Groundbreaking study: Community nature programmes as effective as CBT for anxiety, depression
A comprehensive evaluation of a green social prescribing programme in northern England has demonstrated that connecting people with nature-based activities can significantly improve mental health outcomes within just 12 weeks. The findings, published 16 April 2025 in Health & Social Care in the Community, highlight the potential for nature-based interventions to serve as effective therapeutic approaches for individuals experiencing common mental health conditions.
Research confirms mental health benefits of nature connection
Research from the University of York has provided compelling evidence that green social prescribing – where healthcare professionals refer patients to community-based nature activities – can lead to significant improvements in mental wellbeing and reductions in symptoms of anxiety and depression.
The study, part of the UK government’s cross-governmental Green Social Prescribing Programme, evaluated outcomes for 223 participants across the Humber and North Yorkshire region who were experiencing mild to moderate mental health issues. Participants engaged in various nature-based activities, including horticultural projects, care farming, outdoor exercise, and creative outdoor activities.
The research team, led by Professor Peter Coventry from the University of York’s Department of Health Sciences, measured changes in participants’ mental health using standardised assessment tools including the Hospital Anxiety and Depression Scale (HADS) and the Office for National Statistics measures of personal wellbeing (ONS-4).
“We have known for some time that nature has a positive impact on health and wellbeing, but in more recent years, a stronger evidence-base has grown that proves this to be true for mental health in particular,” said Professor Coventry.
The study revealed that after participating in these programmes, participants showed statistically significant improvements across all four ONS-4 wellbeing domains – life satisfaction, sense of feeling worthwhile, happiness, and reduced anxiety. Participants also experienced notable reductions in symptoms of anxiety and depression as measured by the HADS.
Optimal duration and activity types identified
One of the study’s key findings was that the duration of engagement with nature-based activities significantly influenced outcomes. Participants who engaged in programmes lasting nine to twelve weeks showed greater improvements in wellbeing compared to those in shorter programmes of one to four weeks.
The researchers observed that activities involving horticulture and care farming appeared particularly beneficial. As Professor Coventry explained: “The fact that activities such as gardening, tending allotments, and care farming had the most impact on the participants in our study, demonstrated that it is not just about being passive in nature, but connecting with it in a meaningful way.”
The study’s authors suggest this may be because these activities provide opportunities for stress reduction, social connection, and a sense of purpose through caring for plants and animals. The researcher noted in the paper: “There is broad support for group-based gardening interventions as effective in enhancing well-being and reducing symptoms of depression. Although the mechanisms by which gardening and horticultural activities enhance mental health are not fully understood, small-scale green interventions, such as urban allotments, offer opportunities for stress reduction, social and nature connection and enable self-development.”
Social dimension enhances benefits
The social aspect of these nature-based activities also appeared to play a crucial role in their effectiveness. The research found that participating in shared activities within local communities helped address feelings of disconnectedness and loneliness that often accompany anxiety and depression.
“There is also something to be said for connecting with nature in the company of other people who live in the same place as you. Anxiety and depression can often be born out of loneliness and feelings of disconnectedness, so it makes sense that taking part in shared activities close to home – especially those that involve caring for and improving your local environment – can help lift mood and reduce anxiety,” Professor Coventry noted.
Research associate Trish Darcy, from the University’s Mental Health and Addiction Research Group, highlighted the accessibility of the programme: “In our study 65% of participants were from low socioeconomic groups and we now know that not only can it help improve their mental health, but participation was high for horticultural based activities in particular, meaning that not only is it good for the individual, but for the local community environment too.”
Comparable to conventional therapies
A particularly significant finding was that the magnitude of improvement in mental health symptoms following green social prescribing was comparable to that seen in conventional therapeutic approaches such as cognitive behavioural therapy (CBT).
The researchers noted in their paper: “The effect sizes observed for green social prescribing activities compare favourably with those observed for behavioural activation and CBT and point to the potential to mainstream nature-based activities as alternative therapeutic offers for people with preexisting mental health problems.”
This suggests that for individuals with mild to moderate mental health conditions, nature-based interventions could represent a viable alternative or complementary approach to traditional psychological therapies.
Implications for healthcare provision
The study’s findings have important implications for healthcare provision, particularly in the context of rising demand for mental health services and prolonged waiting times for conventional psychological therapies.
Dr Hannah Armitt, a Clinical Psychologist and Clinical Lead for the programme, commented: “The research conducted in our region has the potential to enhance service delivery by connecting statutory services with local providers of nature based and outdoors activities. It is important to evidence the potential of green space and nature to ensure clinicians and patients alike can harness the benefits of this wonderful free natural resource we have in abundance in Yorkshire and Humber.”
The authors argue that green social prescribing could be particularly valuable for individuals from deprived areas, who often experience poorer outcomes from traditional psychological interventions. Two-thirds of the study participants lived in the most deprived regions and had lower baseline wellbeing than population averages.
Challenges and future directions
Despite the promising results, the researchers identified several challenges in implementing green social prescribing at scale. These include funding sustainability, ensuring equitable access, and the need for standardised referral pathways.
In their paper, the authors acknowledge: “There are limits to the extent to which green social prescribing can function as an effective and sustainable system to enable people to equitably access nature-based interventions. Green social prescribing relies on a mix of health and short-term responsive funding and requires ongoing investment in human and social capital, making it unlikely to be a sustainable option in all settings.”
The study also highlighted the importance of personalising nature-based prescriptions according to individual needs, preferences, and circumstances. This tailored approach could potentially enhance engagement and outcomes, particularly for underrepresented groups.
Anthony Hurd, Humber and North Yorkshire Green Social Prescribing Programme Manager, emphasised the broader implications: “This work has not only shown the positive outcomes that nature-based activities have on mental health, it has also highlighted the role that community-based organisations play in supporting the health and wellbeing of communities. As healthcare begins to move more into the community, and with a focus on prevention, the community-based organisations delivering activities such as gardening, care farming and walking groups need to be recognised as key players in our national health service and be resourced appropriately.”
Future research needs
The researchers call for further investigation to better understand how to improve access to and engagement with green social prescribing among excluded and underserved groups. They also suggest that future research should explore the potential benefits for additional populations, including children, young people, and individuals with serious mental illness.
As demand for mental health support continues to outstrip supply, with forecasts indicating that over the next three to five years, at least 10 million people in the UK will require support for depression, anxiety, or both, the findings from this study provide timely evidence for the potential of nature-based interventions to help address this growing need.
The study forms part of a wider £5.77 million cross-government Green Social Prescribing Programme launched in 2021, which tested approaches to embedding green social prescribing in mental health pathways across seven integrated care systems in England.
Reference
Darcy, P. M., Armitt, H., Hurd, A., Paton, L. W., White, P. C. L., & Coventry, P. A. (2025). Green Social Prescribing: A Before and After Evaluation of a Novel Community-Based Intervention for Adults Experiencing Mental Health Problems. Health & Social Care in the Community, Article ID: 2016261. doi: https://doi.org/10.1155/hsc/2016261
