Forest Therapy as a Modality for Supporting Young People with Experience of Trauma and Adversity
By Jonny Elphinstone
This essay investigates the benefits of forest therapy as a modality for working with young people who have experienced trauma and adversity.
My interest in this topic comes from my twin passions of being outdoors and supporting others to engage with nature and supporting at-risk young people.
To provide some background, I have been working with young people for the past 12 years. Some of this time was spent in natural surroundings such as leading outdoor activities and camping trips, but also in residential settings for homeless young people and the past 5 years in education, supporting students from a safeguarding and welfare perspective.
Through this professional experience, I have gained an in-depth understanding of working with young people as well as regarding Trauma and Adversity and now chair the Trauma and Adversity network for Bristol and facilitate training on the subject.
In contrast to the experiences above, the early part of my career was spent in outdoor-based jobs including forestry and wildlife management, providing me with a wide range of knowledge and experiences with nature.
Academically I hold an HND in Wildlife Management, a BSc in Psychology and an MA in Childhood Studies. My current study of Forest Therapy brings together these seemingly disparate strands of interest, knowledge and experience, to work with at-risk young people, in and alongside nature.
As you will see through the course of this essay, there is a growing body of evidence showing that Forest Therapy supports physical and mental health. There is also evidence that health is seriously impacted by the experience of Trauma and I, therefore, suggest that Forest Therapy can be a suitable modality of support.
Discussion
This discussion will elaborate on what is meant by the terms, Adverse Childhood Experiences, Adversity and Trauma and Forest therapy and will then present specific suggestions of how Forest Therapy, can be used as a modality to support young people.
Adverse Childhood Experiences and Adversity and Trauma
The concept of Adverse Childhood Experiences (ACEs) is based on studies from the late 1980s and 90s by Felitti et al. These investigated the relationship between poor health outcomes and traumatic experiences in childhood such as domestic violence, sexual abuse and neglect, which caused children to experience chronic stress.
Since these early studies, the field of research has developed to investigate trauma-causing issues outside the home such as racist abuse and living in areas of high deprivation which is now termed Adversity and Trauma. I will utilise both terms throughout this essay. Whichever of these terms is used, the focus remains on how chronic stress caused by these experiences, affects individuals and how they can best be supported.
To gain a greater understanding of chronic stress and its effects, Nadine Burke Harris invites us to imagine that we are walking through the forest and see a bear saying that "your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal glands, which says release stress hormones - ADRENALIN! CORTISOL! Your heart starts to pound. Your pupils dilate, your airways open up and you are ready to either fight that bear, run from the bear". As she points out this is "wonderful if you are in a forest and there's a bear. But the problem is what happens when the bear is your parent and comes home every night, and this system is activated over and over again, and goes from being adaptive and lifesaving to health-harming."
Children are particularly sensitive to this repeated stress because their brains and bodies are still developing. Evidence shows that adversity and trauma affect brain development, function, the immune and hormonal systems, and even our DNA. Further to this uninterrupted exposure to toxic stress in childhood has a cumulative impact meaning that the greater the number of experiences of trauma the greater the impact.
Essentially the brain adapts to the threat and fear in the environment. Learning becomes very difficult due to heightened physiological arousal and hypervigilance due to changes in the prefrontal cortex (PFC) and the amygdala and behaviours originally learned as coping mechanisms can cause serious issues for those affected. For example, individuals who have experienced 4 or more adverse childhood experiences are 15 times more likely to have committed an act of violence against another person in the last year, are over 4 times more likely to suffer from depression and are 12 times more likely to take their own lives. Felitti et Al (1998).
Beyond potentially criminal behaviours withdrawal and non-engagement can cause issues with peer groups, leading to social isolation and making young people more susceptible to exploitation and mental health issues.
Other coping strategies are also developed that relieve distress temporarily, such as smoking, substance misuse and poor diet, which through repeated use becomes health-harming.
Research, including the original ACEs study, has even found that even people who had experienced trauma and adversity but had no health-harming behaviours, still had an increased risk of non-communicable diseases such as heart disease and diabetes, with evidence that on average, people with 6 or more ACEs die 20 years earlier than those with no ACEs.
It is suggested that some of these health issues can be attributed to increased levels of inflammation with Lacey et al (2020), citing studies which have shown that early life adversities, such as parental mental illness (O'Connor et al., 2019) and the number of adversities experienced before age 9 (Flouri et al., 2020, Slopen et al., 2013) were associated with elevated Interleukin-6 (IL-6) and C-Reactive Protein (CRP) levels.
With the information above it is clear to see that Adversity and Trauma is a public health issue that can have an intergenerational impact, highlighting the importance of early intervention and support.
Forest Therapy
Forest therapy encapsulates a range of invitation-based activities which aim to connect and deepen participants' experiences of the more than human world and has been shown to have a range of benefits on physical and mental health.
Studies have shown that aerosol-based chemicals released by trees, known as phytoncides can have a significant effect on our bodies. Researchers in Japan have found that the forest environment, enhanced human Natural Killer (NK) cell activity, with Dr Qing Lee reporting, that there is evidence for an increase in "the number of NK cells, and intracellular levels of anti-cancer proteins in lymphocytes, and that the increased NK activity lasted for more than 7 days after trips to forests". Li (2012) Some evidence has even shown that only 2 hours spent in a phytoncide-rich environment can result in raised NK cell levels for up to 30 days.
Microbes found in soil have also been shown to support our immune system which can be compromised by low mood and depression. Mycobacterium vaccae which is in soil and found to be in the air we breathe in the forest was investigated by a researcher at the Royal Marsden Hospital in London looking into lung cancer cures. Who found that an injection of the bacteria "significantly improved patient quality of life" with patients reporting improved mood, energy levels and better cognitive functioning.
Further research into the effects of this bacteria at the University of Bristol found that when mice were injected with M.vaccae they behaved as though they were on anti-depressants and that neurons were activated which are known to be associated with the immune system suggesting a correlation between immunity and our emotions.
Forest Therapy has also been shown to support our wellbeing, with stress levels found to be reduced through these experiences. In his book "Into the Forest" (2018) Dr Li presents evidence showing reductions in cortisol, reduced blood pressure and heart rate and increased heart rate variability (HRV) all of which are indicators of reductions in stress and anxiety. Improved wellbeing is supported by further studies, which have shown positive reports from participants who were asked to complete a "Profile of Mood States" (POMS) questionnaire. Li (2018).
Potentially supporting the POMS data, is evidence that natural light spectrums increase the release of the mood-enhancing hormone Serotonin, which has also been found to support healthy sleep. Studies run by Dr Li into these effects have found that participants average sleep time increased by 15% or 45 minutes after a 2-hour forest therapy experience.
As well as improved physical health, sleep and mental wellbeing, Forest Therapy has also been shown to improve focus as supported by Kaplan and Kaplan’s “Attention Restoration Theory (ART)” (1989) which outlines four states of attention
Clearer head and improved concentration
Mental fatigue recovery
Soft fascination/interest
Reflection and restoration
These restorative states are supported by the mental space and access to fractal patterns found in nature and supported by forest therapy invitations.
In addition to the above, the Biophilia Hypothesis suggests that human beings have evolved to be happiest and healthiest when connected to nature. In his book "The Biophilia Effect” (2018) Clemens Arvay discusses the work of architect Roger Ulrich, who studied the effects of healthcare spaces on patient health. In a nine-year study of patients recovering from gall bladder operations, Ulrich showed that those who had a view of a tree, recovered faster, required fewer painkillers and even had fewer post-operative complications after discharge than the control group who only had a view of a wall. Showing that even a view of nature can support our health and wellbeing.
Finally, Meta-analysis carried out by researchers in Korea concluded that their systematic review found evidence that "demonstrated that forest therapy has a large effect on alleviating depression and anxiety". They even go as far as to suggest that "it is necessary to actively apply forest therapy to improve depression and anxiety in the future." Yeon et al (2021).
As I have shown above, Adversity and Trauma, especially when experienced in childhood can have a serious detrimental impact. Physiologically in terms of heart disease, chronic inflammation and diabetes. From a mental health perspective due to higher rates of depression and anxiety and behaviourally with issues such as substance misuse and violence towards others. All the above factors lead to potentially shortened and negatively impacted life courses for those affected.
Forest therapy offers a modality for individuals to get away from potentially trauma-causing environments and engage with the more than human world. Further to this, the growing body of evidence suggests a range of health benefits, including reductions in blood pressure and stress hormones. Improved mood through production of Serotonin. Reduced inflammation, inflammation being indicated as a causal factor in some cases of depression, improves brain activity and ability to focus by reducing mental fatigue and supporting resilience and participants' stress reaction threshold.
Conclusion: How Forest Therapy can support young people who have experienced Trauma and Adversity
Dr Martin Shaw writes that “the term forest was originally a juridical phrase, indicating an area outside the castle walls, most likely meaning “outside” from the Latin foris”. Many of the young people I have worked with, who have experienced trauma and adversity, see themselves as somehow “outside”. Outside society in the case of those involved in criminal exploitation, outside the family, for those who have been in care or are looked after children. It would be fitting then, for the outside, natural and more than human world to be a part of supporting their wellbeing.
There is clear evidence that Forest Therapy positively supports the areas of physical and mental health which are negatively impacted by Trauma and Adversity. It is exciting to think of the possible ways that this modality could support at-risk young people and how these experiences could provide a lifelong connection to nature and an easily accessible practice that participants could utilise to support their wellbeing and that they could share with those around them.