designed to offer physical, emotional, and spiritual benefits. At the time, these benefits were based on nothing more than intuition and ancestral wisdom.

Beginning in 2004, a new field of study was initiated to seek evidence for this ancient hunch. The research reveals that time spent in nature decreases stress, anxiety, depression, and anger. It increases energy and vitality and improves sleep. It boosts the immune system, not just while you are in the woods, but for up to a month afterward.

Labs show that forest bathing decreases cortisol levels, blood pressure, and blood sugar. It balances the autonomic nervous system, breaking the stress-induced sympathetic response, and activating the parasympathetic nervous system to allow for rest, relaxation, and rejuvenation.

Better yet, we do not have to escape to the forest for extended periods of time to benefit. A study conducted by Qing Li, MD, one of the world’s leading experts on forest bathing, found that a two-hour hike offered roughly the same benefits as a long weekend in the woods. Everyone returned to the city feeling happier, calmer, and more energized. Why not find a park near you and see for yourself? This prescription offers lots of benefits without any side effects, at least if you stay out of the poison ivy, and do not offer your finger to local wildlife as a chew toy!

Wellness Rx: Sensing Nature

For this exercise, return to a favorite trail or, if you are feeling more adventurous, pick a new park to explore. Take a few moments before beginning your stroll to notice your breath, thoughts, body sensations, and emotions. As you walk toward the trailhead, take a few breaths to clear out old worries and stress and create space for a new experience.

Feel the movement of your body. Feel the connection of your feet with the ground.

Tune in and use all your senses. See the colors of the sky, the trees, the grass, the flora. Notice the light as it passes through the leaves or across the ripples of a lake or stream. Look for signs of wildlife.

Listen to the sounds around you: the wind in the trees, the rustle of flora as a small critter scurries by; the songs of birds; the sound of your own footsteps, breath, and heart.

Smell the air, the trees, the flowers, the dirt.

Touch the texture of a leaf or lean against a large tree and feel the bark. Sense the energy of the tree. Feel the air, the sun, the wind on your face and skin.

Experience nature for at least 20 minutes. Walk, sit, run, stand, lie on the ground, whatever feels right. Notice how your breath, thoughts, body, and emotions may shift as you engage with all your senses to the world around you. Notice whatever arises, and then find a quiet spot to write or draw to record your experiences.

Did you notice your body relaxing? Perhaps your mind quieted? Maybe there was even a moment of awe that caught you by surprise, or a sense of deep familiarity and knowing, like seeing your best friend from childhood after decades apart? Americans now spend 93 percent of their days inside the walls of homes, office buildings, and cars, and ten hours a day tethered to technology. Fewer than 10 percent of teenagers spend time outside daily! We have truly become disconnected from our very roots.

Like the research on viewing urban scenes versus natural ones, multiple studies around the world have examined our different responses to walking through an urban area versus a park setting. Whether in Ann Arbor, Michigan, South Korea, or Palo Alto, California, participants who walk in nature show additional benefits above and beyond the exercise. By hiking through parks, individuals saw improved mood and cognition, increased capacity for memory recall, and decreased rumination and negative affect.

Other research has compared exercising indoors versus outdoors. Those who exercised outside felt greater energy, vitality, and enthusiasm. They reported enjoying it more and being more likely to do it again.

Healing Power of Nature

Smelling

Why does being in contact with nature dramatically improve our wellbeing on so many levels? Nature appeals to all of our senses, especially smell. Have you ever walked through a pine forest and felt calmed, energized, and centered by the smell of pine? Ever wondered why pine scents are used in so many cleaning products and candles?

Modern research shows that the “exhalations of turpentine,” first described back in the 1800s as a treatment for tuberculosis, are natural oils produced by the trees, known as phytoncides. These natural aromatic chemicals are released into the air to protect the tree from bacteria, insects, and fungi, and to communicate with other trees.

Each tree sprays its own unique scent, composed of various terpenes, such as D-limonene, which unsurprisingly smells lemony; alpha-pinene, which smells, yep, piney; beta-pinene, which has an herby smell; and camphene, which smells like turpentine.

Li conducted a study in which he diffused Japanese cypress oil into the hotel rooms of participants who slept in the room at night but went to work as usual by day. Even without being in the woods, the aroma of trees improved sleep and energy, increased pain tolerance and immunity, and decreased stress, anxiety, and cortisol.

This is the powerful basis of aromatherapy. We can bring the forest into our homes with a simple diffuser. An earlier study on the diffusion of D-limonene to depressed inpatients showed that this approach was more effective than antidepressants at improving mood. We have much to learn from the natural world.

Seeing

We have already seen that simply viewing images of nature can offer physical and emotional benefits, but it is more than just the beauty. Research suggests that viewing the patterns of nature—the branching of trees; ferns and butterfly wings; the spirals of shells, roses, and pineapples; a moth drawn to light; the scales of a pinecone; the ripples in water and sand; or the cracks in dry earth or shattered ice—can decrease stress by as much as 60 percent. 

Take a moment to look out your window or walk into your backyard, or if you are at work, search for a picture of a flower and spend a few moments just noticing the patterns of color and structure, while breathing deeply into the belly. Notice any shifts in your body or emotions. On your next walk in the woods, consider gathering pinecones, twigs, rocks, and grasses to create a nature mandala on your table, or a larger-scale one in your yard or a park. My kids love to build rock sculptures in creek beds in the summer. Bring your journal on your next hike and draw some of the patterns you see.

Hearing

We all know how it feels when we are surrounded by loud, artificial sounds. I used to dread the birthday parties of my kids’ friends that were held at entertainment centers. My shoulders and neck tightened, my jaw clenched, and I would feel an incredible urge to escape the clangs, pings, chimes, rings, whirls, and shooting sounds of the video games, coin machines, and loud, excited, sometimes irritable children all confined in a relatively tight space. I usually left my husband in charge of those events. Contrary to the stress-inducing sounds of the modern world, the sounds of nature calm us.

Nature’s sounds quiet the sympathetic nervous system and amplify the parasympathetic nervous system. Unlike artificial sounds, which turn our focus myopically inward, the sounds of nature direct us outward, to something beyond ourselves. Better yet, these sounds provide the most benefit to those who are the most stressed.

Most humans gravitate to the sounds of a babbling brook, waves lapping against a shore, rain falling on the rooftop or on a canopy of trees, and the songbirds chirping.

Gordon Hempton, an acoustic ecologist, said that with all the noises created by the modern world, silence, or the absence of human-made sounds, is becoming an endangered species “on the verge of extinction.” Hempton has traveled the globe recording and preserving the sounds of the natural world, including thunder in the desert, sunrise on the shores of Cape Cod, babbling brooks in Belize, evening mist in Sri Lanka, the inside of a Sitka spruce, and the sound of silence within a volcano in Hawaii.

During his travels, Hempton created a list of the world’s “Last Great Quiet Spaces.” He has found only twelve silent sanctuaries in the United States where one can go without hearing the noises of the modern world. He chooses to keep most of these secret so that the spaces remain quiet. If you are interested, he has created over fifty soundscape albums you can download or stream to reconnect you with the natural world outside your office or home.

Touching

A powerful tool of healing, largely unrecognized and barely noticed, is the earth beneath our feet. Our synthetic and rubber-soled shoes have separated us from the energy of the earth. I understand this may sound kooky, but there is evidence to back me up. Before I explain it, though, try connecting with the earth for yourself.

Wellness Rx: Grounding

If the weather allows, take off your socks and shoes and stand in the grass or dirt. Feel the contact of your feet with the earth. Notice any sensations in your toes and feet. Scan your body for other shifts in sensation as you stand there. As you continue to notice body sensations, take a few deep relaxing breaths. Stay here, paying attention to the connection of your feet with the earth and notice any shifts in energy or mood that may occur.

You may want to experiment further and lie down in the grass, allowing the whole back side of your body to be supported by the ground. Notice where the body is making contact with the ground. Feel the body sinking into the ground, allowing the earth to support you. Imagine releasing emotions, thoughts, or even uncomfortable sensations into the ground. Notice any shifts in the breath, emotions, thoughts, and body as you lie there. Write your observations in your journal. The point, as always, is to be open and curious.

Although the earth, throughout history, has been honored as a sacred source of sustenance and life, the evidence for its healing potential is fairly recent—and astonishing! Clinton Ober, an electrical engineer, has pioneered research in this area, which he details in his book Earthing: The Most Important Health Discovery Ever? He describes the planet as a “six sextillion metric ton battery that is continually being replenished by solar radiation, lightning, and heat from its deep-down molten core.”

This battery offers an endless supply of negatively charged electrons. This matters because our bodies are flowing with an excess of positively charged free radicals, which play a critical role in our immune system. These free radicals are incessantly in search of negatively charged electrons to pair with for stability. In cases of acute inflammation, the free radicals will pair with electrons from pathogens and damaged tissue, which effectively kills the pathogens and cleans up tissue debris.

Unfortunately, in states of chronic inflammation, the overabundant radicals go rogue and start killing healthy cells. Contact with the flow of electrons from the earth neutralizes the body’s positive charge and this inflammatory response, freely offering the most potent anti-inflammatory in existence.

It appears that our bodies require connection with the earth to synchronize our circadian and biological rhythms. A series of studies was conducted at the Max Planck Institute involving hundreds of volunteers who were isolated in underground rooms shielded from the earth’s electrical field.

All the participants developed sleep and hormonal disturbances. These disturbances were normalized when electrical rhythms similar to those of the earth’s were pulsed into the rooms, showing that our body’s biological rhythms require calibration by the rhythm of the earth for optimal functioning.

Subsequent research has shown that grounding with the earth, by reducing inflammation and coordinating our biological rhythms, increases sleep and energy; decreases stress, anxiety, irritability, and depression; and improves a range of physical symptoms that include gastrointestinal issues and hormonal imbalances.

It is not only the earth’s electrical power we require for health, but the sustenance of her soil for food—and microbes! Our bodies need dirt and germs to develop a strong immune system.

The Cebu Longitudinal Health and Nutrition Survey has followed a group of over three thousand pregnant women and their children from a variety of urban and rural neighborhoods in the Philippines since 1983. The study reveals that early and chronic exposure to harmless microbes is critical to immune development and future health. Our overly sanitized society is disabling our immune systems and leading to chronic diseases.

The good news is that by making our lives simpler, we build a more resilient immune system for ourselves and our kids. Forget daily baths. Forget throwing away food that falls on the ground. Definitely ditch your hand sanitizer. Make some mud cakes. Garden. Play in your pesticide-free yard and get dirty!

In the summer, my kids are lucky to get a bath every week. Their hands and feet are coated in dirt. This is one of my small contributions toward more time for play now, and less inflammation, depression, and disease when my kids are older.

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This article is an adapted excerpt from Healing Depression without Medication: A Psychiatrist’s Guide to Balancing Mind, Body, and Soul by Jodie Skillicorn, DO, published by North Atlantic Books, copyright © 2020. Reprinted by permission of publisher.

Jodie Skillicorn, DO, is an osteopathic physician board certified in psychiatry and a diplomate of the American Board of Integrative Holistic Medicine.

She integrates conventional medical training with evidence-based holistic methods that include breathwork, meditation, yoga, mindfulness-based cognitive therapy (MBCT), eye movement desensitization and reprocessing (EMDR), Emotional Freedom Technique (EFT), Mind-Body Medicine, energy medicine, nutrition, exercise, and auricular acupuncture at her private practice. She lives in Hudson, Ohio, with her husband, two kids, two cats, and dog.

Check out www.mindfulpsych.com for more resources, information, and audio files of exercises in this book.