Nature-based activities may offer lasting relief from loneliness

About one in three Americans and one in six people worldwide feel lonely on a regular basis, a troubling reality that has prompted some public health officials to declare an "epidemic of loneliness."

A new global study presents a novel remedy. It found that nature-based social prescribing - clinicians literally prescribing things like gardening, hiking or birdwatching - can significantly reduce loneliness. Spending time in nature with others works even better, particularly for the loneliest among us, the study found. 

"There has been a lot of passion about nature-based prescriptions, but not a lot of evidence," said corresponding author Jill Litt, professor of environmental health at CU Boulder and principal investigator for the RECETAS project, which has studied a social prescribing model called Friends in Nature in 1,200 adults in six cities across Europe, Latin America and Australia.

Thus far, all the trials have shown promising results. The latest findings, looking at 320 lonely adults in Barcelona, appear in the October issue of the journal Lancet Regional Health.

"We now have randomized controlled trials showing this works and the impacts last," said Litt.

What is loneliness?

As Litt explains, loneliness is not about being physically isolated. Rather, it is a "subjective disconnect between one's expectations of their social relationships and one's reality."

"I've heard people describe it like a knot in their stomach, like something is just not right," said Litt. "You could be in a room full of people and still feel lonely." 

Studies show that chronic loneliness can increase risk of cardiovascular disease, dementia, stroke, depression and anxiety. It can also burden the healthcare system, as people suffering from loneliness tend to visit their doctor more and are more likely to visit the emergency department with vague complaints on Friday afternoons - a phenomenon known as "Friday afternoon syndrome." 

Due to stigma, people are often reluctant to admit or don't recognize they are lonely and assume the physical symptoms they feel are due to something else.

"Once clinicians really start to drill down to the root causes, they discover that loneliness is a big factor and the solutions may lie outside the traditional medical system," said Litt, who is also a researcher with the Barcelona Institute for Global Health.

Nature as medicine

RECETAS (Re-imagining Environments for Connection and Engagement) was launched in 2021 with a $5.6 million grant from the European Union. It has since conducted randomized controlled trials in Barcelona, Spain; Prague, Czech Republic; and Helsinki, Finland; and quasi-experimental studies in Marseille, France; Cuenca, Ecuador; and Melbourne, Australia.

The newest findings center around the site in Barcelona

The study included 320 lonely older adults from 12 low-income neighborhoods. Half were placed in a group of 8–10, which spent two hours weekly for nine weeks together doing things like gardening, birdwatching or nature-based art programs along with two trained facilitators. The other half were provided the same menu of free, easily accessible nature-based activities that they could do on their own. Both strategies worked. Participants on average showed an 11% reduction in loneliness scores at three months; 12% at six months; and 17% at one year. For those who started with lower emotional wellbeing, the group intervention worked better.

Litt said that nature, with its vivid sounds, smells and sights, can act as an "additional facilitator," augmenting therapeutic benefits.

Even being in nature alone can alleviate loneliness, the research suggests.

"Being out in nature forms this kind of reservoir of calm that we can return to later in life during stressful times," said Louise Chawla, an environmental psychologist and professor emerita at CU Boulder who recently coauthored another paper with Litt about the role that nature can play in fostering social connections. "It's not just restorative when you are in a place but also when you go back to it in memory."

Public health agencies in Spain have already begun to recognize the Friends in Nature model as a best-practice for addressing the loneliness epidemic. Litt is now working to bring similar trials to the U.S. in hopes that someday, insurers might cover things like a membership in a community garden or birdwatching club.

"We have nature in our cities and investment in our green infrastructure," she said. "Now we need a mechanism to bridge these resources with our health systems to offer person-centered care that leverages the power of nature for healing and wellbeing."