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The Research Agency of the
Mindfulness Practice in
Woods and Forests: An
Report to The Mersey Forest
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Forest Research is the Research Agency of the Forestry Commission and is the leading
UK organisation engaged in forestry and tree related research. The Agency aims to
support and enhance forestry and its role in sustainable development by providing
innovative, high quality scientific research, technical support and consultancy services.
This is a report produced by the:
Social and Economic Research Group, Centre for Ecosystems, Society and
Biosecurity, Forest Research
This report was commissioned by:
The Mersey Forest
Tel: 01925 816217
The Mersey Forest is one of the leading environmental regeneration initiatives in the
North West of England with a keen interest in delivering health and wellbeing project
associated with urban greenspace. This report forms part of a Natural Health Service
programme being coordinated by The Mersey Forest team.
An appropriate citation for this report is: Ambrose-Oji, B., 2013. Mindfulness Practice
in Woods and Forests: An Evidence Review. Research Report for The Mersey Forest,
Forest Research. Alice Holt Lodge Farnham, Surrey.
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1. Introduction ................................................................................................... 4
2. Objectives and Methods.................................................................................. 5
3. Wellbeing links to nature: A significant evidence base ................................... 7
3.1. Wellbeing in urban greenspace ...................................................................... 9
3.2. Wellbeing impacts of woodlands and forests ................................................. 10
4. Mindfulness approaches in woods, forests and natural spaces ..................... 11
4.1. Defining mindfulness ................................................................................. 11
4.1.1. Efficacy of different mindfulness approaches........................................... 12
4.2. Mindfulness in woods and forests ................................................................ 13
4.2.1. Forest Bathing – Shinrin-yoku .............................................................. 14
4.2.2. Forest Walking .................................................................................... 17
4.2.3. Mindfulness and CBT approaches in forest and woodland contexts............. 18
4.2.4. Ecotherapy and Forest Therapy ............................................................. 18
4.2.5. Ecopsychology .................................................................................... 20
5. Examples of mindfulness practice in woods and forests in Great Britain ...... 21
6. Conclusions .................................................................................................. 25
7. References ................................................................................................... 26
Annex 1. Examples of mindfulness of projects/programmes/therapists working
in natural/woodland contexts .......................................................................... 36
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Mindfulness Practice in
Woods and Forests: An
According to the World Health Organisation (WHO) we are now entering an era where
health professionals are concentrating on chronic and non-communicable diseases rather
than infectious diseases as the main causes of mortality and morbidity (Hägerhäll,
2010). Amongst these major non-communicable health problems are diabetes,
cardiovascular disease, cancer and depression. Research and clinical practice have
brought improvements in the treatment of the most prevalent physiological conditions,
and more recently mental health and wellbeing are receiving equal attention.
This is due in part because of the marked increase in the numbers of people presenting
with poor mental health and mental illness across developed countries over the last two
decades. In the UK one in four British adults experience at least one diagnosable mental
health problem in any one year, and one in six experiences this at any given time (The
Office for National Statistics, 2001). Figures for England in 2007 showed that 7.2 per
cent of people aged between 16 and 74 had two or more disorders. The largest increase
in rate of common mental disorders between 1993 and 2007 was observed in women
aged 45-64, among whom the rate rose by about a fifth (The Office for National
Statistics, 2009). Psychiatric drug treatments are available for many of the most
common metal health conditions and symptoms. However, there is a growing awareness
of the limitations of drug-based treatments. Alternative approaches with proven impacts
are now being recommended as suitable therapeutic interventions.
As well as recognising the increasing need for mental health treatments, clinicians and
medical researchers are beginning to uncover the strong physiological links between
mental wellbeing and physical health (see for example: Kemp and Quintana, Lindwall et
al., 2012, Wright et al., 2009). The evidence suggests that improvements to mental
health can have positive impacts on physical health, and vice versa.
Mindfulness has fast grown in popularity and credibility as one of the alternative
approaches to alleviating and treating certain forms of mental illness and the symptoms
of poor mental health associated with other diseases and conditions. A body of evidence
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has been accumulating which shows the positive affects mindfulness can have on
medical and psychological symptoms, including depression, anxiety, chronic pain and
fibromyalgia, general and acute stress, high blood pressure, skin disorders, and sleep
disorders. In addition, mindfulness is also recognised as being a positive approach to
maintaining and safeguarding good mental health either with patients after specific
treatment, or as a means of managing the day-to-day stresses of living and working
with people who enjoy relatively good mental health.
In 2004 and again in 2009 1 NICE (the UK National Institute for Clinical Excellence)
recognised the benefits of mindfulness approaches giving certain techniques and
therapies approved medical status as a treatment for conditions such as depressive
disorder (depression). In addition to this, mental health charities and organisations such
as MIND, have been promoting mindfulness as well as ecotherapy as important methods
with synergistic impacts on both mental and physical health, and which present viable
and sustainable options to drug use (see the MIND 2007 strategy report 2).
The impacts and efficacy of mindfulness approaches in clinical practice have been the
subject of study, but this is mostly confined to practice conducted in indoor settings
(Keng et al., 2011, Khong, 2009, Thompson et al., 2012, Worsfold, 2013). Even though
there is a good deal of evidence demonstrating the positive influence of the natural
environment on health and mental wellbeing, research into mindfulness approaches in
the outdoors, in natural and green spaces is only just beginning to emerge as
practitioners begin to take mindfulness practice into green settings.
2. Objectives and Methods
The Mersey Forest is one of England’s Community Forests. It is a leading environmental
regeneration initiative in the North West. The Mersey Forest manages a number of
projects and programmes related to health and wellbeing in urban greenspaces. The
Mersey Forest also has an active partnership with the Mersey Care NHS Trust. It plays
an important role in the “Take Notice” group that are part of the Decade of Health and
Wellbeing across the Liverpool City Region 3. The Mersey Forest are developing and
coordinating the emerging “Natural Health Service 4” as an approach to improving
mental and physical health through links with the natural environment. “Taking notice” is
described by New Economics Foundation as:
1 See NICE Guideline CG90 for example:
2 Find the report here: http://www.mind.org.uk/assets/0000/2138/ecotherapy_report.pdf
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“Be curious. Catch sight of the beautiful. Remark on the unusual. Notice
the changing seasons. Savour the moment, whether you are walking to
work, eating lunch or talking to friends. Be aware of the world around
you and what you are feeling. Reflecting on your experiences will help
you appreciate what matters to you”5
In other words, the Take Notice group are promoting mindful ways of engaging with the
world as an approach to wellbeing.
The Mersey Forest has an interest in finding ways to develop “Take Notice” within the
natural environment, mindfulness in the outdoors, as part of what they offer within the
Natural Health Service. They consequently have an interest in looking at evidence and
examples of how mindfulness approaches have been applied in natural and outdoor
settings, specifically woods and forests.
The aim of this evidence review is to support the Mersey Forest’s interest and intent by
producing a summary of the available evidence relating to mindfulness in natural, and
specifically forest settings.
The specific objectives were to:
1 Identify the range of mindfulness approaches practiced in natural and
2 Summarise the available evidence relating to the impacts of these approaches
3 Summarise any lessons learned about the design and implementation of practice
The research method followed the general guidelines for undertaking a Rapid Evidence
Assessment (REA) developed to support policy in making best use of a mixture of
evidence sources (Government Social Research, 2010).
Table 1. Keywords and search terms used in REA literature review
forest* OR wood*
mental health AND alternative therapy
Forest* OR wood* AND:
Forest Bathing OR Shinrin-yoku
5 Find summary and report here http://www.neweconomics.org/projects/entry/five-ways-to-well-
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A literature search of academic and grey literature, was undertaken using both academic
on-line databases (Scopus, Ingenta, Science Direct, Scirus) and internet search engines
(Google scholar, Bing). The key search terms that were employed are shown in Table 1.
An initial set of 184 documents was generated. Of these 132 related to the links between
mental health and physical health improvements and spending time or exercising in
natural spaces and forests in a general sense. A total of 52 documents related
specifically to mindfulness approaches and nature. Just 37 of these discussed the
theoretical links between mindfulness and nature as well as practice and the evidence of
impact within woodlands and forest settings.
All of the documents were collated in an ENDNOTE database. The key information in the
52 mindfulness documents was summarised through standard content analysis
techniques identifying main trends and essential evidence. A selection of the other 132
general documents was used in this review to set the general context.
Network of contacts was built up through snowball sampling as the best means of finding
examples of practice and projects dealing with mindfulness in woodlands and forests. A
total of 46 people became part of this knowledge network and they provided information
about sixteen different projects and counsellors using mindfulness in natural contexts.
3. Wellbeing links to nature: A
significant evidence base
There is now a very large and growing literature evidencing the links between the
natural environment and people’s general health and wellbeing. Some of the key issues
and research reviews are summarised in this section as a way of setting the context into
which mindfulness approaches to wellbeing are situated.
Chalquist (2009) draws our attention to some startling facts. He points out that “as of
the 1980s, we who live in highly industrialized nations began spending more than 90%
of our lives indoors” and that by “various estimates our time outside has since shrunk to
1%–5%”. Environmental psychologists in particular have insisted that the physical and
psychological problems of modern society are associated with this disconnection between
human beings and their natural environment. Wilson (1984) put forward the “biophilia”
to explain the observed effects. His hypothesis postulated that humans are “hard-wired”
through evolution to hold an emotional and psychological attachment to nature. Placing
people apart from nature disrupts our connection with nature and can lead to negative
impacts on wellbeing (Wilson and Kellert, 1993).
The most widely accepted studies hypothesising the mechanisms behind came from
Kaplan and Kaplan (Kaplan and Kaplan, 1989, Kaplan, 1995), and Ulrich and colleagues
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(Ulrich et al., 1991, Ulrich, 1984). They promoted the idea of the “restorative” effects of
natural environments which eased ‘‘mental fatigue’’ and acute physical symptoms of
stress brought about by modern living and working conditions. These ideas were quickly
taken up and promoted by a number of health programmes and research institutions.
In the UK the NICE guidance on Physical Activity and the Environment published in
2008 6 highlighted the need for more research uncover how the environment influenced
behaviour and attitudes that had an impact on physical activity and associated health
benefits. Since then several comprehensive reviews of the links between physical and
mental wellbeing and the impact of a broad range of natural contexts including woods,
gardens, parks and areas of wild greenery have been undertaken (see for example:
Natural England, n.d, Natural England, n.d., Wilson et al., 2008, De Vries, 2001, Giles-
Cort and Donovan, 2003, Cooper et al., 2008, Natural England, 2009a, Natural England,
2009b, Barton and Pretty, 2010, Faculty of Public Health and Natural England, 2010,
Logan and Selhub, 2012). This and subsequent research provides evidence showing that
the effects of green spaces on human metal and physical are very wide ranging and
The pattern of findings is well summarised by a study undertaken by the University of
Glasgow (Mitchell and Popham, 2008). This research found, that for England as a whole,
people living closer to green space had lower death rates and less heart disease. A
follow-on piece of research used self reported wellbeing and mental health scores from
national surveys to test whether physical activity in a natural environment might
produce greater mental health benefits than physical activity elsewhere. The results
showed an independent association between regular use of natural environments and a
lower risk of poor mental health, but not for activity in other types of environment
(Mitchell, 2012). A large sample survey dataset including more than 10,000 respondents
was interrogated by White et al (2013b), showed that was little evidence of different
activities (e.g. walking, exercising) impacting “restoration”, different kinds of natural
settings had a positive impact on surveys respondent’s recalled feelings of “being
refreshed”. Additional data from a panel survey confirmed that greenspace in people’s
environment increased self reported happiness and wellbeing (White et al., 2013a).
The quality of greenspace appears to have an impact on people’s willingness to access
the outdoors: De Jong et al (2012) researching in Sweden, show an association between
levels of physical activity and better quality greenspace; In the USA the loss of trees
across the landscape due to a significant pest, the emerald ash borer, was associated
with an increase in human mortality related to cardiovascular and lower-respiratory-tract
illness (Donovan et al., 2013) supporting the hypothesised connection between tree-rich
environments and people’s willingness to get out and exercise.
6 Available from: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11917
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The cost effectiveness implications of access to greenspace have also been assessed in
terms of the economic value of parameters such as treatments averted. Although figures
vary and are subject to sensitivity analysis acceptable to key stakeholders, the provision
of greenspace, particularly in urban environments has a significant economic value as it
relates to health benefits (Harnan et al., 2011, Health Council of the Netherlands, 2004,
The evidence base may be impressive, but gaps in knowledge remain. For example, Bell
et al (2007) pointed out the patchy coverage of differential impact by social group, the
effects of different kinds of environment including bluespace (e.g. watery features,
rivers, coasts) as well as greenspace, and a major shortfall in the collection of consistent
longitudinal indicators of change against baseline measures.
3.1. Wellbeing in urban greenspace
Most of the more recent research into the effects of nature on health and wellbeing looks
at impacts in urban locations and on urban populations as significant policy and public
health concerns. As early as (1996) Tanaka et al showed a positive benefit to the elderly
in and around Tokyo, who appeared to live longer if they were resident close to areas
with greenspace. De Vries (2001) calculated that in the Netherlands every 10% increase
in urban green space represented a reduction in health complaints equivalent to making
the population five years younger. Most recently in the UK White et al (2013a) show that
levels of wellbeing are greater, and mental stress lower, in urban landscapes with larger
areas of greenspace.
The distribution of greenspace in urban areas is not homogenous. In most developed
countries the pattern of variation in provision of all types of green areas, including trees
and woodland, reflects the socio-economic status of particular neighbourhoods. Areas of
lower economic status generally tend to have less good quality greenspace (Crawford et
al., 2008, SNIFFER, 2005, Boone et al., 2009, Perkins et al., 2004, Barbosa et al.,
2007). This variation has been found to have a profound effect on the frequency and
duration of visits made into the outdoors by local residents, which has associated
impacts on health issues such as obesity and diabetes (Hillsdon et al., 2010, Crawford et
al., 2008). Improving the quality of physical environments has consequently been
identified as an important factor in reducing urban socio-economic health inequalities
(Mitchell and Popham, 2008, Mitchell, 2012, Milbourne, 2012).
Research in Swedish urban areas (Peschardt and Stigsdotter, 2013, Stigsdotter and
Grahn, 2011) found that nature, in whatever form, has a measurable effect on people’s
wellbeing, although the degree of benefit is greatest for the most stressed individuals.
Similarly, access to any kind of greenspace in the urban work environment has also been
shown to reduces stress (Lottrup et al., 2013), as can access to urban and community
gardens (Adevi and Mårtensson, 2013, Milbourne, 2012). A recent study using
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qualitative and quantitative markers of stress showed significant relationships between
self-reported stress and patterns of cortisol secretion, and the quantity of green space in
the living environment (Ward Thompson et al., 2012). Exercises performed in urban
green environments have also been shown to lead to a significant improvement in self-
esteem and moderation of mood disturbance (Hägerhäll, 2010, Health Council of the
However, other research has shown that variations in the types and locations of urban
greenspace seem to have a differential effect on the degree of wellbeing impacts and
outcomes. White et al (2013b) suggest that urban parks and urban playing fields have
the least impact on wellbeing indicators compared to the impacts felt in coastal settings.
Payne (2013) finds that urban parks have less of a restorative soundscape than rural
areas but are more soothing than the soundscapes of purely built environments.
Personal preferences, psychosocial motivation, age and other socio-economic variables
and features such as vegetation colour and density have been shown to influence
qualitative and quantitative health measures (e.g. Heart Rate Variability (HRV)) of urban
populations (Qin et al., 2013, Wilkie and Stavridou, 2013, Peschardt and Stigsdotter,
2013, Grahn and Stigsdotter, 2010, Home et al., 2012).
3.2. Wellbeing impacts of woodlands and forests
In amongst this general greenspace literature and research, the wellbeing values of
forests and woodlands has been investigated and reviewed in some depth (see for
example: Tabbush and O’Brien, 2002, O’Brien, 2006, O’Brien et al., 2012, Snowdon,
2006, Weldon et al., 2007, Ward Thompson et al., 2010, Ward Thompson et al., 2013,
O’Brien and Murray, 2007, O’Brien and Morris, 2013).
The qualitative studies and evidence reviews all show that the full range of beneficial
restorative effects reported for other kinds of natural spaces and urban greenspace are
present within urban forests and woodlands (Park et al., 2011). It is not uncommon too
for there to be a greater inequality in the provision of wooded urban greenspace
(Heynen, 2006) and the social distribution of beneficial impacts from woodlands (O’Brien
and Morris, 2013).
In some contexts the degree of impact associated with woodlands may be greater than
that in other environments. Fuller et al (2007 ) suggest that this may be because the
restoration values of nature increase with increasing levels of biodiversity and woodlands
or forests tend to be the most diverse kinds of habitats, particularly in urban contexts.
White et al (2013b) confirm that within their large sample study, only two specific
environmental types woodlands/forests and hills/moorland/mountains were associated
with levels of restoration comparable to coastal locations. This included woodlands and
forests in, and close to, urban areas.
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However, some research does investigate the negative associations between wellbeing
and forests. Despite the generally positive affect of nature on human wellbeing,
woodlands tend to be one of the natural settings which can be “non-restorative”.
Woodlands and forests might be associated with negative cultural connections, they may
be particularly unfamiliar landscapes to urban people and can instil feelings of fear and
anxiety. This is particularly true where the woodland is poorly maintained or densely
planted, if they are dark, and restrict visibility and people perceive them to provide
hiding spaces for unknown threats such as muggers and thieves (Gatersleben and
Andrews, 2013, Jorgensen and Anthopoulou, 2007, Jansson et al., 2013, Logan and
Selhub, 2012). However, it is worth noting that design guides are now being developed
which provide advice and key principles in designing greenspace that encourages access
and promotes wellbeing (see for example Schakell and Walter, 2012).
4. Mindfulness approaches in woods,
forests and natural spaces
Having set the general context of health and wellbeing connections with the environment
and with woods and forests, this section turns to the place of mindfulness within this
spectrum of research and practice. The section begins with the general definition of
mindfulness used to guide which evidence has been included. A series of sub-sections
follows: these examine and summarise the detailed research of specific practice
approaches within woodlands, including the impacts and outcomes where these are
4.1. Defining mindfulness
The term “mindfulness” does not refer to a single practice, but to a range of practice-
based approaches seeking to focus an individual’s mind and attention on breathing and
patterns of thought as a means to managing emotions, feelings, habitual patterns of
behaviour and unregulated critical reactions to events (Leary and Tate, 2007).
Running through all these approaches and therapies is practice to increase ‘awareness’
of the self and the environment, ‘taking notice’ of the present thoughts and conditions,
including one’s surroundings and how these impact on the body. Worsfold (2013)
describes mindfulness as:
“denot[ing] a certain quality of awareness of present experience including
habitual reactions to that experience ….. to discover a mode of body
awareness based on the direct experiencing of body sensations”
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Germer (2005), adds some detail to this description and suggests that mindfulness can
‘‘to describe a theoretical construct (mindfulness), the practice of
cultivating mindfulness (such as meditation) or a psychological process
In a clinical and medical context mindfulness is most commonly practised as Mindfulness
Based Stress Reduction (MBSR), Mindfulness Based Cognitive Behavioural Therapy
(MBCBT), Acceptance-Based Stress Therapy (ABST) and Acceptance Commitment
Therapy (ACT). These techniques are largely psychotherapeutic approaches aimed at
tacking specific physiological, psychological and wellbeing issues (Melbourne Academic
Mindfulness Interest Group, Bishop et al., 2004, Leary and Tate, 2007). However, with
roots in Taoist, Buddhist and other Eastern contemplative philosophies, mindfulness is
often practised in more meditative and spiritual forms. Mindfulness may also be
practiced through very informal and loose routes of self reflection, contemplation and
simply taking time to stop and notice the self or place “in the moment”.
4.1.1. Efficacy of different mindfulness approaches
Research and reviews of the effects and clinical efficacy of mindfulness show excellent
results in terms of stress reduction and the treatment of a range of different
physiological and pyschosocial conditions, including: depression and anxiety; mood and
personality disorders; aggression and interpersonal communication; immune system
functioning; response to cancer treatments; heart rate variability; blood pressure; and
substance dependency (see for example: Grossman et al., 2004, Davidson et al., 2003,
Dunn et al., 2007, Selby and Joiner, 2009, Chiesaa and Serrettia, 2010, Hofmann et al.,
2010, Nykcek et al., 2010, Keng et al., 2011, Cramer et al., 2012, Klainin-Yobas et al.,
2012, Thompson et al., 2012, Worsfold, 2013). There is a strong correspondence
between the parameters and measures used to evaluate mindfulness approaches and
those employed in the general studies of physical and mental health reviewed in the
introductory sections of this review. These parameters include both qualitative measures
of psychological factors, for example, SF-36, SF-12 7, self perceived stress, significant
event histories, and quantitative measures of physiological factors, for example, blood
pressure, heart rate and heart rate variability (HRV) 8, and salivary cortisol levels 9.
However, despite these positive results there is a growing view from practitioners and
researchers that sounds a warning against the mainstream acceptance of mindfulness
which leads to a reductionist clinical application of mindfulness as another form of “cure”
7 These are international Quality of Life standard health surveys, more information can be found
8 High Frequency HRV is lowered in association with increased anxiety, stress, and mood
disturbance, and low HRV is also predictive of aging and risk of cardiac failure
9 Cortisol is a hormone produced in response to stress
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to ailments: Greater potential remains in the promotion of mindfulness as a way of being
or mode of living (see for example Khong, 2009).
4.2. Mindfulness in woods and forests
The majority of the research into mindfulness examines impacts on patients and
practitioners who undertake shorter or longer mindfulness therapies in indoor settings
such as hospital and care centres, training venues, retreats and on a one-to-one basis
with individual counsellors, psychotherapists and psychologists.
This is not all together surprising because working with mindfulness in the outdoors does
present challenges to both practitioner and client whatever mindfulness-based approach
is being used. There is a successful example of nature being used as part of
psychotherapy practice conducted in an urban park (Greenleaf et al., 2013) and
evidence that mindful (engaged) walking can enhance the benefits gained from outdoor
exercise (Duvall, 2011). But careful attention needs to be paid to the therapeutic frame
of reference, and to assessing the impacts of how this might be altered by moving
outside (Owens et al., 2012). Jordan and Marshall (2010) and Greenleaf et al (2013)
provide a detailed discussion of how taking mindfulness-based therapies into the
outdoors not only changes the relationship between therapist and client, but can have an
impact on the associated ethical, confidentiality and organisational difficulties.
Implementing this kind of practice in outdoor settings requires sensitive and careful
resolution and planning.
Though not examining mindfulness in outdoor contexts, there are some general
theoretical studies of mindfulness and nature exploring “nature connectedness” and
making links to the early work of Kaplan and other environmental psychologists. Kaplan
(2001) for example, provided a comparison of his nature centred Attention Restoration
Therapy (ART) approach and mindfulness as meditation, and concluded a synthesis of
both approaches would provide a most powerful tool for improving wellbeing. The
theoretical discussion centres on “nature connectedness” being built through mindfulness
practice, internal awareness, and attention to self and place (Horesh, 1998, Cloke and
Jones, 2003, Mayer and Frantz, 2005, Nisbet et al., 2009, Leary and Tate, 2007, Howell
et al., 2011, Wilson, 2011, Richardson and Hallam, 2013). This research does not
however, provide a consensus over any connection or causal relationships between
mindfulness, health and wellbeing and nature. A greater feeling of connection with
nature may strengthen the effects of both mindfulness and well-being impacts, but by
the same token, a greater sense of connection with nature might come about as a result
of mindfulness practice or feelings of enhanced well-being (Cloke and Jones, 2003,
Richardson and Hallam, 2013). In some cases the research goes so far as to consider
the need for nature to brought into the clinical setting, rather than the therapeutic
practice to be taken outdoors (see for example Chalquist, 2009).
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This review has uncovered five broad practice-based approaches involving mindfulness
in nature with examples that document experience and evaluative evidence. These are:
• Forest bathing or Shinrin-yoku
• Forest Walking
• Mindfulness and CBT approaches in woodland contexts
• Forest Therapy and Ecotherapy
The following sections summarise the evidence associated with each of these
4.2.1. Forest Bathing – Shinrin-yoku
Some commentators believe that the idea of “forest bathing” can be traced back to
Kneipp Therapy which was developed by Sebastian Kneipp in Germany during the mid
19th century. Kneipp is famous for hydrotherapy cures, but he also recommended
walking in forests, barefoot and through streams as a route to mental and physical
health (Morita et al., 2008). However, forest bathing is now a term more likely applied to
Shinrin-yoku, an approach developed in Japan. The Forest Agency of the Japanese
government launched the ‘‘Shinrin-yoku Plan’’ in 1982, with the aim of encouraging
people to use forests as therapeutic relaxation and a means to manage their stress.
As the Plan established itself an increasing number of research studies through the
1990s began to measure and assess the impact of Shinrin-yoku, and investigate the
physiological mechanisms responsible. Since 2004, a well known research team at the
Chiba University and Forestry and Forest Products Research Institute have done some of
the most detailed quantitative and longitudinal studies which now cover over 20 forest
sites and several thousand participants.
This review found a total of 18 papers covering the practice and impacts of forest
Shinrin-yoku varies in the way it is undertaken. It may be practiced by walking through
a forest mindfully, taking in the forest air, working with the breath, sitting and
observing, and making an emotional connection with the forest environment (Miyazaki
and Motohashi, 1995). It might also be more about simply spending time in, and gaining
a therapeutic effect from a forest visit. Depending on the forest and the programme,
Shinrin-yoku may therefore encompass explicit mindfulness practice and techniques or
be a more informal experience involving “being mindful” implicitly.
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A significant body of research work demonstrates how Shinrin-yoku facilitates an holistic
mind-body therapy (Ohtsuka et al., 1998b, Yamaguchi et al., 2006, Morita et al., 2007,
Park et al., 2007, Tsunetsugu et al., 2010, Lee et al., 2011b, Lee et al., 2011a, Mao et
al., 2012b, Tsunetsugu et al., 2013). The Japanese and Korean research organises itself
around the five senses to show that forest bathing has positive affects on:
• Stress levels
When Shinrin-yoku was compared to walking in alternative settings such as urban areas,
the forest walks were found to reduce stress levels measured using blood pressure,
pulse rate, heart rate variability (HRV) and salivary cortisol (Park et al., 2007). HRV
heart rate variability read alongside with pulse rate and cerebral activity in the pre-
frontal area showed the positive impact of forest bathing by increasing parasympathetic
measures and decreasing sympathetic parameters (Tsunetsugu et al., 2007, Park et al.,
2010). Alternative measures using salivary amalayse and immunoglobulin as bio-
markers (Yamaguchi et al., 2006), near-infrared spectroscopy (NIRS) to measure
changes in oxygenated and deoxygenated haemoglobin associated with brain activity,
and an index of central nervous activity (Tsunetsugu et al., 2010), all provide similar
demonstrations of the ability of forest bathing to reduce stress and increase relaxation.
Qualitative assessments of feeling refreshed, relaxed, and more comfortable have all
been shown to improve after periods in the forest (Tsunetsugu et al., 2011), whilst
feelings of hostility and depression have been shown to decrease (Morita et al., 2007).
Eighty-seven (29 male and 58 female) non-insulin-dependent diabetic patients took part
in this study (Ohtsuka et al., 1998a). Shinrin-yoku was performed nine times over a
period of 6 years. On each occasion after forest walking mean blood glucose levels were
shown to decrease from 179 (SEM 4) mg.100 ml-1 to 108 (SEM 2) mg.100 ml-1 (P <
0.0001). The level of glycated haemoglobin A1c also decreased from 6.9 (SEM 0.2). The
researchers believed that these positive impacts were brought about because the forest
environment caused changes in hormonal secretion and autonomic nervous functions. In
addition increased calorie consumption prompted by the physical exercise improved
insulin sensitivity. Their conclusion was that forest bathing has significant beneficial
effects on those suffering with diabetes.
Photos of culturally significant Sakuri (cherry blossom) were compared with images of
Shinrin-yoku (people walking in the forest) to track visual stimulation. The cherry
blossom was described by participants as “awakening” and showed a measurable
increase in pulse rate and blood pressure. In contrast forest bathing was described as
refreshing and relaxing and prompted decreased blood pressure levels (Suda et al.,
2001). Similarly, showing people images of walking and meditating in forest
environments compared with similar activities non-forest locations had positive affects
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on the mood of participants (Oishi et al., 2003). Tsunetsugu et al (2013) showed the
same sort of reactions when testing the responses of young male urban residents to the
sight of different urban forest landscapes.
Work in both the laboratory and the forest has demonstrated that forest smells
contribute to the effects of forest bathing. Qualitative assessments suggest that forest
scents induce various biological effects and may cause changes in physiological
functioning. Investigation in the laboratory has shown how phtyoncides (the volatile and
non-volatile substances) produced by forest trees and other plants and inhaled by
humans, have an influence on physiological parameters. Research has demonstrated
reduced levels of stress, anxiety and depression, and positive effects on the immune
system induced by phytoncides (Tsunetsugu et al., 2010).
Katsumata et al (2003) and Yamada (2003) examined the psychological and
physiological effects of hearing the sound of wind blowing through coniferous and
broadleaf trees, and the murmuring of forest streams. Both were found to have stress
relieving properties measured as the reduction of systolic blood pressure and reduced
levels of brain activity.
Tsunetsugu et al. (2010) report on previous work which shows how interior wood and
wooden objects elicit favourable emotional responses compared to other natural or man-
made materials. Mao et al (2012b) also investigated the qualitative properties of wood
experienced by participants and found positive reactions. Researchers therefore
hypothesise that the touch and feel of wood within the forest environment is also likely
to contribute to the overall impact of forest bathing.
The most recent reviews of the research into forest bathing in Japan (for example
Tsunetsugu et al., 2010) recognise that more research outside of the lab would be
beneficial to furthering understanding of the longer term outcomes of forest bathing.
Additional research could also identify more closely the differential benefits of forest
bathing for different segments of the population in terms of socio-demographic
characteristics. For example, the evidence relating to the positive effects of Shinrin-yoku
on managing hypertension and stress in the elderly was not conclusive (Mao et al.,
2012a, Morita et al., 2011). Increasing the variety of forest settings in which Shinrin-
yoku is carried out and researched would also be helpful in identifying which forest
settings are the most appropriate for certain therapeutic effects. Researchers mention
too the need for the development of novel systems of assessment that can capture the
holistic benefits of Shinrin-yoku in a less reductionist way than has been the case to
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4.2.2. Forest Walking
Walking is an essential part of Shinrin-yoku programmes, and mindful movement such
as meditative or mindful walking is a recognised as part of mindfulness practice.
A total of seven papers were found relating to forest walking.
The effects of walking under forest environments on cardiovascular and metabolic
parameters has been the subject of study for a number of researchers, who have shown
that habitual walking in forest environments may lower blood pressure and blood
hormone levels (see for example, Li et al., 2011). Programmes such as “Walking the
Way to Health” demonstrated significant cost benefits against conventional approaches
of tackling obesity and depression which ever economic model was employed (Natural
Differences between meditative and athletic walking were tested in forest environments
compared with indoors in Korea (Shin et al., 2013). The State-Trait Anxiety Inventory-X,
Rosenberg Self-Esteem Scale, and Happiness Index for Koreans were measured before
and after walking. Meditative walking (defined as walking using mindfulness practice
focusing on breathing and the sensations of walking) had greater effects than athletic
walking, whether in the forest or in the gym. Overall the meditative walking in the forest
showed the greatest level of benefits. Shin et al (2011) also tested the impacts of
meditative walking on cognitive function. Using a sample of 60 university students, they
showed that cognitive function and mood both improved as a consequence of walking in
a forest compared with an than urban environment. Students were able to perform
intellectual tests more quickly and effectively, felt more relaxed and at ease after forest
walking. Changing mood state as a consequence of forest walking has been recorded by
other researchers too (see for example, Osaki et al., 2005).
In other studies there was a differential impact in physical stress and mental stress
measures. In one survey of forest walkers (Toda et al., 2013), measured cortisol levels
did not increase but chromogranin A (CgA) did increase. This indicated that physical
stress increased whilst mental stress did not. Participants in this research reported
corresponding feelings of being both uplifted and tired, and a subjective perception of
significant stress reduction after the walk (Toda et al., 2013).
Comparisons of the differences in responses walking in wild compared with tended
forests showed that there were more extreme positive and extreme negative reactions in
the tended forests compared to the wilder settings (Martens et al., 2011). Yamada
(2006) shows how it is possible to take these impacts into consideration when designing
forest walks to take in landscape diversity as well as including soundscape diversity for
increased therapeutic impact.
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4.2.3. Mindfulness and CBT approaches in forest and woodland
Although there are increasing numbers of practice-based projects and programmes
undertaking MBCBT 10 and mindfulness approaches in forest and woodland contexts
(see section 5 of this report), evidence within published literature found as a result of
this review is very scanty. This review found three studies.
Kim et al (2009) describe the impacts of their programme using mindfulness in
combination with Cognitive Behaviour Therapy (CBT). They included a mindful walk
through forest before the CBT exercises, used the forest as a setting for that work, and
included a mindfulness meditation. The mindfulness meditation concentrated on practice
with the breath, awareness of wind in the forest, and other woodland sounds.
Participants in this study who suffered from depression improved their depression rating
scores, saw improved HRV and decreased salivary cortisol levels. Kim et al (2009)
concluded that CBT-based psychotherapy applied in the forest environment was helpful
in the achievement of depression remission. The effect was superior to that of
psychotherapy performed in the more conventional indoor clinical setting. The remission
rate of the forest group was 61% (14/23), significantly higher than both the hospital
group undertaking similar CBT-based psychotherapy, (21%, 4/19) and the controls (5%,
A small study involving 56 men and women on a programme of MBCBT undertaken
within forest settings in Korea (Sung et al., 2012) measured changes to blood pressure
(BP), salivary cortisol, and quality of life (QoL) scores in patients with hypertension.
Although the programme did not induce prolonged systolic blood pressure (SBP)
reduction, there was a significant decrease in cortisol level and improvement in QoL
measures. The researchers concluded that this approach may be a useful model of
community hypertension management amongst older participants.
The application of Acceptance-Based Stress Therapy (ABST) using mindfulness in a
forest garden in Denmark was tested with a small pilot sample (Corazon et al., 2012).
The early results showed that moving the psychotherapy outside, altered the relationship
between the patient and the environment. The environment becomes important in the
therapeutic process, and it also added a physical dimension to the therapy. Detailed
studies of the qualitative and quantitative impacts of the therapeutic framework are
expected late in 2013 as patients are brought into the programme.
4.2.4. Ecotherapy and Forest Therapy
The concept of “ecotherapy” was being debated as early as the late 1960’s as general
environmental awareness spread through academic and populist consciousness
(Rapaport, 1971). This review suggests that contemporary use of the term “ecotherapy”
10 Mindfulness Based Cognitive Behaviour Therapy
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remains contentious amongst those involved in it’s study. For some researchers
“ecotherapy” represents an umbrella term encompassing all forms of clinical and
therapeutic intervention with some reference to or use of nature (see for example
Chalquist, 2009, Greenleaf et al., 2013). Following this generalised view Wilson, Ross,
Lafferty, and Jones (2008) define ecotherapies slightly more narrowly as:
“the implementation of interventions aimed at improving psychological
functioning through the use of green spaces”.
In some ways this definition of ecotherapy does little more than encompass the general
“green exercise” approaches that have weak connections with mindfulness. However,
for others, ecotherapy represents applied ecopsychology, using a philosophy of “green
care” where a range of different green settings including woods and forests allow self
directed empowerment and healing through stewardship of nature (see for example
Burls, 2008). For some researchers, it is “green care” which is the umbrella term, and
ecotherapy is just one form of green care that sits alongside therapeutic horticulture,
care farming, wilderness therapy, or adventure therapy (Hine et al., 2008, Parsons et
Mindfulness is included within these approaches in a very broad and often informal way,
and tends to concentrate on self reflection, awareness of the environment and the
effects on the body of being outdoors, with nature and in the landscape (Hickey, 2008).
A total of six papers dealing with ecotherapy or forest therapy approaches in woodlands
Wilson et al (2008) reviewed the application and efficacy of ecotherapy as an approach
used in conjunction with other interventions used by patients with mental health issues.
Their review found that the holistic benefits of greenspace make ecotherapy particularly
appropriate for clients who use secondary and tertiary mental health care services, and
recommended broad application of this approach. Sackett (2010) describes the
transformation of one individual after a summer involved in an ecotherapy-based
programme. Mental health was promoted with improved levels of self awareness, self-
worth and confidence. This was accompanied by a decrease in weight and lethargy. In
another set of similar approaches, the aspect of ecotherapy that focuses on green
exercise is closely aligned with the ideals of adventure therapy (Alvarez and Stauffer,
2001) which look for personal progression through stepping past comfort zones and
opening the self to challenges (Burls, 2007; Mind, 2007a).
Forest therapies in particular use a mix of different activities that touch on mindfulness
practice in different degrees in the same way as other types of ecotherapy. Depression
and anxiety disorders have been treated with forest therapy in an urban fringe forest in
Sweden (Nordha et al., 2009, Sonntag-Öström et al., 2011). In this context participants
lived and worked in the forest for a period, undertaking educational activities and mentor
led reflective practice. The qualitative and quantitative results both showed a majority of
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the participants enjoyed general improvements to their physical health (better general
functioning and fewer symptoms of illness) and mental state (improved self reported
indicator scores). However, the quality of life benefits seemed to decline towards the end
of the programme. Researchers suggested that this related to participants anticipating
the end of the programme and their building worries about the future. Hickey (2008)
reports on the working of a therapeutic community in Castle Douglas, Scotland. Run by
the Buddhist Ropka Trust ecotherapies such as therapeutic gardening are employed
along with mindfulness practice which is conducted indoors as well as outside and within
the wooded grounds of the community. Impacts reported include improvements to mood
and self reported mental health scores. The “Branching Out” programme supported by
the Forestry Commission Scotland provides three hours a week for participants to take
part in ecotherapy within the forest (Wilson et al., 2011). Mindfulness is implicit to the
approach which concentrates on providing participants with useful work experience in
the woods. The research of pre- and post attendance health scores using SF-12 and the
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), did not show any improvement
to mental health as a consequence of attendance even though physical activity levels
were significantly imporved (Wilson et al., 2011). In another example involving a
partnership comprising Reforesting Scotland, the NHS, Argyll Green Woodworkers’
Association, the Scottish Association for Mental Health and Lochgilphead Community
Council was formed to restore neglected woods next to the Argyll and Bute Hospital. This
provided a natural space for the promotion of wellbeing activities including ‘mindfulness’
in patients – appreciating the present moment without anxiety about the past or future.
For many patients in this hospital with mental health problems, cultivating mindfulness
was an essential skill to learn. Clinicians describe how helpful the woodland setting was
useful in cultivating this feeling of being in the present and represented an important
forest therapy (Schakell and Walter, 2012).
The area of ecopsychology mirrors that of ecotherapy in so far as many of the papers
found by this review concern the definition of ecopsychology and development of
ontology, philosophy and heuristics connected with different ecopsychology perspectives
and techniques(Kerr and Key, 2011, Key and Kerr, 2011). Conn (1998) says:
“Ecopsychology invites psychotherapy practice to expand its focus beyond the
inner landscape, to explore and foster the development of community, contact
with land and place, and ecological identity.”
Wilson (2011) makes a short statement of belief encapsulating the ecopsychology
philosophy “We are in nature and nature is in us”. He says that this realisation should
shift “preoccupation with our separateness and alienation from, and exploitation of
nature” to an understanding that we are integrated with it. In essence ecopsychology
looks to overcome the division between nature and culture, the original starting point for
the current interest in the impacts of greenspace on wellbeing (Kaplan and Kaplan,
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1989, Kaplan, 1995, Ulrich, 1984, Wilson, 1984, Wilson and Kellert, 1993). The manner
in which ecopsychology is practised is very diverse is related to the practitioner’s own
affinity with nature as well as their excposure to and training in ecopsychology (Wolsko
and Hoyt, 2012).
This review found three papers discussing ecopsychology in relation to woods and
Ecopsychology looks to find therapies and therapeutic methods which can reunite people
with natural phenomena (Davis, 1998, Horesh, 1998, Wolsko and Lindberg, 2013). Davis
and Atkins (2009) and Clinebell (1996) consider ecopsychology to be the development of
theory and technique which underpins ecotherapy as practice. The aim for Davis and
Atkins (2009), is for psychotherapy to learn from non-Western, land based societies,
about alternative forms of healing practice.
Davis and Atkins tested this alternative approach in their early development of a training
course for students in the United States. They based the course around a weekend
retreat in the woods in the Great Smoky Mountains National Park. (Davis and Atkins,
2012). Alternative approaches to counselling based on non-Western and traditional
forms of healing, with an implicit integration of mindfulness techniques noticing the
environment, and using the breath, were tested with students (Davis and Atkins, 2009,
Davis and Atkins, 2012). The evaluation conducted at the end established a sense of
rejuvenation in students, who were also able to use learning from their experiences to
solve life problems. Wolkso and Lindberg (2013) confirmed the paucity of published data
relating to mindfulness practice within ecopsychology approaches within natural settings,
but “continue to hypothesize a positive association between mindfulness and connection
5. Examples of mindfulness practice in
woods and forests in Great Britain
The review found a total of 16 different projects, programmes and counsellors using
mindfulness practice in outdoor settings in Scotland, England and Wales. A list of
contacts is included as Annex 1. The practice examples can be grouped into four main
1. Ecopsychologists and ecotherapists practising mindfulness (often more holistic and
spiritual forms) with clients (individuals and groups) in natural settings including,
mountains, woods and forests to improve natural connectedness and response to
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2. Ecotherapists and ecopsycholgists practising mindfulness (mainly MBSR and
MBCBT) with clients (individuals and groups) in natural settings including,
mountains, woods and forests to improve mental wellbeing and specific clinical
3. Wellbeing projects working with clients (individuals and groups) where
mindfulness is an implicit part of the therapeutic approach improving mental and
4. Community-based projects using mindfulness in local woodlands to improve
connection to place and local residents wellbeing.
The first approach fostering increased nature-connectedness is well illustrated by the
Eco-self project based in the South West of England and Knoydart, Scotland 11 . The
overall aim of the project is to encourage people to live within their ecological limits by
developing individual ecological identities. The project runs “Wild Mindfulness” courses
which run over the course of several days and take participants into wild and natural
settings (including woodlands and forests) to “explore experiences of elemental nature”
as a route to reconnect with the natural world, rejuvenate, and “inform the way we
respond to current ecological crises”.
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Examples of counsellors and ecotherapists working to improve the mental wellbeing of
clients include Wilderness Minds based in North Wales, Tao Mountain based in Cumbra,
and Culture Probe in Manchester. Mindfulness practitioners in each of these initiatives
seek to employ MBSR and similar techniques within wild mountain, moorland and
wooded settings, with the general aim of using the outdoors as a challenging and
contemplative environment from which to draw “restoration” and experiences which help
model behaviours that move forward from dwelling in the past or within unwanted
responses. In the case of Tao Mountain there are examples of ecotherapuetic
interventions using a more structured MBCBT approach within natural settings to help
clients with specific mental health conditions. In the case of Culture Probe there is also a
strong element of introducing mindfulness and ecopyschology as a route to sustainable
working practice and bringing nature in to the working environment, improving working
relationships and reducing work associated stress.
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Into the Woods and The Cart Shed are examples of the third type of project integrating
mindfulness in woodland settings. Both these initiatives are set up to provide woodland
skills sessions which aim to deliver positive physical and mental health benefits to people
from vulnerable backgrounds. This includes people with learning difficulties and those
living with significant mental health conditions. Many of the participants are supported
by local referrals and local health service funding through public service contracts or
individual health budgets. In each of these two examples, working in the woodlands
incorporates mindfulness in an implicit way. The Cart Shed enables participants to “just
be” in the woodland, and draws people into a social setting where being aware of the
moment in the woodland, the passing seasons, the sounds and smells is encouraged.
Guided by the Five Ways to Health framework, Into the Woods aims to integrate
mindfulness as “Taking notice” and uses a variety of educational and other techniques to
encourage and help people to develop their awareness of the woodland environment and
their connection with it as a way to broaden horizons and increase confidence and skills.
It is interesting to note that both of these initiatives have had experiences where clients
have not reacted very well to the woodland environment. Both projects stress that
introducing people into environments which are very different from their every day
experience takes skill and patience, and not all clients will necessarily respond positively
to ecotherapeutic interventions (Into the Woods and The Cart Shed pers comm.
The Parish of St Michael and All Angels project near Durham is an interesting example of
a community based initiative to use mindfulness as one of a suite of activities following
the Five Ways to Health framework in local woodland to improve wellbeing amongst the
local community. Partly funded by the church and partly through health service funding
streams, mindfulness practice is undertaken in the small woodland nature reserve, and
is practiced in a variety of different ways including monthly “Mindfulness Walks”,
incorporating contemplative meditation.
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In conclusion this review has summarised a good deal of the most accessible evidence
relating to mindfulness practice in woodland and forest settings. There are five broad
approaches to mindfulness in natural contexts which have been researched or debated in
the scientific literature. These are forest bathing, forest walking, MBSR and MBCT
practiced in woodlands, ecotherapy/forest therapy and ecopsychology. There is a variety
of evidence relating the impacts of these particular approaches. Clinical and neurological
studies demonstrate quantitative physiological benefits, and assessments of less tangible
metal states and attitudes have tracked improvements using qualitative self reporting
However, for evidence of the outcomes of mindfulness practice in outdoor settings is
very limited. Only two of the found studies explicitly discuss remission rates from
depression compared with other talking therapy treatments or medical interventions.
This is a significant barrier to those wanting to demonstrate the value of mindfulness
practice in natural settings to health professionals. Of the evidence in the found scientific
literature, much of the evidence comes from a few country regions and from specially
established scientific studies / clinical assessments rather than documenting effects and
impacts from practice case studies. Assessments are mostly clinical in approach and tend
not to assess and evaluate outcomes at a more holistic level.
Similarly studies of the non-restorative impacts of working in nature and in woodlands
particularly are limited to two examples, even though this is a particularly problematic
issue for urban populations, and vulnerable people, not comfortable with “wild” and
wooded environments. On a related point, there is a distinct lack of elaboration within
the mindfulness and nature literature of which kinds of people are likely to benefit most
from this kind of therapy. Again this is a particular barrier to providing evaluation of
client’s suitability to such ecotherapeutic approaches to wellbeing.
Finally, there is very little in the way of grey literature documenting practice examples or
developing design guidelines, practice guidelines or case studies to share experiences
amongst practitioners and those who may wish to commission mindfulness programmes
in outdoor settings. There are a number of social networks for practitioners, so exchange
is happening, but these avenues do not necessarily reach all interested audiences, and
may not generate research and evidence of significant interest to health care
commissioners and policy makers.
Hopefully, the limitations outlined here will be overcome as the range of mindfulness
practices in woodlands and forests develop, collect more learning and evaluative
evidence. The many new mindfulness and nature initiatives emerging are extending the
value of woods and forests, and represent creative ways of following policy instruments
such as the Five Ways to Health framework in England, as well as the central tenets of
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Annex 1. Examples of mindfulness of
in natural/woodland contexts
Name of project /
programme / counsellor
Grounds for Learning
Growing Action for Nature
In to the Woods
Kate Measures consulting
The Cart Shed
Trees in Mind - Reforesting
The Parish of St Michael and All Angels
All websites accessed between April-October 2013