Advances in Integrative Medicine 2 (2015) 5–12

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Advances in Integrative Medicine

Natural environments and mental health

A R T I C L E I N F O A B S T R A C T

Article history: Ancestral experiences and evolutionary processes continue to influence the brain in ways that may
Available online 15 April 2015 escape conscious awareness by contemporary adults. It is becoming increasingly evident that the 2.2
million years our genus has spent in natural environments are consequential to modern mental health.
Keywords: This might be especially true in the context of rapid global urbanization, loss of biodiversity and
Attention environmental degradation. Here, we examine some of the emerging research related to natural
Delay discounting environments (and specific elements within them) and mental health. Our synthesis includes research
Green space from various branches of science and medicine, e.g., epidemiology, psychology, physiology,
Light at night anthropology, evolutionary biology, and microbiology. Significant knowledge gaps remain. However,
Melatonin
the accumulating strength of research from multiple disciplines makes it difficult to dismiss the clinical
Microbiota
relevancy of natural environments in 21st century mental health care.
Mindfulness
Negative ions
2015 Elsevier Ltd. All rights reserved.
Stress physiology
Urbanization

What is already known about the topic? 1. Introduction

The study of natural environments and mental health is an In contemporary lexicon, natural environments are defined as
expansive topic. those that are relatively unchanged or undisturbed by human
Experience within natural environments (or with components of culture [1]. These environments are often rich in vegetation and/or
natural environments) produces a differential effect on human non-human animal life, with varying degrees of trees, shrubs,
stress physiology vs. similar activity in predominantly built rocks, soil, sand and water. Natural environments are inclusive of
environments. atmospheric components such as light, radiation, charged ions,
Experience within natural environments (or with components of aromatic chemicals and microbes. Distinct from the purely human-
natural environments) supports cognitive restoration. built environment, natural environments are typically not defined
as exclusively wilderness areas; they can include areas that are
designed, manipulated and/or sustained by human interventions.
What this paper adds? In the context of urban settings this may include gardens, parks,
forests and waterside areas.
Our review attempts to tie evolutionary aspects of the human- In the context of rapid global urbanization, loss of biodiversity
natural environment relationship to modern clinical relevancy. and environmental degradation, natural environments are in-
Our review attempts to break down the silo-contained research creasingly being viewed as an ‘ecosystem service’ for the
related to the topic so that the relevancy of compartmentalized promotion of psychological well-being [2]. This, of course, is not
natural environment research areas (e.g. microbiota) can be a new concept. The notion that natural environments can influence
viewed through a single lens. human health dates back to Hippocrates’ teachings on Airs, Waters
and Places [3]. Biologist Sir John Arthur Thompson continued this
argument in his 1914 keynote address at the Annual Meeting of the
British Medical Association, maintaining that human evolutionary
connections to natural environments were being eroded by
* Corresponding author. Tel.: +1 519 745 7800.
modernization. In Thompson’s view, individuals were contending
E-mail address: aclnd@cfs-fm.org (A.C. Logan). with stressors of the urban built environment while missing a layer

http://dx.doi.org/10.1016/j.aimed.2015.03.002
2212-9588/ 2015 Elsevier Ltd. All rights reserved.
6 A. Mantler,
A. Mantler,
A.C.A.C.
Logan
Logan
/ Advances
/ Advances
in Integrative
in Integrative
Medicine
Medicine
2 (2015)
2 (2015)
5–12
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of mental health resiliency otherwise provided by mindful inflammation [27,28]. In addition, fatigue [29] and cognitive
awareness of nature [4]. deficits in attention and executive functioning are common
In this illustrative review we will discuss Thompson’s conten- findings in adults with depression, including individuals who
tion from the view of multidisciplinary research. Although are subthreshold to major criteria [30,31].
referencing depression and anxiety, we approach our discussion In a vicious cycle, cognitive demands can promote mental
with mental health being defined as the World Health Organiza- fatigue and hyperactivity of the sympathetic nervous system [32].
tion sees it: the ability of an individual to reach their potential, Mental fatigue impairs emotion regulation [33], increases the
cope with normal stressors, work productively, and make perception of physical effort, and may diminish the motivation to
contributions to the community [5]. The absence of a mental engage in physical activity and/or negatively influence energy
health disorder is not assumed to be synonymous with a state of expended during activity [34,35]. Once induced, mental fatigue
good mental health. further limits the ability to discount distracting information in the
environment [36].
Ancestral experience, contemporary implications There are many theoretical propositions concerning the
mechanisms that might explain the mental health value of
For over 2.2 million years, our ancestors in the genus Homo natural environments. Two complementary and oft-cited theories
etched out an existence within natural environments. These include the psycho-evolutionary stress recovery theory (SRT) [37]
experiences have shaped many aspects of modern brain function- and the attention restoration theory (ART) [38]. The former
ing [5,6]. Human ancestral survival necessities related to suste- focuses on the contention that ancestral experiences within
nance, shelter, and predator avoidance (as well as other threats) natural environments have resulted in better physiological and
continue to influence emotion, motivation, learning, and reasoning perhaps psychological adaption to natural vs. built or ‘‘artificial’’
in subtle ways. In addition, since the ancestral experience was urban environments. The central discussion of SRT is emotion.
often an outdoor one, sleep and mood-regulating circadian Positive emotion as a result of experience in natural settings can in
rhythms became coordinated by the cycles of natural light [7]. turn limit the burden of stress physiology. Positive moods offered
Detailed discussions of advances within the fields of evolution- advantages to our ancestors [39], and there is every reason to
ary and environmental psychology are available in recent reviews suspect that (alongside the dangers which may have helped shape
[8,9]. A sample of recent findings may help to underscore the subtle our effective physiological stress response) uplifting experiences,
resonance of ancestral experiences that still influence brain amusement and awe in natural environments were common-
functionalities today. For example, while processing complex place.
photographic scenes inclusive of many different objects, humans The ART focuses on directed attention, the effortful cognitive
display attentional privilege toward animals [10,11]. Children as work that requires non-salient distracters to be largely ignored.
young as 9-months of age demonstrate perceptual bias for Blocking out distracters during directed attention exacts a
threatening reptiles and even the mere sound of an ancestral cognitive toll; it ratchets up the requirement for inhibitory energy.
threat can elicit a differential physiological response [12,13]. Even The modern urban environment, and much of the work we do
in crowded market environments, humans display enhanced within it, requires a good degree of directed attention. Mental
spatial memory for locations that are purveyors of calorie-dense fatigue is a primary consequence of sustained directed attention. In
foods. Since this finding was independent of taste and personal turn, mental fatigue itself, and states associated with mental
food choices, it more likely reflects ancestral foraging experiences fatigue such as sleep deprivation and low-grade inflammation
[14]. Other researchers have linked human preference for the [40,41], impair the ability to direct attention. ART proposes that
shininess of contemporary glossy (versus matte) objects to the natural environments are ‘‘restorative’’ settings because they do
ancestral requirement of sourcing a daily supply of fresh, flowing not require taxing mental effort. The distinction is that such areas
water [15]. are inherently fascinating; that is, they provide a more automatic
Human preferences for images of nature scenes over those of engagement of attention (involuntary attention) and this facil-
the built environment are apparent even when they are presented itates a rest and rejuvenation period for the taxed executive
for a mere 1/100th of a second [16,17]. Recent functional magnetic system.
resonance imaging (fMRI) studies have shown that scenes of These theories are complementary in that mental fatigue can
natural environments (versus urban built environment) increase promote stress and vice versa. They are by no means the last word
activity in brain regions associated with positive mental outlook, on the mechanistic pathways of natural environments. The
emotional stability, altruism, empathy and depth of love. On the development of social capital, opportunity for physical activity,
other hand, urban built scenes consistently increase activity in the and immune function via exposure to beneficial microbiota
amygdala, an area well known for processing threat, arousal and (described later) are examples of other pathways. However, since
risk assessment [18–21]. Moreover, a greater degree of realism in psychological distress and fatigue are interrelated with detrimen-
the display of nature images presented to subjects – e.g. 3- vs. 2- tal lifestyle habits such as unhealthy dietary patterns [42,43] and
dimensional – alters cerebral oxygen use in ways that support sedentary behavior [44], any potential mitigation by way of natural
subjective reports of improved mental functioning [22,23]. environments could have a ripple effect in the promotion of mental
health.
Theoretical constructs, primary mechanisms
Psychological connection to nature
In order to contextualize the specific value of natural
environments to mental health, it may be helpful to briefly Several validated instruments are now used to assess the extent
underscore known links between psychological distress and to which an individual is connected to the natural world. A recent
cognitive load in relation to depression and anxiety. The meta-analysis found that a higher level of nature connectedness
accumulation of stressful life events, ranging from daily hassles (also called nature connectivity, nature relatedness) is positively
to more significant negative events, have been associated with a associated with vitality, positive affect and life satisfaction [45].
trajectory toward compromised mental health [24–26]. Over time, Other studies published post-analysis have shown that higher
this may take its toll in the form of damaging physiological scores are negatively correlated with lower anxiety and anger
consequences, most notably captured by markers of low-grade [46,47].
7 A. Mantler,
A. Mantler,
A.C.A.C.
Logan
Logan
/ Advances
/ Advances
in Integrative
in Integrative
Medicine
Medicine
2 (2015)
2 (2015)
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While more research is required, there are indications that Stress physiology
nature relatedness can be cultivated [48,49]. Mindfulness (aware-
ness of the present moment and its associated thoughts, emotions The epidemiological studies are supported by intriguing
and sensations), contentiousness, and the ability to perceive experimental studies. A popular research design is to employ
nature’s beauty appear to be prerequisites for achieving maximal measurements of physiology and/or validated instruments of
health benefits associated with natural environments [50–54]. In neuropsychological relevance before and after experimental
other words, images of nature, views to nature, and even time exposure to actual natural environments, elements of nature
spent in nature may not fulfill its full clinical promise if the (e.g. sounds, aromatic chemicals), or surrogates such as photo-
individual is distracted from mindful awareness. graphic images of nature. The control in these studies is typically
the built urban environment or images thereof. Using this design,
Residential proximity to natural environments researchers have explored the impact of the natural environment
on stress physiology.
A variety of international studies have examined relationships Spending time in nature, participating in activities associated
between residential proximity to natural environments and with gardening, or simply viewing scenes of nature have each been
mental health. For example, studies found increasing residential associated with favorable responses as measured by autonomic
distance from areas high in green space, or low levels of green control and heart rate variability [79–83]. As an illustrative
space surrounding the home, were associated with increases in example, viewing scenes of nature versus an urban built
self-reported stress as well as poor scores on measurements of environment for 10 minutes prior to the induction of mental
general health, vitality, overall mental health and bodily pain [55– stress results in enhanced heart rate variability and more
60]. Research on residential proximity to bodies of water, or so- dominant parasympathetic activity [84]. These studies strengthen
called ‘blue space’, also report positive impact on general health the previously described evolutionary and epidemiological re-
and well-being [61]. Even self-reports on the perceived degree of search that also suggest a strong connection between the natural
greenness of urban neighborhoods correlate positively with environment and mental health.
individual life satisfaction and mental health among residents Research interest in so-called shinrin-yoku (Japanese term for
[62,63]. ‘‘forest bathing’’) or forest therapy is increasing [85]. Researchers
Of particular interest is a Dutch study that found residents of engaged in field work have evaluated various end-points while
areas with a low degree of green space had a greater risk of subjects walk (or contemplate while seated comfortably) within
depression and anxiety disorders vs. residents with the highest forest settings. They have compared these outcomes with similar
concentration of green space in proximity to the home. Those walking or contemplation within urban built environments while
residing in areas with small amounts of green space ( 10% within under similar weather, atmospheric conditions and time of day.
1 km of home) had a 25% greater risk of depression and a 30% Improvements in mood are reported after experiences within
greater risk of anxiety disorders versus those with the highest area forest settings. Subjective reports are matched by changes in stress
of green space ( 90%) near the home [55]. Similarly, a study in New physiology and associated markers such as lower cortisol, reduced
Zealand found every 1% increase in the proportion of useable or sympathetic tone, lower burden of oxidative stress and systemic
total urban green space in proximity to the home was associated inflammation, improved blood pressure, natural killer cell count/
with a 4% lower rate of anxiety/mood disorder treatment [64]. activity and heart rate variability [85–95].
Furthermore, individuals who moved into areas with a higher
degree of green space (vs. previous residence) experienced Cognition
improved mental health, a benefit that continued to endure over
three years of study [65]. Some research suggests that the mental Several studies have found inverse relationships between
health benefits of green space can remain after controlling for childhood play experiences in green/blue spaces and hyperactivity
urbanization, gender, physical activity, socioeconomic status [66], and/or inattention [96–99]. The results of controlled laboratory
and specifically in depression, they are also evident after experiments indicate that certain environments are more likely to
controlling for genetics [67]. facilitate cognitive restoration following mental fatigue. For
Residential proximity to natural environments may be of example, viewing scenes of nature (vs. urban built scenes) can
relevance in the developmental origins of health and disease lead to more rapid recovery of cognitive performance (executive
(DOHaD) construct. DOHaD is based on volumes of evidence that attention, memory recall, target identification, reaction time,
link perinatal and early life experiences with long-term health logical reasoning, anagram task performance) in the period
outcomes [68]. Low birth weight has been associated with following research-induced mental fatigue [100–106].
subsequent depression and difficulties in cognition, academic Field studies indicate that natural environments can mitigate
achievement, motor skills, and social adaptive functioning later in cognitive fatigue. For example, researchers induce neuro-cognitive
life [69–71]. The ripple of unchecked psychological stress and a fatigue in subjects via mentally challenging tasks, after which they
sedentary lifestyle during pregnancy [72,73] may even extend take a walk in a vegetation-rich park or on streets with very few
from generation to generation [74]. elements of natural environments. Prior to and at the conclusion of
Several studies have linked residential greenness with healthy the walk, neuropsychological tests are utilized to measure effects
term pregnancies [75–78]. A recent study of over 64,000 birth of the differing environmental experience. Using this general
outcomes in Vancouver, Canada, showed that greenness within design, researchers have reported significant cognitive benefits
100 meters of residence is associated with higher term birth following a walk within urban natural (versus built) environments
weight and reduced likelihood of preterm births. Importantly, in adults with depression [107], children with attention deficits
these associations in were independent of air pollution, noise, [108], and otherwise healthy adults [109,110].
walkability, and distance to the nearest park [78]. This suggests Natural environments may be an effective means to mitigate
that stress reduction, perceptions of the neighborhood, or other consequences of the increased cognitive load that is often
undefined biological interaction with natural environments during characteristic of modern urban environments. Research shows
pregnancy may influence birth outcomes. Moreover, taking these that humans discount the value of future rewards, instead
findings together underscores the notion that the benefits of prioritizing smaller immediate rewards, and that greater dis-
natural environments may begin even before birth. counting is associated with impulsivity, depression, obesity, and a
8 A. Mantler,
A. Mantler,
A.C.A.C.
Logan
Logan
/ Advances
/ Advances
in Integrative
in Integrative
Medicine
Medicine
2 (2015)
2 (2015)
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host of detrimental lifestyle habits [111–113]. Overall cognitive human microbiota is an open question [143]. Recent European
load, perceived competition for resources, and even physical studies have connected the level of green space and biodiversity of
aspects of urban environments may magnify delay discounting. For vegetation surrounding one’s residence with both diversity of
example, when queried on an urban street while in the vicinity of a select bacteria on the skin, and lower odds of an allergic IgE
fast-food outlet, respondents are much more likely to discount the reaction to common allergens [144,145]. These results appear even
value of a future financial reward, choosing instead a smaller more intriguing in the context of a recent report showing that live
immediate gain [114]. On the other hand, researchers have found Mycobacterium vaccae (non-pathogenic microbe, typically found in
that viewing scenes of nature or actually being in urban natural soil, mud and/or natural water wells [146]) can improve cognition
environments (versus control scenes of, and actually being in, the and reduce experimental signs of anxiety in an animal model [147].
urban built environment) is associated with significant reductions While the research is still in its beginning stages, it indicates that
in impulsivity and future discounting [115,116]. microbial load is another way in which the natural environment
Time spent in natural environments has also been associated may interact with mental health.
with improved creativity and overall vitality [117,118]. If natural Although the relationship between reduced daylight exposure
environments can buffer stress, improve cognition and influence and excessive light at night (LAN) has been the subject of extensive
affect, as cited in the literature above, then it would seem plausible reviews in the mental health realm, there is no question that non-
these benefits might carry forward to academic performance. image forming components of the eyes are critical in the
Although this is a new area of enquiry, emerging studies have transduction of light energy into circadian-regulating commu-
linked proximity of academic settings in relation to natural nications [148]. This system is a product of the multi-millennia
environments as well as classroom views to natural environments experience of life outside in day light and under a dark sky at night
with enhanced academic performance [119–121]. In occupational [7]. Residing in areas that were particularly dense in green space –
settings, window views to nature and the presence of indoor in the range of 80% – was associated with healthier patterns of
potted plants have been linked to improved workplace perfor- sleep (duration), a finding that was distinct from association with
mance [122,123]. physical activity, socioeconomic status or current psychological
distress [149].
Non-visual aspects, natural light The extent to which green space is a surrogate marker for less
exposure to light at night is an open question; however, spending
Studies involving photographic images lend strong support to time outdoors allows individuals to obtain levels of light levels
the idea that physiological responses to natural environments can associated with mood support and lower body mass index
be mediated through the visual system [100]. However, real-world [150,151]. In particular, in the morning there are high levels of
experiences in the natural environment involve all sensory the shorter wavelength blue light and this may have a specific
systems; thus, differences in natural versus urban built environ- evolutionary relationship to the processing of emotion, and
ments are not limited to those detected by the visual system. maintaining/resetting circadian rhythms [152–154]. Thus, areas
Building on aforementioned research, studies have indicated with greater green space may increase the time spent outdoors
beneficial effects on stress physiology, relaxation and mood using during these critical times when blue light is at its maximum, and
auditory (sounds of nature), olfactory (volatile chemicals released less LAN, enabling the body to set appropriate circadian rhythms
from leaves), and even tactile (touch of real leaf vs. synthetic leaf and establish healthier sleep patterns.
made of resin) experiences [124–130]. Research related to charged
ions and respirator health is controversial; however, recent Grey space, vulnerable populations
reviews support the assertion that negative ions have mood-
regulating properties [131,132]. While there is little doubt that the It is difficult to discuss the potential health benefits of natural
relative concentration of negatively charged ions is higher in environments without reference to the Janus of detriments known
natural environments [133], there is no evidence to guide a clinical as grey space. These are residential areas with disproportionate
‘‘dose’’ and duration of exposure via ion-generating machines. industrial and commercial activity, high levels of traffic, freight
The hygiene hypothesis suggested that modern environmental transportation hubs, bars/liquor stores, convenience stores, fast-
changes contribute to a loss of contact with microbial diversity and food outlets, and highly visible marketing toward unhealthy lifestyle
increased risk of allergy/autoimmune conditions [134]. However, choices [154–163]. As these references indicate, grey spaces do not
over a decade ago it was suggested that beneficial influence of non- occur at random in urban areas, they are more prevalent in lower
pathogenic microbes in regulating allergy (through T helper cell socioeconomic areas. Also noteworthy is the higher burden of
TH1:TH2 immune effects [135] and other pathways [136]) might mental health disorders and psychological distress that is slanted in
also extend into conditions where diminished mood is commonly the direction of disadvantaged populations [164].
reported. Groundbreaking studies in rodents and humans have Green space may simply be a surrogate marker for less of the
supported the concept that environmental microbiota may grey space factors that work against mental health. In other words,
influence mood [137]. Although the research primarily examines more green space, if only through displacement alone, may equate
the relationship between microbes and mood using probiotics as to less noise, traffic, environmental toxins and marketing cajoling
the modality, it is worth noting that lactic acid bacteria and other toward (and opportunity to partake in) unhealthy lifestyle choices
beneficial microbes are frequently found in natural environments [165–167]. Urban vegetation is an essential ecosystem service, and
[138,139]. The microbes within the mammalian intestinal tract, its density is often slanted along socioeconomic, political and
although undoubtedly influenced by dietary factors, are also a demographic lines in favor of the socially advantaged [168].
product of environmental bacteria [140,141]; thus, it can be Furthermore, since trees clear millions of tonnes of pollutants each
postulated that similar effects may be conferred through interac- year, their absence from grey space is not merely an aesthetic issue
tion with microbes in an environmental setting. [169].
Greater overall diversity of microbes is found in the rural (vs.
urban) near-surface atmosphere, including a relatively higher level Environmental degradation
of the phyla that are commonly found on human skin and in the
intestines such as Actinobacteria, Bacteroidetes, Firmicutes and If natural environments are working toward the promotion of
Proteobacteria [142]. How geography and culture influences public health – mental health in particular – we would expect
9 A. Mantler,
A. Mantler,
A.C.A.C.
Logan
Logan
/ Advances
/ Advances
in Integrative
in Integrative
Medicine
Medicine
2 (2015)
2 (2015)
5–12
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there to be consequences when such environments are subjected environments are not without risk; examples include excess
to degradation. Industrial activities, climate change, invasive exposure to ultraviolet radiation, contact with disease-carrying
species, or a combination are examples of environmental variables vectors, encounters with dangerous animals [194–197]. However,
that alter natural environments. Indeed, emerging research with proper precautions these potential risks are significantly
highlights that visible environmental degradation impacts health. minimized.
Changes to vegetation and tree loss at the community and regional
level are associated with increased physical illness and declining Conclusion
mental health. Specifically, these losses appear to provoke
depressive symptoms and a loss of sense of place [170–175]. Despite limitations and knowledge gaps, it is evident that the
natural environment and its parts (e.g. natural light) has a
Clinical considerations significant impact on numerous levels of mental health. The
results of epidemiological studies are being bolstered by laborato-
For now, there remain significant knowledge gaps in the ry and field studies that examine markers of stress physiology.
relationships between natural environments and mental health. While many questions remain, especially those concerning
However, despite the limitations and the obvious need for more mechanisms, effect size and gradients of importance based on
research, it seems safe to conclude that an increasingly robust body gender, socioeconomic status, and specific natural environment
of research suggests natural environments are of clinical impor- attributes (features; blue space vs. green space; safety; aesthetics),
tance. Given the significant aforementioned body of evidence, the available research may have implications in clinical applica-
clinicians can play an important role in bridging the gap between tion. The extent to which the natural environment can influence
the potential benefits of nature and the realized promotion of mental health, as well as how it can be effectively utilized, is an
positive mental health. area for future research.
Natural environments provide top-level opportunity for physi-
cal activity and social engagement – both factors encouraging Contributions
positive mental health. Community gardening and horticultural
group activities that can influence social connections, physical Both authors made substantial contributions to this illustrative
activity, healthy dietary habits and nature connection [176–183]; review, including acquisition, analysis and interpretation of data;
however, some research has shown that the benefits of green space both authors drafted and revised the article for important
seem to transcend physical activity alone [184]. For the clinician it intellectual content and agree to its final version.
is worth noting that physical activity conducted in natural
environments is reported to be more enjoyable and less taxing
Conflicts of interest
(vs. indoor, treadmill, oval track, or in the built environment) [185–
189]. Such motivation may be particularly beneficial for patients
AM, none; ACL is co-author of Your Brain on Nature (Harper-
with mental disorders for whom exercise may not feel pleasurable;
Collins, 2012).
therefore, using natural environments could lead to enhanced
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