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Forest therapy as a trauma-informed approach to disaster recovery: Insights from a wildfire-affected community [1]
['Cat Hartwell', 'Department Of Environmental', 'Occupational Health Sciences', 'School Of Public Health', 'University Of Washington', 'Seattle', 'Washington', 'United States Of America', 'Juliette M. Randazza', 'Gregory N. Bratman']
Date: 2023-10
A trauma-informed approach to disaster recovery recognizes the potential impacts of trauma, promotes resilience to protect against retraumatization, and can support catering the needs of disaster survivors in affected communities. A growing body of evidence demonstrates that interaction with nature is associated with a number of physical and mental health benefits, though literature surrounding nature-based therapy and disaster survivors is limited. Through key informant interviews with forest therapy guides from a program in wildfire affected Butte County, CA, this exploratory study investigates if and how “Forest Therapy ’’ can serve as a trauma-informed approach to promote wellbeing in the face of climate change and associated disasters. We find that community-based forest therapy programs offer a promising, flexible approach to community-based trauma-informed mental health servicest in disaster-affected communities. Findings also identify opportunities to tailor implementation of future programs to better reach populations most impacted by disasters, including through targeted outreach and diverse guide recruitment. Future research should investigate the impacts of forest therapy on the mental health and wellbeing of participants, as well as the scalability of forest therapy programs in disaster-affected communities.
Funding: Funding for this research was provided by the University of Washington Interdisciplinary Center for Exposures, Diseases, Genomics and Environment (NIEHS Grant #: P30ES007033 to NE) and a gift to the Chico State Ecological Reserve (BE, EG). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Data Availability: We have created and published a project on the National Science Foundation-funded DesignSafe-CI’s Data Depot Repository, and have uploaded the data to the repository. In alignment with DesignSafe’s Protected Data Best Practices, we have published the metadata and descriptive information about the dataset with the project. However, the data set is restricted because it contains sensitive or potentially identifiable information. This is because, although the transcripts have been reviewed to remove direct and indirect identifiers, our small sampling frame precludes complete de-identification. Specifically, we interviewed 11 of 14 individuals who served as forest therapy guides for the “Forest Therapy Pilot Program” established by Chico State University following the Camp Fire in Butte County, CA. Given that the guides’ identities are public, contextual information provided during the interview may enable identification. As noted in our DesignSafe publication, interview transcripts have not been made public because complete de-identification is not possible, due to the small study population sample and the personal nature of the conversations. The data that is available for public access on DesignSafe includes the analytic matrix, which contains summarized, de-identified data from the individual interviews that was used for analysis. We have referenced the published data in our manuscript (DesignSafe project PRJ-3883, DOI:
https://doi.org/10.17603/ds2-sffr-0489 ).
Copyright: © 2023 Hartwell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction
Climate change is contributing to increasing frequency and severity of wildfires [1–3]. In the United States, the western state of California is among the nation’s most affected. Between 2017 and 2021, California has experienced 7,930 wildfires, resulting in 2,132,516 acres burned and costing an estimated 4.5 billion dollars in fire suppression expenses alone [4–6]. In November 2018, Butte County, CA was devastated by the Camp Fire, which stands as California’s deadliest wildfire in recorded history. The Camp Fire killed at least 85 civilians, displaced 53,000 people, destroyed 18,804 structures, and burned 153,335 acres of land [7, 8]. The Camp Fire is one of many fires that continue to ravage the area; we estimate that subsequent wildfires in 2020 and 2021, in combination with the Camp Fire, resulted in over 20% of Butte County being burned [9–11].
Wildfires and associated smoke events have been shown to have mental health consequences, including anxiety, depression, environmental grief and other sub-clinical impacts [12–15]. The loss of or damage to a person’s home, property and community, compounded by the threat to their safety or to that of loved ones can negatively impact survivors’ mental health for years after the disastrous event [13]. However, many rural communities hard hit by wildfires lack sufficient mental health services [16]. These baseline service limitations are only exacerbated by disasters; wildfires and other climate disasters may damage, destroy, or otherwise minimize access to existing mental health resources and services within a community [17, 18]. Indeed, Butte County is designated as a Mental Health Shortage area by the Health Resources & Services Administration [19]. Compounding pre-existing mental health shortages, the Camp Fire resulted in disruptions to the healthcare and education sectors where formal and informal mental health and social support services may have been previously accessed [20].
At the same time, the multitude of psychological impacts that commonly occur in the wake of a disastrous event are likely to yield increased demands for both acute and long-term mental health services in disaster-affected communities [18]. Community-based mental health services offered in a variety of settings can provide a broader range of functions compared to hospital-based mental health care [21], and may stop-gap the dearth in services amid rising demand following disasters. In particular, programs that use a “trauma-informed approach” may facilitate community healing and prevent retraumatization of community members [22].
“Trauma-informed care” as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) is a program, system or organization that understands the extensive impact of trauma and identifies potential paths for recovery; recognizes the symptoms and signs of trauma in clients, staff, families and others involved in the system; and responds by fully incorporating knowledge of trauma into practices, procedures and policies while actively seeking to resist retraumatization [23]. SAMHSA has identified the following six key principles as integral to trauma-informed care: Safety; Trustworthiness and Transparency; Peer Support, Collaboration and Mutuality; Empowerment, Voice and Choice; and Cultural, Historical and Gender Issues (Table 1) [23]. While a trauma-informed approach to disaster recovery has been proposed to acknowledge and address community trauma throughout the redevelopment process [22], little research has explored the trauma-informed methods to increase well-being and decrease ill-being in the face of climate-related disasters.
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TIFF original image Download: Table 1. Key points related to each trauma-informed principle. Table 1 provides SAMHSA definitions for each of the six principles of a trauma informed approach along with examples from interviews with forest therapy guides of how these principles appear during forest therapy walks. SAMHSA, 2014.
https://doi.org/10.1371/journal.pclm.0000096.t001
Forest therapy is inspired by the Japanese practice of “Shinrin-Yoku,” also known as “forest bathing,” a traditional technique designed to mindfully stimulate the five senses while connecting with nature [24]. According to the Association of Nature and Forest Therapy (ANFT), forest therapy is an evidence-based approach that supports well-being and healing through immersion in the natural world. Sessions are directed by certified forest therapy guides who lead participants on a clearly defined sequence of invitations and optional activities [Fig 1], providing structure to support engagement while creating space for unique personal experiences [25, 26]. Described as an “open-ended approach,” forest therapy transfers autonomy and efficacy to the individual, a central pillar of trauma-informed practice [23, 25].
Forest therapy may be considered a misnomer, as no psychotherapy services—at least as traditionally understood by Western mental healthcare–are provided. Forest therapy is a wellness practice that has been implemented in over 60 countries, based on a secular, research-based framework [25, 27]. Forest therapy guides trained in the ANFT program complete a 6-month remote training program, followed by a 4-day immersive training in-person before they are eligible to receive certification to be an ANFT Certified Forest Therapy Guide [28]. The curriculum for training includes an introduction to the ANFT Standard Sequence [Fig 1], fundamental concepts and pedagogy for connecting to nature, lessons on safety and trail awareness, facilitation techniques for promoting open environments to encourage group sharing, and modes of learning about the history and other characteristics of one’s bioregion, among other relevant topics of instruction [Fig 2] [28]. Open to clients of any background, forest bathing and similar nature therapy experiences have been conducted in a variety of environments, including recreational forested areas, campsites, controlled laboratory settings simulating the natural world with live plants, and fruit orchards [24, 29–33]. Forest therapy programs are being adapted and offered in some locations to be more accessible for people with limited mobility and physical and intellectual disabilities [34–36]. Throughout this paper, we will describe forest therapy sessions as “walks,” however they can be guided at accessible locations and walking is not actually required for the experience.
Exposure to and interactions with nature demonstrate diverse health benefits, including improved sleep, relief from anxiety and stress, and opportunities to engage in physical activities that aid in the prevention of many chronic diseases and conditions such as diabetes and cardiovascular disease [37, 38]. Relatedly, research reports the therapeutic effects of the practice of forest therapy, including improved immune function, reduction in pain and symptoms associated with hypertension, coronary artery disease, mood disorders and stress, among other beneficial health outcomes [24, 39, 40]. For example, an experimental study of “Shinrin-Yoku” conducted in 24 forests across Japan between 2005 and 2006 identified lower cortisol levels, pulse rates, and blood pressure among the study participants exposed to the forest environment compared to those exposed to an urban setting [39]. These findings were echoed in a broader literature review of 64 publications dated between 2007 and 2017, which found forest bathing and nature therapy to be associated with lower blood pressure and heart rates, reduced symptoms of depression in certain populations, and a heightened sense of calm and wellbeing [24]. A second 2017 systematic review focusing exclusively on randomized control trials (RCTs) involving forest therapy found that in addition to an association with lower blood pressure, there was a positive effect of forest therapy on oxidative stress, hypertension, and cardiac and pulmonary function, although the effects of forest therapy on inflammation, anxiety and depression had mixed results [40]. Specific to public health emergencies, a recent study of healthcare workers with distinctly higher job stress during the COVID-19 pandemic found reductions in insomnia and daytime sleepiness, as well as reduced anxiety, depression and somatic symptoms following engagement in forest therapy [41].
Chico State University’s Forest Therapy for Community Recovery program In October 2019, the Chico State University’s Chico Ecological Reserves received funding from the North Valley Community Foundation’s (NVCF) Butte Strong Fund for the “Forest Therapy for Community Recovery’’ pilot project in response to the Camp Fire. The pilot project funded the certification of 15 interested members of the community, including mental health professionals, teachers and academics, outdoor educators, and those working in other fields to become forest therapy guides. Potential guides were recruited through local community organizations and partner agencies via news outlets and social networks, and once selected, they completed the ANFT certification program. During the training period, guides were Wilderness First Aid certified and learned about the ethos, techniques and tools of forest therapy, including the ANFT Standard Sequence [Fig 1]. The goal of the “Forest Therapy for Community Recovery’’ pilot was to develop and implement a scalable program to provide professionally guided forest therapy experiences to at least 450 individuals impacted by the 2018 Camp Fire and to evaluate the effectiveness of participation in forest therapy experiences on mental health and wellbeing. Forest therapy experiences were advertised and offered to the general public, with priority given to individuals impacted by the Camp Fire. The publicly announced “Forest Therapy for Community Recovery’’ walks occurred during July and August of 2021 and served 378 individuals. The pilot program faced implementation limitations due to the ongoing COVID-19 pandemic and because of some cancellations due to poor air quality from the 2021 Dixie Fire.
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[1] Url:
https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000096
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