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112 NATURE THERAPY
In this state of sustained stress, loss, and confusion, people instinctively turned to the outdoors and nature for solace and a sense of normalcy. Most public recreational areas were temporarily closed, resulting
in a deep sense of longing. With the extraneous noise of contemporary
life silenced, it was the first time that many experienced the draw to the
natural world. As restrictions were lifted, people ventured out to parks,
public gardens, or their own backyards. Many were inspired to explore
gardening for themselves (Figure 5–13). For some, growing food was a
way to save money; for others, it was a connection with their childhood
or a memory of a parent or grandparent. Still others gardened for exercise or as a way to learn a new hobby or to break up the boredom of long
days at home without daily human contact. Unknowingly, these “pandemic gardeners” were practicing hortophilia. The discovery or rediscovery of engaging with plants, for many, is comparable to meeting an
old or new friend, offering a sense of connection and control in a time of
uncertainty. Although the trauma of living through the COVID-19 pandemic will remain for some time, people across the globe were given the
chance to connect with the stability and comfort found in nature and inherent in the people-plant relationship. Therapeutic horticulture provides a universal approach for treating individuals through a wellness
model, supporting their physical, cognitive, and behavioral healing.
KEY POINTS
• Horticultural therapy is distinguished from other nature
therapies by being an active process involving the
physical care of plants or gardens.
• When engaging in the care of a plant, a patient experiences intimacy with nature at the most foundational
level, engaging with and nurturing a living thing. This
experience lends itself to recognizing metaphors that
parallel the human condition and the opportunity to
learn from them.
• A registered horticultural therapist (HTR) often practices in clinical settings, collaborating with a treatment
team and developing goals, objectives, modifications,
adaptations, and safety precautions for an individual or
group with specific therapeutic needs.
• Professionals in allied disciplines can use their knowledge of horticulture and understanding of the peopleplant relationship to enrich their practice by engaging
a patient in therapeutic horticulture.
Horticultural Therapy 113
Figure 5–13. Client engaging in focused attention while
weeding an overgrown garden border.
The client is using adapted seating because of lower extremity weakness.
Source. Photograph courtesy of A. Meore.
• Engagement in structured horticultural activities may expose a patient to a new activity that they can turn to and
use as a tool for health and well-being at any time in their
life. Whether it is the care of a few houseplants at home
or in the office or the planting and maintenance of a
114 NATURE THERAPY
whole garden, patients will understand that a simple, sustainable, and meaningful resource for self-care exists.
QUESTIONS
1. What are the four most important things you must consider when
planning a therapeutic horticulture session?
A. The patient, the plant-based activity, the date, and the avail-
ability of water.
B. The patient’s preferences, the setting, the resources needed
for a plant-based activity, and the desired outcome.
C. The setting, the biophilia hypothesis, the plant-based activity,
and the patient.
D. The setting, the patient’s preferences, plants, and snacks.
E. The desired outcome, garden tools, access to water, and seeds.
Correct answer: B. The patient’s preferences, the setting, the resources
needed for a plant-based activity, and the desired outcome.
Therapeutic horticulture is a person-centered modality. Therefore, the person and the person’s preferences are at the center of
the therapeutic relationship. The desired outcome, or goal, is
critical because it identifies the purpose of the session. Finally,
knowing the setting, materials, tools, and other resources needed
allows the therapist to be prepared to introduce the activity, give
instructions, and manage the materials and tools while engaging
with the participant during the activity.
2. When performed outside the context of a goal-based treatment plan,
the use of plants as an intervention for healing is called
A. Plant science.
B. Biophilia.
C. Psychoanalysis.
D. Therapeutic horticulture.
E. Ecotherapy.
Correct answer: D. Therapeutic horticulture.
Therapeutic horticulture is defined as a plant-based activity that
differs from horticultural therapy in that an activity session can
Horticultural Therapy 115
be facilitated by an allied professional with training in horticulture. Treatment goals are determined by the mission and desired
outcomes of the organization and are generally focused on health
maintenance and wellness.
3. Horticultural therapy must include which components?
A. A plant, a bottle of water, soil, and a pot.
B. A patient who has gardening experience and a selection of
plants.
C. A patient with a special need, engagement in a horticultural
activity, defined treatment goals, and a therapeutic process
delivered by a skilled horticultural therapist.
D. A professional with a degree in horticulture, a patient with an
expressed desire to garden, and a greenhouse with classical
music playing.
E. A social worker and a patient who both like working with
plants.
Correct answer: C. A patient with a special need, engagement in a horticultural activity, defined treatment goals, and a therapeutic process
delivered by a skilled horticultural therapist.
A horticultural therapy session must include a patient with a
special need, one or more plants for the patient’s engagement in
hortophilia, and clearly defined treatment goals and objectives
and must be facilitated by a registered horticultural therapist.
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116 NATURE THERAPY
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6
Staying Indoors
UTILITY OF BIOPHILIC DESIGN IN MENTAL HEALTH
Kishan Shah, M.D.
Muhammad Aadil, M.D.
Chaden Noureddine, M.D.
I will simply paint my bedroom. This time the colour shall do
everything. By means of its simplicity it shall lend things a
grand style, and shall suggest absolute peace and slumber to
the spectator. In short, the mere sight of the picture should be
restful to the spirit, or better still, to the imagination.
—Vincent Van Gogh (1913, p. 31)
119
120 NATURE THERAPY
Buildings are
first century. Some estimates indicate that most Americans spend 90%
of their lives indoors. Although nature’s salubrious elements can be
easily found outside, constructed environments often exclude them by
default (Kellert et al. 2011). Over the years, people have spent less time
outdoors. The 2019 Outdoor Foundation survey, which reviewed respondents’ outdoor activities over the previous year, marked a nadir in
a decade-long downward trend of time spent outdoors. The data
showed 1 billion fewer outdoor outings in 2018 than in 2008. Although
35% of Americans reported recreational outdoor outings more than
once per week, 32% reported one per month, and 11% went out only
one to three times the entire year. Because we spend 90% of our time
indoors, we have been connecting less and less with nature both indoors and outdoors (Kellert et al. 2011). The downward trend in recreational outings translates to fewer incidental nature interactions.
Sustained nature connectivity then depends on intentionally bringing
nature indoors. Luckily, biologists, sociologists, ecologists, and architects have incorporated evidence-based natural elements into architectural and structural designs. In this chapter, we first define the
significance of bringing natural elements into indoor environments.
Then, we examine the health outcomes of staying indoors and the mental health effects of the coronavirus disease 2019 (COVID-19) stay-athome orders. Finally, we introduce the innovative ways that we can
incorporate nature into indoor environments, through and beyond
technological advancements.
the de facto human environment of the twenty-
BIOPHILIC DESIGN
The biophilia hypothesis, coined by biologist Edward O. Wilson (1984),
suggests that humans possess an innate tendency to seek connections
with nature. In his book Biophilia, Wilson (1984) theorized that human
beings possess a natural and innate affinity for living systems and seek
connections with natural forms of life. The concept of humans being attracted to the living world, or a love for life, has been referenced for centuries, dating back to the writings of the ancient Greeks and Aristotle
(Santas 2014). It speaks of a human evolutionary tendency to adapt to
the natural world, which is instrumental in promoting physical and
mental well-being (Wilson and Kellert 1993).
Biophilic design, in the setting of the biophilia hypothesis, places an
emphasis on connecting building occupants and urban environments to
the natural world. Because the modern-day natural habitat is an indoor
Staying Indoors 121
constructed environment surrounded by a vast array of technology, it
becomes important to reflect on Wilson’s biophilia hypothesis and its
application to the current standard living space. The incorporation of
biophilic design aims to connect people’s affinity toward the natural
system to built environments.
Stephen Kellert, a social ecologist who helped pioneer the theory of
biophilia, defined biophilic design through two different dimensions.
The first dimension is “organic and naturalistic,” and it is defined by the
shapes and forms reflecting biophilia in the built environment. The second dimension is “place based or vernacular,” and it is defined by landscapes or buildings and their connection to the ecology or culture of a
certain geographic area. The second dimension embodies how an inanimate environment can feel lifelike. These two dimensions of biophilic design can be executed by six different biophilic design elements,
which can be further discussed in more than 70 biophilic design attributes. The six biophilic design elements are
1. Environmental features
2. Natural shapes and forms
3. Natural patterns and processes
4. Light and space
5. Place-based relationships
6. Evolved human-nature relationships
Attributes used to study and accomplish these elements include
color, water, air, sunlight, plants, animals, biomorphy, geomorphy,
bounded and translational spaces, complementary contrast, and light
and shadows. Kellert et al. (2011) also emphasized the importance of
humans’ innate dependence on and propensity toward nature because
it plays a crucial role in enhancing emotional, physical, and intellectual
well-being and fitness during evolutionary processes.
Biophilic design focuses on creating a habitat for people as biological organisms within a larger ecosystem. The modern ecosystem constitutes a built environment, where the principles of biophilic design
seek to foster wellness, health, and fitness. The principles that were discussed by Kellert et al. (2011) frame the foundations of successfully implementing biophilic design within the built environment and include
the following:
• Requiring repeated and sustained engagement with nature
• Focusing on human adaptations to the natural world that have ad-
vanced people’s health, fitness, and well-being
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