How Nature in Design Influences Health and Wellness

In late May 2020, I found myself under the giant sycamore tree in the deserted commons outside my locked office. The coronavirus pandemic state-mandated lockdown had closed a huge number of businesses in my state. I thought being near my office would help me feel some sense of normalcy as I tried to make sense of the situation, but the eerie quiet was unnerving. The wellness center I own had been shuttered for two months with no definitive date to re-open, and I had big bills to pay. I bought the business property the year prior, amassing no small amount of debt to turn it into the beautiful center of my dreams, and had moved my business into the space only six months before the shutdown. We were burning through cash quickly with no income in sight. I wondered if the expanded business would even make it through its first year. Hope felt elusive. 

Sleep felt elusive, too.  Many nights I awakened in a panic, my brain circling frantically around questions that had no answer.  I wasn’t the only one. The pandemic had not only decimated the country medically and financially, but also psychologically.  Depression in the U.S. was measured at three times higher (1) during the height of COVID than it was in the pre-COVID world. A report (2) by Kaiser Health Network showed 41% of adults nationwide reported symptoms of clinical anxiety or depression in the summer of 2020 compared to just 11% reporting those symptoms in early 2019.   Daily anxiety plagued me as it did other small business owners I knew as we tried to comprehend how we would survive the economic shutdown. As I pondered the sobering new reality, I leaned into the tree and closed my eyes. I was surprised to find myself feeling more peaceful despite the gravity of what I faced.  Sunlight filtered through the leaves to touch my face. Birdsongs soothed my ears with gentle melodies. The trunk against which I rested my back drained anxiety from me like a powerful grounding cable into the earth below. 

I was not the only one who found solace in nature. During the pandemic shutdown, people took up gardening in record numbers (3). Many of us, especially during this anxiety-provoking time and in need of decompression, instinctively turned to nature: taking walks in the woods, dipping our feet in the ocean, sitting under trees, tending our gardens. Many major cities have designated green space (4). It’s probably no coincidence that resorts are often situated near oceans, lakes and other water features. Think about your top five favorite places to relax. Chances are they involve some aspect of nature or a natural element.  

We are living beings that thrive when living things are around us. We are not separate from nature, but an intrinsic part of it, and being in nature helps our health. In Japan forest bathing” (5), walking for a period of time in forest settings, has been shown to increase immune function, decrease stress hormones, and lower anxiety, anger and depression. A University of Michigan study (6) showed that walking in nature increases short-term memory and elevates mood. A study (7) of Paoli Hospital patients found that having views of nature improved healthcare outcomes in patients, shortened hospital stays, and decreased the need for pain medication. Even simply viewing photos of nature scenes (8, 9, 10) or listening to nature sounds (11) may help autonomic nervous system recovery after mental stress and decrease stress levels. Per one study (12) “Viewing green scenes may thus be particularly effective in supporting relaxation and recovery after experiencing a stressful period, and thereby could serve as an opportunity for micro-restorative experiences and a promising tool in preventing chronic stress and stress-related diseases.”  

In short, nature can heal us.

Just how does this work?  Perhaps it is because nature has a way of engaging multiple senses, and this engagement encourages mindfulness, helping us be in the present moment. Imagine you are sitting under a tree in the woods: listen to the sound of birds chirping in the canopy above, feel the breeze playing across your skin, watch the interplay of sunlight and shade as you hear leaves rustle overhead, inhale the scent of pine and earth. Chances are you are fully immersed in this imaginary scene, and all other thoughts are temporarily on hold. This is mindfulness. And mindfulness begets better working memory, improved attention to tasks, less emotional reactivity, greater cognitive flexibility, more positive affect, better interpersonal skills, increased immune function, and decreased stress and anxiety ( 13, 14 ). And if imagined scenes can promote mindfulness, think of the positive impact that actual multi-sensory engagement would have on health, productivity and teamwork in an office setting. 

This is where employing nature in designing offices is key. 

Biophilic design (15) is a concept in building and interior design that seeks to create within our built environments the sense of place and space we experience in natural environments. When done most successfully, it seeks to create an immersive experience in our indoor spaces engaging all our senses. According to an Interface Human Spaces’ article (16) by Bonnie Casamassima, founder of biophilic design consulting firm Interweave People Place, “Biophilic design has profound benefits to engaging our senses and supporting emotional wellbeing: reduced cortisol levels (a marker of our body’s stress response), increased kindness, improved learning engagement and increased social connectivity. Beyond supporting emotional wellbeing, it has even been shown to positively impact an organization’s financial wellbeing (17) through increasing focus and productivity, for example.” When I spoke with Bonnie, she emphasized the importance of multi-sensory engagement and the overall sense of place as having the greatest impact. Appealing to one sense (say sight, with the inclusion of green plants) can be good; a couple senses, a little better. But finding a way to light up all the senses through an intentional natural environment is the best approach to biophilic design.

This type of design considers human evolution and how our biology has become attuned to certain elements in order to obtain food and water or to feel safe and secure.  For instance, a biophilic design element known as “Prospect-Refuge” (18) posits that in the wild, both predators and prey look for small, shaded, sheltered spaces from which they can survey a wider vista and still remain hidden.  Human beings do this, too.  We build walled towns on top of hills; we covet the corner office with the grand views of outside; we vie for the conference room chair in the corner furthest from the door where we can survey the room.  It’s why we feel safer when entering a lower ceilinged room from a wide open vaulted space. Well-designed hotels use this to great advantage. 

Biophilic design elements such as living plants, water, texture, color, light and scent can be used to create office spaces for health and wellness practices that better support their goals for improved patient/client health outcomes. While many holistic practices often naturally gravitate toward this type of design, clinically-based practices often tend to take on a more sterile feel, devoid of these natural elements. Consider the average medical practice: smooth white walls with minimal décor except for the occasional medically-related informational poster, bright fluorescent lighting, no scents or living plants. Many physical therapy practices often sport plain walls, no plants, bright overhead lights (even though many patients are on treatment tables on their backs), and wide open spaces in which multiple patients are treated within eyesight and earshot of each other. Patients in these settings may not be in the optimal mindset for healing or feeling safe enough to fully disclose what ails them. It’s no wonder people can suffer from “white coat syndrome” (19).  

Imagine how patient experiences and outcomes would improve with the intentional integration of even a few biophilic design elements into these practices, celebrating the spirit of nature and engaging all senses. People can heal faster, require less pain medication, and feel better overall. Patient compliance, return visits and overall satisfaction will improve when patients feel drawn to a clinic because they feel comfortable, safe and cared for on a subliminal level. Furthermore, practitioners in these spaces will also reap the same benefits as patients, resulting in greater employee delight, increased engagement and improved wellness.

*****

A year later, the world is beginning the slow unwinding from this pandemic. Our wellness center is open and we are recovering some semblance of business-as-usual. Clients tell us how they feel peaceful simply walking through the courtyard under the giant sycamore, and then are surprised to find that same feeling of nature and peace permeating our office. We have brought the healing power of nature into our small center to help people in their journey to health and wellness. Clients delight in the sound of the fountains, views of live plants, the scent of essential oils, the quality of light, natural textures and quiet colors.  They tell us that just being in the center they feel better, calmer, more relaxed. In our environment, even I feel better, calmer, more relaxed.  As I look out the front door of our space at the massive tree that sheltered and calmed me months ago, I imagine that its roots are cradling our center and grounding us back into what truly heals us. 

—

The Healing Sanctuary in Exton, PA, with the help of Stage of Design, incorporated biophilic design through the use of elements of nature throughout the wellness center in order to enhance the experience and well-being of clients and practitioners in the center. The Healing Sanctuary was voted Best of Chester County 2020 in Massage Therapy and Alternative Medicine.  Visit our website for a peek at our photo gallery and our services, or call 484.872.8217 to schedule time at the center in-person. 

Instagram: @healingsanctuaryexton
Facebook: @TheHealingSanctuaryExton

With grateful acknowledgement to Bonnie Casamassima, founder of Interweave People Place and Adjunct Professor of Interior Design at SCAD, for her words of wisdom, passion for nature and willingness to share her knowledge of biophilic design.  

SOURCES

(1) AMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146

(2) Prevalence of Depression during COVID
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686

(3) Gardening increases during COVID lockdowns
https://www.reuters.com/article/us-health-coronavirus-gardens/home-gardening-blooms-around-the-world-during-coronavirus-lockdowns-idUSKBN2220D3

(4) http://www.worldcitiescultureforum.com/data/of-public-green-space-parks-and-gardens

(5) Forest Bathing Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793341/

(6) Interacting with Nature improves cognition and affect in people with depression
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393816/

(7) Paoli Hospital Study
https://www.theatlantic.com/health/archive/2013/03/how-nature-resets-our-minds-and-bodies/274455/

(8) https://pubmed.ncbi.nlm.nih.gov/23590163/
Brown DK, Barton JL, Gladwell VF. Viewing nature scenes positively affects recovery of autonomic function following acute-mental stress. Environ Sci Technol. 2013 Jun 4;47(11):5562-9. doi: 10.1021/es305019p. Epub 2013 May 16. PMID: 23590163; PMCID: PMC3699874.

(9) https://pubmed.ncbi.nlm.nih.gov/22270487/
Gladwell VF, Brown DK, Barton JL, Tarvainen MP, Kuoppa P, Pretty J, Suddaby JM, Sandercock GR. The effects of views of nature on autonomic control. Eur J Appl Physiol. 2012 Sep;112(9):3379-86. doi: 10.1007/s00421-012-2318-8. Epub 2012 Jan 21. PMID: 22270487.

(10) https://positivepsychology.com/positive-effects-of-nature/

(11) https://pubmed.ncbi.nlm.nih.gov/20617017/
Alvarsson JJ, Wiens S, Nilsson ME. Stress recovery during exposure to nature sound and environmental noise. Int J Environ Res Public Health. 2010 Mar;7(3):1036-46. doi: 10.3390/ijerph7031036. Epub 2010 Mar 11. PMID: 20617017; PMCID: PMC2872309.

(12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690962/
van den Berg, M. M., Maas, J., Muller, R., Braun, A., Kaandorp, W., van Lien, R., van Poppel, M. N., van Mechelen, W., & van den Berg, A. E. (2015). Autonomic Nervous System Responses to Viewing Green and Built Settings: Differentiating Between Sympathetic and Parasympathetic Activity. International journal of environmental research and public health, 12(12), 15860–15874. https://doi.org/10.3390/ijerph121215026

(13) http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.912.4622&rep=rep1&type=pdf
Davis, Daphne & Hayes, Jeffrey. (2011). What Are the Benefits of Mindfulness? A Practice Review of Psychotherapy-Related Research. Psychotherapy (Chicago, Ill.). 48. 198-208. 10.1037/a0022062.

(14) Clinical trial: Brief mindfulness based programs can improve stress levels in health care professionals. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769761?resultClick=1
JAMA Netw Open. 2020;3(8):e2013424. doi:10.1001/jamanetworkopen.2020.13424

(15) https://en.wikipedia.org/wiki/Biophilic_design

(16) https://blog.interface.com/can-biophilic-design-improve-emotional-wellbeing/

(17) https://blog.interface.com/biophilic-design-good-for-you-good-for-business/

(18) https://landarchconcepts.wordpress.com/what-is-prospect-refuge/

(19) https://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome#1