Exposure to nature has been shown to improve mental health. It comes as no surprise therefore that healthcare practitioners are starting to "prescribe" nature for patients with anxiety or depression. Do they benefit? It depends.
People differ in their feelings about what is "safe" in nature and that has an influence on their level of anxiety. Open "blue space"; smoky skies, leaden sea. Photo: © Donald J. Rommes
As described in previous blogs, there is a large and increasing body of evidence showing that increased exposure to woodlands, green spaces, or blue spaces is associated with better physical and mental health. The magnitude and duration of this health benefit may depend on the quality of green and blue spaces and people’s access to them, but it may also be affected by other factors.
For instance, research has shown that exposure to safe natural environments can reduce the risk of onset of common mental disorders such as anxiety and depression. But less is known about the impact of such exposure on people who are already anxious or depressed.
Prescription—advice or pressure?
Furthermore, since the potential benefits of exposure to nature appear to greatly outweigh the risks, healthcare practitioners have shown increasing interest in “prescribing” such exposure—especially to people who have existing mental health issues. Such prescriptions or encouragement could be perceived as “pressure” by the people who receive them depending on the way they are delivered. Since self-determination theory posits that feeling pressured by others to engage in activities may undermine intrinsic motivation, questions remain.
Do people—especially those with depression or anxiety—who are encouraged to get out into nature, feel social pressure to do so? If so, does it have a negative impact on their motivation to get out there? How does that affect their experience?
In other words, do well-intentioned efforts by friends and healthcare practitioners undermine the benefits they hoped nature would provide? Maybe.
Lush birch and maple forest in early summer. Clear footpath, gentle grade, tree top canopy. Idyllic stroll or an anxiety-filled adventure into the unknown? Photo: © Donald J. Rommes
A recent large-scale survey of nearly 19,000 people in 18 mostly European countries (but including Canada and California in the U.S.) provided data to help answer the question. The responses in the survey were self-reported and the presence of depression and/or anxiety was determined by whether the respondent took medication commonly prescribed for the condition. Nearly 2700 people (2698) reported they had either anxiety, or depression, or both.
All respondents were asked if they felt pressured to expose themselves to nature, how often they went out into nature, and what the effects on them were from that exposure. The results are reported in a recent paper. Details on how the researchers made their conclusions are explained in the text.
Not surprisingly, people with depression, anxiety, or both had lower intrinsic motivation to get out to natural spaces. However, people with those conditions went out into nature just as often as those who reported no conditions, and people with anxiety visited more often.
Only people with anxiety reported less happiness from their most recent visit to a natural space. The rest reported improved happiness.
Rabbitbrush, wide open high desert, and big skies of northern New Mexico. Far from help; snakes? Maybe not the most restorative place for agoraphobes. Photo: © Donald J. Rommes
Perceived social pressure reduced the intrinsic motivation of respondents to go to natural spaces while actually resulting in increased natural space visitation. Unfortunately, an increase in perceived social pressure resulted in a corresponding decrease in happiness derived from the visit.
The study concludes: “higher perceived social pressure was associated with a greater likelihood of visiting nature, especially for those with anxiety, but lower visit-related happiness, and greater visit-related anxiety, suggests that although some (perceived) pressure may be effective at getting people out, it may undermine intrinsic pleasure from visiting nature.”
How we say something may be just as important as what we say.
In other words, we have to be careful in how we try to motivate our friends and loved ones—even patients—to get out into nature. We should be mindful of our encouragement, careful in our choice of words, and considerate of the person’s mental state. Even so, and unbeknownst to us, they may still feel we are pressuring them. Unfortunately, while that perceived pressure may get them into nature, it may erode the benefits we hoped they would realize from the experience.
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