Ecotherapy and Nature-Based Therapy

What is ecotherapy?

Mind says there is no single definition of ecotherapy. It describes a regular, structured activity, led by trained staff. It happens in nature, or close to water.

The thing you do is the focus, rather than your health.

Mind draws one distinction that saves confusion. Formal ecotherapy is a treatment, run by a trained therapist. People also use the word loosely, for the way a walk lifts them.

Those two are not the same. Mind counts gardening, growing food and work with horses or dogs under the heading. Three of those have sections below.

Sources: Mind: ecotherapy, Mind: nature and wellbeing

How a session works

The setting changes. The therapy does not. You are still working with a trained therapist towards something you named together.

What the outdoors adds is context. Weather, ground and the length of a path become part of the hour. Some people find it easier to speak while walking.

Getting there through the NHS

NHS England runs green social prescribing. It describes this as helping people take up nature-based activities for their health. A link worker or a GP is the usual way in.

This is not a referral for ecotherapy as a treatment. It points you towards an activity. A charity or a community group often runs it.

Sources: NHS England: green social prescribing, BACP: outdoor therapy, Mind: ecotherapy

Walk and talk therapy

This is a session held while walking outdoors. BACP calls it outdoor therapy. It notes that walking and talking therapy is another name for it.

It is a way of holding sessions, not a therapy of its own. Your therapist brings the same approach they would use indoors.

BACP names the risk you might not think of first. Being overheard matters, and so does meeting someone you know. A therapist should agree with you beforehand what happens then.

They should also cover how outdoor sessions differ from indoor ones. That includes what to do in an emergency. BACP expects a risk check covering the route, your footwear and the weather.

BACP points to the Institute for Outdoor Learning on what makes an outdoor therapist competent. Its good practice statement warns that loose outdoor practice can fail people, or harm them.

Some therapists here record walking sessions as one of the places they work. Our own conversation asks whether you would rather meet in person, online or by phone. So if you want to walk, raise it with the therapist.

Sources: BACP: outdoor therapy, Richards et al. 2023

Equine-assisted therapy

This covers therapy that involves horses. In most forms the horse is not ridden. The work is done on the ground.

The research is weak, and its reviewers say so. A 2019 umbrella review pulled together thirteen earlier reviews. Those covered 79 separate studies.

Its authors called the evidence equivocal, and weakened by poor method. They concluded that therapy involving a horse cannot be called best practice.

A 2024 review looked at veterans with post-traumatic stress disorder. It pooled thirteen studies, with 344 people between them. Scores improved after treatment.

Its authors urged caution. Almost all of those studies were of low quality.

Sources: Eagala: certified practitioner, Stern & Chur-Hansen 2019, Provan et al. 2024

Animal-assisted therapy

Three things get similar names, and they are not the same.

Animal-assisted therapy is planned, goal-directed treatment. A qualified health, education or social care worker delivers it. Progress is measured and written up, as in any therapy.

An animal-assisted activity is a different thing. It is an informal visit, for motivation, learning or enjoyment. A visiting pet scheme in a care home is this, not therapy.

An assistance dog is a third thing again. It is trained to do set tasks for its handler.

The rules are thinner than most people assume. The main UK code of practice says no national standards for this work exist here. That code is voluntary.

It covers risk, insurance, privacy and animal welfare.

On the evidence, a 2022 review screened 2,494 studies and kept thirty-five. Almost all of them used dogs. It found short-term anxiety and stress fell, with no clear effect on thinking.

Two limits matter here. Everyone studied was a student in higher education. Its authors said strong differences between studies blocked a clear finding.

They also rated no study as low risk of bias. Living with a pet is a separate question, and we have written up what the research finds.

Sources: IAHAIO: AAI definitions, SCAS: code of practice, Huber et al. 2022

Finding a registered therapist

There is no protected title here. The Health and Care Professions Council regulates a set list of jobs. Ecotherapist and animal-assisted therapist are not on it.

Psychotherapist and counsellor are not protected either.

One accredited register covers part of this ground. It belongs to the Association for Animals, Horticultural and Equine Practitioners. Its roles include animal-assisted therapist and equine-assisted psychotherapist.

Check the therapist's own core register as well. That register admits people on their training. Membership alone does not prove they hold a counselling registration.

For walk and talk there is no separate register. The therapist's own professional body is the thing to check.

Sources: HCPC: protected titles, Lally & Naulls 2025, PSA: AAHEP accreditation, AAHEP: accredited register

The evidence

The largest review of nature-based activity screened 14,321 records. It kept fifty studies. Sixteen of those were randomised trials.

It judged the risk of bias low to moderate for those trials. For the rest it judged that risk moderate to high.

It found mental health outcomes improved. It found less evidence of gain in physical health. On anxiety, its authors called the pooled result imprecise.

Two large British programmes have been looked at. Both are honest about the same gap.

Mind's Ecominds scheme funded 130 projects. It reached more than twelve thousand people. Its report found wellbeing rose, then said the study had no control group.

The national green social prescribing project supported 8,339 people across seven pilot areas. Reported happiness rose. Reported anxiety fell.

Its authors set out the limit themselves. People were often getting other support at the same time. So the share owed to the nature activity is unknown.

There was no control group in that work either.

Sources: Coventry et al. 2021, Bragg et al. 2013, Haywood et al. 2024

What NICE says

NICE does not recommend ecotherapy in its guideline on depression in adults. It does not recommend green social prescribing there either. The nearest thing it says is about activity, not therapy.

It tells staff to advise people that regular activity could help their sense of wellbeing. Walking and gardening are two of its examples. It adds that the gain can be greater outdoors.

So the fair summary is this. Being outdoors is good for most people. The formal versions of it are less well tested than the talking therapies NICE does back.

Our guide to the different approaches sets those out.

Source: NICE NG222