How can Forest bathing help persons leaving hospital or institutions after an extended period, in particular looking at those families having been in NICU after the birth of their child?

By Lyndsay Andrews

I have a particular interest in parents who have been in Neonatal intensive care settings after having a sick or premature baby.

My own lived experience is as a parent of a baby born at 24 weeks, who went through a huge list of interventions due to conditions arising from my daughter's prematurity, from Meningitis, sepsis, brain bleed, hole in her heart, blood transfusions and a lifesaving emergency surgery among other things.  We spent the next 16 weeks in 3 different hospitals, gradually getting less intensive in the preparation to be sent home eventually.  However during that extended period, I was becoming very reliant on medical personnel, machines, monitors, processes and procedures, it was not clear at the time but in hindsight I had become institutionalised.

After a couple of years, I went back to volunteer in one of the hospitals and I found after speaking to dozens of families, that it really didn’t matter whether you were in NICU for a week or a year, after the trauma of what you and your family go through, the world becomes a hugely frightening place.  Just as a mini example, a lot of NICU babies find it very difficult to sleep without a lot of noise.  They are very used to beeps, footsteps, clicks, knocks and chatter.

During my own experience, when I stepped outside the hospital, my brain, in order to protect myself, disassociated, it felt like I was inside a bubble observing the world and those in it, but the bubble was fragile and just the slightest human contact could cause it to pop and for my world to fall apart.  After speaking to the families in this NICU setting and afterwards, it is clear that I was/am not alone in how this felt.

I spoke to a few parents about how they felt leaving NICU  and they said the following:

“Honestly, I felt so scared.  I had no idea of any support once we left NICU.  I cried every night not knowing why this happened.  No one understood what it was like visiting my baby in NICU.  I was so alone.  I was not offered any kind of support to process what happened and to move on from it, when we left it was like we were forgotten about.  Even now 4 years later, I just deal with it myself and cry from time to time.  I will be forever grateful for being able to leave with him and his care was unbelievably fantastic, but our care, as parents going through it too, it was just figments in the wind”

“I felt so alone and isolated, and I was scared to go out and to go to groups, which was something so alien to me as I had looked forward to this with my firstborn and loved to be out in nature.  I felt so unsupported especially as all the hospital support was coming to an end”

“My baby was born at 29 weeks, she was in NICU for 98 days, It was a complete rollercoaster ride of her being well then having life threatening setbacks.  To everything being so good and the doctors being so pleased with her, to then pass away within hours.  I am a dog walker by profession and went back to work a week after her funeral as being in the woods with animals, I knew it would be the best way to try and heal.  My daughter is buried in a natural burial ground in mature woodland, where trees are planted instead of headstones, it is such a lovely peaceful place to visit her.”

Bliss, the charity for babies born premature or sick, conducted a survey on over 600 parents and it was found that 80% said their mental health got worse after being on the neonatal unit and that they felt overwhelmed and isolated and they missed the support and reassurance of the unit and staff.

Bliss also states that many parents go on to develop PTSD.  In fact, the NHS say that 1 in 3 people will develop PTSD after a traumatic experience.  Add on to that 1 in 7 babies ends up in NICU, and then add on to that, of those babies a significant amount will end up with conditions of varying severity and will need follow ups for a period, some for life.

It has been well researched and documented that Forest therapy can make a positive impact on physically conditions such as Diabetes, cardiovascular conditions, blood pressure etc and it was suggested in Qing Li’s article that it could have an impact on depression and anxiety as in studies it was shown that after forest therapy there were reductions in urinary adrenaline, noradrenaline and cortisol or the stress hormones.

I don’t think anyone would argue that you or your unborn or newly born child being in a life-or-death situation is stressful.  When your body is in an acute state of stress, your sympathetic nervous system activates the hormones which trigger the fight or flight response, those hormones being adrenaline, noradrenaline, and cortisol.  The parasympathetic nervous system can take 20–60 minutes to return to normal after the threat that caused the spike has gone.  Now imagine that the threat can last, days, weeks, months or years.

Constantly being in a state of fight-or-flight, such as when facing repeated stressors as well as causing PTSD, can be harmful to your physical health. Chronic stress can increase your risk of; Chronic fatigue, depression, gastrointestinal issues, headaches, migraines, heart attack and stroke, high blood pressure, cholesterol levels, diabetes, obesity, poor immune function, breathing problems.  In fact, all of the problems that were stated in Qing Li’s article.  It seems to make sense to me then that this could in fact be a vicious circle in which one of the empirically proven ways to reduce the adrenaline and cortisol level, i.e. Forest therapy is a no brainer!

Looking at other institutions in particular where people have faced trauma or high stress, it has been found that 1 in 10 ex-military has sought mental health support (from MOD annual report 2020/2021),  and a study by Singleton, Meltzer and Gatward found that 90% of prisoners have a mental health condition and without support and employment 50% of those go on to re-offend. 

But even a church or college, not necessarily associated with high stress, could be described as an institution but what does it feel like to be part of one?

Irrelevant of the institution that a person has experienced, what you will have while part of it is; a form of support, boundaries, routine, an expected way of doing things, a relinquishing of some of your control, possibly a loss of some freedoms, a disconnect from the wider world. Whether you have joined these institutions by choice or by necessity, when you leave them, it will be a difficult transition.

So back to my journey again, after leaving NICU aside from my amygdala being well and truly switched on after leaving NICU and everything that this controls, panic, stress, anxiety, PTSD,  I now had to learn how to look after a baby that was fragile, prone to infections and respiratory conditions, was on oxygen and it was unknown what life challenges she may face, but I had to do it without professional or any other support, while putting in place my own routines and boundaries and I felt totally disconnected, I felt scared and alone.

But how could Forest therapy help with this then, the lowering of stress hormones seems obvious, but the disconnect?  Well tuning into firstly the benefits of Attention Restoration Theory, to help renew and restore us,  to be able to reflect on life, goals priorities as well the relaxation benefits of Forest Therapy.  But also, to reconnect with the world, ourselves and hone in on our senses.  Forest Therapy offers the perfect gentle reintroduction to the world.  By offering invitations, you are not forcing someone, by helping people to focus on themselves and how they feel, they can start to identify where their problem areas may be.  You can use some of the sensory techniques to help calm when overwhelmed.  The natural environment gives a person the opportunity to breathe and restore, (stress reduction theory), once you/they are feeling calmed and focused, your brain is more efficient at working out what is needed in order to support yourself.  

Through Forest Therapy, an individual can learn what is needed for their wellbeing, the routines and boundaries and control that was present in the hospital or other institution is still something, that most people I speak to in a mental health capacity, need, but you can start to learn that you can rely on yourself for these things.  Forest Therapy can help you tune into yourself and how you feel, so you can start doing this for yourself.

Lastly, Forest Therapy can help you learn how to slow down.  When on a ward you are forced to slow down against your will, this is not something that we are generally used to in today’s world.  So, to discover that slowing down is not something that only happens in the worst of circumstances but that is something that can restore you and help you focus can be highly beneficial.

Just in addition to the above, I am a huge advocate of preventative medicine, the research on forest therapy and lowering stress hormones which can exacerbate physical conditions is well documented, and a lot of research has also been carried out on the reasons for preterm births. An article in the American Psychological Association Sept 2022, documented research where it was found that pregnancy-related anxiety in the third trimester was most strongly associated with earlier births. However, general anxiety in the first trimester also contributed to risk for early birth. So again, just an educated guess but if we could help parents with stress and anxiety during pregnancy, could we help to reduce preterm births?