I am currently sitting by the ocean at my brother-in-law’s 19th-century cottage in Horten, Norway, a small coastal town located along the Oslo Fjord. It is the perfect time for such an outing — the week prior was filled with stressful meetings in regards to evaluating pain treatment programs, chronic pain patient outcomes, research design, and doctoral lectures about integrative medicine and pain. To be beckoned out from the city and toward this coastal town nurtures a deep sense of well-being, peace, and gives my mind and eyes a coastal sea to rest upon.
For hundreds of years people have been drawn to this small town for its cool breeze, fertile farmland, and, of course, its proximity to the ocean. It feels good to be away from the clinic and the demands of designing treatments for patients in pain. But as I sit and let my mind wander away from my profession and field, I couldn’t help but be drawn back to questioning again and again: what is effective and what is needed to address suffering and mental well-being in patients with chronic pain, distress, anxiety, and depression?
It’s a complicated question, and I think always will be. I’m not sure if there is an exact answer. Yet as I dig my feet deeper into the sand to bury my professional angst and rest my stress upon the horizon before me, I am reminded that the nature, the ocean, and the air around me may be the very things one can use in order to heal and to nurture a deep sense of psychophysiological well-being.
Neurobiological research has been showing us again and again that there is a strong association between our psychophysiological well-being and nature. But the loss of biodiversity, population growth, climate change, and urban relocation are posing major challenges to not only the natural environment but also to our psychophysiological well-being. I believe that it may be slowing our progress toward developing a more holistic sense of treatment, whether it be within the fields of affective disorders, cognitive dysfunctions, or even pain.
Our oldest practices of medicine and concepts of mental well-being stem from our relationship to the nature that we were born out of — but now too often stay away from. In order to develop an emotive and meaningful relationship with the natural environment to nurture our mental well-being, I believe that we must look toward the research and investigations that have been already attempting to unravel the neurobiological associations between our human condition and the condition of our surroundings.
Medical practitioners and the public often think of health and well-being as the absence of disease within the body. Yet, so much of what determines the inner state of our physical, and especially mental, well-being is the quality and character of our outer environment, which surrounds us, supports us, and, at times, challenges us. Understanding how our mental health may be strongly intertwined with the diversity, health, and even beauty of the ecosystem will be imperative for developing new and innovative mental health care services that promote environmental interaction, conservancy, and awareness.
A broad-based literature assessment conducted by Sandifer, Sutton-Grier, and Ward, titled “Exploring connections among nature, biodiversity, ecosystem services, and human health and well-being: Opportunities to enhance health and biodiversity conservation,” published in 2015 found that there is a large and growing body of literature that demonstrates that contact with nature (broadly defined as urban green spaces, parks, forests, oceans, etc.) can lead to a broad-spectrum of measurable psychophysiological health benefits.
Interestingly, there was a wide range of positive health responses from people who especially interacted with more natural and biodiverse environments, as compared to city streetscapes and workplaces. The researchers reported that, even though there were a few studies that reported no positive effects of nature exposure, these findings were far outweighed by evidence supporting positive mental and psychological feelings of well-being in the presence of nature that included: attention restoration; perceived restorativeness; decreased depression, anger, aggressions and stress; improved mood; increased prosocial behavior and vitality; decreased fatigue; improved cognitive functioning; and even enhanced spiritual well-being. But it seems that in order to utilize the environment as a means of nurturing our mental well-being one must not only be “exposed,” but more importantly, be in contact with those natural surroundings.
A 2007 study, titled “Psychological benefits of greenspace increase with biodiversity,” published in Biology Letters found that the psychophysiological benefits of contact with nature directly increased in public, urban green spaces. Researchers used health and well-being measures such as: the ability to think and gain perspective (“reflection”); the degree of feeling unique through association with a particular place (“distinct identity”); and the degree to which one’s sense of identity is linked to green space through time (“continuity with past”). All of these outcomes were shown to significantly increase for people who were in contact with higher species diversity and plant biodiversity within an urban green space. The researchers also reported that the diversity of habitats, plants, and bird variety in an urban green space were positively correlated with higher measures of psychological well-being.
Even though causal factors are still unknown, these findings suggest that gross structural habitat heterogeneity, as found in a city, might nurture one’s positive perceptions and feelings toward biodiversity and their place within it. Many of us may think that these psychophysiological benefits are only usually achievable through other means, such as changes in nutrition, medication, behavior, relationships, and exercise. Yet it seems that when all of those factors of health, especially that of exercise, is related to outdoor contact with the environment, the health benefits are greater. Some studies have explored the degree of psychological well-being and exercise in regards to whether that exercise is performed outside or indoors.
A 2003 study published in the Journal of Environmental Psychology, titled “Tracking restoration in natural and urban field settings,” compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention, collected from 112 randomly assigned young adults. After performing a variety of cognitively stressful tasks, the researchers found that participants experienced a more rapid decline in diastolic blood pressure when experiencing restoration, i.e. sitting, in a room with tree views, as compared to a viewless room. Walking in a nature reserve after performing these stressful tasks fostered a greater blood pressure change associated with a greater reduction in stress, compared to walking in urban surroundings. Performances on attentional tests improved from pretest when participants were instructed to walk in nature reserves, while it declined in those who walked in the urban setting. But the positive outcomes weren’t only cognitive. Positive affect increased and anger decreased in the nature reserve by the end of the walk, while the opposite pattern emerged in the urban environment.