# The Implicit Ecosystem of Outdoor Therapies: A Grounded Theory Exploratory Study of International Practitioners’ Guiding Frameworks and the Proposition of a Practice Theory

## TL;DR

This study explores how outdoor therapies can improve mental and physical health by identifying a new framework used by practitioners worldwide.

## Contribution

The study proposes a novel practice theory called the 'implicit ecosystem of outdoor therapies' based on practitioner insights from 18 countries.

## Key findings

- Outdoor therapies can be applied across diverse populations and settings for health promotion and treatment.
- Eight interrelated components describe the therapeutic mechanisms of outdoor therapies.
- The proposed theory can guide training, research, and practice in the field.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Mental and physical health concerns increasingly exceed healthcare system capacity, necessitating identification of accessible, low-cost health promotion and treatment strategies that can improve population health outcomes.Outdoor therapies offer biopsychosocial approaches to address stress-related and mental health concerns with broad applicability across populations and settings.

Mental and physical health concerns increasingly exceed healthcare system capacity, necessitating identification of accessible, low-cost health promotion and treatment strategies that can improve population health outcomes.

Outdoor therapies offer biopsychosocial approaches to address stress-related and mental health concerns with broad applicability across populations and settings.

Public health significance—Why is this work of significance to public health?
This international study elicits implicit therapeutic frameworks from 68 practitioners across 18 nations, proposing a practice theory comprising eight interrelated components that describe the therapeutic mechanisms of outdoor therapies.The proposed practice theory can be applied to diverse populations along the continuum of care from health promotion to specialized treatment, and across varied nature environments and cultural contexts.

This international study elicits implicit therapeutic frameworks from 68 practitioners across 18 nations, proposing a practice theory comprising eight interrelated components that describe the therapeutic mechanisms of outdoor therapies.

The proposed practice theory can be applied to diverse populations along the continuum of care from health promotion to specialized treatment, and across varied nature environments and cultural contexts.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Outdoor therapies provide dynamic and multi-dimensional therapeutic approaches adaptable to physical, mental, emotional, social, behavioral, and cultural needs.Outdoor therapies can be applied as self-care, health promotion, health care and rehabilitation, and as such offer versatile approaches that can be implemented along the continuum of care from preventive strategies across to specialized treatment.

Outdoor therapies provide dynamic and multi-dimensional therapeutic approaches adaptable to physical, mental, emotional, social, behavioral, and cultural needs.

Outdoor therapies can be applied as self-care, health promotion, health care and rehabilitation, and as such offer versatile approaches that can be implemented along the continuum of care from preventive strategies across to specialized treatment.

Human health and well-being are dependent on natural environments, which is the core foundation of the growing discipline of outdoor therapies. However, as with psychotherapy research in general, the field of outdoor therapies lacks descriptive process-oriented theoretical frameworks that precisely reflect this multi-faceted practice. Therapeutic work, whether this takes place indoors or outdoors, comprises numerous implicit relational and environmental dimensions. Implicit aspects are largely sensed, embodied and intuitive, and therefore hard to pin down and describe accurately. In this exploratory study, a survey mapped implicit guiding frameworks amongst outdoor therapy practitioners (n = 68) representing 18 nations. A constructivist grounded theory analysis resulted in the proposition of a practice theory, called the implicit ecosystem of outdoor therapies, made up of eight interrelated components: (1) joint engagement and co-creating agendas; (2) a foundation of safety and trust; (3) being in parallel and not fix; (4) awareness and attunement here-now; (5) the dynamic of outer and inner landscapes; (6) a constantly moving and meaning-making endeavor; (7) creativity, play, and whole-body activation; and (8) working through natural barriers and rewriting narratives. This grounded theory offers a preliminary blueprint of a practice-guiding framework developed from within the outdoor therapy discipline intended to advance theory, training, and research.