![A clearing at the edge of woodland with the chair on a mossy platform and a path leading away through the trees](https://viacara.com/img/content/approaches-ecotherapy-feature-light.webp) # Ecotherapy and Nature-Based Therapy How therapy outdoors works, what walking, horses and dogs add to a session, and what the UK evidence on nature-based support really shows. ## 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](https://viacara.com/approaches/ecotherapy/#ref-1), [Mind: nature and wellbeing](https://viacara.com/approaches/ecotherapy/#ref-2) ## 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. Different ways to work *outdoors* - **Outdoor therapy** A therapist holds a talking session outside. - **Nature activities** A programme may centre gardening or other outdoor activities. - **Social prescribing** A referral can connect you with a local nature programme. These routes differ. A nature activity or a referral is not itself a psychotherapy method. Sources: [NHS England: green social prescribing](https://viacara.com/approaches/ecotherapy/#ref-4), [BACP: outdoor therapy](https://viacara.com/approaches/ecotherapy/#ref-8), [Mind: ecotherapy](https://viacara.com/approaches/ecotherapy/#ref-1) ![The woodland path seen from the clearing, with an open wooden gate in a low drystone wall](https://viacara.com/img/content/approaches-ecotherapy-mid-light.webp) Outdoors the walk, the weather and the route all become part of the session ## Walk and talk *therapy* The conversation moves *outside* - **The setting** You and your therapist meet outdoors, walking or sitting. - **The conversation** The therapist brings their way of working to that setting. - **The agreement** Access, privacy and weather form part of the plan. Outdoor therapy describes a setting. Walking is one option, not a requirement. 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](https://viacara.com/approaches/ecotherapy/#ref-8), [Richards et al. 2023](https://viacara.com/approaches/ecotherapy/#ref-9) ## Equine-assisted *therapy* Horses within a *therapy session* - **The horses** In the Eagala model, contact happens on the ground. - **The therapist** A mental health professional works with the client. - **The horse specialist** An equine specialist works alongside the therapist. This describes Eagala, one model of equine work. Its sessions do not involve riding. 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](https://viacara.com/approaches/ecotherapy/#ref-19), [Stern & Chur-Hansen 2019](https://viacara.com/approaches/ecotherapy/#ref-10), [Provan et al. 2024](https://viacara.com/approaches/ecotherapy/#ref-11) ## Animal-assisted *therapy* An animal within a *professional plan* - **A plan** A qualified professional sets goals for the work. - **An animal included** The animal takes part within that planned work. - **Progress recorded** The professional measures and records progress. An informal animal visit is an activity, not the same service as 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](https://viacara.com/research/pets-and-mental-health/). Sources: [IAHAIO: AAI definitions](https://viacara.com/approaches/ecotherapy/#ref-12), [SCAS: code of practice](https://viacara.com/approaches/ecotherapy/#ref-13), [Huber et al. 2022](https://viacara.com/approaches/ecotherapy/#ref-14) ## 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](https://viacara.com/approaches/ecotherapy/#ref-17), [Lally & Naulls 2025](https://viacara.com/approaches/ecotherapy/#ref-18), [PSA: AAHEP accreditation](https://viacara.com/approaches/ecotherapy/#ref-16), [AAHEP: accredited register](https://viacara.com/approaches/ecotherapy/#ref-15) ## 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. 130 projects funded Mind's Ecominds [Bragg et al. 2013](https://viacara.com/approaches/ecotherapy/#ref-3) over 12k people reached across those projects [Bragg et al. 2013](https://viacara.com/approaches/ecotherapy/#ref-3) over 8.3k people supported seven pilot areas [Haywood et al. 2024](https://viacara.com/approaches/ecotherapy/#ref-5) 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](https://viacara.com/approaches/ecotherapy/#ref-6), [Bragg et al. 2013](https://viacara.com/approaches/ecotherapy/#ref-3), [Haywood et al. 2024](https://viacara.com/approaches/ecotherapy/#ref-5) ## 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](https://viacara.com/guides/understanding-approaches/) sets those out. Source: [NICE NG222](https://viacara.com/approaches/ecotherapy/#ref-7) On this page [What is ecotherapy?](https://viacara.com/approaches/ecotherapy/#what-is-ecotherapy) [How a session works](https://viacara.com/approaches/ecotherapy/#how-a-session-works) [Getting there through the NHS](https://viacara.com/approaches/ecotherapy/#getting-there-through-the-nhs) [Walk and talk therapy](https://viacara.com/approaches/ecotherapy/#walk-and-talk) [Equine-assisted therapy](https://viacara.com/approaches/ecotherapy/#equine-assisted-therapy) [Animal-assisted therapy](https://viacara.com/approaches/ecotherapy/#animal-assisted-therapy) [Finding a registered therapist](https://viacara.com/approaches/ecotherapy/#finding-a-registered-therapist) [The evidence](https://viacara.com/approaches/ecotherapy/#the-evidence) [What NICE says](https://viacara.com/approaches/ecotherapy/#what-nice-says) Related [Climate Anxiety](https://viacara.com/support/climate-anxiety/) [Low Mood and Depression](https://viacara.com/support/depression/) [Understanding Anxiety](https://viacara.com/support/anxiety/) [Pets do not improve mental health on average](https://viacara.com/research/pets-and-mental-health/) [Counselling](https://viacara.com/approaches/counselling/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) Thanks for your interest. We're not taking on new clients at the moment. ## Would you rather talk *outdoors*? We ask what matters to you, then find professionals who fit. Leave your email and we'll let you know as soon as we're ready for you. This conversation helps us find you the right support. What you share helps us understand what you're looking for and find someone who fits. Your email keeps you updated on what's happening next and isn't shared with anyone we introduce you to. [Privacy policy](https://viacara.com/privacy/) [Terms of service](https://viacara.com/terms/) ## References 1. Mind (2024). *Ecotherapy*. [mind.org.uk](https://www.mind.org.uk/information-support/drugs-and-treatments/talking-therapy-and-counselling/ecotherapy/) 2. Mind (2025). *Ways to use nature to support your mental health*. [mind.org.uk](https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/wellbeing-ideas-to-try-in-nature/) 3. Bragg, R., Wood, C. & Barton, J. (2013). *Ecominds effects on mental wellbeing: an evaluation for Mind*. [mind.org.uk (PDF)](https://www.mind.org.uk/media/4418/ecominds-effects-on-mental-wellbeing-evaluation-report.pdf) 4. NHS England (2023). *Green social prescribing*. [england.nhs.uk](https://www.england.nhs.uk/personalisedcare/social-prescribing/green-social-prescribing/) 5. Haywood, A., Dayson, C., Garside, R., Foster, A., Lovell, R. & Husk, K. (2024). *National evaluation of the Preventing and Tackling Mental Ill Health through Green Social Prescribing project: final report*. [shu.ac.uk (PDF)](https://www.shu.ac.uk/-/media/home/research/cresr/reports/g/gsp-eval-main-report-2024.pdf) 6. Coventry, P. A., Brown, J. V. E., Pervin, J., Brabyn, S., Pateman, R. M., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R. & White, P. C. L. (2021). *Nature-based outdoor activities for mental and physical health: systematic review and meta-analysis*. SSM - Population Health. [doi:10.1016/j.ssmph.2021.100934](https://doi.org/10.1016/j.ssmph.2021.100934) 7. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222/chapter/recommendations) 8. British Association for Counselling and Psychotherapy (2026). *Outdoor therapy*. [bacp.co.uk](https://www.bacp.co.uk/about-therapy/types-of-therapy/outdoor-therapy/) 9. Richards, K., Hardie, A. & Anderson, N., Institute for Outdoor Learning (2023). *Outdoor mental health interventions and outdoor therapy: a statement of good practice*. [outdoor-learning.org](https://www.outdoor-learning.org/Good-Practice/Good-Practice/Outdoor-Mental-Health/) 10. Stern, C. & Chur-Hansen, A. (2019). *An umbrella review of the evidence for equine-assisted interventions*. Australian Journal of Psychology. [doi:10.1111/ajpy.12246](https://doi.org/10.1111/ajpy.12246) 11. Provan, M., Ahmed, Z., Stevens, A. R. & Sardeli, A. V. (2024). *Are equine-assisted services beneficial for military veterans with post-traumatic stress disorder? A systematic review and meta-analysis*. BMC Psychiatry. [doi:10.1186/s12888-024-05984-w](https://doi.org/10.1186/s12888-024-05984-w) 12. International Association of Human-Animal Interaction Organizations (2018). *The IAHAIO definitions for animal assisted intervention*. [iahaio.org (PDF)](https://iahaio.org/wp/wp-content/uploads/2018/04/iahaio_wp_updated-2018-final.pdf) 13. Society for Companion Animal Studies (2019). *Animal assisted interventions: SCAS code of practice for the UK*. [scas.org.uk (PDF)](https://www.scas.org.uk/s/SCAS-AAI-Code-of-Practice-August-2019.pdf) 14. Huber, A., Klug, S. J., Abraham, A., Westenberg, E., Schmidt, V. & Winkler, A. S. (2022). *Animal-assisted interventions improve mental, but not cognitive or physiological health outcomes of higher education students: a systematic review and meta-analysis*. International Journal of Mental Health and Addiction. [doi:10.1007/s11469-022-00945-4](https://doi.org/10.1007/s11469-022-00945-4) 15. Association for Animals, Horticultural and Equine Practitioners (2026). *AAHEP accredited register*. [aahep.uk](https://aahep.uk/) 16. Professional Standards Authority for Health and Social Care (2024). *Association for Animals, Horticultural and Equine Practitioners*. [professionalstandards.org.uk](https://www.professionalstandards.org.uk/organisations-we-oversee/find-a-register/association-animals-horticultural-and-equine-practitioners) 17. Health and Care Professions Council (2026). *Professions and protected titles*. [hcpc-uk.org](https://www.hcpc-uk.org/about-us/who-we-regulate/the-professions/) 18. Lally, C. & Naulls, S., Parliamentary Office of Science and Technology (2025). *Regulation of psychological professionals in mental health care*. [post.parliament.uk](https://post.parliament.uk/regulation-of-psychological-professionals/) 19. Eagala (n.d.). *What it means to be an Eagala certified practitioner*. [eagala.org](https://www.eagala.org/blog/what-does-it-mean-to-be-an-eagala-certified-practitioner/) ## Related ### [Climate Anxiety](https://viacara.com/support/climate-anxiety/) Climate anxiety is an understandable response to a real threat, not a condition. Find a professional who helps you carry it without it running your life. ### [Low Mood and Depression](https://viacara.com/support/depression/) Low mood that lasts two weeks or more can be a sign of depression. It is common and treatable. Find a professional who works with low mood. ### [Understanding Anxiety](https://viacara.com/support/anxiety/) Learn about anxiety, its symptoms and how therapy can help. Find the right practitioner for anxiety support. ### [Pets do not improve mental health on average](https://viacara.com/research/pets-and-mental-health/) Across 159,322 people, pet owners were no less likely to be depressed. Dogs do get people walking, and a pet softens a bereavement. The costs are real too. ### [Counselling](https://viacara.com/approaches/counselling/) Learn what counselling is, what sessions look like, how it differs from CBT and psychotherapy and how to find a counsellor on a recognised register. ### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods.