Skip to main content

Integrating nature into acceptance and commitment therapy for anxiety and comorbid medical diagnosis: Two case studies

5 June 2014


The effectiveness of integrating nature-based interventions into acceptance and commitment therapy (ACT) for individuals with anxiety and comorbid medical diagnosis was examined. Participants experienced a 5-minute nature-based exercise before every session and were asked to spend at least 15 minutes in nature every day between sessions. These nature-based interventions were integrated with an adapted eight-week protocol for ACT. Relying on a quasi-experimental single subject design involving two participants from the Pacific Northwest, this study found clinically significant changes in anxiety, mindfulness, and experiential avoidance for participant one but clinically non-significant change in these areas for participant two. Although change in general health was found to not be clinically significant at post-treatment for both participants, it was at 3-month follow-up for participant one. Common journal themes for the two participants included an increased sense of calmness and increased present moment awareness with insight. Limitations included absence of a control group, an untested protocol, restricted generalizability, and the use of self-report measures. This was the first study to use a combination of nature-based intervention and ACT to treat this population. The potential effectiveness of using nature-based interventions was supported. Future research is needed to test whether a true difference exists between treatment using ACT with a nature-based component and ACT alone through randomly-controlled study. Also, future research should compare the effects of this treatment with PTSD versus GAD, as well as its impact on individuals with and without a comorbid medical diagnosis. Other research could explore ways to maximize the effectiveness of nature-based interventions and help individuals overcome barriers to spending time in nature. Further research could investigate more extensive long-term effects.


File nameDate UploadedVisibilityFile size
Main File
19 Mar 2020
559 kB