Integrating Nature into Cognitive Behavioral Therapy: A Randomized Controlled Trial of Individuals with Depressive Symptoms

Cognitive Behavioral Therapy (CBT) is an effective treatment for depression; however, it has limitations such as high dropout rates and limited long-term sustainability. This study examined whether integrating nature into CBT could enhance treatment outcomes. In a randomized controlled trial, 55 participants with symptoms of depression were assigned to either a nature-based CBT or a traditional CBT program. Outcomes were assessed using the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dysfunctional Attitude Scale-A, and the Connectedness to Nature Scale at baseline, one-month, and six-month follow-ups. Both groups showed significant reductions in depressive symptoms. However, the nature-based CBT group demonstrated greater long-term maintenance of cognitive restructuring and sustained increases in nature connectedness at the six-month follow-up. We discussed the possible mechanism behind nature exposure and dysfunctional thoughts particularly related to need for approval. Overall, the findings highlight the potential value of incorporating environmental context into psychological interventions to enhance treatment sustainability. This study contributes to the emerging field of nature-based interventions by providing a structured protocol for integrating natural elements into CBT. Further research is warranted to clarify underlying nature-depressive mood mechanisms and extend these findings to broader clinical populations.