Last updated on 27 Nov 2025
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Therapeutic Landscapes
Authors: Clare Cooper Marcus, Naomin A. Sachs, published in 2014.
Kaya Leaf’s Key Urban and Tropical Horticulture Takeaways
Humans seem hardwired to seek out nature. Yet, for many, we can’t back this belief beyond pure intuition alone.
As this topic crops up too often at dinner parties, we dug into this book and put together a science-based evidence cheatsheet to back up our passionate plant assertions. 💪🏼
Hypothetically speaking…
According to The Biophilia Hypothesis by E.O. Wilson, Biophilia, the emotional affiliation of human beings to other living organisms is hereditary and hence part of ultimate human nature.
Geographer Jay Appleton shares another interesting view point from his Prospect Refuge Theory that although we no longer live as hunter-gatherers, we still respond positively to environments that provided early humans with safety and survival.
This includes open spaces with clear views (prospect) where we can observe without being observed (refuge), and free of danger (hazards).
This may explain why a savannah-like landscape with scattered trees remains a universally preferred environment.
Stress? Just Add Green!
Roger Ulrich’s Stress Reduction Theory emphasises how supportive gardens reduce stress, especially for people who are sick or caring for the sick.
His theory of supportive gardens outlines how contact with nature reduces stress in four key ways:
- A sense of control and access to privacy
- Social support
- Physical movement and exercise
- Positive natural distractions
For example, by providing lightweight chairs in healing gardens, patients can choose where to sit, whether they want to be alone or in a group, in the sun or shade.
Despite their health battles, giving patients even a small amount of control contributes to their stress reduction.
Designing Gardens That Heal
Not just about creating pretty spaces.
In their 2014 book Therapeutic Landscapes, Clare Cooper Marcus and Naomi A. Sachs talked about using research-backed guidelines to design outdoor spaces for healthcare.
Two types of therapeutic gardens:
- Restorative gardens are designed for passive enjoyment and can be found at hospitals, hospices, and senior living facilities.
- Enabling gardens offer hands-on activities like weeding or watering, typically led by a professional horticultural therapist, occupational therapist, or physical therapist. These are commonly found in rehabilitation hospitals and mental health facilities, where activities aid in recovery.
View to Heal: The Power of a Window
Roger Ulrich’s much-cited 1984 study, “View through a Window May Influence Recovery from Surgery“, found that hospital patients with views of trees asked for less pain medication, called the nurse less often, and went home sooner than those whose rooms faced a brick wall.
His earlier study in 1979 found that students experiencing stress due to final exams reported greater restoration when viewing nature-dominated settings compared to urban environments without greenery.
In a follow-up study, Honeyman (1992) added urban scenes with vegetation and found that even a touch of green improved stress recovery more than concrete-heavy environments.
In 2008, Ulrich’s team also examined over 400 peer-reviewed articles on healthcare design.
They found strong evidence that access to nature reduces both pain and stress, proving that healthcare environments dominated by nature have tangible health benefits.
Screens Aren’t Enough: Real Nature Matters
Can digital nature scenes provide the same benefits as real nature?
Research says otherwise.
In a study by Friedman, Freier, and Kahn (2004), a real-time nature stream on a plasma screen improved psychological well-being, but not as much as real views.
Kahn et al. (2008) compared three office views—outdoor scenes, a plasma screen with the same scene, and a blank wall. The researchers found that heart rate recovery after mild stress was much faster with a real view than with a screen or blank wall.
Nakamura and Fujii (1992) further demonstrated the difference with brain wave data: greenery elicited relaxation, while concrete triggered stress responses.
When it comes to sounds, nature still has the upper hand. Mace, Bell, and Loomis (1999) studied the impact of congruent nature sounds (birds, water, breezes) versus urban noise (helicopters).
Even low-level urban noise significantly reduced the restorative effects of viewing nature, suggesting that the location of healing gardens should carefully consider noise pollution.
Smell That Green? It’s Good for You!
The healing power of nature extends to its scents.
Fujita, Miyoshi, and Watanabe (2010) discovered that “green odour” (a mix of trans-2-hexenal and cis-3-hexenol) reduced both maternal stress and prenatal stress in mothers’ offspring.
Watanabe et al. (2011) also found that green odour had a therapeutic and preventative effect on depressive-like states in rats, while Oka et al. (2008) found that it lowered blood pressure in humans.
Get Outside—Whether You Like It or Not!
Not a fan of nature walks?
Researchers Li et al. (2008) studied the effects of forest versus city walks and found that forest walking increased Natural Killer (NK) cell activity and reduced adrenaline levels, an important stress indicator.
City walks showed no such benefits.
In a larger study, Park et al. (2010) found that stress levels (measured by cortisol levels) were 13.4% lower in people who walked in forested areas compared to urban settings.
Similarly, Berman, Jonides, and Kaplan (2008) found a 20% improvement in memory performance and attention span after an hour-long walk in nature, even in winter.
What’s surprising was that enjoyment wasn’t necessary.
Whether it’s 40°C in summer or – 10°C in winter, the benefits remain the same!
Designing for the Patient, Not Yourself
Now that we’ve proven beyond reasonable doubt (I’m stealing this saying from our lawyer friends!) that exposure to nature is just better for your health, how do we design with nature in mind?
It’s not always that simple.
Designers often unknowingly create gardens that reflect their own aesthetic preferences rather than the needs of patients. According to Ulrich (1999), designers sometimes favour abstract or stylized content, while patients consistently prefer realistic nature imagery.
Winston and Cupchik (1992) found that artists and experienced viewers enjoy art that is intellectually challenging, while the general public, particularly hospital inpatients, prefers calming, realistic nature scenes.
Carpman and Grant (1993) further confirmed that patients dislike abstract art in healthcare settings.
This is a great reminder for us to prioritise patient-centric design, and not design for yourself or the managers of the institution!
Books You Need to Read
If you’re interested in diving deeper into the design and benefits of healing gardens, here are three essential reads:
- The Healing Landscape: Therapeutic Outdoor Environments by Martha Tyson (1998)
- Restorative Gardens: The Healing Landscape by Nancy Gerlach-Spriggs, Richard E. Kaufman, and Sam Bass Warner Jr. (1998)
- Healing Gardens: Therapeutic Benefits and Design Recommendations, edited by Clare Cooper Marcus and Marni Barnes (1999)
Conclusion
In summary, nature isn’t just for weekends in the park—it’s an essential part of our well-being, especially in healthcare settings.
Whether it’s through passive enjoyment in a restorative garden or active participation in an enabling garden, thoughtful, research-backed designs can significantly improve health outcomes.
So, the next time you’re tempted to skip that nature walk, think twice. Your body and mind will thank you!