Therapy in the Trees: An Interview with Katarzyna Simonienko

k_simonienko_shinrin_yoku_4.jpg, default, Katarzyna Simonienko, photo: Forest Therapy Centre, Therapy in the Trees: An Interview with Katarzyna Simonienko

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Let’s go to the forest and be fully present, without any particular goal – that’s the advice of one psychiatrist, who sees these green-filled spaces as ‘friends’, with numerous benefits for our bodies and minds.

Dr Katarzyna Simonienko holds a doctorate in ethnobotany, toxicology and psychiatry. She works at the Stanisław Deresz Psychiatric Hospital in Choroszcz as well as the Psychiatric Clinic at the Medical University of Białystok. Since 2018, she has been a licensed tour guide for Białowieża National Park.

Dr Simonienko is also a member of the Japanese organisation INFOM, which is dedicated to shinrin-yoku, or forest bathing. She offers workshops in forest therapy, which she supplements with visualisation techniques and breathing exercises. She also studies forest therapy and shares her findings in the medical community both in Poland and abroad.

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Photo: Forest Therapy Centre

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Michał Dąbrowski: How does forest therapy differ from a regular walk in the woods?

Katarzyna Simonienko: It’s a difference in principle. The purpose of a regular walk through the woods is usually pleasure. Forest therapy, as the name implies, has a therapeutic goal – so it has a preventative or rehabilitative function, or it can be part of a treatment for a specific disease.

Forest therapy affects the psyche, body and immune system. It has proven to be effective for dealing with anxiety and depression, as well as problems with blood pressure. I always try to select a form of therapy that will allow the forest to influence the body as effectively as possible.

MD: Does this kind of therapy rely on awareness?

KS: Forest therapy helps improve the natural defences of our bodies. This is obviously something that can’t be used alone, as a replacement for medication. Nature instead of pills? Absolutely not. If someone has clinical depression, I would never tell them to stop taking medication, as if the forest could fix every problem.

MD: So it’s more about prevention?

KS: It depends. In healthy people plagued by stress, such as those who have intense jobs or difficult living situations, the sympathetic nervous system is overstimulated. A forest bath helps to calm the system. Simply put, after forest therapy, we are generally more relaxed, and the stress that we experience is not as destructive. Moreover, if we have a diagnosis of anxiety, depression or PTSD, we can get back to our regular state much more quickly.

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Photo: Forest Therapy Centre

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MD: How does a therapeutic walk through the forest affect the body and mind?

KS: It affects multiple systems in the body. From a research standpoint, I’m above all interested in the nervous system. Multiple studies have confirmed that when the parasympathetic nervous system is activated, the sympathetic system slows down. This translates into our stress and fight-flight-freeze responses calming down, and the relaxation and regeneration mode turning on. When it comes to the cerebral cortex, the activity in the prefrontal cortex decreases, so we can stop obsessing over our problems and allow ourselves to relax.

What’s interesting is that simply looking at a forest is relaxing. In a study that showed participants the image of a forest on an LCD screen, it was proven that activity in the prefrontal cortex decreased, and participants rated themselves as more relaxed. However, the autonomic nervous system didn’t react at all – blood pressure didn’t drop, and the body was still ‘tense’.

A later study looked at people spending time in the forest. Some of the participants wore blindfolds; the rest did not. It turns out that both groups still relaxed. Eyesight wasn’t necessary in order to relax deeply. This means that it’s the sounds and smells that strongly influence relaxation.

Another study looked at natural killer cells. After forest therapy, they show an increase in both presence and activity. These are the cells responsible for the body’s response to infections and cancer. The study also looked at people with diabetes – it turns out their sugar levels dropped with no effort.

Forest therapy also improves sleep. Spending time in the forest is a kind of digital detox, because we’re stimulated by the natural light.

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Photo: Forest Therapy Centre

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MD: As a psychiatrist, how did you become interested in these… I wanted to say unorthodox methods, though that’s perhaps not the right word, since there are multiple studies proving their efficacy?

KS: Forest therapy spans conventional and unconventional medicine. That’s because on the conventional side, we have shinrin-yoku as well as serious studies that have been cited in many articles and newspapers, but there’s also a pseudo-scientific branch which pulls its sources from ethnography and esotericism. If someone likes hugging trees, they can – but that’s not the goal in forest therapy.

How did I come into it? I’ve always been inclined towards nature. Despite the fact that I’m a doctor, I’ve always liked sitting in the forest, relaxing, looking for inspiration, whiling away time.

During a meeting with Peter Wohlleben [editor’s note: author of The Secret Life of Trees], we had a discussion about what kind of role the forest plays in our lives – and what role we play in the forest’s life. The question came up: is it better for a forest to affect us subjectively, or is it better to have biological proof? I thought then: why differentiate between the two? In psychiatry, the subjective and objective are often integrated with each other. We don’t differentiate between what’s more important – the patient’s subjective experience, or what’s objectively happening in the brain. Subjective emotions are just as important.

After the meeting, I went to work and began to look into the idea. It turned out there was already something like forest therapy, so I began reading about shinrin-yoku. It quickly turned out to have a lot in common with psychiatry. I thought – wow! This is how my two paths combine – as a nature-lover and a doctor. I thought that it was time to do something about the two. So it began.

MD: Do you send your own patients to the forest?

KS: Yes. Nowadays, many people have anxiety disorders related to burnout or stress. Going into the forest is a classic form of therapy.

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MD: How quickly do the effects become visible?

KS: That depends on multiple factors, including one’s sensitivity to nature. If someone’s a sceptic, it takes longer. Many studies have shown that calm people have an easier time entering a state of relaxation, whilst those who are impulsive and energetic take longer.

I once visited a closed nature reserve with a group. At the beginning, the participants couldn’t smell the wonders of the forest. We passed by a gloeophyllum odoratum, a type of mushroom which smells like delicious anise candy, and not a single person in the group could smell it. After the four-hour walk, we passed it once again, and this time, all the participants could catch its intense scent.

In other studies, it’s been shown that the state of the immune system can be improved for 30 days after a visit to the forest. This means that it’s enough to take a weekend and spend two days in the forest to feel better for the whole next month.

MD: Do you have to get a degree to become a forest-bathing therapist?

KS: The school that I studied in has two different tracks. You can be a guide after the first course, but to become a therapist for forest bathing, you have to complete a higher level of training. A guide is someone who simply works with wellness, preventive care, ecotourism. A therapist is someone who deals with health problems, both psychological and somatic. There are a few of these kinds of schools. There are also plenty of self-taught people, who lead excellent walks – I know, because I’ve met many of them.

At first, I used my medical knowledge as well. I figured, since I’m a psychiatrist and a guide at Białowieża National Park, I have knowledge about nature as well as anti-stress methods. When I completed my certification, it turned out that my methods were very similar to the ones used by the school.

There are both group and individual walks available. To get certified, we have to know how to lead different types of groups. It’s important to be knowledgeable, because we’re guiding people into a world that may be very foreign for them. A lot can happen, so it’s important to be open to anything.

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Photo: Forest Therapy Centre

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MD: In order to reap the most benefits, is it better to take a walk with someone who has the proper qualifications?

KS: There are no international regulations for this profession. It’s a situation similar to psychotherapy, where certain standards have been developed – we know it’s better to go to a specialist who is certified, as various therapeutic approaches are taught in different ways. Forest therapy is similar. Each school has its own certificate; it’s not standardised. If you do want to try forest therapy, however, I would recommend going to a certified practitioner, because that way, we can feel certain that this person will work with you in a professional manner.

A guide will show us how to activate your senses, how to achieve a state of relaxation. It’s also important for someone to show you the proper tempo. In Japan, the standard is 2 kilometres per hour, which is a very slow march. Sometimes, when I lead a group, some participants can’t handle the slow pace. They walk ahead of me, because they have a sense of unease that ‘something is chasing them’ – especially young people.

The school where I studied offers different exercises that allow you to slow down, to immerse yourself in the forest. The point is to focus on the here and now, the same as in mindfulness. The goal is to adapt your pace to the one the forest is offering you. It seems very simple, and of course later, you can do it by yourself, it’s hardly a difficult philosophy – but it’s better to have someone show you at first.

MD: What kind of forest is needed?

KS: The Japanese have their own definition of what counts as a forest. When we look up from the ground, the leaves must cover 30 per cent of the surface, the trees have to be a specific height, and the area has to cover at least a certain amount of land.

It doesn’t have to be a primeval or natural forest; it can be man-made as well. I spoke with a Korean professor, Park, who also takes part in forest therapy. He’s conducted studies in a variety of places. I asked him: which forest is the best? He thought long and hard over the question and finally answered: the best forest is one that’s far away from any highways. This way, there’s no noise – because the auditory component of this therapy is very important.

Forest therapy can also be conducted in parks or even in hospital or hospice gardens. It’s important for there to be plenty of trees, a sense of peace and a lack of man-made noises such as cars. That’s enough.

MD: What does a forest bathing session look like? We walk into the forest… and then what?

KS: First, I explain how the therapy works, what goes into it. Then we walk from the starting point to get away from the noise and cars. The first thing we do is awareness exercises, to open up everyone’s sense of hearing and smell. Sight is not the priority. We try to use these [other] senses. The best is perhaps the sense of touch, because we use it so rarely and it’s such an ancient sense. Most people who want to use their sense of touch begin with the pad of their finger – touching moss, bark. Then it turns out they can use their whole hand. The biggest thrill is when you can touch the forest every step of the way – by taking off your shoes.

We try to hear the space between sounds, sense the different flavours and nuances. Then we walk slowly. We do different exercises to immerse ourselves in the here and now – we focus on our breath, we breathe through our diaphragm, and we listen to how our bodies are feeling.

It’s important to feel that we’re ‘participating in the forest’. It’s not a museum exhibit – the whole time, we are part of this organism that strives towards equilibrium. It has plenty of mechanisms that help it stay balanced. We become one tiny part of this giant machine. We breathe the air produced by these trees; we walk on the earth. The soil also contains bacteria that act as a stress reliever, prompting our brain to release serotonin. All along, we are part of numerous processes without even realising it. At the end, we take some time to integrate ourselves.

With this kind of session, proper closure is important – to allow yourself to think through everything that happened, and not just immediately jump into your car. In Japan, you prepare noodles together, which you then eat as a group. We have a ceremonial tea drink, discussing our experiences in a circle.

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MD: I saw on your website that we’ve lost a lot as a society by moving into cities. What specifically?

KS: [We have lost] a lot, especially when it comes to childhood. The forest is a wonderful place to play. At home, sitting in front of a computer, children don’t have the ability to explore the natural world. Playing amongst the trees improves the immune system, leading to fewer allergies and even a better memory. It builds physical strength, social skills.

Forests offer children a wide range of space to play, and their imagination can run rampant. Sometimes I work with groups of children and the things they come up with – secret rooms, islands of treasure – it’s incredible. At home, it’s normally Minecraft and that type of entertainment for them. There are also studies that show that people who didn’t spend time in nature as children are more likely to become depressed. This is impossible to make up for later.

On the pharmacological side – in Białowieża, there are multiple mushrooms that can be used for medicine, such as for cancer treatment. Currently, the Białystok University of Technology and the Medical University of Białystok are studying heterobasidion annosum, under the direction of Professor Halina Car – this mushroom has the ability to help with cancer of the large intestine. They’ve even applied for a patent. These types of rare mushrooms exist in the forest, but they’re endangered. If they disappear, we may also lose ways to heal certain illnesses.

The forest contains many species of plants that have healing properties. The soil also contains bacteria which live symbiotically with certain plants. In man-made forests, where only pines and spruce trees grow, these microflorae don’t exist. In this way, we cut ourselves off from what was natural and normal for us for so many years. I have a feeling that living in an apartment is kind of like entering an apartment or a zoo – we have food and water, but we’re cut off from nature.

MD: Is biodiversity important for happiness?

KS: There’s the theory of biophilia, which says that we all come from the ‘same soup’, or a single ancestor to whom we’re all genetically related. And truly – when comparing the DNA of a person to the DNA of a monkey or pig, it turns out that there are similarities. Biophilia claims that we have a natural predisposition to interacting with other species. It’s important to our happiness. That’s why we grow flowers. It’s enjoyable. That’s also why we keep cats or hamsters. These types of interactions with different species in nature causes us to feel complete and happy.

Biodiversity is also healthy from the point of view of sanitation. This kind of system is stable; it won’t be destroyed by woodworms or drought. It can easily regenerate itself. Unfortunately, in Białowieża Forest, we are now seeing the effect of human interference – the forest is less stable, despite its age. The larger the genetic pool, the healthier the organisms are. And the more species there are, the better our living standards. There are fewer diseases, epidemics, cataclysms.

Biodiversity is also important from a cultural perspective. Many people feel a kinship with certain species of animals. And that’s not just in the Amazon – take a look at our local bison. That’s our shared connection. Without it, we wouldn’t be who we are now.

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Bisons in Białowieża Forest photo: Robert Canis / FLPA / East News

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MD: Do different species fulfil our emotional needs?

KS: Yes. It’s easy to see in certain kinds of therapy, where humans come into contact with different species – such as dogs or horses. These two are very well-known, but I recently watched an excellent program where children interacted with llamas. This type of contact helps with rehabilitation and healing. Green spaces viewable through the windows can have a similar effect – thanks to them, our vitality improves, and we feel supported. This is important, and it’s backed up by science as well.

MD: What kind of homework would you propose to readers?

KS: Let’s go to the forest and be fully present, without any particular goal. Let’s not try to beat records for speed or for the most mushrooms collected. Let’s immerse ourselves in the forest. Let’s use all our senses and be aware of our surroundings.

Look at the forest as a friend – someone capable of protecting and understanding us. Let’s feel that we can take care of each other. We can take care of the forest so it can take care of us. Let’s not have high expectations. Let’s just try to feel.

Give yourself the space to be fascinated, to feel a reverential ecstasy. It’s a type of wonder where we feel ourselves as a miniscule part of the world, and our experiences in nature become a kind of contact with the sacred. In Białowieża Forest, I have these kinds of experiences. When I experience its richness, I think to myself: how incredible this world is. From a psychological point of view, I think it’s important to let yourself have this experience.

Originally written in Polish, Feb 2020; translated by AZ, edited by LD, Mar 2020.

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Selected research on forest therapy:

Song C, Ikei H, Miyazaki Y. 'Physiological Effects of Visual Stimulation with Forest Imagery. Int J Environ Res Public Health'. 2018 Jan 26; 15(2)

Horiuchi M, Endo J, Takayama N, et al. 'Impact of Viewing vs. Not Viewing a Real Forest on Physiological and Psychological Responses in the Same Setting'. Int J Environ Res Public Health. 2014; 11(10): 10883-901

Li Q, Morimoto K, Kobayashi M, Inagaki H, Katsumata M, Hirata Y, et al. 'Visiting a Forest, But Not a City, Increases Human Natural Killer Activity and Expression of Anti-Cancer Proteins'. Int J Immunopathol Pharmacol. 2008; 21(1): 117-27

Ochiai H, Ikei H, Song C, Kobayashi M, Takamatsu A, Miura T, Kagawa T, Li Q, Kumeda S, Imai M, Miyazaki Y. 'Physiological and Psychological Effects of Forest Therapy on Middle-Aged Males with High-Normal Blood Pressure'. Int J Environ Res Public Health. 2015 Feb 25; 12(3): 2532-42

B.J. Park et al. 'Effect of the Forest Environment on Physiological Relaxation – the Results of Field Tests at 35 Sites Throughout Japan', Forest Medicine, January, 2013, pp. 55-65

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