If You Can Make It Visible — Part 4
☕ Welcome to Eva’s Tea
Modern psychiatry spends enormous time discussing cognition, trauma, neurotransmitters, sleep, medications, and therapy models.
Far less attention is given to the environments surrounding the nervous system itself.
Indoor living.
Alien lighting.
Constant notifications.
Noise.
Screens.
Concrete.
Climate-controlled boxes.
Most patients spend the bulk of their waking hours in some form of a box while simultaneously reporting rising levels of anxiety, irritability, insomnia, emotional exhaustion, and attentional fatigue.
At some point, it becomes reasonable to ask:
What happens when the brain lacks the environment it was originally designed for?
This edition of Eva’s Tea may challenge some readers a bit because the goal is not simply to recommend “going outside more.”
The goal is to examine whether exposure to nature, green space, gardening, and environmental regulation deserve more serious attention as adjunctive psychiatric interventions.
Not a 1:1 replacement for medication.
Not wellness influencer content.
Not magical thinking.
But another example of a category of interventions that modern psychiatry may have underutilized.
And importantly:
the evidence is also growing.
The World Already Understands This Better Than We Do
In Norway, there is a cultural concept called Friluftsliv (pronounced “FREE-loofts-leave”), roughly translating to “life in the fresh air.”
The philosophy centers around regularly spending time outdoors regardless of weather, temperature, or season. Importantly, nature exposure is not framed as optimization.
It is simply viewed as a normal part of emotional, physical, and social wellbeing.
Nordic countries consistently rank among the happiest populations globally. Of course, other variables contribute to this, including economics, healthcare systems, social trust, and cultural cohesion (SDoMH).
But their relationship with outdoor living is difficult to separate from the conversation.
There is even a common Nordic phrase:
“There is no bad weather, only bad clothing.”
That statement probably sounds mildly insane to many Americans.
But it also reflects something important:
many Americans avoid environmental discomfort almost entirely.
Another reason Eva’s Tea is a fan of ACT therapy: making room for discomfort.
What the Research Actually Shows
One of the strongest clinically relevant papers for psychiatry was a 2024 meta-analysis published in Ecopsychology titled:
Nature Exposure, Even as Little as 10 Minutes, Is Likely to Yield Short-Term Benefits for Adults with Mental Illness
The findings were notable.
Even brief nature exposure was associated with measurable improvements in:
• stress
• mood
• emotional regulation
• psychological wellbeing
Importantly, these findings were observed in adults already living with mental illness, not “healthy” control populations.
☕ ☕ The authors discussed the concept of “nature prescriptions” as scalable interventions.
That should probably get our attention.
Because psychiatry routinely discusses:
• sleep
• exercise
• socialization
Yet many clinicians rarely ask:
How much time do you spend outdoors each week on average?”
“Forest Bathing” Is Not Hiking with Earbuds
Another concept increasingly studied is Shinrin-yoku, often translated as “forest bathing.”
Originally developed in Japan, forest bathing refers to intentionally attentive time in natural environments with the goal of reducing physiologic and psychological stress load.
This is not hiking for performance.
It is not cardio, although we support that too as a separate intervention.
Forest bathing emphasizes sensory engagement:
• noticing light through trees
• ambient sound
• air movement
• texture
• smell
• visual depth
Over the past two decades, research has associated forest exposure with measurable reductions in:
• cortisol
• sympathetic nervous system activation
• heart rate
• blood pressure
• perceived stress
Potential gains include improvements in:
• mood
• attention
• emotional regulation
In many ways, forest bathing may be better understood as a sensory reset for an overstimulated nervous system.
And in today’s world, many nervous systems appear profoundly overstimulated.
Green Space Matters More Than Most People Realize
Another highly cited paper published in the International Journal of Environmental Research and Public Health examined neighborhood green space exposure and mental health outcomes.
The findings associated greater neighborhood greenery with:
• lower depression
• lower anxiety
• lower stress
What makes this particularly interesting is that the effects persisted even after controlling for socioeconomic variables.
That matters.
Because it suggests the impact may not simply be reduced to:
Wealthier neighborhoods are healthier.
Instead, the environment of the neighborhood itself also exerts a measurable influence on stress physiology and emotional regulation.
This also highlights something clinically important:
not every intervention requires a formal exercise program.
Passive exposure adds up.
Seeing trees may matter.
Walking near water may matter.
Natural visual depth may matter.
Modern psychiatry has become highly focused on internal states while often ignoring external environments.
That may prove shortsighted.
Gardening Is More Useful Than Growing Plants
A few decades ago, I had a good friend in high school who studied horticulture in college.
At the time, with the maturity level and ignorance I possessed then, I genuinely could not understand the appeal.
Years later, I am jealous of both his knowledge and his relationship with something I completely overlooked.
A 2025 longitudinal paper published in Journal of Environmental Psychology:
Gardening, Healthy Aging, and Longevity: Longitudinal Evidence from 25 Years of the Lothian Birth Cohort 1921
adds another layer to this discussion.
Gardening intersects with multiple domains simultaneously:
• movement
• sunlight exposure
• routine
• sensory engagement
• behavioral activation
• attention
• environmental contact
And notably:
it creates visible progress.
Psychiatry often asks patients to pursue interventions with delayed or invisible rewards.
Gardening does the opposite.
You water something.
It grows.
That matters psychologically.
Especially in the context of:
• depressive disorders
• loneliness
• aging populations
• retirement transitions
• grief
• behavioral disengagement
Grounding and Barefoot Exposure
This is probably the most controversial section of the article.
Reminder: individualize your care and approach these ideas cautiously.
Research on grounding, or “earthing,” remains early and far from settled science. Still, most people recognize that walking barefoot on grass or sand feels different than walking in thick athletic sneakers.
At the same time, dismissing environmental interventions simply because they lack pharmaceutical-scale evidence may cause clinicians to overlook low-risk interventions that appear to influence measurable physiological systems.
Grounding studies have demonstrated potential changes in:
• sleep quality
• stress perception
• inflammation markers
• autonomic regulation
One of the more frequently cited studies, published in the Journal of Alternative and Complementary Medicine, found grounded participants demonstrated:
• reduced nighttime cortisol
• more normalized circadian cortisol rhythms
• improved sleep
• lower subjective stress
Again:
this evidence is not as definitive as some of the psychiatric evidence discussed earlier.
But it is another signal that deserves curiosity.
Brave enough to explore further?
The earth also contains measurable electromagnetic activity, including naturally occurring Schumann resonances studied in geophysics.
While some theorists have speculated about biologic interactions between natural electromagnetic fields and human physiology, direct psychiatric implications remain largely unproven and should be discussed cautiously.
Still, the broader idea remains interesting:
modern humans now spend dramatically less time outdoors and have almost zero contact with the earth compared to prior generations.
Whether through:
• shoes
• screens
• artificial environments
• indoor living
the nervous system now exists in conditions that are historically very unusual.
☕ Make It Visible
One practical exercise worth considering in clinical practice:
Ask patients to describe an average day.
Then ask them to share their smartphone screen-time report. ( For example:7.11 hours per day on average)
Determine if the report aligns with their values.
“What’s your reaction seeing the number in front of you?”
Not judgmentally.
Not performatively.
Just honestly.
Then compare:
• hours indoors
• hours outside
• hours exposed to artificial light
• hours exposed to natural light
For many patients, the imbalance becomes visible almost immediately.
And for many, you may be the first healthcare professional to ever steer the conversation here.
Especially when connected back to values the patient already identified:
• wanting more calm
• wanting more energy
• wanting better sleep
• wanting more presence
• wanting less anxiety
Most people do not intentionally avoid nature.
Modern life simply makes nature invisible.
☕ Final Thoughts
Recently, I evaluated a patient with an anxiety disorder who developed significant hyponatremia from a commonly prescribed SSRI.
Cases like that are always worth reflecting on carefully.
Not because medication is inherently wrong.
But because psychiatry has become extremely comfortable discussing interventions with known pharmacologic risk while often feeling strangely uncomfortable discussing:
• outdoor exposure
• gardening
• green space
The risk profile is not equivalent.
And perhaps that should make us pause.
Nature exposure alone is not enough to “cure” major psychiatric illness.
But the growing body of evidence suggests it may meaningfully influence:
• stress physiology
• autonomic regulation
• mood
• emotional recovery
The nervous system is always responding to something.
Psychiatry should probably pay more attention to the environments surrounding it.
Selected References
Bettmann, J. E., Speelman, E., Blumenthal, E., Couch, S., & Schmalz, D. L. (2024). Nature exposure, even as little as 10 minutes, is likely to yield short-term benefits for adults with mental illness: A meta-analysis. Ecopsychology, 16(3), 174–190.
Corley, J., Pattie, A., Harris, S. E., Deary, I. J., & Cox, S. R. (2026). Gardening, healthy aging, and longevity: Longitudinal evidence from 25 years of the Lothian Birth Cohort 1921. Journal of Environmental Psychology, 109, 102889.
Ghaly, M., & Teplitz, D. (2004). The biologic effects of grounding the human body during sleep as measured by cortisol levels and subjective reporting of sleep, pain, and stress. Journal of Alternative and Complementary Medicine, 10(5), 767–776.
Park, B. J., Tsunetsugu, Y., Kasetani, T., Kagawa, T., & Miyazaki, Y. (2010). The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): Evidence from field experiments in 24 forests across Japan. Environmental Health and Preventive Medicine, 15(1), 18–26.
Twohig-Bennett, C., & Jones, A. (2018). The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environmental Research, 166, 628–637.
White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., Bone, A., Depledge, M. H., & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports, 9, 7730.
Hunter, M. R., Gillespie, B. W., & Chen, S. Y.-P. (2019). Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Frontiers in Psychology, 10, 722.
Additional Reading
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 & Technology, 44(10), 3947–3955.
Bratman, G. N., Hamilton, J. P., Hahn, K. S., Daily, G. C., & Gross, J. J. (2015). Nature experience reduces rumination and subgenual prefrontal cortex activation. Proceedings of the National Academy of Sciences, 112(28), 8567–8572.
Kondo, M. C., Jacoby, S. F., & South, E. C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & Place, 51, 136–150.