The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health

This review (2020) of psychedelic therapy and nature relatedness argues that both may work in synergy and that maximizing nature relatedness during psychedelic therapy could provide added benefits.

Abstract

“Therapeutic psychedelic administration and contact with nature have been associated with the same psychological mechanisms: decreased rumination and negative affect, enhanced psychological connectedness and mindfulness-related capacities, and heightened states of awe and transcendent experiences, all processes linked to improvements in mental health amongst clinical and healthy populations. Nature-based settings can have inherently psychologically soothing properties which may complement all stages of psychedelic therapy (mainly preparation and integration) whilst potentiating increases in nature relatedness, with associated psychological benefits. Maximising enhancement of nature relatedness through therapeutic psychedelic administration may constitute an independent and complementary pathway towards improvements in mental health that can be elicited by psychedelics.“

Authors: Sam Gandy, Matthias Forstmann, Robin L. Carhart-Harris, Christopher Timmermann, David Luke & Rosalind Watts

Notes

Two of the authors (Gandy & Watts) are associated with the for-profit Synthesis Institute.

The paper uses the following definition of nature relatedness: “a sense of ‘oneness with the natural world’ or a ‘sustained awareness of the interrelatedness between one’s self and the rest of nature’.”

In the review the authors “lay out the argument for utilising nature based settings and practices for some stages of psychedelic therapy (mainly preparation and integration).”

The paper walks through the various arguments for the benefit of nature relatedness and how together with psychedelics it may synergistically increase mental health.

Summary

Introduction

Nature relatedness is a state of consciousness that is experiential, emotional and highly personal, rather than rational or deliberation-based. It is associated with mental well-being and increased contact with nature.

Abstract

Psychedelic therapy and nature-based settings are associated with improvements in mental health. Increasing nature relatedness can be a pathway towards improved mental health.

Psychedelics can foster sustained increases in nature relatedness, and appreciation for and contact with nature, through a number of different mechanisms, including increased mindfulness-related capacities, connectedness, openness to experience and eliciting strong emotional states.

Psychedelic substances are being investigated for the treatment of major depressive disorder, existential anxiety secondary to a terminal cancer diagnosis, addiction, and PTSD. In healthy populations, sustained increases across numerous measures of psychological well-being are observed.

Psychedelics have been found to promote well-being by enhancing mindfulness, connectedness, empathy, unitive states and awe. They have also been found to increase openness to experience.

In this review, we argue that incorporating nature-based settings and practices into the preparation and integration phases of psychedelic therapy could support the therapy model, potentially by amplifying some of the key therapeutic mechanisms and increasing the likelihood that a patient will use nature as an ongoing resource.

Nature contact and mental health

Nature has a healing power and can be defined as areas containing elements of living systems, including plants and nonhuman animals.

Contact with nature is associated with reductions in mental distress, anxiety and depression, and improves mood and memory in patients suffering from major depressive disorder and post-traumatic stress disorder. It can also reduce rumination and stress levels.

Contact with nature is a strong predictor of psychological well-being, elevating both hedonic and eudaimonic well-being and facilitating psychological restoration. Time spent in nature has been found to increase vitality, self-esteem, and result in higher positive affect and lower negative affect.

Nature relatedness and mental health

There is a strong association between nature relatedness and psychological health and eudaimonic well-being, with nature relatedness being four times larger than the increase in eudaimonic well-being associated with higher socio-economic status.

Nature relatedness has been associated with enhanced vitality, greater perceived life meaning, life satisfaction, feelings of worthwhileness, greater happiness and positive affect, and reduced levels of anxiety. It is also associated with physical activity, which is linked to good mental health.

Nature relatedness is a strong predictor of pro-environmental attitudes and behaviour, and is associated with well-being and prosociality. However, aspects of nature relatedness reflecting self-identification with nature and a conservation worldview may be associated with increased depression, anxiety or stress.

Nature relatedness is an important mediator for many benefits obtained while spending time in nature. It is also associated with increased attentional capacity, propensity to experience positive emotions and the ability to reflect on a life problem, as well as a more positive body image.

Research indicates that greater contact with nature during childhood is associated with greater nature relatedness, contact with nature and pro-environmental behaviours in adulthood. However, as urbanisation increases globally, more people are being brought up in nature-depleted environments, which is likely to negatively impact people’s connection to nature.

Interventions able to foster sustained increases in nature relatedness are needed, as passive contact with nature alone may only elicit transient increases or be insufficient to increase it.

Overlapping mechanisms between psychedelic administration and contact with nature

Natural settings may elicit mind/brain states that share some similarities with psychedelic mind/brain states. Both psychedelics and contact with nature appear to reduce rumination and activity in areas of the brain implicated in depression.

Rumination has been linked to the dorsolateral prefrontal cortex (DMN) and increased functional connectivity between the DMN and subgenual prefrontal cortex (sgPFC), including increased regional cerebral blood flow in the latter. Contact with nature appears to reduce activity in the DMN.

Psychological

Connectedness has been suggested as a key phenomenon relevant to both the acute action of psychedelics and their longer-term effects. The Watts Connectedness Scale measures three subscales: connection to self, connection to others and connection to world/universe.

Ego-dissolution and the unitive experience may be central to the experiences of increased interconnectedness that can occur. Psilocybin administration has been found to elicit dose-dependent increases in measures of external unity.

Nature contact can lead to greater connectedness, similar to psychedelics, and can increase empathy and an acknowledgement of other people and life as a whole.

Psychedelics and nature contact can increase a sense of connectedness, which is notable as a sense of ‘disconnection’, alienation or isolation has been implicated with a broad range of mental illnesses including eating disorders, bipolar personality disorder, PTSD and depression.

Psilocybin can occasion a mystical experience, which includes feelings of interconnectedness, unity, timelessness and states of mindful absorption. This experience has been found to be strongly associated with positive changes in people’s relationship to nature.

A study found that mystical experiences that occur in natural and human-built settings both significantly predicted psychological well-being, but only mystical experiences occurring in natural settings predicted an increase in pro-environmental behaviour.

Awe is an experience that can be induced by exposure to natural environments and is associated with enhanced well-being, life satisfaction, prosociality, reduced negative affect, and mental distress. It has been proposed that administering psychedelics in natural settings may enhance treatment efficacy. Experiences of awe in nature are associated with perception of large natural objects, events, or objects with infinite repetition, such as waves, trees, clouds, rain and birdsong. Awe is linked to feelings of spirituality and nature relatedness, and spirituality can act as a mediator between nature relatedness and psychological well-being.

Psychedelics may elicit strong emotional states during the acute experience, but their longer term impact on affect has been consistently demonstrated to be positive. Nature relatedness and nature contact appear to have similar and potentially synergistic effects on reducing negative affect.

Major depression diagnoses are characterised by high levels of negative affect, with concurrent attenuated levels of positive affect. Reduced levels of negative affect have been found to reduce the strength and frequency of substance cravings following contact with natural environments.

Psychedelics can foster mindfulness, which can enhance the acute psychedelic experience, as well as the long-term psychological benefits obtained from psychedelic use. Mindfulness is also associated with nature relatedness, psychological well-being, and pro-environmental behaviour.

Contact with natural settings can induce meditative, reflective mind states and may induce alpha activity in the brain, an indicator of a wakefully relaxed state and internalized attention. Nature contact can increase mindfulness, which can enhance the benefits of nature contact.

Psychedelics have been shown to increase openness to experience, which is a personality trait related to connectedness to nature and pro-environmental attitudes. Ayahuasca users have been found to rate more highly in the personality trait of self-transcendence, which is a trait related to openness.

Psilocybin was found to increase trait absorption in healthy volunteers, and reduce trait neuroticism in patients with treatment resistant depression. Ayahuasca usage in a traditional context was also found to reduce neuroticism.

Potential benefits of natural settings for therapeutic psychedelic experiences

Psilocybin is currently designated as Schedule 1 drug in the UK and USA, imposing onerous and highly restrictive regulations around its use in a research and therapeutic context. However, clinicians are calling for such restrictions to be revised to more fairly reflect its relative harm and potential benefit.

The set and setting of psychedelic usage is known to be a key determinant of experiential outcomes. In clinical settings, psilocybin is often administered in a pre-prepared hospital room or living-room-like environment, and participants typically wear eyeshades and headphones playing music.

Psychedelics can act as catalysts or amplifiers for psychotherapeutic practices and processes, and nature can also act as an amplifier for therapeutic effect. This suggests that incorporating nature-based settings into psychedelic treatment models could elicit a beneficial synergy.

There are many reasons to consider holding therapeutic psilocybin sessions in a natural setting rather than a hospital room. Such settings have a soothing effect on the mind, and can reduce stress, and allow for mental space for reflection, with reduced likelihood of challenging experiences with psychedelics.

The natural environment may partly explain why psychedelic experiences are commonly taken in natural settings, and taking psychedelics with the intent to connect with nature has been associated with greater well-being scores and likelihood of mystical-type experiences.

Given that we have spent almost our entire existence in natural environments, it is likely that we have an innate preference for them. When taking psychedelics in natural/nature-rich settings, we may experience the sensory aspects of nature more richly and immersively than usual.

There are major barriers to attempting to hold psychedelic sessions in nature, such as disturbances, privacy, inclement weather and a lack of control, comfort and safety. However, bringing some natural elements into the clinical space can be beneficial.

The Usona Institute will use hybrid indoor/ outdoor secure, sheltered structures incorporating biophilic design elements in a nature-based setting for psychedelic therapy.

Potential benefits of natural settings for preparation and integration of psychedelic experiences

Psychedelic preparation sessions can include some elements of nature immersion, and are used to establish trust between the person having the psilocybin experience and the therapists who will be supporting them through the psychedelic experience. Horticulture exercises could be a perfect complement to a preparation session, such as weeding and tilling the soil, and adding compost, and to an integration session, such as planting a seed in the freshly tilled soil and caring for it daily.

The practice of Shinrin-Yoku, a Japanese form of nature therapy and active mindfulness practice, could be useful at every stage in the psychedelic therapy journey. Sitting in a calming sheltered garden could also enhance mindfulness practice. Awe walks are a simple intervention that has been demonstrated to increase positive prosocial emotions and facilitate a reduction in mental distress. Awe walks may be beneficial post psychedelic experience, helping consolidate any feelings of awe which may persist beyond the psychedelic session.

Parts of preparation and integration sessions contain standard talking therapy elements, and having these discussions in a natural setting may be helpful. Maintaining standard therapeutic boundaries outdoors may require some additional training, and some psychoeducation may need to be discussed with participants.

Linking preparation and integration to an outdoor nature-based setting may help people establish a connection to nature as a therapy room they can later return to by themselves to self-sooth. This may be especially helpful for people suffering from severe depression.

Journaling with an emotional focus and nature journaling may be effective ways to maintain the benefits of psychedelic sessions. Nature can teach people via metaphor, such as interconnectedness and seasonal change, and the recognition that humans go through cycles of light and dark, death and rebirth. This can be therapeutically beneficial for people who suffer from depression.

Developing a new model for psychedelic therapy to treat nature disconnection

A therapeutic model could be developed that incorporates nature contact into preparation and integration sessions, and then graduates onto an outdoor nature-based session once people are more experienced with psychedelic effects.

Conclusion

Nature-based settings have the potential to enhance some aspects of psychedelic therapy, and could under certain circumstances be used for psychedelic sessions themselves, without neglecting vital safety concerns regarding safeguarding vulnerable people under the influence of psychedelics.

Future studies should investigate the benefits of natural settings and how they may complement clinical or indoor settings in greater detail, incorporating nature relatedness measures and introspective attitudinal and behavioural measures of environmental concern.

Albert Hofmann saw the capacity of psychedelics to reconnect humans to nature as one of their most important properties.