When I first met John, he spent most days in silence, scrolling through his phone, watching true crime, and cancelling visitors. He said his world was shrinking. His wife had tried to make him feel better by decorating the living room with his football memorabilia and buying indoor plants. But it only amplified feelings of isolation. He said the plants ‘looked dead inside’. Hopelessness dominated our early sessions.
Six months earlier, he’d had a stroke. Understandably, the sudden change in mobility, cognition, and perception of identity, caused psychological distress that was difficult to navigate. John spoke to me about what he missed. His past identity, the things he felt he could not connect with, and amongst these losses, the outside world. One Tuesday morning when I step into his house, John is lying in bed by the window, a position he has not left for the past three months. He overlooks the high rises of London and makes a comment about only seeing grey.
Then, in one session, a turning point. I noticed how animated John became when describing Australia, where he had lived in his 20s. He described the sound of waves, the smell of salt water, the heat of sand. His words carried a sense of escape. For the first time, I attempted to integrate nature into my work.
Integrating nature
In my initial few months of clinical training, I experienced several difficult life events, and although not particularly drawn to the natural world before, I found the peace and solitude of forests and hills as comfort. It helped me navigate the chaos and adapt to change. Now, qualified as a Clinical Psychologist working in neurorehabilitation services, I notice how connection with nature can support the adjustment process.
My work on stroke wards highlighted this shift in perception, with patients lighting up when telling me they found some sense of joy or normality by looking at the clouds, making friends with the pigeons that landed on the windowsill, or watching the change of the seasons on the trees. I found myself integrating nature into approaches like Acceptance and Commitment Therapy for people adjusting to change.
John and I began introducing moments of connection with memories of Australia. We found a video of the ocean he could play during our sessions, or, as he slept, seashells arranged on his windowsill, and a diffuser with ‘sea breeze’ scents. After a while, he reported ‘a new calmness’ when he played the video. He spoke vividly of ocean scenes he imagined when trying to sleep. These became grounding tools when he felt panicked or alone. He bought a fish tank so he could view more of what he once loved. He began sleeping better and said mornings felt ‘less dark’. We started using the imagery of water as a metaphor for his recovery, saying, ‘sometimes you just need to float until the waves bring you back to shore’.
Eventually, John started inviting his friends to visit him again.
A garden memory box
I began thinking about how I could incorporate indirect nature contact into more of my work in health and neurorehabilitation settings. I found it helped those who had fond memories of nature connection yet couldn’t access it anymore.
Another client, June, was recovering from a spinal cord injury and was unable to leave her flat due to pain and anxiety. She spoke fondly of her parents’ garden. Rather than rushing in and returning to gardening itself, we looked for ways she could revisit the experience safely and imaginatively. Together, we created a small ‘garden memory box’ using a shoebox as the base. Inside, she placed sensory objects that represented what she remembered. It included dried soil, a small stone that reminded her of the garden path, a sprig of rosemary (as this was something her mother always planted), and dried leaves and flowers. We also added a small patch of moss to represent the spot where she sat with her father as he taught her about the garden. Each element became a sensory link.
Not only did June enjoy making the box, but she described it as ‘building somewhere I can visit when I’m in too much pain to move’. Within weeks, she said her pain was more manageable when interacting with the box. Her occupational therapist noticed she was more focused and motivated, and that sessions were no longer dominated by discussions of pain and illness.
Introducing nature after illness or injury
For clients that do not have pertinent memories with nature, indirect contact with the natural world is still valuable in adjusting to change. Mary lived in a nursing home and was struggling with a respiratory illness. When listing things that could help an otherwise difficult breathing exercise, Mary decided to try listening to the sounds of a forest, despite her describing herself as someone who is ‘not a nature girl’. When playing the audio, Mary found it helped regulate her breath more than with just music or silence. She started to connect her mind and body with the natural earth. She told me it made sense that being around nature at this time was what she needed, as ‘we are nature after all’. By having the forest audio, particularly during times when it was difficult to breathe, she could imagine sitting in the woods and said, ‘It feels like I’m breathing with the trees. They’re helping me do it. We’re working together.’
Such seemingly simple interventions demonstrate how sensory and symbolic contact with nature can not only promote hope and connection but could give life to otherwise homework-like tasks of standard therapeutic tools.
The natural outdoors is not an equitable resource
These indirect nature connections were all different, but all meaningful and important. They brought people a different perspective and ways to manage difficult thoughts and feelings. Of course, this is not new. We have known for decades, that connecting with nature can benefit mental, physical and cognitive function. Time in nature can lead to stress dropping, mood lifting, and attention sharpening (Kaplan, 1995; Kasap et al., 2021).
But there is a harsh truth that is often overlooked, particularly with the case examples above. That stepping outside into nature is not a given, it’s a privilege. Many of my clients can’t simply go for a walk, sit under a tree, or do some gardening. They might be housebound, struggle with their mobility, or cognitively unable to undertake activities in nature without support. Often psychologists encourage go-to nature-based interventions like ‘wellbeing’ walks, gardening initiatives or forest bathing. But green prescriptions like those listed, which involve staff supporting people to engage with outdoor activities or natural spaces (NHS England, 2023), present a very significant problem for clients such as my own.
And beyond my client base, there are several populations that face substantial barriers to accessing what we might normally offer as a nature prescription. Living in urban settings often means limited green spaces, inequitable access to them, or the presence of threat and danger (Sarabi et al., 2019). Changing weather, wildlife, and uneven terrain can make even local parks seem daunting (Gatersleben & Andrews, 2013). For those who may be more vulnerable, it can also mean increased experiences of stigma and discrimination from others (Larson et al., 2021; Burrell et al., 2024).
If nature prescriptions are to be part of our toolkit, we cannot assume equal access. When direct contact is limited, it becomes essential to find adaptive ways to connect with the natural world.
Finding connection indirectly
Several studies have now shown benefits of indirect contact with nature as having restorative properties. Viewing photos or videos of natural scenes has been found to improve attention and concentration, improve autonomous nervous function, and reduce stress and anxiety (Jo et al., 2019). Listening to sounds like birdsong has also been associated with reduced experiences of anxiety and paranoia (Stobbe et al., 2022). In fact, there is still no clear evidence as to what type of nature-based interactions may be of most psychological benefit, be that active, passive, direct or indirect. And so, using indirect contact with nature remains evidence-based and a vital part of what should be a ‘nature prescription’.
There could be concern that this does not remove barriers for those that can access the outdoors. Is it just a loophole for stakeholders and policy makers? However, I argue that where a psychological need should be met to minimise distress, but there are very real barriers to its access, this must be found through other means. For this reason, our understanding of ‘nature prescriptions’ surely has to include indirect contact with the natural world.
When doing so, it is important to adhere to personal meaning and memories. Cultural and personal preferences vary drastically. What feels inviting or calming to one person may feel threatening or alien to another. Preferences are shaped by culture, values and memories (Kaplan, 1995).
Once we have explored the types of nature that might hold most personal meaning, adapted ways of nature connection may include:
- Nature images – Photographs or artwork of forests, beaches, mountains, or even specific landscapes that hold personal meaning. It’s not just about beauty but about choosing scenes that feel safe and resonate with someone.
- Soundscapes – Recordings of waves, birdsong, or leaves in the wind can create a subtle but powerful shift in mood.
- Sensory objects – Smooth pebbles, dried leaves, roughness of pinecones, or the scent of lavender and grass can bring a tactile and olfactory connection to nature. For many people, these small hands-on details can be used as a grounding resource.
- Nature documentaries – Immersive visuals of rainforests, coral reefs, deserts, or even urban wildlife can transport someone beyond the four walls they’re in, while still being accessible and safe.
- Visualisation and grounding – Guided imagery that draws on memory and imagination can help someone ‘step into’ their favourite natural space. By weaving in sights, sounds, textures, and even scents, this practice can feel real and restorative.
Nature within reach
For my clients who feel isolated by their condition, indirect contact with a personally meaningful natural world offers something bigger to belong to. It is a reminder that ‘nature prescriptions’ should not just include the direct and active interactions as currently designed. But it is about providing means to feel part of the living world despite barriers in accessing it.
So, if you are working with clients who cannot reach the outdoors, or even if nature is simply not as accessible as it should be, think about the type of connection that is accessible and potentially meaningful. It might be more powerful than you think.
References
British Ecological Society. (2022, September 27). Nature is for everyone yet people with disabilities face many barriers. Here’s what needs to change.
Burrell, M. W., Barton, J., Yannitell Reinhardt, G., & Wood, C. J. (2024). Psychological, psychosocial and physical barriers preventing nature-based intervention participation in adults with mental health disorders: A scoping review. Journal of Health Psychology, 30(8), 1735–1750.
Gatersleben, B., & Andrews, M. (2013). When walking in nature is not restorative — The role of prospect and refuge. Health & Place, 20, 91–101.
Jo, H., Song, C., & Miyazaki, Y. (2019). Physiological benefits of viewing nature: A systematic review of indoor experiments. International journal of environmental research and public health, 16(23), 4739.
Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15(3), 169–182.
Kasap, E. Z., Ağzıtemiz, F., & Ünal, G. (2021). Cognitive, mental and social benefits of interacting with nature: A systematic review. Journal of Happiness and Health, 1(1), 16-27.
Larson, L. R., Zhang, Z., Oh, J. I., Beam, W., Ogletree, S., Bocarro, J., Lee, K. J., Casper, J., Stevenson, K. T., Hipp, J. A., Mullenbach, L., Caruson, M., & Wells, M. (2021). Urban park use during the COVID-19 pandemic: Are socially vulnerable communities disproportionately impacted? Frontiers in Sustainable Cities, 3, Article 710243.
NHS England. (2023, January 31). Green social prescribing.
Sarabi, S., Han, Q., Romme, A. G. L., De Vries, B., & Wendling, L. (2019). Key enablers of and barriers to the uptake and implementation of nature-based solutions in urban settings: A review. Resources, 8(3), 121.
Stobbe, E., Sundermann, J., Ascone, L., & Kühn, S. (2022). Birdsongs alleviate anxiety and paranoia in healthy participants. Scientific Reports, 12(1), 16414.
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