Nature & Well-Being

On an early (3:30AM) August morning a few summers ago, a less-than-enthused younger me groaned at the unwelcomed sound of my alarm clock going off. I had agreed a few days prior to go on a hike with a friend in order to catch the sunrise from the top of a look out. While I put on my hiking clothes and collected my water bottle and head lamp, I glanced back at my inviting bed and asked myself why in the world I decided to say yes to going on a hike at this ungodly hour. After a long car ride to the trailhead and an almost pitch dark ascent, my friend and I found two rocks to sit on while we silently awaited daybreak. After about twenty minutes of waiting, this is what we saw:

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I remember leaving that hike feeling revitalized–whatever feelings of lethargy I had before had been totally lifted. Spending time outside simultaneously grounded, restored, and humbled me.

I am sure that this is not the first time you have heard a story like this. Nature is revered by many, and descriptions and portrayals of it’s “healing power” can be found almost everywhere the human hand has touched–in music, films, poetry, documentaries, science…you name it. Take the following quotes by E.O. Wilson and John Muir, for example:   

“Just being surrounded by bountiful nature rejuvenates and inspires us.”

E.O. Wilson

“Keep close to Nature’s heart…and break clear away once in a while, climb a mountain or spend a week in the woods. Wash your spirit clean.”

John Muir

Or this painting…

Nature and Well-Being

Research has also demonstrated this link between nature and enhanced well-being. For example, exposure to nature has been shown to minimize stress levels, lift mood, and bolster psychological and spiritual well-being.^1,2,3 Given the elevated potential for stress, anxiety, depression, and other negative mental health outcomes in AYA cancer survivors ^4,5,6 and the link between exposure to nature and higher levels of well-being, AYA cancer survivors are likely to benefit from spending time in nature. 

Nature and Cancer Patient & Survivor Well-Being

As mentioned in prior posts, in comparison to other adolescents and young adults without a history of cancer, AYA cancer survivors have increased risks for various negative outcomes including but not limited to psychosocial risks and increased levels of anxiety and depression.^4,5,6 Unfortunately, these negative outcomes are not always short-lived. Researchers have found that AYA cancer survivors may suffer long-term depression, anxiety, and distress even well into permanent survivorship.⁷ Because of the growing recognition that many AYA cancer survivors do face these difficulties, more research and intervention efforts are dedicated to the amelioration of these negative outcomes and consequently have suggested various ways in which well-being can be cultivated (e.g., bolstering social relationships, seeking supportive care)⁸. More specifically, there is research to suggest that time spent in nature may act as a useful tool to help lower levels of negative outcomes in AYAs.^9,10

There is some research that investigates the benefits of nature specifically for cancer patients. In a review of the literature on the role of nature in cancer patients’ lives, a researcher outlined seven themes that were descriptive of the various roles that nature played. ⁹ (a few of the themes are listed in the table below).

Theme	Description
Connecting with what is valued	Patients found that time in nature helped them connect with something ‘emotionally uplifting’. They noted connecting with:  –Themselves. Nature allowed them to reflect on their own state of being  –Other people. Nature helped to bring patients and other people together in nature activities  –Nature itself. They reported new perspectives and appreciation toward nature
Being somewhere else, seeing and feeling differently	Nature allowed participants to get some distance from their experience with cancer.
Benefitting from old and new physical activities	Patients participated in both old and new activities in nature which was tied to various positive outcomes (e.g., improved fitness, a sense of accomplishment, etc.).
Enriching aesthetic experiences	Many patients reported that nature stimulated their physical senses, enriching and enlivening them.

As noted in the table above, nature was helpful to cancer patients in that it 1) connected them with themselves, other people, and nature itself; 2) allowed them to get away momentarily from their cancer experience; 3) gave them an opportunity to participate in both old and new physical activities; and 4) provided them with richer aesthetic experiences. Moral of the story?

In all seriousness though, both anecdotally and scientifically speaking, nature has the potential to really do a lot of good things. Because my reason for creating this blog is to help AYAs, I wanted to provide a few scientifically-backed suggestions for you (and other AYAs) in regard to how AYAs might intentionally interact with nature in order to elevate levels of well-being. 

Exercise in Nature

Physical activity in the presence of nature has been linked to various positive outcomes. In an analysis of ten research studies featuring 1,252 participants, researchers found that exercising in the presence of nature improved self-esteem and mood significantly more than exercising while not in the presence of nature.¹¹ Other researchers discovered that 90% of participants who walked in a natural setting demonstrated increased self-esteem while 44% of participants who walked in a shopping mall experienced reduced self-esteem.¹²

Simply Spend Some Time Outside 

As mentioned before, time spent in nature is associated with various benefits including but not limited to enhanced physical health and relationships, restoration, and decreased levels of stress and depression.^1,13,14 I have made a point to do this myself–when I feel stressed, I often just sit in the presence of nature and I am always surprised at the difference that simply sitting in nature makes.

Can’t Get Outside? Look at Photos of Nature or Watch Planet Earth! 

Research has demonstrated that simply looking at photos or videos of natural scenes has also been found to lower stress levels and bolster psychological well-being.¹⁵ In one study, participants were assigned to either look at photos of nature or photos of buildings. Those that looked at the photos of nature experienced an increase in vitality (having physical and mental energy) while the people that viewed the photos of the buildings reported decreases in vitality.¹⁶

Spend Time Outdoors with Other AYA Cancer Survivors 

As mentioned in the study of cancer patients and nature, nature enabled the patients to connect with what they really valued, for example, spending time with other people. I have spoken with various AYA cancer survivors, and a common theme that I have derived from many of these conversations is how truly life-changing participating in an outdoor program specifically designed for AYA cancer patients and survivors can be. This combination of time spent in nature and time spent with other AYAs has many powerful benefits (anecdotally and scientifically speaking).

One study investigates the positive outcomes associated with participation in an adventure program for AYA cancer patients and survivors called First Descents, a non-profit organization that is based in Colorado that offers week-long outdoor excursions for AYA cancer patients and survivors.¹⁰ These excursions feature various activities (e.g., rock climbing, kayaking, surfing, etc.). Researchers found that AYAs who participated in First Descents exhibited lower levels of psychological distress and improved feelings of self-efficacy and social support upon completing the program. Participation in outdoor adventure programs for cancer survivors has also been associated with improved body image, self-compassion, self-esteem, and depression.¹⁷ The AYAs that I have spoken with speak very fondly of these trips, and it is evident that the time they spent with other AYAs in nature had a very profound impact on them.

So, next time you’re feeling less-than-awesome (or you’re feeling fine and are just looking for a little boost), maybe try interacting to some extent with nature. Even looking at photos can make a difference :). 

There you have it, the healing power of nature. Thank you for reading my post and please always remember that in your journey through cancer/cancer survivorship, you are never alone.

*I feel it is important to note again that I am not a licensed therapist, rather I am merely putting forth a few suggestions based off of the existing literature.

References 

1. Hull, R. B., & Michael, S. E. (1994). Nature-based recreation, mood change, and stress reduction. Leisure Sciences, 17, 1–14.
2. Burls, A. (2007). People and green spaces: promoting public health and mental well-being through ecotherapy. Journal of Public Mental Health, 6, 24–39.
3. Louv, R. (2008). Last child in the woods: Saving our children from nature-deficit disorder. Chapel Hill: Algonquin.
4. Cantrell, M., & Conte, T. (2009). Between being cured and being healed: The paradox of childhood cancer survivorship. Qualitative Health Research, 19(3), 312-322. 
5. Hewitt, M., & Rowland, J. (2002). Mental health service use among adult cancer survivors: Analyses of the national health interview survey. Journal of Clinical Oncology, 20(23), 4581-4590. 
6. Rabin, C., Simpson, N., Morrow, K., & Pinto, B. (2011). Behavioral and psychosocial program needs of young adult cancer survivors. Qualitative Health Research, 21(6), 796-806. 
7. Ander, M., Grönqvist, H., Cernvall, M., Engvall, G., Hedström, M., & Ljungman, G…von Essen, L. (2016). Development of health-related quality of life and symptoms of anxiety and depression among persons diagnosed with cancer during adolescence: A 10-year follow-up study. Psycho-Oncology, 25(5), 582-589. 
8. Warner, E., Kent, E., Trevino, K., Parsons, H., Zebrack, B., & Kirchhoff, A. (2016). Social well-being among adolescents and young adults with cancer: A systematic review. Cancer, 122(7), 1029-1037. doi: 10.1002/cncr.29866
9. Blaschke, S. (2017). The role of nature in cancer patients’ lives: a systematic review and qualitative meta-synthesis. BMC Cancer, 17(1).
10. Zebrack, B., Kwak, M., & Sundstrom, L. (2017). First Descents, an adventure program for young adults with cancer: who benefits?. Supportive Care In Cancer, 25(12), 3665-3673.
11. Barton, J., & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental Science and Technology, 44, 3947–3955.
12. Pretty, J., Hine, R., & Peacock, J. (2006). Green exercise: the benefits of activities in green places.Biologist, 53, 143–148.
13. Gass, M. A., Gillis, L., Russell, K. C. (2012). Adventure Therapy: Theory, Research, and Practice. New York: Routledge (pp. 95-108)
14. Beyer, K., Szabo, A., & Nattinger, A. (2016). Time Spent Outdoors, Depressive Symptoms, and Variation by Race and Ethnicity. American Journal Of Preventive Medicine, 51(3), 281-290. 
15. Greenleaf, A., Bryant, R., & Pollock, J. (2014). Nature-Based Counseling: Integrating the Healing Benefits of Nature Into Practice. International Journal For The Advancement Of Counselling, 36(2), 162-174. 
16. Ryan, R. M., Weinstein, N., Bernstein, J., Brown, K. W., Mistretta, L., & Gagne, M (2010). Vitalizing effects of being outdoors and in nature. Journal of Environmental Psychology, 30, 159-168.
17. Rosenberg, R., Lange, W., Zebrack, B., Moulton, S., & Kosslyn, S. (2014). An Outdoor Adventure Program for Young Adults with Cancer: Positive Effects on Body Image and Psychosocial Functioning. Journal Of Psychosocial Oncology, 32(5), 622-636.