Write Yourself a Prescription for Nature

Feb 20, 2023

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We all know that spending time in nature is a wonderful stress-reducer. Numerous medical studies support the health benefits of allowing nature to rejuvenate us, and countless testimonials to this fact could be garnered from around the world. Why, then, do we not spend more time outside? Could it be because we believe we’re too busy to have it matter?

In this episode, I want to explore this topic, including the results of some studies and the benefits of even spending just 20 minutes outside. And I hope after spending about 20 minutes or so with me, pondering the statistics and anecdotes I’ll share regarding the healing power of being outdoors, you’ll write yourself a prescription for nature and heed it right away.

“You can boost your mood just by walking in nature, even in urban nature. And the sense of connection you have with the natural world seems to also contribute to happiness, even when you’re not physically immersed in nature.” – Dr. Sara Dill

What You’ll Learn

  • Stats and studies
  • Break lengths
  • Improvements and benefits
  • Forest bathing
  • Intentionally immersing in nature
  • Bring it in if you need to

Contact Info and Recommended Resources

Podcast Episodes that pair well with this one:

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I read all my own emails and would love to hear from you. Feel free to ask me questions or make topic suggestions for the podcast. Email me at [email protected].


I'm Dr. Sarah Dill, and this is the Stressless Physician Podcast, episode number 54.
Welcome to the Stress Less Physician Podcast. I'm your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feel good to you, you are in the right place.
Everyone, welcome back to the podcast. Happy Monday, or whatever day of the week it might be. I am excited to hang out with you for the next 20 minutes or so, and I've actually been thinking about this podcast episode for a little while, and I'm excited to talk to you about something that I think we all maybe know, or have experienced. But I just wanted to discuss it a little bit more because it's something that I have found so useful in my life across many different phases, many different situations, many different times in my life. And that is, about spending time in nature, whatever nature might look like to you, as a specific tool or technique to reduce your stress, specifically to reduce your cortisol levels.
And what's really interesting to me is, I love to go and look at the research and there is a ton of research in the last 10 or even 20 years showing a lot of the benefits of time spent in nature on our health, on our mental wellbeing, and on so many other factors. So it's one of those things that I think many of us probably know from personal experience. I don't know about you, but when I'm stressed, for me, a lot of times going outside, taking a walk, going to the ocean or going someplace, especially a place that is a little bit quieter where you can be alone, is somehow naturally where I turn as a way to feel better.
And so I wanted just to take this opportunity to review some of the research and then to offer my perspective on it and encourage you to do your own mini trial of one right, an N of one, and see what your experience is. So I just wanna share a statistic that I find a little bit crazy, but also believable. According to a study sponsored by the Environmental Protection Agency, the average American spends 93% of their time indoors. That's a lot. And yet, when I think about my life or the lives of other people I know, that's probably not far off depending on how much of an effort you make to get outside, and depending on where you live and the weather, and what your habits are. 93% though of time indoors.
And I will say, especially because I live in California now, and I know many of you live in places where the weather is a lot more severe, but even when I lived in New England, I did always spend some time every day outside. And that's because I have a dog and I believe in walking my dog. And so Tucker and I would walk three to four times a day regardless of the weather. So I hear you, those of you who live in colder climates, I'm not saying it's always easy, but it was something that didn't really have an excuse for in that case. Tucker wanted to go out. He wasn't really a yard dog, and so we would take a walk.
I will say that in blizzards and in windstorms, and when it was really cold, I did not spend that much time outside. Neither Tucker nor I really wanted to spend an extended period of time outside. But we went out. And it's interesting in that the first research article I want to share with you, was a small study.
It was 36 people, but it was people residing in urban environments and they were asked to spend 10 minutes or longer outside three days a week for eight weeks in some sort of outdoor place where they could interact with nature. So the settings varied from yards to public parks to green spaces, like public green areas near their place of. And these subjects either walked or they sat during their nature time. It was up to them.
And the results, which were published in 2019 in the Frontiers in Psychology, showed that spending just 20 minutes connecting with nature helped lowered stress hormone levels - so they measured cortisol levels - significantly, so just 20 minutes. And it was interesting in that 20 minutes seemed to be the sweet spot. After 20 minutes you might accrue some additional benefits, but they weren't particularly significant.
A much larger study, 20,000 people came out of England, and a researcher there at the University of Exeter, who found that people who spent two hours a week, that was cumulative, it didn't have to be all at once, but two hours a week in green spaces, which included local parks, yards, other natural environments, we're substantially more likely to report good health and psychological wellbeing than those who don't. So this was a non-interventional study, so again, it didn't matter where, whether the 120 minutes or the two hours was achieved in a single visit or over several shorter visits.
And it found that the 120 minute threshold seem to apply to both men and women to older and younger adults, and seem to cross occupational and ethnic groups, and even people with chronic illnesses and disabilities. It was interesting in that a lot of the benefits didn't really seem to accrue below that 120 minute per week mark. I'm never a fan of hard and fast rules. I would say anytime outside may be beneficial, but 120 minutes over the course of a week seems like maybe that's the goal.
Another study showed that subjects had a 20% improvement in memory and attention spans after spending an hour interacting with nature. This was an improvement that was consistent across different seasons and different temperatures. This was out of the University of Michigan in 2000.
Another researcher states that you can boost your mood just by walking in nature, even in urban nature, and the sense of connection you have with the natural world seems to also contribute to happiness even when you're not physically immersed in nature. So somehow just having that sense of connection. I think this is something that may be relevant for most of us physicians who spend a lot of time clicking, with the electronic health record.
But this study was published in 2015 and it came out of Australia. So Australian researchers asked students to engage in a dull attention-draining task in which they pressed a computer key when a certain number flashed on a screen. Students who looked out at a flowering green roof for 40 seconds, so not very long, 40 seconds, midway through the task, made significantly fewer mistakes than students who paused for 40 seconds to gaze at a concrete roof. So that's an example where 40 seconds, very brief intervention, and that's just looking out at a roof that's not even really being exposed to nature.
Another study out of University of Michigan again found that even the sounds of nature may be recuperable and restorative. So the study looked at participants who listened to nature, sounds like crickets chirping, and waves crashing, and their performance was better on demanding cognitive tests than those who listened to urban sounds like traffic and busy cafe noises. That was published in 2019. So just listening to nature sounds.
There's a lot of research that shows that contact with nature, in whatever form, is associated with increases in happiness, subjective wellbeing, positive affect, positive social interactions, and a sense of meaning and purpose in life, as well as decreases in mental distress.
I mean, that's a lot. The citation, there was a publication in 2019 in a journal called Science Advances. The interesting thing is that we don't really know why. We see these benefits, right? There's other research that shows decreases in systolic blood pressure of about 10 points after spending up to four hours in nature. There's other studies again that show measurable decreases in cortisol, which is fascinating.
So researchers have proposed a number of ideas to explain why we might see these benefits in our physical and mental wellbeing after time spent in nature or time even spent looking at nature. One theory is a hypothesis that since we evolved in wild settings and relied on the environment for survival, we have some innate drive to connect with nature. Been called the biophilia hypothesis. Love of of nature. There's a stress reduction hypothesis that basically posits that spending time in nature triggers a physiological response that lowers stress levels. I think that sounds like more of an observational theory. That doesn't really explain why that's true.
And then there's another hypothesis that has to do with attention restoration. And this holds that nature replenishes one's cognitive resources, restoring the ability to concentrate and pay attention. And again, that seems to be anecdotally true in studies. I don't know if that explains why there's a benefit, but stress reduction and attention restoration are clearly.
So if you are able to concentrate and pay attention, that's also probably gonna be tied in with having a reduced physiological stress response. This idea has also been talked about in just the public domain and in a lot of less scientific articles and journals and coined forest bathing, and that was a term that emerged from Japan in the 1980s as an intentional physiological and psychological exercise in which the point is to immerse yourself in nature, to slow down and become immersed in the natural environment, tuning into all of the different aspects of the forest- the smells, the textures, the tastes, and the sights.
There's actually been a lot of studies coming out of that, again, that support the idea that this is a health promoting activity. And in fact, this is something that is getting prescribed, nature experience prescriptions, in many countries, including England, including New Zealand, including Japan.
So again, I love looking at the research, but I also think that as with anything, we need to try it out and see if it works for us. And so I would encourage you one, just to check in. Have you had that experience? Do you find nature particularly soothing? Where do you go? What do you do when you're feeling stressed out, and how much time are you spending in nature right now?
I know it's February when I'm recording this. So in many parts of the country it's cold. I don't know if you can hear that. I am actually recording this in my office here in Santa Barbara, and there is a hawk that is really noisy right now. So I apologize. But consider it some free nature sounds. So there's a hawk that's set up its position here near my house. I hear it almost every day. So I don't know where it's nesting, but it is outside right now and that's something I pay attention to. I'm actually super into birds and I noticed how often I notice the sound of the hawk, even when I'm inside doing something else.
And that maybe is a way that I feel connected to nature. Even when I'm inside. Even when I'm standing here recording this, I'm standing in front of a window and I look out and I see part of a tree and there's a little bit of a breeze, so everything is blowing in the wind a little bit. I see a blooming rosemary bush and a little bit of ivy. I live on a suburban street, but there's a little touch of nature there as well.
And even talking about it, I can feel myself relaxing a little bit. So just notice, is nature a tool that you are in the habit of using consciously and intentionally to lower your stress hormones to connect with nature, to improve your physical and mental wellbeing, to offer yourself a reset? Can you challenge yourself or try to have a 20 minute nature experience every day, or three times a week? What about achieving the 120 minutes weekly? See how you feel. Is there an improvement?
Can you look at some natural scene, whether like me, it's a tree outside a window, or whether you look at an orchid or the sky birds, whatever it is. Can you look at some natural scene daily? Whatever your situation is. If it's really impossible to get outside or spend 10 or 20 minutes outside a day in a natural environment, even an urban, natural environment, there are additional studies that suggest that just looking at images of nature can accrue positive benefits. So if you really can't get outside, can you look at images? I have this beautiful scene of a stormy ocean with stormy skies and surfers taped to my wall. Came out of the Triple A Westways magazine, but I really love it. It's a really beautiful, evocative picture. I just have it taped to my wall, so it's something I look at frequently as well. But can you try it? See how you feel.
The caveat here is that you can't be doing other things. You can't be talking on the phone or reading or anything. You need to take it in. It's like a mindfulness exercise. Maybe see if you can notice something that you never have before, even if it's a familiar scene. Or, look at whatever you are looking at as if you were a child or someone seeing it for the first time.
My thought is that nature is amazing. Can we see it so clearly that we feel a little awestruck? Even a walk around the block on your lunch or whatever break you might have can be helpful. It definitely helps me. It's something that I try to do, and on the days I don't do it, I notice a difference. It's a mini reset for me. Can you go outside? Can you feel the air? Can you see what you see? Can you find a pocket of nature wherever you are?
And in thinking about this podcast and doing some research, I have come up with my own challenge. So when I'm in the office seeing patients, where I document, where my computer is, I work at a computer that's in a lab space. So there's no window, there's no natural light. We have windows and natural light in the exam rooms, but nothing where I spend the rest of my time. So I just look at a blank wall, which is definitely not ideal.
And so one is, I'm gonna really work on changing where I sit. There've been some options there and I'm gonna follow up on that, but in the meantime, I'm gonna bring in some nature. I love orchids. I'm gonna bring in some of my orchids. I love to just look at them. I find that amazing when you really look at the beauty and the intricacy of an orchid. And I'm gonna bring in some pictures of nature, preferably, maybe some images of nature that I know well and like. I have a lot of photographs that I take of beautiful places here or places I've traveled to.
And again, I walk my dog Teddy three to four times a day outside rain or shine here, fog or wind. And I really notice a difference in my own mood and level of tension. Before and after, especially if I'm really noticing the nature around me. Not if I'm hooked on a podcast or talking on the phone, but that's been interesting for me to reflect on too. And as much as I like walking and talking or listening to a podcast, when I take a walk outside, I do notice that my mood and my sense of capacity to reengage with whatever tasks I have waiting for me, are significantly better when I just take a walk and take a walk. I don't do anything else with it.
And I will say that when I lived in rural Maine, one winter, I loved walking through the quiet, snowy forest. It was so quiet, so soothing, smelled so fresh, clean. It was chilly, but even that was sort of a pleasant sensation. You have to bundle up. You have to be dressed appropriately. Here in California, I have more flowers and birds, beaches, and the mountains, but mostly I walk through my neighborhood. I watch the trees, the plants, the birds. Again, I think nature is available to most of us, certainly not everyone, and there are certain environments, depending on how urban an environment in which you live, that it's a little bit more challenging.
But again, the research is clear. Even looking at an image of nature can be helpful. Taking a 40 second break to look at some greenery can allow you to function better and more accurately. So I'm gonna take on the challenge myself, but I would just love to encourage you to recommit to spending time outside.
And if you're someone who doesn't, maybe again, take an opportunity to write yourself a prescription for nature. Can we recommend this to patients as well, but recommend it first to ourselves, 10 minutes a day, 20 minutes a day, two hours a week, 40 seconds here or there. Let's see. Let's take our own cortisol levels into our own hands, right? And let the research guide what we do. So let's all try it. I will report back how my experience goes with bringing in nature to my concrete office. And also, in the meantime, working on maybe changing where I sit so that I have a little bit more of a natural view.
All right, everyone. I look forward to talking to you again next week. Have a wonderful week. Bye.
If you are a busy practicing physician ready to start feeling less stressed, enjoy work more, and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at saradill.com. It would be my privilege and pleasure to work with you.

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