Can wilderness therapy really improve health and well-being? Here's what the research says

By Jules Murtha | Medically reviewed by Amanda Zeglis, DO, MBA
Published March 1, 2023

Key Takeaways

  • Research shows that nature-based activities can improve the psychological and physical health and well-being of patients who engage in them. Factors like urbanization and environmental degradation, however, may diminish patients’ access to nature.

  • Wilderness therapy is a promising treatment model which combines therapeutic activities and the rural outdoors in order to help young people who struggle with substance use disorders, defiance, and problems at school.

  • Doctors who wish to promote relaxation, social connection, confidence, physical exercise, and improved overall well-being among patients may incorporate nature-based interventions in treatment plans.

If you’re a nature-lover, you probably know first-hand the benefits that come from engaging with the outdoors. Stress reduction, healthier sleeping patterns, and a boost in mood are just a few, according to BMC Health Services Research.[]

It may come as no surprise, then, that health experts are discovering the clinical uses of nature-based therapies and interventions to address the rising rates of chronic physical and mental illness associated with modern living. In order to help patients improve their well-being, doctors may consider using nature-based approaches in treatment.

Nature heals

Nature plays a vital role in the lives of many. According to an article published by the International Journal of Environmental Research and Public Health (IJERPH), exposure to natural environments can foster psychophysiological healing. 

In order to get a better understanding of nature’s effects on health, researchers analyzed 180 self-reported essays on “Forest Therapy Experiences” submitted to the Korea Forest Service.[]

They found that participants who spent time in forests experienced six stages of nature-based healing: Stimulation, acceptance, purification, insight, recharging, and change.

When immersed in nature, participants first reported a positive emotional change. Any anger, anxiety, or tension they felt began to subside, followed by the emergence of more positive emotions.

One participant living with cancer spoke to the healing effects of being with the trees.

“Holding a pine tree, which was my friend, seemed to make me lean and listen to my heart. The forest seemed to comfort me every time I visited,” the participant said.

The next shift to occur was that of positive cognitive change. Participants were able to practice self-reflection while occupying a more stable state of mind. Being in nature ultimately allowed them to reframe their problems, and better plan for the future.

Finally, participants’ behavior changed as a result of spending time in the forest.

"Those who had experienced emotional and cognitive changes [in the forest] were found to be healthier in body and mind than they were before. "


Research paints a very positive picture of the effects nature has on human health and well-being. So: How can physicians put this knowledge to clinical use?

Behavioral effects of wilderness therapy

One example of a nature-based therapy is wilderness therapy.

A meta-analysis published by Criminal Justice and Behavior defines wilderness therapy as “a form of youth diversion and intervention programming which involves the use of rural outdoor settings in conjunction with therapeutic activities.”[]

Designed to treat younger patients with substance use disorders and behavioral issues, wilderness therapy often consists of hiking, canoeing, camping, and other outdoor activities in combination with established therapeutic practices (such as group counseling).

The meta-analysis evaluated 11 studies pertaining to the effects of wilderness therapy on young patients with behavioral issues. The results showed that the therapy yielded significant, positive effects, with effect sizes of 0.832 for self-reported delinquency and 1.054 for caregiver-reported delinquency. 

The finding that caregivers observed a marked decrease in behavioral dysfunction among the participants speaks to the promise of this nature-based approach.

The authors of the Criminal Justice and Behavior study note that there are a few key differences that distinguish wilderness therapy from other wilderness programs.

For one, non-therapeutic wilderness programs may rely on punishment and psychologically abusive tactics to get participants to comply. The wilderness therapy approach, in contrast, is non-forceful and nurturing.

Wilderness therapies may require state licensure, program supervision by clinical staff, family participation in treatment, both individual and group therapy, tailored treatment plans, and cooperation between program staff and aftercare agencies.

All of these characteristics are what make wilderness therapy what it is intended to be—therapeutic.

Other nature-based interventions for your patients

Physicians may explore a number of other nature-based interventions besides wilderness therapy to help improve patients’ well-being.

A review of 27 nature-oriented programs from seven countries was reported in Sports.[] The purpose of the study was to characterize the various types of interventions in terms of their format, potential health outcomes, and target beneficiaries.

For their analysis, the researchers categorized the programs into two groups: those that were designed to change the environments in which patients live, work, learn, and heal, and those that were intended to produce a change in behavior.

For four of the intervention types—green prescriptions, wilderness therapy, green gyms, and outdoor exercise groups—the researchers looked more closely at barriers to their use and potential negative implications.

Outcomes and target beneficiaries varied widely across the programs, ranging from promotion of well-being and prevention of illness, to targeted treatments for specific patients, such as those with high blood pressure. Overlaps occurred, too. For example, a “nature prescription” can promote both physical activity and mental well-being. Visiting forests, engaging in group walks, and visiting public parks, all of which fall under this umbrella, can be therapeutic as well as relaxing for patients.

One main challenge to engaging in nature therapies is lack of access. These programs may not be feasible for all patients. The risk of physical injury from participation is also a consideration.

Overall, though, as noted in the BMC Health Services Research article, clinicians still support the use of nature-based interventions for their ability to promote relaxation, personal empowerment, and social connections among patients. 

What this means for you

Engaging with nature can provide a number of physical and psychological benefits, ranging from improvements in cognition and memory to healthier sleeping habits. Nature-based therapies, such as wilderness therapy, can be used to target and treat behavioral issues in younger patients. But you may help patients of any age to improve their well-being by implementing nature-based interventions, such as forest visits, in treatment plans.

Share with emailShare to FacebookShare to LinkedInShare to Twitter