This review (2020) of psychedelic therapy and nature relatedness argues that both may work in synergy and that maximizing nature relatedness during psychedelic therapy could provide added benefits.
Therapeutic psychedelic administration and contact with nature have been associated with the same psychological mechanisms: decreased rumination and negative affect, enhanced psychological connectedness and mindfulness-related capacities, and heightened states of awe and transcendent experiences, all processes linked to improvements in mental health amongst clinical and healthy populations. Nature-based settings can have inherently psychologically soothing properties which may complement all stages of psychedelic therapy (mainly preparation and integration) whilst potentiating increases in nature relatedness, with associated psychological benefits. Maximising enhancement of nature relatedness through therapeutic psychedelic administration may constitute an independent and complementary pathway towards improvements in mental health that can be elicited by psychedelics.
Nature relatedness — a stable, trait-like sense of oneness with the natural world — and direct contact with nature have each been associated with broad benefits for mental health, including reductions in rumination, negative affect and stress, and increases in mindfulness-related capacities, connectedness and well‑being. Earlier research suggests that these psychological processes overlap with those reported after administration of classical serotonergic psychedelics (notably substances acting at the 5-HT2A receptor such as psilocybin), which have been linked to sustained increases in nature relatedness, openness, mystical or transcendent experiences, and improvements in clinical and non-clinical measures of psychological health. Gandy and colleagues set out to review and synthesise evidence for potential synergistic effects between therapeutic psychedelic use and nature contact. The paper argues that incorporating nature-based settings and practices—particularly during preparation and integration phases of psychedelic therapy—could amplify shared therapeutic mechanisms, increase the likelihood that participants adopt nature-based habits, and thereby provide an additional pathway by which psychedelics contribute to improved mental health. The authors also consider practical and safety constraints and propose avenues for future research and clinical models focused on enhancing nature relatedness.
Papers cited by this study that are also in Blossom
Agin-Liebes, G. I., Malone, T., Yalch, M. M. et al. · Journal of Psychopharmacology (2020)
Barrett, F. S., Griffiths, R. R. · Current Topics in Behavioral Neurosciences (2017)
Barrett, F. S., Doss, M. K., Sepeda, N. D. et al. · Scientific Reports (2020)
Belser, A. B., Agin-Liebes, G. I., Swift, T. C. et al. · Journal of Humanistic Psychology (2017)
The review brings together evidence across several topical domains to support the proposition that psychedelics and nature contact operate through overlapping mechanisms relevant to mental health. Nature contact and nature relatedness: Contact with natural environments is associated with reductions in anxiety, depression, stress and rumination, and with improvements in mood, attention restoration and vitality. Even brief exposure (for example, 5–10 minutes) to natural settings can improve psychological well‑being. Separately, nature relatedness (one's enduring identification with nature) correlates with eudaimonic well‑being, life meaning, positive affect, resilience and pro‑environmental attitudes. The authors note that nature relatedness appears relatively stable and resistant to change, making interventions that produce sustained increases valuable. Neurobiological overlap: Evidence cited suggests parallel effects of nature contact and psychedelics on large‑scale brain organisation. Walking in forested environments increases functional connectivity relative to urban walking, while psychedelics acutely reduce modularity and enhance global connectivity, with some effects persisting for weeks. Both interventions are reported to reduce rumination and dampen activity in nodes of the default mode network (DMN); specifically, nature exposure appears to reduce subgenual prefrontal cortex (sgPFC) activity, while intravenous psilocybin acutely decreases blood flow and metabolism in the sgPFC and posterior cingulate cortex (PCC). Psychological mechanisms: The authors review several psychological constructs shared by psychedelics and nature contact. Connectedness—an empathic, embodied closeness to self, others and the wider world—is increased by both, and ego‑dissolution or unitary experiences under psychedelics are strongly associated with subsequent increases in nature relatedness. Mystical‑type and transcendent experiences occur in natural settings and under psychedelics and predict improvements in psychological well‑being; mystical experiences in nature have been linked particularly to increased pro‑environmental behaviour. Psychedelics and nature both elicit awe, which correlates with greater life satisfaction, prosociality and reduced negative affect. Both reduce negative affect over the longer term, which is relevant for mood and substance‑related disorders. Mindfulness capacities are enhanced by psychedelics and by nature contact; these capacities mediate reductions in rumination and support recovery in depression, addiction and PTSD. Finally, psychedelics can increase personality traits such as openness and absorption and decrease neuroticism, traits that are associated with more positive responses to nature. Practical and therapeutic considerations: The review discusses how natural settings could benefit psychedelic therapy. Natural environments may be more psychologically soothing, reduce anticipatory anxiety (a predictor of challenging psychedelic experiences), and foster ‘soft fascination’ and present‑moment attention that supports therapeutic processing. The authors argue that nature elements can be incorporated even when sessions must occur indoors (plants, nature imagery, biophilic design, hybrid sheltered structures) and that the degree of nature immersion could be titrated to individual needs. Preparation and integration: Gandy and colleagues outline specific nature‑based practices for preparation and integration: horticultural rituals (weeding, planting) as metaphors for inner work; Shinrin‑Yoku (forest bathing) and awe walks to consolidate feelings of wonder and connectedness; outdoor ‘walking and talking’ therapy; barefoot grounding exercises; nature journaling; and the development of personalised nature plans to encourage sustained contact post‑session. The authors note practical safeguards (e.g. multiple facilitators outdoors) and the difficulty that severely depressed individuals may have accessing nature, arguing that integration work could help establish nature habits as a durable resource. Constraints and implementation issues: The paper highlights barriers to holding psychedelic sessions outdoors, including privacy, disturbances, weather and safety concerns, and emphasises legal and regulatory constraints around Schedule 1 substances. The authors also describe more contained solutions (biophilic indoor spaces and screens depicting nature) and mention initiatives planning to use sheltered nature‑based facilities.
The authors interpret the collected evidence to suggest a plausible synergistic relationship: nature contact could augment key therapeutic mechanisms engaged by psychedelics—reducing rumination and negative affect, increasing mindfulness, eliciting awe and mystical‑type experiences, and enhancing a general sense of connectedness—and thereby potentially increase the therapeutic yield of psychedelic therapy. They propose that maximising increases in nature relatedness might itself be an independent, complementary pathway to mental health improvement following psychedelic treatment. Relative to earlier work, the paper emphasises the convergence of neurobiological, psychological and behavioural findings linking both interventions to similar outcomes, and it extends the clinical discourse by proposing concrete ways to incorporate nature into preparation and integration phases, and in some cases into the psychedelic session proper if safety and privacy can be assured. The authors also suggest developing a distinct therapeutic model aimed specifically at treating 'nature disconnection', including a staged approach that moves from indoor, inward‑focused sessions toward outwardly focussed sessions in natural settings as participants gain experience. Limitations and uncertainties are acknowledged. The review notes practical, legal and safety barriers to outdoor psychedelic sessions and cautions that not all participants will find nature immersion appropriate; some may prefer indoor clinical environments for difficult therapeutic work. Measurement issues are raised: short scales may suffer ceiling effects and the authors recommend using validated instruments such as the NR-6 or the longer Disposition to Connect with Nature scale, alongside attitudinal and behavioural measures of environmental concern and lifestyle. The authors call for empirical studies that conduct fine‑grained assessments of settings, carefully evaluate potential risks, and test whether nature‑based elements concretely augment clinical outcomes and sustain behaviour change.
Gandy and colleagues conclude that nature‑based settings and practices have potential to enhance preparation and integration phases of psychedelic therapy and, under appropriate safety conditions, might be used for psychedelic sessions themselves. They argue that combining psychedelic administration with intentional efforts to increase nature relatedness could reduce anxiety and rumination, boost mindfulness, and foster awe and connectedness, thereby constituting an additional pathway to improved mental health. The authors recommend future empirical work to evaluate these propositions with sensitive measurement of setting characteristics, nature relatedness and environmental attitudes, and with careful attention to safety and implementation constraints.
Nature relatedness has been associated with a broad range of benefits to psychological health and well-being. It is a measurable, trait-like construct of one's self-identification with nature, defined as a sense of 'oneness with the natural world'or a 'sustained awareness of the interrelatedness between one's self and the rest of nature'. It is a stable state of consciousness, that is experiential, emotional and highly personal, rather than rational or deliberation-based. Nature relatedness is considered to be a basic psychological human need, associated with mental well-being and also with increased contact with nature. Contact with nature is associated with an extraordinarily broad range of benefits to physical and mental health and well-being (for reviews see. Nature relatedness (sometimes referred to as nature connectedness in the literature) is distinct from nature contact, yielding independent and additive benefits, although the two have a positively reinforcing relationship. Research suggests that experiences with classical or serotonergic psychedelic compounds (acting as agonists at the serotonin 5-HT 2A receptor)can foster sustained increases in nature relatednessand appreciation for and contact with nature. Furthermore, access to nature-based settings during psychedelic sessions predicts positive changes in nature relatedness. An increase in nature relatedness likely occurs through a number of different mechanisms, such as through increased mindfulness-related capacities, connectedness, openness to experience and eliciting strong emotional states (for a review see. That psychedelics such as psilocybin are capable of eliciting sustained increases in nature relatedness even when administered in clinical settings lacking in nature) is a noteworthy finding. Increased nature relatedness is just one of many psychological benefits that can be occasioned through therapeutic administration of psychedelics to both healthy and clinical populations. In clinical populations, psychedelic substances are currently being investigated for the treatment of major depressive disorder and existential anxiety secondary to a terminal cancer diagnosis, addictionand PTSD. For reviews of clinical studies with psychedelics see dos. In studies looking at psychedelic administration amongst healthy populations, sustained increases across numerous measures of psychological well-being are observed (see reviews by. The mechanisms by which psychedelics confer benefits to well-being share overlap with how nature relatedness and nature contact yield benefits. Psychedelics have been associated with eliciting sustained increases in mindfulness-related capacities, facilitating enhanced connectedness, empathy and unitive statesand eliciting awe. Psychedelics have also been found to increase openness to experience in an enduring way. In this review, we lay out the argument for utilising naturebased settings and practices for some stages of psychedelic therapy (mainly preparation and integration). The current model for psychedelic therapy requires the psychedelic sessions themselves take place in a secure clinical setting for the safety and predictability this provides. However, it may be that incorporating some elements of nature contact and connection into the preparation and integration phases could support the therapy model, potentially by amplifying some of the key therapeutic mechanisms, whilst also increasing the likelihood that a patient will use nature as an ongoing resource. The potential of psychedelics to increase nature relatedness may warrant the development of a new model of psychedelic therapy specifically focused on increasing nature relatedness for the sake of the well-being this can bring to the individual, and the nature-protective potential this could bring to our communities. Such a model could be used with a healthy (non-clinical) population, with whom the possibility of conducting the psychedelic session itself in a secure and sheltered natural environment could be explored.
The inherent healing power of nature has been recognised for centuries. Nature can be defined in this context as 'areas containing elements of living systems that include plants and nonhuman animals across a range of scales and degrees of human management, from a small urban park through to relatively "pristine wilderness"'. When it comes to mental health, contact with nature is associated with reductions in mental distress, anxietyand depression. Nature contact can yield improvements in mood and memory in patients suffering from major depressive disorderand improve symptoms of post-traumatic stress disorder (PTSD). It can also reduce rumination, and stress levels (for reviews see, with this stress reduction being an important health benefit alone and a potential mechanism for further health benefits. Contact with nature is a strong predictor of psychological well-being, elevating both hedonic and eudaimonic well-beingand facilitating psychological restoration, the latter being defined as the renewal of psychological resources depleted by mental exertion or stress, such as attention and mood. Time in nature has been found to increase vitality, self-esteem, and result in higher positive affect (associated with the extent a person feels happy, joyous, interested and active) and lower negative affect (associated with a predisposition towards negative feelings such as emotional distress and states such as sadness, guilt and fear). Even 5-10 minutes spent in a natural setting is sufficient to improve psychological well-being and lower anxiety and stress levels.
In addition to nature contact, there is a substantial body of research literature that highlights a strong association between nature relatedness and psychological health and eudaimonic well-being, that is, subjective experiences linked to living a life of virtue in pursuit of human excellence, associated with experiences of self-actualisation, vitality and personal expressiveness (for a review see. One study reported a positive relationship between nature relatedness and eudaimonic wellbeing that was nearly four times larger than the increase in the latter associated with higher socio-economic status. Specifically, nature relatedness has been associated with enhanced vitality, greater perceived life meaning, life satisfaction, feelings of worthwhileness, greater happiness and positive affectand reduced levels of anxiety. In addition, nature relatedness is associated with higher levels of selfreported personal growth, enhanced psychological functioningand resilience. Nature relatedness is also associated with physical activity, which is linked to good mental health. While nature relatedness is associated with a broad range of psychological benefits, it may be associated with modern health worries perceived to result from living in artificial environments. Nature relatedness is also a strong predictor of pro-environmental attitudes and behaviour, this being a salient finding, given a notable lack of effective interventions for reversing environmentally damaging human behaviour. Proenvironmental behaviour has been associated with well-beingand strongly linked to prosociality (the intent to benefit others) -with the two likely being mutually reinforcing. However, aspects of nature relatedness reflecting self-identification with nature and a conservation worldview may be associated with increased depression, anxiety or stress, likely due to increased awareness of human driven ecological damage and destruction. Nature relatedness acts as an important mediator for some of the benefits obtained while spending time in nature. For example, nature relatedness was reported to mediate the link between contact with nature and subjective wellbeing and ecological behaviourin addition to mediating the relationship between engagement with natural beauty and pro-environmental behaviour. Likewise, it was found to partially mediate a number of other positive effects experienced in natural settings such as increased attentional capacity, propensity to experience positive emotions and the ability to reflect on a life problem, while promoting a more positive body image. Furthermore, nature relatedness was found to be positively associated with the perceived restorativeness of natural settings, psychological benefits obtained from outdoor exerciseand predicts life satisfaction and self-esteem when individuals are attuned to nature's beauty. Following contact with nature, higher levels of nature relatedness have been found to positively predict life satisfaction, transcendent and awe-inspiring experiencesand to elicit higher valuations of intrinsic (e.g. personal growth, intimacy and community) as opposed to extrinsic (e.g. money, image and social status) aspirations. Research indicates that childhood is a crucial life period for the development of a bond with nature. Greater contact with nature during childhood is associated with greater nature relatedness, contact with nature and pro-environmental behaviours in adulthood. However, as urbanisation increases globally, increasing numbers of people are being brought up in nature-depleted environmentswhich is likely to negatively impact people's connection to nature. In addition, increasing usage of electronic entertainment technology and smartphones appears to be fuelling a growing disconnection from nature. This disconnection is further evidenced by a shift away from nature-based content in media and cultural products since the 1950's. There is a need for interventions able to foster sustained increases in nature relatedness, as passive contact with nature alone may only elicit transient increasesor be insufficient to increase it. Investigations into experimental manipulations of nature relatedness are lacking. From what is known, with the exception of being an occasional consequence of passive and active nature contact, nature relatedness appears to be a deeply held and stable trait, and seems resistant to change like other environmental attitudesand personality traits.
Neurobiological. Natural settings may elicit mind/brain states that share some similarities with psychedelic mind/ brain states. Subjects walking in forests have been found to exhibit stronger functional connectivity between different brain regions than people walking in busy urban environments. Similarly, psychedelics appear to reduce modular activity, while enhancing global connectivity in the brain, with effects extending at least a month after the psychedelic session. Both psychedelicsand contact with natureappear to reduce rumination and activity in areas of the brain implicated in depression, including the default mode network (DMN). The DMN is involved with capacities involving self-projection, including remembering the past, envisioning the future and considering the thoughts and perspectives of otherswith parts of this brain region thought to mediate the sense of self. Rumination has been linked to the DMNand increased functional connectivity between the DMN and subgenual prefrontal cortex (sgPFC), including increased regional cerebral blood flow in the latter. Rumination is associated with mood disorders such as depression and anxiety (for a review seeand is an important predictor and maintaining factor of persistent PTSD (for a review see. Contact with nature appears to reduce activity in the subgenual prefrontal cortex (sgPFC) which is a major node of the DMN. Similarly, intravenous psilocybin administration has been found to acutely decrease blood flow and metabolism in the sgPFC and also the posterior cingulate cortex (PCC) which is another major node of the DMN.
Connectedness. Connectedness has been suggested as a key phenomenon relevant to both the acute action of psychedelics and their longer-term effects. The construct of connectedness is currently being defined as an empathic and embodied sense of closeness to self, others and world/universe. An upcoming measure of connectedness, the Watts Connectedness Scale (WCS) has three subscales (i) 'connection to self' which includes connection to senses, emotions, values and life meaning; (ii) 'connection to others' which includes feeling part of the surrounding environment and empathy for others (iii) 'connection to world/universe' which includes connection with nature, the 'bigger picture' and feeling that everything is interconnected. All of these are important components of the capacity for communion with the natural world. We propose that the ability of psychedelics to increase nature relatedness may be a component of a more general sense of connectedness so often associated with the psychedelic experience. Ego-dissolution and the (arguably mutually dependent) unitive experience may be central to the experiences of increased interconnectedness that can occur. Ego-dissolution has been described as 'a disruption of ego-boundaries, which results in a blurring of the distinction between self-representation and object-representation'and is strongly associated with nature relatedness, both retrospectivelyand prospectivelysuggesting this relationship is causative, rather than merely correlative. This dissolution of boundaries is reliably occasioned by psychedelics, and may result in feelings of unity and oneness with natureand the universe. Additionally, administration of psilocybin has been found to elicit dose-dependent increases in measures of 'external unity', or feelings of interconnectedness with the external world. Nature contact itself can lead to greater connectedness, acting in a similar way to psychedelics. Just as ego-dissolution under psychedelics is associated with the dissolution of self-referential boundaries, connectedness to nature can yield a similar effect. Nature relatedness is also associated with empathy, and an increased acknowledgement of nature has also been implicated in enhancing connectedness to other people and life as a whole. The capacity of psychedelics and nature contact to increase a sense of connectedness is notable, as a sense of 'disconnection', alienation or isolation has been implicated with a broad range of mental illnesses including eating disorders, bipolar personality disorder, PTSDand depression. Interestingly, feelings of disconnection from nature and other humans are not uncommon insights described by psychedelic users, and this disconnection is frequently viewed as a source of health and societal problems, with these substances perceived to partly facilitate healing by amending this disconnection. Connectedness is considered a key predictor and mediator of well-being, in addition to a factor linked to recovery of mental health, including recovery from depression and addiction. Mystical experience. Feelings of interconnectedness are a core facet of the peak or mystical-type experiences that psilocybin can occasion. Other core features of this experience include deep feelings of unity, a sense of sacredness, deeply felt positive mood, a sense of transcending time and space, ineffability and paradoxicality and a noetic quality. In addition to being a key component of the long-term benefits reported in both clinical and healthy populations undergoing psychedelic sessions, this experience has been found to be strongly associated with enduring positive changes in people's relationship to nature in a retrospective study of people's first psychedelic experiences. Inversely, nature-based settings appear prone to eliciting transcendent or mysticaltype experienceswhich may include experiential components such as deeply felt positive mood, unity, timelessness and states of mindful absorption. In addition, one study comparing mystical experiences that occur in natural and human-built settings found that both significantly predicted psychological well-being, but only mystical experiences occurring in natural settings predicted an increase in pro-environmental behaviour. Mystical-type experiences occasioned by psychedelics are likely linked to the sustained increases in measures of spirituality reported by people that take them; for a review see. Spiritual feelings occur on deeper levels of experience than the intellect alone, involving emotions and meaning, and perceptions of connecting to something larger than oneself, similar to nature relatedness. Awe. The experience of awe has been linked to enhanced well-being, life satisfaction, prosociality, and reduced negative affect, and mental distress, in addition to being associated with nature relatednessand pro-environmental behaviour, all enduring effects associated with psychedelic use. Psychedelics have been found to elicit feelings of awe, and an enhancement of awe may persist beyond the acute experience. This in turn has been linked to enhanced feelings of connectedness and empathy. Nature can be considered a prototypical inducer of awe, with experiences of awe more reliably triggered by exposure to natural rather than built environments. It has been proposed that administering psychedelics in natural settings known to elicit awe may enhance treatment efficacy of psychedelic therapy if safety is ensured. Experiences of awe in nature may be associated with perception of large natural objects such as mountains or vistas, events such as storms, or objects with infinite repetition, including waves and fractal patterns, such as trees, clouds, rain and birdsong -and a 'smallness of self' in this context. Perception of fractal patterns is also commonly associated with the visual imagery elicited by psychedelics. Awe is deeply tied to feelings of spirituality, and spirituality and nature relatedness appear to be strongly linked. Spirituality can act as a mediator between nature relatedness and contact with nature and psychological well-being. Reduction of negative affect. Psychedelics may elicit strong emotional states during the acute experience, and challenging emotions such as fear or grief are not uncommon. However, their longer term impact on affect has been consistently demonstrated to be positive. Reductions in negative affect are usually reported the day after a psychedelic session and tend to endure for weeks or months. Both nature relatedness and nature contact appear to have similar and potentially synergistic effects on reducing negative affect. Major depression diagnoses are characterised by high levels of negative affect, with concurrent attenuated levels of positive affect, this being established in numerous studies. Negative affect has been found to act as general predictor of psychiatric disorder, and is strongly associated with mood and anxiety disorders, substance cravingand with rumination in depression. A reduction in negative affect has been found to reduce the strength and frequency of substance cravings following contact with natural environments. Mindfulness. Mindfulness has been defined as 'being attentive to and aware of what is taking place in the present'. Psychedelics can foster enduring increases in measures of mindfulness-related capacities, even when used outside the context of a mindfulness meditation practice. Cultivating mindfulness also enhances qualities of the acute psychedelic experience, in addition to the long-term psychological benefits obtained from psychedelic use. Mindfulness has also been found to be related to both nature relatedness and psychological wellbeingand is associated with pro-environmental behaviour. There is a synergistic, positive association between mindfulness and nature relatedness, and the former has been found to enhance the latter in natural settings. Other studies confirm nature relatedness to be strongly associated with mindfulness. Contact with natural settings can yield meditative, reflective mind statesand perception of fractals in nature may induce alpha activity in the brain, an indicator of a wakefully relaxed state and internalized attention. Nature contact can increase mindfulnessand the benefits of mindfulness appear to be enhanced in nature-based settings. In turn, mindfulness can enhance the benefits yielded by nature-based settings, acting as a mediator between nature contact and psychological well-being. Enhanced mindfulness capacities are associated with reductions in rumination, positive outcomes in the treatment of depression and addictionand may contribute to the treatment of PTSD. Personality. Psychedelics have been shown to increase personality trait openness to experience in an enduring way. Openness is one of the primary personality correlates of connectedness to natureand pro-environmental behaviour, and predicts a propensity for awe-like experiences, including in response to nature. It is associated with a number of traits including aesthetic appreciation, one of the enduring effects linked to psilocybin usage. Appreciation of aesthetics in nature may partly explain the positive relationship between people and nature and act as a pathway to enhanced nature relatedness. Ayahuasca users have been found to rate more highly in the personality trait of self-transcendence, which is linked to an expansion of personal boundaries to encompass that which is greater than the self, and is strongly related to openness. Like openness, it is also a predictor of nature relatedness and pro-environmental attitudes. Psilocybin was found to increase trait absorption (characterised by a disposition to become absorbed in one's internal mental imagery) for at least a month post experience in healthy volunteers. Absorption predicts a proclivity towards experiencing awe and positive emotional states in response to natural but not built settings, in addition to predicting response to psilocybin. Psilocybin therapy for treatment resistant depression was found to significantly reduce trait neuroticism scores, with psilocybin administration among healthy volunteers also found to lower neuroticism. In addition, ayahuasca usage in a traditional context was found to significantly reduce neuroticism, with changes sustained at 6-month follow up. This is notable, as individuals reporting lower levels of neuroticism appear to gain greater psychological benefits through contact with nature.
Classical psychedelics such as psilocybin are currently designated as Schedule 1 drugs in the UK and USA, imposing onerous and highly restrictive regulations around their use in a research and therapeutic context, with clinicians calling on such restrictions to be revised to more fairly reflect their relative harm and potential benefit and to facilitate greater access for research and potential medical development. Presently, most human psilocybin studies occur in monitored hospital or research settings, despite psilocybin in its naturally occurring fungalform having an ancient history of human usage. Psilocybin has a very favourable toxicity profile and negligible addiction potential and a number of independent analyses reporting that it has a benign safety profile. The set (immediate and extended psychological context) and setting (extended sociocultural and immediate environmental context) framing psychedelic usage is known to be a key determinant of experiential outcomes. In clinical settings, psilocybin is often administered in a pre-prepared hospital room or livingroom-like environment. People undergoing clinical psilocybin sessions typically wear eyeshades and headphones playing music, and they are instructed to focus their attention inwardsas an internal focus is required to limit distractions and facilitate the processing of autobiographical content that can arise. However, in an inwardly focused therapeutic session, where eyeshades are worn, there are many instances where the participant removes the eyeshades. For example, discussions with the therapists tend to take place with the eyeshades removed whereby the participant will be aware of the surrounding environment. Part of the efficacy of psychedelics when utilised in a therapeutic context appears to be through their capacity to act as catalysts or amplifiers of psychotherapeutic practices and processes. Nature seems to also act as an amplifier of therapeutic effect: one study found that cognitive behaviour therapy (CBT)-based psychotherapy applied in a forest environment was helpful in achievement of remission of major depression among sufferers, with the forest setting enhancing the effect of the psychotherapeutic intervention when compared to a clinical hospital setting. A course of forest therapy was also found to hold great promise in ameliorating depression among people with alcohol dependency. If both psychedelics and nature can act as amplifiers for therapeutic effect, this is suggestive that incorporating nature-based settings into psychedelic treatment models could elicit a potential beneficial synergy. There are many reasons to consider that therapeutic psilocybin sessions, despite the usual 'inward focus' could, for some participants, be better supported by being held in a natural setting than in a hospital room. Given that anxiety is a predictor of challenging or anxiety reactions to psychedelics, the importance of a psychologically soothing setting cannot be overstated. Nature-based settings have a tendency to be inherently more aesthetically pleasing than built environmentswith natural stimuli having the capacity to induce psychologically restorative 'soft fascination'. Such settings have a soothing effect on the mind, allowing for mental space for reflection, with reductions in stress in line with attention restoration theory (the renewal of attention and depleted psychological resources, and reductions in mental fatigue, in a natural environment), in addition to stress reduction theory. Given the capacity of nature contact to reduce rumination and encourage present moment focus, holding psychedelic sessions in natural environments could counteract mental preoccupation which has been associated with increased likelihood of challenging experiences with psychedelics. The soothing effect of a beautiful natural environment may partly explain why they are commonly selected as settings for psychedelic experiencesand taking psychedelics with the intent to connect with nature has been associated with greater well-being scores and likelihood of mystical-type experiences in comparison to a number of other potential motivations behind usage. Natural settings are also the preferred setting for some indigenous psychedelic using groups, including the Wixáritari (Huichol) of Mexico, the planet's oldest surviving psychedelic using culture. Given that our species has spent almost its entire existence in natural environments, it is likely we have an innate preference for them. The perceptual effects associated with psychedelic administration include heightened sensory capacity and altered visual perception, which can lead to a more absorbing and intensified experience of the environment in which they are taken. When psychedelics are taken in natural/nature-rich settings, the sensory aspects of nature may be perceived more richly and immersively than usual. For example, a flower may be experienced as overwhelmingly beautiful in its intricacy and vibrancy. In addition, feelings of interconnectedness with the natural world are likely to be more prominent in outdoor nature-based settings. However, despite all the benefits of calm, beauty and a sense of interconnectedness with all life that a natural setting could potentially bring, there are major barriers to attempting to hold psychedelic sessions in nature. There may be issues with disturbances, privacy, inclement weather to name but a few. Indoor settings offer a greater amount of control, comfort and safety than wild outdoor settings. In situations where a clinical room is needed, bringing some natural elements into the clinical space can be beneficial, for example plants (including those that belong to the session participant), nature-based photography and art and a nature-based backdrop. Screens depicting woodland scenes were incorporated into the clinical protocol of the Phase II psilocybin for major depression treatment room at Imperial College London (see Figure). Even better than this would be the use of a hybrid indoor/ outdoor secure, sheltered structure incorporating biophilic design elementsin a nature-based setting with large skylights and windows. This would allow the therapist to titrate the amount of nature immersion according to the client's needs as the session progresses. Structures incorporating biophilic design elements, sheltered gardens, based in a rural, nature-based setting will be utilised by the Usona Institute in their future psychedelic therapy treatment centre.
Even when psychedelic sessions take place in a clinical environment, elements of nature contact and connection can be incorporated into some aspects of the preparation and integration sessions (before and after the psychedelic session). Preparation and integration sessions for individuals and groups of people undergoing psychedelic therapy could include some elements of nature immersion. The purpose of psychedelic preparation sessions is to establish trust between the person who will be having the psilocybin experience and the therapists who will be supporting them through the psychedelic session. Preparation sessions usually take place the day before, and include psychoeducation about the likely effects of psilocybin, discussion of the participant's intentions for the upcoming session, and some time for establishing therapeutic rapport. Horticulture exercisesmay be a perfect complement to a preparation session; that is, 'preparing the ground' for the work to come. Individuals and groups could spend time weeding a patch of land, and tilling the soil, and adding compost as a ritual to mark the cleansing and preparation of the inner landscape (the psyche) ready to receive new insights, and experience psychological growth. Integration sessions, which happen the day after psilocybin sessions, are intended to support the participant in fully understanding any insights discovered during the session, and applying them to their life going forward. Horticultural exercises could be useful here too, that is, planting a seed in the freshly tilled soil, as a ritual to mark a new beginning, and a commitment to provide the psychological conditions for personal growth. Commitments to change may fall flat unless they are 'fed and watered' on a daily basis. Participants could take home a seed they have planted in a pot, to care for daily, as they nurture the lessons that are growing within themselves. Other nature immersion exercises could enhance two other key aspects of preparation and integration sessions: mindfulness training and talking therapy. The practice of Shinrin-Yoku (forest bathing), a Japanese form of nature therapy and active mindfulness practicecontains exercises to assist people to come out of their heads and into their environment, which could be useful at every stage in the psychedelic therapy journey. In the Phase II psilocybin for major depression clinical trial conducted by Imperial College London, mindfulness exercises were used to supplement the preparation and integration of psilocybin for depression treatment. Sitting in a calming sheltered gardencould also enhance mindfulness practice, focusing on the smells of different flowers, the sounds of birdsong and running water, and the soothing appearance of trees or bodies of water. A garden can offer a rich canvas for reflective therapeutic process. Awe walks are a simple intervention where people take a walk with the prior suggestion that they attend to details of the world around them and tap into their sense of wonder. A weekly 15 minute awe walk (over a time frame of 8 weeks) has been demonstrated to increase positive prosocial emotions and facilitate a reduction in mental distress in people's day to day emotional state over time. Awe walks in natural settings post psychedelic experience may be beneficial, helping consolidate any feelings of awe which may persist beyond the psychedelic session. Such a practice may also help consolidate feelings of connectedness present post psychedelic session, as an increased acknowledgement of nature has been implicated in increasing connectedness in a broad sense, and awe and connectedness appear to be strongly linked. Parts of both preparation and integration sessions contain standard talking therapy elements: discussion of challenges in life, reflecting on traumatic experiences. Although some participants may feel more comfortable having these discussions with their therapist in a clinical room, others may feel more comfortable 'walking and talking' with their therapist in woodlands or gardens adjacent to the clinicwhich could provide a soothing setting for discussions which can be emotionally challenging. Participants often feel anticipatory anxiety during preparation session discussions, and integration sessions often touch on tender places and deep wounds that may have been revisited in the session. Having such discussions whilst walking and talking in a natural setting could be helpful. Walking barefoot outside has been found to increase nature relatednessand this could also be a deeply grounding exercise for participants and therapists to engage in together. An appropriate safeguard for therapeutic work in nature, which is less contained than a clinical setting, might be that all outdoors activities include more than two people (i.e. a two therapists with a participant, or a group of participants with one or two facilitators). Maintaining standard therapeutic boundaries outdoors may require therapists to engage in some additional training, and some psychoeducation around this may need to be discussed with participants. Another benefit of linking preparation and integration to an outdoor nature-based setting is the possibility of establishing a connection to the outdoors as a 'therapy room' one can later return to by themselves to self-sooth. Establishing a nature habit as part of the integration process may serve to consolidate access to a very helpful resource in an ongoing manner. A nature habit may sustain feelings of connectedness beyond what the psilocybin alone may elicit, especially as the antidepressant effects of psychedelics are rarely permanent. The Synthesis Institute has recently launched a nature-based therapy programme for people undergoing psilocybin therapy for depression, a component of which is individually tailored nature plans, where participants select nature-based hobbies, activities, practices and service options, to encourage a deeper connection to, and more contact with nature for the associated psychological benefits this can foster. It is important to point out that although the restorative potential of nature may be well evidenced, actually going into nature may be very challenging for people suffering from severe depression. Therefore, encouraging contact with nature as a factor which could boost psychedelic integration practices may help people commit to visiting nature even when this feels hopeless or pointless, because such habits may confer such important benefits. The practice of journaling with an emotional focus has been used to effectively supplement therapeutic psychedelic sessions. Nature journaling (recording three things one enjoys about nature each day for five days) has also been found to increase nature relatedness in a robust and sustained way. This suggests that journaling about nature before and after the psychedelic experience could be incorporated into therapeutic models. Spending time in nature may be one of the most effective practices for maintaining the benefits of psychedelic sessions. However even if people are not able to access beautiful nature on a regular basis, nature can still teach via metaphor. Two core metaphors offered by nature are of interconnectedness and seasonal change. Interconnectedness -recognition of being a small part of a greater whole, for example, demonstrable in many different ways, and seasonal change -with the recognition that humans, like all of nature, go through cycles of light and dark; death and rebirth can be therapeutically beneficial. Just as nature goes through spring, summer, autumn and winter, so do human beings, and it can be helpful to remember that dark times play their part in the cycle, and that 'this too shall pass'. Our culture is not synchronised with the rhythms of nature: the valuing of productivity, 'doing' and happiness, and devaluing of retreat, sadness and loss, may be a contributing factor in the current mental health crisis. Nature can teach humans how to accept darkness as a fundamental part of life, and one that precedes growth. Recognition of this can be life changing for people who suffer from depression. Metaphors about nature have been incorporated into the ACE model for psilocybin for depression, an upcoming therapy model for group settings, and an upcoming extended integration model.
As well as incorporating nature contact into preparation and integration sessions where the specified intention is to use the psychedelic session for the improvement of mental health, a more specific model of nature-focused psychedelic work could be developed, with the specified intention of enhancement of nature relatedness. In the former context, an internal focus is required, whereas in the latter context a more outwardly focused session could be facilitated. This would add to the array of different therapeutic options in psychedelic work. As therapy models expand and more is learned about optimising the experience, there is a need for a variety of options. Just as with mindfulness meditation practices there are exercises for inner and outer focused mindfulness, this is also applicable to psychedelic usage. Whereas the inner focused clinical session might encourage connectedness to self, the outer focused session in nature could encourage interconnectedness with the environment. There could be a therapeutic model developed which starts with inner-focussed work in an indoor clinical setting before then graduating onto an outdoor nature-based setting once people are more experienced with psychedelic effects.
Aside from their intrinsically psychologically restorative and soothing qualities, nature-based settings could enhance some aspects of the preparation and integration phases of psychedelic therapy, and could under certain circumstances be used for psychedelic sessions themselves, without any neglect of vital safety concerns regarding safeguarding vulnerable people under the influence of psychedelics. Such settings have the potential to reduce anxiety and rumination, increase mindfulness, and elicit transcendent experiences and feelings of awe and connectedness. Furthermore, given the numerous demonstrated benefits to mental health associated with increasing nature relatedness, maximising its enhancement in combination with psychedelic therapy could constitute an independent and complimentary pathway by which psychedelics can lead to improvements in mental health, with nature contact undervalued and heavily underutilised as a health-promoting resource. Future studies should seek to investigate the benefits of natural settings and how they may complement (or supplement) clinical or indoor settings in greater detail, employing fine-grained assessments of the settings in question, with thorough attention to potential risks. In addition, future studies should incorporate nature relatedness measures such as the NR-6, or the longer but psychometrically superior Disposition to Connect with Nature scalewhich may help avoid ceiling issues associated with shorter item measures. Furthermore, the inclusion of introspective attitudinal and behavioural measures of environmental concern, in addition to measures assessing related lifestyle choices and materialistic and consumerist behaviours may enhance the validity of findings and avoid common methods bias. The chemist and inventor of LSD and discoverer of psilocybin Albert Hofmann came to view the capacity of psychedelics to reconnect our increasingly nature-alienated species to the natural world as perhaps their most important fundamental property. He recalled that among his most satisfying experiences were hearing people say things like 'I grew up in the city, but once I first took LSD, I returned to the forest'.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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