# Motivation and emotion/Book/2024/Ecopsychological approaches to trauma

* Multimedia presentation (3 min)

## Overview

* Case study: Patient's background
* Sarah is a young person who experienced extensive childhood trauma in the form of emotional and physical abuse. Sarah has been experiencing post-traumatic stress disorder since childhood with symptoms that range from hypervigilance to emotional numbness as well as issues surrounding trust (Fisher 2022). Sarah had previously engaged with conventional methods of treatment such as talk therapy, however, Sarah still struggles to truly experience her emotions and is finding it difficult to progress in her trauma recovery (Fisher 2022). [What has this got to do with ecopsychology? Explain.]
It's strange to think that as humans, we are the only animal that sees ourselves as separate from nature. However, as Joschko et al., (2023) suggest, nature is inextricably linked to our mental health and well-being. Thus, a growing body of evidence supports the therapeutic benefits of connecting with nature. Trauma has an extensive and varied impact on an individual's physiological and psychological experience (Porges, 2016). Where Western culture lacks integration of holistic mental health treatments and traditionally advocated for modalities that provided quantitative results such as cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR), growing research surrounding less traditional areas of study (such as the human-nature connection) have begun to provide further insight into providing a more comprehensive implementation of trauma recovery (Wilson-Dixon, 2024){rewrite}}. Ecopsychology is the interconnection of psychology, ecology and philosophy and views the connection between humans and nature as central to individual and collective emotional healing (Milton & Corbett, 2011). An ecopsychological perspective to mental health can be applied through the implementation of nature-based therapies and can be used as a framework for the treatment of trauma.
This chapter provides insight into an ecopsychological approach to trauma and how nature-based therapies such as wilderness therapy (see Figure 1), forest bathing and horticultural therapy can assist in people's emotional healing from trauma. This is explored through insights from the theoretical framework based on the polyvagal theory, the biophelia[spelling?] hypothesis and attachment theory. Empirical research is utelised[spelling?] and the most effective application of nature-based therapies when considering trauma is explored based on relevant findings.
* Focus questions:
* [Use a numbered list or bullet points as taught in Tutorial 02]
* 1. What is an ecopsychological approach to trauma?
* 2. What are the main theories that underpin an ecopsychological perspective on trauma?
* 3. How can nature-based therapy assist in people's emotional healing from trauma?
* 4. What are the applications for effective nature-based therapy in respect to emotional healing from trauma?
* 5. What are the limitations surrounding nature-based therapy and trauma?

## What is an ecopsychological approach to trauma?

An ecopsychological approach to mental health explores the idea that humans are intrinsically linked to nature and the natural world and thus a disconnection from nature can be linked to psychological distress (Milton & Corbett, 2011). This perspective suggests that the modern day human experience can add to these feelings of distress and our negative impact on nature (such as climate change and urbanisation, see Figure 2) can even contribute to individual and collective trauma (Milton & Corbett, 2011). Put simply, the perspective believes that as humans, we are intrinsically linked to nature and cultivating our connection to it is an integral part of our overall mental health and well-being.
Studies about the impacts of the natural world on mental health became popular in the 1960s coinciding with a rise in concerns for the degradation of the environment (Williams et al., 2020). Since this time the area has become increasingly popular with many studies exploring the many ways in which nature interacts with mental and physical health (Coventry et al., 2021).
An ecopsychological perspective offers an alternate insight into the many facets of trauma through the exploration of the interdependent nature of human beings and nature (Milton & Corbett, 2011). Trauma can be defined as adverse life events and experiences (physical or emotional) that have a lasting impact on an individual's mental, emotional, physical, spiritual or social functioning and well-being (Stevens & Truong, 2024). While trauma can be viewed as both a psychological and emotional experience, an ecopsychological perspective suggests that a disconnection from nature and modern living in general can intensify symptoms of trauma (Milton & Corbett, 2011). Further to this, extensive evidence links time in nature to an improvement in psychological wellbeing and a reduction in trauma symptoms and thus further proving the importance for an ecopsychological perspective on trauma (Stevens & Truong, 2024).
This interconnection between nature and psychological health constructs the foundations for nature-based therapies, therapeutic approaches which utilise immersion in nature to create a safe space for healing and can use nature as a 'co-facilitator' (Fisher 2022). These therapies often involve a direct interaction with nature such as contemplative practices in a forest, working with animals or hiking in the wilderness which can evoke sensory experiences that can facilitate emotional healing (Fisher 2022). When considering trauma recovery from an ecological perspective, the approach is not just about working with psychological state but also re-establishing a sense of connection with the earth.

## Theoretical underpinnings that link Ecopsychology and Trauma

When considering how an ecopsychological approach, nature-based therapies and trauma symptoms interrelate, psychological perspectives provide a beneficial framework for attempting to explain nature's impact on trauma symptoms. Through the examination of the biophelia[spelling?] hypothesis, the polyvagal theory and attachment theory, a theoretical framework will be created to explore the benefits of nature-based therapies in emotional healing from trauma.

### The Biophelia Hypothesis

The biophelia[spelling?] hypothesis is a key psychological theory that underpins an ecopsychological approach and can be linked to trauma recovery. The hypothesis suggests that humans have an inextricable link to nature which is fundamental to our overall health and psychological wellbeing (Fisher 2022). As Ulrich (1984) found, simply witnessing nature through a hospital window could support patients in healing with their study finding that patients post-surgery recovered faster and with fewer painkillers when they had tree views rather than a view of a brick wall. When considering this theory, trauma can be seen as a symptom to be cured with time in nature being the 'medicine'.

### Polyvagal Theory

Trauma symptoms can be expressed through both the mind and body and can often affect the way in which an individual regulates their emotions and their overall feelings of safety in their every day functioning (Porges 2016). The polyvagal theory examines this mind-body connection through the role of the autonomic nervous system (ANS) which responds to stress, which can mean that people who have experienced trauma can experience heightened states of hypoarousal (dissociation or shutdown) or hyperarousal (fight-or-flight) when faced with stimuli that they find triggering (such as something that reminds them of their traumatic experience) (Porges 2016). The vagus nerve plays a role in regulating emotions and impacts our ability to relate to others, especially when in hypo or hyperarousal (Fleming, L. et al. 2020). When considering this through an ecopsychological perspective, nature is seen as safe and calm space and has been characterised in studies as a protector and space of safety that can be linked to calming nervous systems (Milton & Corbett, 2011).

### Attachment theory

Attachment theory highlights the importance of secure, safe relationships in emotional development and wellbeing (Kliethermes et al., 2014). Findings from Kliethermes et al.'s, (2014) extensive research, suggest that 90% of young people who experience complex trauma have insecure attachment stemming from inconsistencies in the caregiver (i.e. abuse or neglect) relationship at a young age and resulting in issues with emotional connection and issues surrounding developing safe and secure relationships in their future. When viewing attachment through an ecopsychological lens, studies have suggested that nature can be viewed as a secure 'caregiver' and can create a secure attachment when people have a strong connection to a specific place in nature (Basu et al., 2019). As (Grahn et al., 2021) suggests this idea is called place attachment (or nature connectedness), the theory suggests that this can mirror a safe, secure caregiver attachment and has been found to have a significant positive relationship on higher levels of healing in nature.

## Nature-based therapies and emotional healing from trauma

Trauma is a complex mix of psychological and physiological responses and has many symptoms, with many people have issues feeling connected to their bodies and regulating their emotions (Milton & Corbett, 2011). As Porges (2016) explores, the connection between mind and body is inextricably linked and thus the need to address both psychological and physiological symptoms is neccessary[spelling?] for emotional healing.
As the Center for Substance Abuse Treatment (2014) discuss, people who have experienced trauma may have difficulty managing and regulating their emotions (such as anger, sadness, anxiety or shame) or on the other hand may have difficulty identifying emotions that they feel. This may result in either feelings of being overwhelmed and out of control when feeling intense emotion (emotionally dysregulated) or feeling numb or detached (dissociated) (Center for Substance Abuse Treatment, 2014).
Further to this, trauma symptoms can be grouped into two distinct categories based on severity and how emotions are expressed (Maercker et al., 2022). Post traumatic stress disorder (PTSD) [Use this link and abbreviation the first time the term is used] describes symptoms that emerge after a person has experienced a single extreme trauma and can be overwhelming and debilitating to a person's everyday functioning (Gupta, 2013). Emotional expression in PTSD can be expressed through psychological symptoms, such as intense 're-living' of the traumatic event, dissociation, nightmares, intrusive thoughts, negative cognition and mood changes. Physiologically, symptoms may include avoidance of triggering stimuli, persistent symptoms of heightened arousal expressed through hypervigilance, difficulty sleeping, heightened fear response, issues with concentration and difficulty regulating emotions such as increased irritability and anger (Gupta, 2013).
In contrast, complex post traumatic stress disorder (or C-PTSD, see Figure 3) tends to develop after a period of sustained and repeated trauma (often during childhood) and which can have a more pronounced impact on an individual's ability to regulate emotions, self-concept, interpersonal connections (Maercker et al., 2022). Emotional dysregulation is a hallmark of C-PTSD and is characterised by difficulty managing heightened emotional reactions such as extreme anger, fear, shame or sadness (Maercker et al., 2022). Understanding how an individual experiences trauma is essential for developing appropriate treatment plans and considering an intervention that targets the complex nature of emotional and physiological symptoms is crucial for successful emotional healing from trauma.
Given this insight into the ranging severity of emotional symptoms of trauma survivors, research has shown that Nature-based therapies (see Table 1. below) can be used as unique and effective tools to address emotional healing (Hansen et al., 2017; Pringle, 2024; Williams et al., 2020). This is can be seen through the following processes.
* Case Study: Nature Therapy Intervention
* Sarah started to engage in nature-based therapy implemented by a trauma-informed therapist (Fisher 2022). Sessions are conducted in calming outdoor environments such as forests and parks and near the water. The therapist creates a safe and supportive trauma-informed therapeutic space utilising care principles to make sure Sarah isn't dysregulated or overstimulated by her environment (Fisher 2022).

### Nature as a healer

The biophilia hypothesis suggests that nature is not simply a superficial tool for supporting healing but a neccessity[spelling?] to our human mental health and wellbeing (Wilson-Dixon , 2024). This is supported by research surrounding forest bathing (see Table 1.) which found that time in forests can significantly reduce physical signs of stress and emotional regulation (Hansen et al., 2017). This is further supported through Williams et al. [grammar?] (2020) study of randomised controlled studies which found that environmental therapies where[grammar?] effective in the reduction of anxiety, depressive symptoms and trauma related symptoms such as emotional regulation. However the study suggested further research would be beneficial due to some contradictory results (Williams et al. 2020). Furthermore, as Hansen et al., (2017) suggest, longitudinal research spanning many cultures would be beneficial in providing further insight into the therapeutic effects of nature based therapies such as forest bathing.

### Regulating the nervous system

Horticultural therapy, which draws on principles of Polyvagal Theory, has been explored as a promising approach for emotional healing from trauma through the role of the autonomic nervous system in the regulation of emotional states (Fleming, et al. 2023). Fleming (et al. 2023) found that horticultural therapy had positive implications for self-regulation (encompassing emotional regulation) through the regulation of the ANS. Furthermore, this idea that nature can be used as a tool to calm the ANS, is supported through extensive review found that Forest Bathing and nature-based therapies in general had a positive relationship on soothing physiological expressions of stress which in turn as suggested by the polyvagal theory, help with attunement and emotional regulation. Fleming (2023) also discuss mindfulness as a tool that is utelised[spelling?] by horticultural therapy for soothing the ANS and regulating the ANS. This is further supported through the case study addressed throughout this book chapter with mindful walks and time in nature supporting emotional regulation (Fisher 2022). In saying this, as the study further empirical research implementing studies specifically focusing on the polyvagal theory, emotional healing from trauma and nature-based therapies are needed in providing further insight into this theory.
* Case Study: Key approaches and techniques
* Sarah is tasked with engaging with her senses mindfully in the natural environment such as going for walks and listening to her surroundings, feeling the ground underfoot and feeling the wind on her face. This mindfulness-based practice supports to ground her in the present and helps reduce feelings of anxiety and hypervigilance (Fisher 2022). Sarah is also guided through grounding exercises through moments of emotional intensity. For instance, Sarah would sit on the ground or touch a tree and utilise this as an anchoring point to help her return to a feeling of safety (Fisher 2022).
* Furthermore, nature is used as a helpful metaphor for her healing journey (i.e. seasons, growth) and her time walking and hiking in nature helps her reconnect with her body safely and unthreateningly (Fisher 2022). Finally, Sarah utilises moments of reflection in nature where she observes her thoughts and feelings and in turn, addresses previously suppressed emotions (Fisher 2022).

### Healing attachment

As Joschko et al. (2023) discusses, attachment is a key contributor in nature-based therapies and emotional healing from trauma. Their findings suggest that a safe and consistent attachment to a certain place in nature can mirror a secure caregiver relationship with findings supporting positive relationships to increased emotional attunement and safety. This is supported through Grahn et al.'s (2021) research that found nature to be a tool for creating positive attunement and healing attachment, however suggested that the therapeutic space in nature must be a controlled environment that supports growth and promotes feeling of security.
* Case Study: Outcomes of therapy
* Throughout nature therapy, Sarah was able to improve her emotional regulation and reported feeling more control over her emotions and saw a reduction in panic attacks and anxiety (Fisher 2022). Being in an informal setting helped Sarah feel more at ease and helped her build a connection and trust with her therapist, something that she previously found difficult (Fisher 2022). Sarah also saw a noticeable easing of PTSD symptoms, including fewer nightmares and flashbacks. She also experienced an increase in the quality of her sleep, and sense of peace and began to feel a greater sense of empowerment, hope and resilience (Fisher 2022).
Table 1.
Examples of key nature-based therapies and their implementation and benefits in relation to trauma.
| Nature Therapy | Implementation | Benefits for trauma survivors |
| Wilderness/Adventure Therapy | A form of group therapy in nature (predominantly working with young people) with a goal of self-growth, often involving activities such as hiking, building connection and immersion in nature (Milton & Corbett, 2011). | A review of literature between 2014 and 2023 looking at adolescents with complex trauma found that there was a positive link to improved attachment, management of stress and improvement in mood and anxiety (Pringle 2024) |
| Horticultural therapy | Utelises[spelling?] the process of gardening and the care of plants as a tool to support mental and physical health and wellbeing (Fleming, et al., 2023) | In a review of randomised controlled trials on effectiveness of nature-based therapies, participants who received horticultural therapy in contrast to recieving[spelling?] conventional therapy reported a significant decrease in depression, anxiety and stress measures (Williams et al., 2020) |
| Forest Bathing/Therapy (Shinrin-Yoku) | Is a concept that originated in Japan and is the practice of mindfully spending time in a forest setting (Hansen et al., 2017). For people who have experienced trauma, forest bathing creates a calm, safe, low-stimulation space for quiet reflection, sensory engagement and emotional regulation (Hansen et al., 2017). | A literature review conducted using 127 papers published on online databases between 2007-2017 indicated that empirical evidence found that forest bathing lowered cortisol levels, reduced heart rate, lowered blood pressure and supported a relaxed state for participants (Hansen et al., 2017). |

## Application of nature-based therapies and trauma treatment

When considering how nature-based therapies can be used to help people heal from past trauma, a treatment plan should be tailored to an individual's needs and abilities (Wilson-Dixon,2024). As Pringle (2024) discusses, some people may benefit from an active and intensive experience such as wilderness/adventure therapy however, some individuals may benefit from a more gentle approach to nature emersion such as forest bathing or horticultural therapy. When considering emotional healing, it is important to consider an individual's trauma journey, capacity for growth and how complex their trauma symptoms are.
Furthermore, as Wilson-Dixon (2024) suggests a holistic approach to mental health through the use of an integrative approach that combines conventional trauma interventions such as cognitive-behavioural therapy (CBT) or eye movement desensitisation reprocessing (EMDR) with nature-based practices that address both the psychological and physiological symptoms of trauma.
As Pringle (2024) discusses in their review of literature surrounding wilderness therapies, there have been ethical issues surrounding the implementation of such therapies without therapeutic [missing something?]. This has lead to harmful experiences for participants with young people reporting coercive behaviour and abuse.
As Pringle (2024) suggests, based on an analysis of previous reviews of the literature, a complex trauma informed approach to nature therapy (in this case adventure therapy) could be utilised to alleviate these issues. This theory proposes a three step process which includes (1) safety, (2) processing and (3) integration with the third step continuing to be implemented after the program has finished to ensure continued aftercare (Pringle 2024). Furthermore, Pringle (2024) suggests that a human rights based approach should be utilised with therapists undergoing adequate and complex trauma informed practices.
Case Study reflection...
After reading the case study, would you engage in nature-based therapies to assist with emotional healing from trauma?
Yes
I feel like I need more information. :

## Conclusion

Nature-based therapies are helpful for emotional healing for people who have experienced trauma, however as the research suggests, this would be more beneficial as a part of an integrative approach to trauma rather than being implemented on it's own (Williams et al., 2020) Further to this, while there is mounting positive evidence surrounding nature-based therapies, there is still a need for further trauma specific evidence with complex trauma informed nature-based therapies utelised[spelling?] to ensure safe and effective practice (Pringle, 2024). With these implications in mind, there is extensive evidence to suggest that nature-based therapies can be an effective tool for emotional healing from trauma.
* Take home message:
* Utilising nature-based therapies can be an effective component of an integrated approach to trauma
* Nature-based therapies are helpful in supporting people who have experienced trauma with emotional healing