nature therapy

CEO RUTH STRONGE ON BUILDING RESILIENCE & REDUCING ANXIETY VIA DONKEY EXPOSURE THERAPY

An Interview with CEO Ruth Stronge

Ruth Stronge, MA is the CEO of Snowdonia Donkey Sanctuary. She has a master's degree in environmental and development education, and a master's degree in clinical and health psychology. She specializes in helping children, teens and adults build resilience and mitigate various anxiety disorders at her farm sanctuary.

Jennifer Smith:  Hi, thanks for joining us today for this installment of The Seattle Psychiatrist Interview series. I'm Dr. Jennifer Smith, Research Director at Seattle Anxiety Specialists. We are a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us Ruth Stronge, CEO of Snowdonia Donkey Sanctuary, located in Bangor, Wales. She has a master's degree in environmental and development education, and a master's degree in clinical and health psychology. Ruth was a primary school teacher by training, and with the founding and development of Snowdonia Donkeys, she has been able to combine her passions. Before we get started today, Ruth, can you tell our listeners a little bit more about yourself, and how the rescue organization got started?

Ruth Stronge:  Hi. Well, thank you for inviting me. Yeah, I would say I have a passion for donkeys, and I have always loved donkeys. Maybe about 12 years ago now, there came an opportunity for me to get two donkeys, and I got two little donkeys. I kept them with my daughter who had a pony, and my children were older, my daughter had a pony, and our son was at the village, so we never rode our donkeys. We always took them for walks. And for me, spending time with those donkeys before work and after work were just the best time of the day. I would do it before I'd go to school where I was teaching, so then I was ready for school. And then on the way home, that would be my downtime of reflection. It went on from there and people, our friends that we knew said, "Please, can we come and walk the donkeys with you?"

And then we would bump into people with our donkeys, and they would say, "Oh, it's been ages since we've seen a donkey." And then, people just wanting to come and spend time with our little donkeys. It grew from there in as much as I wanted a donkey to ride, so I got another donkey. And then a group of friends, when we were out walking the donkeys, we were talking and decided if we could help any local donkeys, we would do that. We set up a small charity, and that was just 10 years ago now, a small charity to help local donkeys, and that's how we began, really.

Jennifer Smith:  Wow. That's great. Your website has a large banner that states, "Rescuing donkeys and changing people's lives," and I think that's a pretty moving statement, and I'd like to talk about some of the work that you do there. One of the first courses that you developed was for vulnerable adult learners, so that they could help build confidence by working with the donkeys. Can you tell us a little bit about that? How can caring for donkeys help someone?

Ruth Stronge:  It was a chance meeting with another organization, and telling them about the looking after the donkeys we do, and how volunteers were coming to help us, and how we were working with just giving people opportunities and time to spend time with the donkeys. And it was an organization in the center of Bangor who worked with adults, providing them with opportunities for support if they had mental health difficulties. And I invited their manager to come out and see the site that we worked on, and go through some of the activities that we did of how we managed our donkeys, which was following a simple routine in a quiet place, and basically just really being quiet around the donkeys, and being around each other, explaining to people how some of our donkeys are not used to people, and how we have to approach them, and how we read their body language so that we can support them in the best way.

And it was that opportunity and those conversations that allowed us to run a small program of one afternoon a week for people to come spend time outside with the donkeys. Initially, our volunteers and staff had done all what we would class as the "donkey work", so they'd done all the cleaning out, and the working out, and the feeding. But then just giving people time to brush a donkey and learning which brushes to use, how you would approach a donkey, basically reading body language, as well, of an animal, and giving them the story of the animal, and finding their character was the start of all that then, really. And for some of the people engaged with us, they became more and more interested, wanting to come more often, be more involved with what the animals needed for their welfare needs. And one of the really important things that we took from it was that it was a conversation piece for people. They had something to talk about with other people, what they had done.

Jennifer Smith:  Wow. Oh, that's great. And just for our audience to know, I actually met Ruth when I went for a tour of Snowdonia Donkeys, and it was really fabulous just getting to spend time with the donkeys, and I have to say there is something very soothing about it. Just brushing them, like you said, just petting them, just having that quiet moment, it really is nice. And going for a walk, and seeing beautiful scenery with them is a wonderful thing. I think you've stumbled upon, and definitely have built, a beautiful organization.

Ruth Stronge:  Oh, well, thank you for that. But I would say it's how I want to spend time with my donkeys. I know it works for me. And sometimes when I'm talking to people, if we're explaining the kind of work we do, and with our young people as well, and I would have to say it isn't for everyone, and that's okay. If you are more interested in fast moving things, and you are boisterous, and you are running around, then we are actually not the right place for you to be, because you would frighten the donkeys. And it's a case of, okay, let's take a step back. And our donkeys and our organization is very good at supporting quiet, anxious people, because that's the way we look after our donkeys in a quiet way, building confidence, following routines. And partly that has just evolved, but also my training as a teacher, I was an early years teacher, so the routines and the structures that we put in place to take away too many decisions initially for people were simple things like which donkey you're going to work with.

Well, if you've got a pink brush in your hand, then you are going to be brushing the donkey that's wearing a pink head color. The one in the picture behind me is wearing a pink head color. So you would know, she would have pink brushes, a pink bucket for her feed, and if you were going for a walk with her, she would have a pink lead rope. It sounds simple things, but it takes away anxiety from people if they don't have to ask questions. Some things are just pointed out for them, and next time they come, that routine is built upon.

Jennifer Smith:  Wow, that's wonderful. Through a partnership with Adult Learning Wales, you run an accredited course on animal care, which focuses on supporting young adults. Can you speak about what that entails, and how can young adults psychologically, emotionally, and socially benefit from that course?

Ruth Stronge:  Again, you realize as you do these other, things happen by meeting and talking to people. Behind the scenes, the young people that we work with, or the adults, for them, they don't always know where the funding comes from as enablers to deliver sessions for them. So behind the scenes, it's a bit like a jigsaw puzzle so that they can have the best opportunities. And if they are interested, they can stay as long as they can if we can afford them to stay, and to progress their development. So Adult Learning Wales are a national organization here in Wales that fund accredited and non-accredited courses for people over 16, and we had been delivering some courses that it called engagement courses, which were non-accredited. But working with some of our other young people who had come through us from another grant program which allowed them to do one-to-one sessions with an adult and a donkey, basically just being in a nice quiet environment, having someone to talk to if they wanted to, or just spending time with a donkey.

We were looking for a next step for some of these young people when we identified that for a vast majority of them, they hadn't engaged with the education system at all. They had, whether it be anxiety built on after COVID, or for whatever reason that they had, not been in the education system, so there were no exams, and there was nothing on paper for them to take their next steps. With the program that we had delivering one-to-one sessions, we then built on that, offering them some small group sessions, which for us would be no more than four or five at the most for a few weeks. And then Adult Learning Wales, because myself as a trained teacher, I can be a tutor for them, I approached them and said, "I have this group of young people, who some would like to go to formal college in the future, but I want to be able to acknowledge the progress they've made. And also once the summer holidays comes for some of our other young people, what do they do for six weeks?"

And I wanted them to be able to come and work with us, but we didn't have any funding to enable that to happen. So Adult Learning Wales helped me find a couple of, we would call them entry level modules, so not too high, but requiring some academic input on animal care. We would do things like how to muck out, and how to brush an equine. And the young people that we had focused on having come for one time, one session a week as an individual, and then as a small group, were then asked to apply, we knowing that they would always get on the course, but to give them a formal leading to it, to apply us for a fortnight, coming every day to take part in practical activities and record those activities using photographs and written work so that they could then submit it for an accreditation from one of our organizations, Agored Cymru which accredits their work and then they can build on that.

That was a journey. We've been plotting a journey for some of those young people, and they themselves wouldn't know who had funded their journey, but behind the scenes, we were able to do that. And for our funders, that's interesting as well, because they like to see that it has an impact, which it certainly does.

Jennifer Smith:  Oh, that's really fantastic that you help people to transition in that way.

Ruth Stronge:  And one of the things you asked was about their anxiety and their social skills, so that because they had had those small steps before they got to something that we called education, but we often didn't use that term, then we were trying to look at adding one new thing every time they came. If they were all familiar with the setting, then one-to-one was their first step, be familiar with the setting. The next change would be to work with a small group of people, and then to come every day for a longer period, so trying to increase that confidence, and reduce the anxiety as they took on new things, then.

Jennifer Smith:  Oh, wow. Yeah, that's similar to exposure therapy, correct? And like you said, to lessen their anxiety, the social anxiety and such, that's wonderful.

Ruth Stronge: By the time they got to the accredited side, brushing a donkey was what they would do automatically, so it wasn't the new thing. The new thing may have been recording or talking about what you'd done. So yeah, it's those small steps, and just building on that was really important.

Jennifer Smith:  Ah, fantastic. You also offer one-on-one sessions for those with additional learning needs. What types of conditions is this specifically geared for, and who can benefit the most from these sessions? Would it be people with social anxiety like you mentioned, or general anxiety, or anything else?

Ruth Stronge:  A lot of people with either social anxiety or general anxiety, and we do quite a bit with people with autism as well, who have communication difficulties. Communication difficulties on the side of struggling to verbalize their needs, or anxiety, or shyness, or selective mutism. And again, through following those routines and building that confidence, we've worked with quite a number of young people in that way to increase their confidence. And again, hopefully moving from one-to-one sessions onto small groups. For some of the people that we work with, it isn't always appropriate to do that, but if we can, we can do that, or we would then change or build on the activities that they're doing, so they are being more engaged in different activities. Some of our work, we also work with young people who may have learning disabilities, and may have reduced cognitive abilities, and again, we would match the donkey to their needs.

Some of the autistic people we have worked with are very sensory, some of them like to throw things around, so sawdust moving around the place obviously isn't appropriate for all our donkeys. And so, we've got some donkeys who are very chilled, and don't mind those things happening. But I would say where I find most pleasure is working with people with anxieties, and shyness, and quietness, because to see them make that progress, and to be able to talk, even to their families, about the donkey that they've worked with is just amazing, really.

Jennifer Smith:  Wow, that's wonderful. In terms of the people who have the mutism, as you said, or if they're on the spectrum and not very, or nonverbal, have you noticed where they do become more verbal, or this therapy isn't really applicable for that? Have you noticed a change?

Ruth Stronge:  We do notice a change, yes. And for us, it's trying to not put them into situations where they become more anxious, or it's not putting them in those situations where it makes it more difficult for them to speak. Just by following those routines every time they come, and building a rapport with one of our support workers, and especially with the donkey, then we found almost that the donkey acts as that diversion, that there's someone else, so there's something else to talk about, to be involved with. And then our staff are very much aware of the sensitivities of some of the people we work with, and wouldn't then ask them direct questions. They are very good at supporting the people to shine, and to build on the skills they've got, so almost praising them in a positive manner, using the language of support, and making suggestions together to do things is the way that we tend to build on people's development.

Jennifer Smith:  That's fantastic. And this sounds so perfectly suited for you and your background. It's really wonderful that you've been able to develop this.

Ruth Stronge:  It has just been amazing. Yeah, I feel very privileged to be able to do that, and also then to look around at the other people that I work with and say, "Yeah, I couldn't do it all myself," because there's not enough hours in the day, but we have some lovely members of staff who themselves have maybe been through some of our systems as well, and are able to talk about how working with the donkeys, and following the routines, and just being out in the fields with them doing field work, and then having something to talk about to people. Because we have visitors coming to see the donkeys, and they've got something that they can talk about that they've achieved, they know about this donkey, in a supportive environment. There would always potentially be a member of staff or a key volunteer who would be around, if we saw them faltering or being more anxious, could then step in and support, so that they didn't have extra worries themselves then.

Jennifer Smith:  That's fantastic. Can you tell us about the program that you run with the BBC Children in Need? What is it, and who does it serve?

Ruth Stronge:  Okay. BBC Children in Need is a national charity, a national grant-giving charity here in the UK, and we've had funding for quite a few years from them. And our program for them has always been targeted at young people, so for them, that's under 18, who have social and communication difficulties. And that can be, from our point of view, I guess it started with shy people and quiet people with anxiousness, and that's how we've kept on going with that. We offer them one-to-one sessions for an eight-week period of an hour with an adult and a donkey, in a quiet period of our week. And then, if they are keen to carry on, then we offer them small group sessions for a longer period. So that, again, a bit linking what you were saying back to the exposure therapy, they are quite familiar with the donkeys and the donkey routine when they've done the one-to-one sessions for six to eight weeks, and wanted to come for longer.

The only thing that is different then is there may be more people around. The staff tend to be the same, so they've got familiar people to support them. They know the donkeys. It's just extra new people, then, and that seems to work quite well. And those groups then go on as they get older, and we've had some people with us for quite some time now, so we've moved to being volunteers, or we call them supportive volunteers. Again, they are supported by key staff, funded by Children in Need, familiar adults who know or are aware of their own personal needs. But the older young people then, one of the targets is to take our donkeys to a local agricultural show, and show the donkeys to be part of something bigger, and that works really well. We do that as a day out, so they take the donkeys out for the day.

The show is a four-mile walk to get to, so they have to come the day before and get the donkey ready for the show. Then they have to come early on the day it's happening, walk the donkey to the show, be in the show ring. They will have spent quite a few months actually preparing for all this, but that is on those following through, and that's what we aim for them to be part of, so that then, again, following the journey with Children in Need, then they can be active volunteers then, in some respects giving something back to us, as well as their own lives then.

Jennifer Smith:  Wow, that's a fantastic cycle. Like you said, people get help, and then they help others, and it's just a wonderful thing.

Ruth Stronge:  It's really important for me behind the scenes, to provide that route for people. And I guess that's not just my teacher background, but also the psychology side of it is where do you go? Where is your journey on it? And I would say that I actually do that for all the donkeys as well. They all have a learning journey, too, and targets that I need them to achieve, and things that they can be good at, and stuff like that. But if the young people or the adults coming to us on the one-to-ones are making progress and want to stay with us, then we discuss with them those journeys we would like them to be able to take, if that's what they want, and how we can best support them on that.

Jennifer Smith:  Wow, that's wonderful to have those specific goals to try to reach for, if they're able and want to. One thing I saw on your website was that there was a video showcasing the experience of Zoe, who is 16 years old. Can you tell our listeners a little bit about what she experienced in life, and why time at the sanctuary has been essential to her mental health? And this is just one story, but I think it really signifies what your sanctuary can do to help people.

Ruth Stronge:  Yeah. Zoe has been with us for quite a few years now, and when she first joined us, as with all our children funded through BBC Children in Need, we asked them to be referred to us by a professional working with them. That could be a school nurse, it could be a teacher. We have something we call CAMHS over here, which is Children and Adolescent Mental Health Services so that we had some kind of filtering system, and we'd sent information to our school nurses and CAMHS, and also I often will give talks to the local authority, and give them some examples so that we work with the right people, so that we can have those best outcomes for ourselves, and for the people we work with. And Zoe was referred to us by CAMHS. She had moved to Wales just before COVID time, it was. She'd moved to Wales with her mother.

It was a one-parent family, and moved to quite an isolated place in Wales, as well. Quite in the countryside, quite remote, but didn't go to school, so was homeschooled as well as moving to a new place with one parent. And so Zoe came to us doing one-to-one sessions for her eight weeks. We had to let Zoe know before she came which donkey she would be working with, which adult would be there, reassure her that the adult would be waiting for her when she got there, again, to remove all those anxieties. And we actually sent her, before she came to us, a picture of the donkey she would be working with, so that she had some knowledge of what she was going to be doing. We knew that Zoe liked animals, and this was a good opportunity for her.

After her one-to-one sessions, she wanted to carry on coming, which was wonderful. And so, she joined a group that stayed for more, so she came from morning session again, five or six children at the most, with adults that she had met. But again, those preparation time and the information, so she knew what was coming, who she would be working with. Zoe had quite a lot of anxiety, as it sounds like, obviously when I'm presenting that to you, quite a lot of anxiety. And her anxiety would not only manifest before she came, but also during sessions, as well. If there was going to be something new happening, we would tell her beforehand.

There would be a lot of demonstrations. If it was maybe learning how to tie the donkey up, then a lot of demonstrations, let her do it without being watched, because she found that very anxious to be watched, or if she felt she wasn't achieving it, or couldn't get it right. A lot of support for Zoe in that way, repeating, and again, positive reinforcement, the things that she had done right, and then taking those small steps.

Zoe came when we were talking before about the two-week course. Last summer, Zoe came on that course for two solid weeks and she had never been... She was 16 then. She had never been in education since 11. That was the first time she'd ever done anything like that. In order for her to get support at college, which she then managed to go to college on the basis of having spent a fortnight with us and could demonstrate to college that she could commit to something, and was able to do that.

She had to have a psychology report, an educational psychologist's report. And what I personally found quite touching, and also quite a big responsibility, is that we were actually the only outside organization involved with that child, because she was homeschooled, didn't attend anything. There was nobody else to talk to the psychologist about her needs, and how best she learned. I spent a lot of time with the team that would've been supporting Zoe when she moved on to college, with the local authority, explaining how we supported Zoe. And again, I would say had I not been in the profession I was, I wouldn't have liked to have taken it on. And fortunately for me, the psychologist who was assessing Zoe, I knew her from school. She used to be my Ed Psych in school, so it was like, oh, that's great. We knew the language we could talk, which was really useful.

Having set that up for Zoe, and then her doing the two-week course, she was keen, and as she said in the little video clip, she was keen to start college, and excited to start college. And she has now just completed her first year at college, and has had really good attendance, a few ups and downs along the way, as most teenagers would do, but was very pleased to have finished her first year, and be accepted into the second year. We are just so pleased for her.

And the time with the donkeys, when you listen to her talking about it, she has a favorite donkey, and that's the donkey she's drawn to every time she comes, and the conversations that she would have with that donkey to help her work through some of her anxieties, and also helping him to work through some of his, because sometimes, we ask our donkeys to do things they don't necessarily understand. And it is those conversations that are helping the children or the young people that we're working with understand why we're doing this with the donkeys, and how do we teach them to do that, enables them themselves then to think about themselves, and how they can move forward as well.

Jennifer Smith:  Oh, wow. I recall also in the video, and correct me if I'm wrong, that Zoe was initially homeschooled due to bullying, and she developed some severe depression. And it sounds like because of the social support that you offered her as an adolescent, which is really critical to maintaining good mental health, that she was able to really develop great resilience. And, like you said, now she's in college, whereas before, it sounded like her life was almost at a debilitating level, where she was unable to really just get out there and function with others.

Ruth Stronge:  Yeah, it is amazing when you listen to what she says that we were the only place she would come, and then small number of people around her was all she could cope with. She wouldn't talk to anybody else. And some of the young people that we work with in BBC Children in Need who did that video always ask us can we give them a case study? They'd asked before, and Zoe wasn't ready to talk, because, and this is something we've had on a couple of occasions from our young people, when I come to the donkeys, this is special and I don't want anybody to spoil this, so I don't want to tell people at school, because that isn't a nice place where I want to be. This is my safe space.

For Zoe, on a number of fronts, it was very brave of her to talk about, not just what she had been through, but then almost that this is what she does, and she loves what she does, and she's a wonderful advocate for it. But it was an incredibly brave thing for her to do. And the amount, like you say, her resilience, and how far she has come is all credit to her. She's worked really hard.

Jennifer Smith:  Oh, fantastic. And the donkey that she likes is Norman, am I correct?

Ruth Stronge:  No, that's Walter. It's Walter.

Jennifer Smith:  Oh, Walter!

Ruth Stronge:  She likes Walter, and she says they have the same birthday. They're exactly the same age. Yeah, he's her favorite, and she does have a special relationship with him. He can be, as most animals can sometimes, he can be quite cheeky, and she won't stand any nonsense from him. One of the wonderful things that they did with this group of donkeys, and she was in charge of Walter, is one of the walks, I know you went on one of our walks, and one of the walks that we do, there's a little bridge going over a small stream, and if we could cross the bridge, we can go on longer walks.

But Walter couldn't cross the bridge. He just couldn't cross over this bridge, because of the running water underneath it. He was quite frightened. And for long, I'm saying years here, we would stand and look at this bridge. And one day I was on site, but I wasn't leading the group that Zoe was with. I think there was four young people with one of our other members of staff. And apparently, they'd gone out for a walk, and I knew they were due back at a certain time and they were late coming back.

As you do, I was worrying, where had they all gone? The parents were arriving, and they all came back laughing, but very late. And I said, "So, where have you been?" And Zoe said, "Well, I just said to Walter, 'today is the day we're going to cross that bridge. Sometimes, we have to do things like that. It's hard, but we can do it.'" And she got him to cross the bridge, and they all went over the bridge and could go for a walk. But he couldn't come back over the bridge, so they had to walk the long way round. They were all laughing. These young people were just howling with laughter that they've managed to do this with Walter, and Zoe had been wonderful and got him over there, but he said once was enough.

Jennifer Smith:  Oh, that's wonderful. And what a fulfilling experience for her to be able to get across, at least that one time.

Ruth Stronge:  He will go now. Next time, he was fine. He was just once was enough on that day. Because we do say to him now, "Zoe, are you going over the bridge?" and she says, "Yes, and we're coming back over the bridge, too."

Jennifer Smith:  So Walter had his own exposure therapy, it sounds like.

Ruth Stronge:  His own exposure, but for her, when she was saying to him like, "Walter, we look at this so often, we are going to do this bridge now." And that was just like, yeah, you are an amazing young woman to be able to say, yeah, I'm going to do this, and do it for herself, and for him. So, yeah, it's lovely.

Jennifer Smith:  It's very empowering. That's wonderful. Thank you. During the pandemic, you started a Long Ears Listening Project. I know donkeys have long ears, but what is this project?

Ruth Stronge:  Long Ears Listening is really all my passions all in one place, which was quite a privilege to do. As an early years teacher, when I left school, I knew I still wanted contact with young children. We do a lot of work with young people and with adults, but young children is an interest I've taught all my life in the early years, we would call it here in the UK, and outdoors and environmental education is my other interest.

When I left school and worked with the donkeys full time, when the pandemic came, we have a lovely patch of woodland that we manage, and it was used a lot during the pandemic by people visiting. I would leave activities and resources in for people to use, and then when we could meet together, we started a formal parent and toddler group for parents, and it's outdoors in the woods, and the donkey comes every session and carries some of the resources. With a focus on language and literacy through storytelling, then, we have a group of parents who meet every Monday morning and share time together. And whilst it is an emphasis on language and literacy for them, it's also a time for them to get together and just be outdoors enjoying themselves, and giving their babies and young children exposure to nature, access to animals, in a friendly, supportive environment.

Jennifer Smith:  And the benefits of nature therapy, or ecotherapy, like you said, just spending time in nature, and then you're with an animal, and then there's the reading... It's just beneficial on so many levels.

Ruth Stronge:  It's been a fascinating journey, that one, as itself has developed, too. And we have a small number of songs that we now use every time we meet in Welsh, so that we are then doing that bilingually for them. And they are about donkeys, obviously, so we do a few counting rhymes that we have. If you've ever met early years teachers, they'll sing to anything, a song, a counting song or anything like that, to a familiar tune, so we've made up a couple of songs that we sing about donkeys to start it off, and just a relaxing place for them to be out there. And they all have a little activity bag, which would have some sensory activities in, and a book. And again, that bit started with COVID when we couldn't share resources the same, so everyone had to have their own resources, and we actually just kept that up. If the child is not old enough to walk around, they've still got activities that they can do and interact with their babies with, then.

Jennifer Smith:  Oh, that's great. This has been extremely informative, and I think this time has unfortunately flown, for me, anyway. As we wrap up, is there anything else that you'd like to share with our audience about the sanctuary, or anything else mental health related at all?

Ruth Stronge:  Yeah, I think one of the things that it makes me realize is that I started it probably by accident, and because I know the benefit I got from being with the donkeys, and stroking them, and mucking them out before and after school, and then part of my work, making time to be out of doors in nature was so important to me, personally. And to be able to offer those opportunities to other people that, as you said, I went back to Uni to do my clinical health psychology degree, because I'm thinking, I don't want to just be the person that says, "I know it's good, and it really is nice." I wanted to embed it in the research, really. And we still work with Bangor University to try and get the psychology students to use as case studies. And for us, it's often another pair of interested hands as well.

But we're really keen that the work we do is the best it can be, not only for the people we work with, but to give the work that we do with donkeys, who often get quite a bad press, or are often looked down upon, and they're very hardworking animals, to give them a value as well. Because it just doesn't happen by accident. If it looks from the outside that it's easy, then sometimes, I think, well, actually that means we're working really hard, and it is working well. But behind the scenes, all that theory, and the small steps, and the thinking about how people need to move forward, and how we can help them do that is important. And I guess I would also throw in as well that for our staff and volunteers, we try to make time for them always to have what we would call "donkey time," so that they have their own mental health moments where they can just be with the donkeys, and enjoy doing those things and being in the moment with them.

Jennifer Smith:  Oh, that's wonderful. For our audience listening, for those of you who are local, or plan on traveling to Wales or the Bangor area, we're definitely going to link up in the interview so people can check out your website. Also, learn about different ways to support your group, sponsorship opportunities. I know you have some wonderful little knitted donkeys. I forgot to bring mine. (*photo at bottom of page)

Ruth Stronge:  I forgot to leave one out as well. Yeah, should have done that.

Jennifer Smith:  Yeah, different ways to support you guys and this wonderful mission that you're doing, that's helping both donkeys and people in a really wonderful cycle. So, again, thank you Ruth Stronge, for speaking with us today. And tell Jenny the donkey that I said hello. That was my friend that day. And we wish you all the best.

Ruth Stronge:  Thank you very much for the opportunity to talk to you, and we would love to see people over here. It'd be amazing.

Jennifer Smith:  Thank you.

Jennifer Smith with Jenny the donkey. (left)

A souvenier “knitted donkey” from Snowdonia Donkeys posing for a picture near the sanctuary in Bangor, Wales. (right)

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.


Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychotherapy Intern Debora de Souza on Grief Support

An Interview with Psychotherapy Intern Debora de Souza

Debora de Souza is a clinical intern at Seattle Anxiety Specialists for 2022-2023, providing care to those in need within our low-cost therapy program. She is finalizing her Master's degree in Clinical Mental Health Counseling at Seattle University and specializes in helping clients work through grief, loss and trauma.

Tori Steffen:  Hi everybody. Thank you for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Tori Steffen, a research intern at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders.

I like to welcome with us today, Clinical Mental Health Counselor, Deb de Souza. Deb is a clinical psychotherapy intern at Seattle Anxiety Specialists and she is currently earning her master's degree in clinical mental health counseling at Seattle University. She works with parents experiencing perinatal mood and anxiety disorder, known as PMAD. And she also worked as a grief hike guide, helping those grieving the death of a loved one to process their loss. So before we get started today, Deb, could you let us know a little bit more about yourself and what made you interested in studying mental health counseling and grief?

Debora de Souza:  Hi Tori. Thank you so much for having me.

Sure, absolutely. This is a second career for me. I have been in the business world for quite some time locally here in Seattle in corporate settings. I always had an interest in the psychology when I first started college, that was definitely one of the careers I was... one of the schools that I was hoping to go into. Just life happens, it didn't happen. I ended up being program management and business operations for most part of my adult life. But when the opportunity came with COVID and things happened, I got laid off and I decided that it was the right time to go into counseling given that was something that I really wanted to do. And I had a lot of interest and passions, like you said, in the area of grief and PMAD and anxiety disorders, as well.

So I said, no time like the present. I had already applied to Seattle University and got accepted prior to COVID and I decided let's just make this a new career path for me. And it's been really enjoyable. I really am glad that I took the leap. It's a little bit threatening, but it was fun.

Tori Steffen:  Yeah, that's amazing. It sounds like it just worked out time wise and you got to love that smooth transition.

Debora de Souza:  Yeah, it was great. Meant to be.

Tori Steffen:  Yeah, exactly. Well, can you describe for us how your time at SAS as a clinical intern has been so far for you?

Debora de Souza:  I started in September and I have to say it's been really, really good for me. I feel very supported at SAS, that's one thing I really wanted. I applied to several sites and I actually had already accepted another site. And when I got an email from SAS to interview. And it just clicked, it really clicked with the folks that I talked to on my interview, the approach that they had to internship and also I like the low-fee model that was offered, that interns participate, where we provide service to folks that may be in that gap where they can't qualify for insurance, and they don't have private insurance or state insurance, and we can provide a service to that population. That otherwise may not even have access to care. So it's been really, really nice. It's a small group of interns, a lot of support from great supervisors and also from the staff. So I feel ... again, I think as a new person, as an intern, new person on the field learning how to become a counselor, the support is critical.

Tori Steffen:  Absolutely. I would definitely agree with that. It's a lot of stuff to learn and I feel like you really learn it from experience. So having supervisors help you through a little bit is crucial.

Debora de Souza:  It's vulnerable work.

Tori Steffen:  Absolutely. What would you say has been the most challenging about being a clinical intern?

Debora de Souza:  Well, I think the truth that come to mind right away is that I kind of expected, but experiencing it is a little bit different, is how vulnerable it is for me as a person sometimes, and how I can get flooded and overwhelmed, emotions when people share things that might be triggering for me and trying to differentiate what is mine, what is the client? So that's been a learning. And I knew from a scholastic standpoint, but it's different when you feel it, when you're in the room with someone. So that has been something.

Also how imposter syndrome is real. Sometimes you sit with somebody explaining their circumstances and you're like, "I deal with that too and I'm still finding my way. How can I support you?" So that is real. I think just learning how to be a counselor or a therapist and sit with someone. One thing that I did not expect, I've always worked long hours and being tired. And I remember telling Case (Lovell), who is my supervisor, in the first week how completely exhausted I was after a full day. I think it was my first day with four or five people.

Tori Steffen:  Wow.

Debora de Souza:  And I was very emotionally and physically tired. I just wanted to come home and go to bed. That was surprising for me because it takes a lot of effort to really focus and listen. It's a different way of engaging with people that I wasn't used to. Because that's not how we do it in our lives.

Tori Steffen:  Right. Yeah, that's something I wouldn't have expected either. But knowing that, it does make sense that it'd probably be drained, especially emotionally and need a good day of rest after your first week probably.

Debora de Souza:  It's a learned skill I hope, it gets better over time as you-

Tori Steffen:  Yeah. Yeah. I think it's one of those things that the more you practice, the more that you learn how to do it better. And-

Debora de Souza:  Absolutely.

Tori Steffen:  Deal with the feelings that come with it. Well, what would you say has been the most rewarding about being a clinical intern? Any specific moments come to mind for you?

Debora de Souza:  Yeah, I keep going back to the... I guess, I'm surprised and touched a lot how vulnerable people get with you. And it sounds like cliche, but really genuinely honored that sometimes without not knowing much, two or three sessions maybe, people really share deep things that they may not have other spaces in their life outside of session to talk about. And I'm very honored by that. And I think that is one thing that I keep it in mind a lot, is that I get to do this job. I get to sit with folks and support them and how intimate it can be, the relationship in one way. When you are really vulnerable, and also how much trust they have on us to be themselves and not being judged.

And as for an example, one that I have a client that we have sessions where the camera's off. My camera's on, but the client's camera is off. I got used to it, that's how this client prefers to engage. And I remember the first time he turned the camera on and in the middle of a conversation and it was to show his dog, he was talking about his dog. And he kind of came into frame very briefly, but he turned the camera to himself and said “hi.” It was the first time I actually saw his face and I was almost a little bit emotional. It was so meaningful to me that he... because he trust me enough to be a little bit more vulnerable and just say hello. So we've been seeing each other for some time and he still keeps the camera off most of the time. But every once in a while he'll turn it on and say hi or bye.

Tori Steffen:  Ah, that's amazing. Yeah, that's, I'd say, such a wonderful moment to have with the client and kind of just know that you've built that trust with them. So that's amazing.

Debora de Souza:  It felt really good.

Tori Steffen:  And it must have been amazing to see his dog, too.

Debora de Souza:  Yes. He has a very close connection with his pet. We always talk about the dog. He always comes to the session with us.

Tori Steffen:  Really? Ah. That's amazing. Well, kind of moving over to the outdoor grief groups that you work with. Can you explain how those work for the audience and maybe what activities you guys usually do?

Debora de Souza:  Yes, I do, I do. I love ... it's a volunteer position with the local... not company, but with the local group called Wild Griefs in Olympia, Washington, it's a small group, they're expanding now. We are volunteer hike guides. And basically it's to partner the power of nature to process grief. It started off as initiative to support teens that were grieving. A lot of times the loss of a parent or a caretaker or maybe a sibling, and provide them opportunity in nature to bond with each other, to share their experiences. And that was how it first started.

Wild Grief has several programs, all nature related, all outdoors throughout the entire year. So it's not a summer/spring only. We go out in December, the day before Christmas sometimes.

Tori Steffen:  Wow.

Debora de Souza:  And they offer programs that are day programs, like hikes. Some are more nature walks, some are more hikes, like five hours or so. Also overnight programs, which is a four day backpack with teenagers and a group of us take teenagers out backpacking in mountains around Washington. And each day is framed, there is some process. Each day is framed to go... they use the four tasks of grief as a baseline, basically accepting grief, feeling your feels, adjusting to a life without the person that you lost, and then making a new relationship with that person. So we try to frame all... even if it's a short hike or if it's a four day camp, we try to do that.

We also have a camping program that I usually participate on, that I really like. It's with the family. So it's a family camp, everything's provided, literally from shoes to food to pants. The family just comes. So a parent or a caretaker and children that experience a loss within that family unit. And we spent three days together camping somewhere around Washington. And it's beautiful to see not only the parents relating and connecting, but how the kids really find support on finding another child that has lost their dad, for instance. And be able to just talk about it, which they don't have a lot of space, maybe, in their life outside, in school and other friends.

So both the family camp and the hikes are the longer programs. The other programs are day hikes. And they say something else like nature does the heavy lifting and we just really provide the safe space to share, it's optional. And it has been really beautiful to see. We don't know who's coming, they sign up and we meet up in the trailhead. And usually there's two, maybe three guides, depending on the number of people. And we start hikes and then we stop in some places we usually kind of case out hikes and spaces before. Because we have two or three stops where we do little small processing groups.

And we talk about our person and we share memories of that person, the impact of that person in their life. And we compare with nature sometimes the changes of seasons. How does that reflect on the changes that grief does throughout time. And the rebirth when we see a log and there's a whole bunch of new growth in that dead tree. And the same thing with our grief, after the loss, we adjust and we move forward, and we bring that person with us in a different capacity. And just being with other people. So you can talk about your feelings with no judgment.

Tori Steffen:  Right. Yeah, it sounds like kind of the perfect safe space to provide people who are grieving. And you're right, you just have to get away from everyday life sometimes. Because work and school and all these responsibilities get in the way of processing the heavy emotions. So that's amazing. Yeah, it sounds good.

Debora de Souza:  Being outdoors really helped.

Tori Steffen:  Great program.

Debora de Souza:  Yeah, it's very nice because being outdoors, I even feel myself just with the trees and the sounds of nature. You are walking, you're also moving. We do have strategic stop times, but they're brief. I think it's a great idea, I'm glad that the board, the founders, the couple people that found that decided to expand and move forward and be more inclusive.

Tori Steffen:  Yeah, it sounds like they're doing a great job with being inclusive for all types of experiences, so that's amazing.

Debora de Souza:  Absolutely.

Tori Steffen:  What are the main benefits that you see the participants gaining from their experience in the hiking program?

Debora de Souza:  I think it's community. We talk a lot about acceptance, just have a space. Grief can still be a taboo topic in a lot of places at work or people, maybe people rush you like, "Oh, it's been already six months or a year." You hear a lot of those terms so people feel like, oh, I should ... it's not okay for me to talk about it or to bring it up. So people push it down their emotions, so that's a space that they can do. And it's amazing that we were all strangers in the beginning of the hike, it's oftentimes by the end, people exchange numbers or want to keep in touch. Or people come to several, we have hikes once a month, at least. So we'll see people coming again and again and them bringing children or bringing a friend. So definitely community and acceptance. And being outdoors. Yeah, being outdoors is always good.

Tori Steffen:  Right. Yeah, it sounds like just the perfect mixture of things to help you along that healing journey. Yeah. And that's amazing.

Well, if we could discuss the topic of grieving parents, specifically. There's a specific topic around it. So how it's become more acceptable for men to grieve where it was previously not really as accepted. Would you mind going into that a little bit?

Debora de Souza:  Yeah, absolutely. I think it's even harder for men. I think sometimes men get forgotten. And especially around parenting, I think we're talking about specifically about... there's another volunteer position that I have with the Perinatal Support Washington. I'm a warm line for answering the phone on certain shifts during the day. And most of the callers are women who are experiencing PMAD, Perinatal Mental Anxiety Disorders. So postpartum depression, postpartum anxiety, some miscarriages, sometimes stillbirth or birth trauma is very common. So we do a lot of talking to them, just trying to assess their situation, how we can provide support.

Sometimes every once in a while we get a dad or a grandfather calling to support someone that they love in their lives, who they're concerned about. So there's a lot of psycho-education, a little bit, like “Where do I go with this? How can I help my daughter or my wife?” And eventually, as you get to work with them, we have extended peer support. So if the person... until they get connected with some sort of therapist or service, they have the option to keep working with us and we can call them once a week. We can set up a cadence and we have brief calls with them. And I found that with fathers or with males, eventually it comes to their grief and their experience with, in the case of a miscarriage or stillbirth. And being able to express that because they think it's all around the woman, the mother, the expecting person.

Which makes sense and they feel a little bit lost or they say, "Oh, my wife just had a baby. And all the attention goes to her and I'm not feeling safe to say that because that's not cool. What kind of dad are you? What about me?" Or, "I'm grieving my wife because it used to be just me and her, and now there's this baby who's a newborn is very demanding." So we end up supporting and doing a lot of psycho-ed and just help and listening to both parents, to both caretakers. And grandparents do it the same and call and say, "I don't know how to help more or how to be present to my daughter, to my family member."

As far as personal experience with a male, a coworker, I did suffer a pregnancy loss and I was far along enough that people in my work knew. So I was away for recovery. And when I come back to the office a few weeks later, one of my coworkers, another gentleman that was in my team and asked me out to lunch, he wanted us to talk. And I think in the beginning, just to support me, “Welcome back, how can we be there for you?” But more in a private setting. And he got really emotional during that meeting with me and start crying and openly grieving a son that he lost, I believe it was like 30 years earlier. Because we talked about how weird was talking about pregnancy. But because I was so evidently pregnant, there was no way around it. And he just shared his own story that back when his wife lost their first child, he had nobody... men do not participate. They never talked about it. It was like they did the medical procedures, she came home. That wasn't even their first child, the second child was.

So it was just culturally different. I'm sure at the time, things were difficult. We have come a long way of normalizing not only perinatal mental health, but miscarriages and birth losses and challenges with IVF, challenges with fail adoption, the journey to become a parent can be riddled with challenges. And fathers feel it, too. And that gentleman really touched my heart, I will never forget because it end up kind of me making space for him and listening about his boy and how much that hurt him. That pregnancy wasn't viable and he didn't get to hold him. So it was a very powerful, and beautiful moment. And I'm very thankful that he felt safe to share with me.

Tori Steffen:  Yeah. And it really brings to light that men experience the same grief. And it is more evidently the mother is physically going through it and that's definitely significant. But the father is in there just as much. It's their child, as well.

Debora de Souza:  Absolutely. A lot of anxiety for dads when the first baby comes.

Tori Steffen:  Oh yeah, I bet.

Debora de Souza:  They're adjusting too. So it's nice to have a service like Perinatal Support Washington. So we have fathers volunteers, as well. So if you want to, you don't have to talk to a mom, you can also talk to a dad who has been through postpartum depression with their wives and whatnot. And it's really nice. It's a really great service.

Tori Steffen:  It sounds like just such a great resource for new parents, anybody who's gone through it.

Debora de Souza:  Oh, the landscape has changed. Even from my time of my losses, I really struggled to find someone, a therapist that was familiar with perinatal mental health, how that could support me. And I'm glad there's a lot more resources, I think, right now, nowadays.

Tori Steffen:  Yeah, that's amazing. It's not something that I have seen be super common out there. But it's absolutely needed, I would think. So, that's amazing. So what are some good resources that you know of that grieving parents can look into maybe after losing a child or losing a loved one? Are there any good go-to resources that you know of?

Debora de Souza:  There's several, like I said, the landscape did change. I will share the Wild Grief link and page, as well as the Perinatal Support Washington for Washington only. But there's also Perinatal Support International. A lot of resources, a lot of support groups are ran by those organizations and they're usually free of cost. And now since COVID, especially, they're online. They also list other ones, sometimes with churches or with community centers that people can find locally and connect. And they're a lot of support groups, which is wonderful. Because the safe spaces and the peer-to-peer support can be vital.

One that I like a lot myself and they offer trainings and they're very laid out website, it's called the Return to Zero. And they made a movie, they have a book. It's a couple talking about the experience when they lost their son, their first child. And from there, it kind of sprout into this beautiful website, where you can go in there as a parent grieving. And they really go the gamut, like I said, in fertility, IVF, anything in the Journey to Parenthood. Beautiful site, a lovely work, very well done and well set up. So you can get from referral to therapists, training classes. They have a lot of training classes for volunteers and people that work with parents and people in experiencing PMADs.

And it's just something that I wish I had access to back in the day because you just feel it can be very lonely. You go through very... and nobody wants to talk to you because people think that it's a baby and it's going to make you sad. Or they don't know what to say. I get it. It get all that. And when all you want to do is talk about it. And that's the funny part, all you want to do is ... especially when a baby. A baby is a baby and has a whole life already, the minute that you realize you're expecting.

Tori Steffen:  Yeah.

Debora de Souza:  It's amazing how you're already think the weddings, it's sounds silly. But a whole life become concrete. So that's another thing, as well. We used to have a miscarriage early on, sometimes people say, oh, at least try to do those kind of modifiers. “Well at least it was early enough. Or at least you can get pregnant again.” And for a parent, I think that life has already happened from conception on. So those are great support that folks can go to and get all kinds. And very cultural responsive too, and inclusive because different cultures... and I think I can speak from my culture, as well. It's very unique sometimes how you deal with the topic, how you deal with grief itself. So they do a very good job of having a multicultural approach and training and language that is inclusive to all parents. So Return to Zero, I will share the link, as well. They're excellent.

Tori Steffen:  Perfect. Yeah, we'll make sure to link those in the notes later, but that's so helpful. Thank you for sharing the resources. I'm sure it'll be really helpful to hopefully some of our audience.

Debora de Souza:  I hope so. Yeah.

Tori Steffen:  Awesome. Well, are there any final words of advice or anything else you'd like to share with the listeners today?

Debora de Souza:  No, it's been really a pleasure. I think I said my thing is about normalizing grief, normalizing sharing feelings. And even if we don't know what to say, sometimes not saying anything, just being there. Just letting the person know that you are there to say... and it sounds cliche again, but it's so important so you don't feel so lonely. You feel like it's okay, people understand. Because that's one common experience that we’re all going to have. At some point, we're going to lose someone.

But also other griefs, as well. It doesn't have to be a death of a person, ending of relationships. I mean, through COVID there were so many changes. And I always like to think about positive changes. Some people say positive changes, happy changes bring grief. And I'm like, oh, it's true. In order for something new to happen, something had to die or change. And I didn't think of that. I said, well, think about a wedding, there's a different life that you're entering now. But things are changing... sometimes and a lot of times bring grief with it. And I think it's uncomfortable, we don't like to talk about it.

Tori Steffen:  Right and it's like-

Debora de Souza:  We all feel it.

Tori Steffen:  Exactly. And those big positive changes are great. You're having-

Debora de Souza:  New jobs, moving to another country. I mean, there's so much that you can think, "Oh, this is so fun and exciting." But there's always some... the other side, that you're leaving something, there's a cycle ending in some way. And just honoring that and taking time to feel the feels just like the best... it's beautiful. Doesn't apply only to death, physical death.

Tori Steffen:  Right. Yeah, just taking the time to process the change, I think will help you, lead you into the future and make it easier on you emotionally.

Debora de Souza:  And be a kinder human being. Understand when other people go through their change, it promotes kindness. It's definitely a positive in my book.

Tori Steffen:  Yeah, absolutely. Well, thank you so much for sharing your knowledge with us today, Deb. It was great talking to you.

Debora de Souza:  Thank you so much. It's my pleasure.

Tori Steffen:  All right. And thank you everybody for tuning in and we'll see you next time.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.


Editor: Jennifer (Ghahari) Smith, Ph.D.

Journalist Florence Williams on Nature Therapy

An Interview with Journalist Florence Williams

Florence Williams is a journalist, author, podcaster; her work specializes in the interconnections of the environment, health and science.

Chris Russo:  Thank you for joining us today on our installment of The Seattle Psychiatrist Interview Series. I'm Chris Russo. I'm a clinician with Seattle Anxiety Specialists, and I'd like to welcome journalist, author, Florence Williams. Florence is a contributing editor for Outside Magazine, freelance writer for a dozen publications, including National Geographic, the New York Times. She's the writer-host of two award-winning Audible original series, a distinguished public speaker, has held fellowships and visiting scholar roles at different universities and centers, engaged and worked in nature and environmentalism. And you're known for work that focuses on environment, health and science. Before we jump into things, just want to start a little general, if you could maybe tell us a little bit about yourself and what led you into exploring nature's effect and relationship with humans.

Florence Williams:  Sure. Thanks so much for having me, Chris, I'm excited to be here and serving your good work and your clients. I am a journalist and most recently I'm the author of The Nature Fix: Why Being Outside Makes us Happier, Healthier, and more Creative. And also a brand new book that's coming out any second, it's actually available now called Heartbreak: A Personal and Scientific Journey. And I've long been interested in the relationships, or the relationship really, between humans and nature and the hidden relationships— so the ways that our environment can actually make us sick. I wrote a book that looked at women's reproduction and the effects of toxic chemicals on breast cancer, for example, and breastfeeding. And also now interested in how the environment can help us and make us feel better.

And so the reason I wrote The Nature Fix, well, it started as an article for Outside Magazine. And I had just moved from the Rocky Mountains to the heart of Washington DC, and I felt personally that my own nervous system really responded negatively to that move. And I started to think a lot about what journalist Richard Louv calls Nature Deficit Disorder. Was that a real thing? Was I experiencing increased anxiety, depression, a lot of just general stress because of what I'd lost in terms of my daily connection to the mountains? And I think that actually was a big part of it. And so for Outside Magazine I went to Japan. That was the first place I went, where researchers there were actually studying the physiology and stress hormones, heart rate variability, some brainwave patterns and people in different environments and how being in nature actually really helped calm a lot of people's nervous systems.

And then, I started finding out there was more science. I wrote an article for National Geographic called “The Power of Parks.” And I realized there was really a book there looking at doses of nature and different levels of research and studies, what were the benefits of being outside on a city block where there's some nice trees, where there are still benefits, all the way to the three-day effect of what our brains are like after three days in the wilderness.

Chris Russo:  Yeah. There's been such a journey through starting with an article to now having multiple books, podcast series that have come from this. When you started, did you anticipate that there was going to be such a hefty dive into all of this?

Florence Williams:  I really didn't. For me, I thought my premise was very obvious. "Nature makes us feel good. Like, duh, everybody knows that, nobody's going to buy this book. Nobody cares, we all know it. It's so intuitive." But in fact, a lot of people don't know it or don't know it consciously. And I was really amazed by how many emails I would get from people saying, "Wow, I read your book and now I go outside." And it really spoke to, I think the society wide and cultural wide level of disconnection that so many of us do feel from the non-human world. And of course then the pandemic hit and it turns out the lessons from the book were more relevant than ever. And I think a lot of people have found so much comfort in the natural world, have gotten to know their local nature better. And so the book turned out to actually be way more relevant than I could have ever anticipated.

Chris Russo:  Yeah. Really this resource and tool that possibly was in people's backyards and right around them, that they weren't sure how to access and engage with and know that it could be really helpful and supportive and beneficial. Curious for us to maybe dive into a little bit of some of that science, we hear it's good for us. And I think what you touch on is a really important piece is that many folks intuitively maybe know that. I do want to acknowledge within the world of eco-psychology and a lot of nature-based stuff, they talk about traditional ecological knowledge. We use terms like indigenous wisdom and there's generations of people that have known this, that has been passed down through stories and culture. But the Western science wants to have the data, which is something that I think you really dive into, right?

Florence Williams:  Yeah.

Chris Russo:  So curious if we could maybe look at and talk about, what's some of the data, what's some of the science that tells us how we can benefit when engaging with nature?

Florence Williams:  Yeah. I was so interested to learn that there are so many neuroscientists and psychologists and immunologists and physicists who are really captivated by this topic. And I think it's because there is a recognition that we live in an increasingly urbanized world, where not only our children, so cut off from nature and disconnected, but we are ourselves because of our phones and because of our increasing time indoors, there's this increased anxiety that's I think driving a lot of the research. And so there is a lot of really interesting research going on. As I mentioned, I started in Japan and what researchers there were finding, there's this popular practice there called forest bathing, or shinrin-yoku, it's now been popularized here in the United States, there are guides all over the place.

But in Japan, what they were finding out was that even after just 15 minutes of people just strolling around or sitting in a forest that their blood pressure dropped, their heart rate variability shifted to a profile that was more consistent with stress reduction, their brainwave patterns changed a little bit. Additional studies since then have shown that their immune cells, their killer T cells increase in the presence of these forests, their blood sugar improves, it's just this big list. So that's just looking at an individual. And there are also these really large scale epidemiological studies, especially in Western Europe where there's great socialized medicine, like big public health databases and really good maps of where people live, like how close to green space do people live? And when they put these data sets together, what they see is that people are just a lot healthier who live closer to green space and that's after adjusting for income and education.

So there are just lower rates of all these illnesses, including a lot of cardiovascular, stroke-related… There's less anxiety medication prescribed, and in fact, better learning outcomes even in schools that don't have so much urban noise, that may be closer to green space. Lower mortality rates overall, pretty statistically significant drops in mortality and especially true in people who are underprivileged, so who may not have access to a lot of the other stress reducing things that wealthier people have. And so it turns out that if you live close to a green space, it's this social equalizer or leveler a little bit in terms of health. And then there have been a lot of other studies looking at, even in cities, the density of trees on your block, for example, once you hit a certain threshold of trees, it's the equivalent of a $20,000 boost in income in terms of health outcomes.

And in communities that have lost trees, for example, to the various blights like the Elm blight, that cardiovascular rates go up, risk goes up, and disease goes up. And then there have been some research in places like Finland, looking at depression specifically, and finding that people can prevent mild depression if they spend a couple of hours a week in nature. Really again, well, that was in medium scale studies, but in the UK, that was replicated in a really large scale study looking at I think 10,000 people, showing that two hours a week in green space was the optimal for wellbeing, both physical and mental.

Chris Russo:  Yeah. So a lot of these physical markers that are, you said, indicating a profile that would resonate with reduced stress, reduced anxiety, increased mood.

Florence Williams:  Yeah, exactly. And now there have been some interesting brain studies as well showing actually that blood flow to the brain is different when you are in nature. If you're out for a 90 minute walk, for example, there's reduced activation in a part of the brain associated with depression. And they think that's because there— the psychologist who was at Stanford at the time of the study, Greg Bratman, he's actually now in Seattle, found that rumination is associated, sort of negative thought cycling, associated with depression. And that there's a part of the prefrontal cortex called the subgenual prefrontal cortex, that was really reduced in activation after walking in nature, but not after walking in a city.

Chris Russo:  I was hoping we would touch specifically on rumination, so I’m glad you brought that up. Because I think that's, whether anxiety, depression, I work a lot with folks with obsessive compulsive disorder and rumination. It really impacts us, distraction, our attention, mood, right?

Florence Williams:  Yeah, it does. That voice in our heads is a brilliant mechanism of evolution. It helps us do so much. It helps us form priorities and articulate our thoughts and have some self concept, all that good stuff, but it can also run away with us. And sometimes it's good to quiet that voice or to give ourselves some distancing and some perspective, that that voice isn't really the most important thing all the time and we need to quiet it down. And it turns out that being in nature looks like it's one tool among many for just being more in the moment, waking up our senses. And that's what forest bathing is actually, as practiced by the Japanese and as practiced here now, increasingly.

It's a series of cues that are very simple, that just, you know, go outside for a little while and take some deep breaths and focus on your senses. What are you hearing? What bird song is out there? Are there some interesting patterns of light that you see in the trees? What is the breeze? What does the temperature of the air feel like on your face? Just some really basic elemental cues that are so easily grounded in nature. And when our sensory sort of animal brains wake up, our thinking brains dial down a little bit in a really healthy way.

Chris Russo:  Yeah. I want to, I think on that note but steering us a little bit, if we could touch a little bit on the role awe plays. That came up through some of your work. I was wondering if you could maybe speak a bit more about that?

Florence Williams:  Yeah. I talk a lot about this emerging science of awe in The Nature Fix. It's really interesting to me, as a positive emotion, it's been late to the psychology game. People weren't studying it until quite recently. Of course, philosophers have talked about it and poets have talked about it for a long time. Typically the way awe is described or defined is that it's receiving vast input from a view or looking at the Milky Way or something like that. Looking at the sky, looking at the sunset, looking at the ocean. So something vast that also in a way may surprise us or be unexpected. It makes us open our mouths, drop our jaw, raise our eyebrows like, "Oh my God, look at that moon." And it's really interesting what that sensation does to us. And what the brain studies have shown is that when we see something arrestingly beautiful and overpowering, it shuts down our brain in a way, because we need to take that in.

We don't necessarily fully understand it. It may challenge our expected schema of what we think we're seeing. For example, an eclipse or something like that. It's like, "What is going on? My brain is not used to taking that in, I need to understand that." And so our thinking brains, again, shut down for a moment. And suddenly we feel deeply moved, we feel connected to the world around us in a powerful way. We actually feel diminished in terms of ourselves, our ego takes a backseat for a minute. And in fact, in studies, when people go look at views in Yosemite, for example, and another group goes to look at a view of Fisherman's Wharf in San Francisco, which is a cityscape, the subjects are asked to draw a picture of themselves in the landscape.

And people actually draw themselves as being much smaller when they're looking at powerful nature. So there's this like literal diminishing of self. And again, that's powerful in terms of wellbeing, where we feel like maybe other people and other things in the world are worthy of our attention, not just our own problems all the time. It makes us actually more empathetic and can also make us more creative, again, wakes up different parts of our brains in these really interesting ways.

Chris Russo:  Yeah. Many folks that have maybe spent a lot of time in nature, we've had some of those really powerful awe moments that seems so unique that there's a novelty to it, right?

Florence Williams:  Yeah.

Chris Russo:  I'm wondering for folks that maybe are a bit more stuck in the city, you mentioned Fisherman's Wharf in San Francisco. Can we experience awe in the everyday?

Florence Williams:  Yeah. I'm glad you brought that up. So one thing I learned through the course of writing The Nature Fix was how to cultivate a sense of beauty and awe in a city. And I actually participated in a study, I think it's called the North Bay Awe study. And there's some preliminary data from it already. And what it was is we were asked by the researchers to go out a couple times a day, just even walking around the block— this was in the middle of the lockdowns— and find something beautiful, like a flower or a sunset or the moon, they called it “micro-dosing awe,” to just stop for a moment and just be with this beautiful object or thing or feeling, could be even a food that you were eating or a house plant that you could look at, and take three breaths, just take three breaths while being with this point of beauty.

And then write about... there were a lot of questionnaires about, "Well, how do you feel today? How does your body feel? How does your mood feel? What's your sense of yourself? Are you liking your job? How is waking up this morning?" And what they found was that people who had engaged in this practice of micro-dosing awe for a period of weeks actually had a much stronger sense of wellbeing by the end of it. So I think we're used to awe being the Grand Canyon but it doesn't have to be, and we can in fact become better at savoring these moments of small beauty that can be very effective for mental health.

Chris Russo:  Thanks for that. You have spent time rafting with veterans down Western rivers, hiking through super, super cold weather with women who have been trafficked and faced abuse and experiencing PTSD, have hung out with researchers in Utah and learning what they're doing. Curious what you found most surprising through all the work you've done so far.

Florence Williams:  Yeah, good question. As you say, I knew intuitively that nature makes us feel better. But what I was surprised about was I think the cognitive piece, that even these quick walks outside could actually really make us feel more awake and more alert and more productive, and so that was a surprise. It can actually make us feel more creative. So that was really nice to learn. And then also in terms of how it makes us better members of society. The studies show that people who can feel awe on a pretty regular basis, those people in studies, they become more altruistic, they have a stronger sense of community and less a sense of self-driven ambition. So they want to make their communities better, not just themselves.

And this has been shown in various psychology studies where you give away more money or more lottery tickets, or you fold more paper cranes for earthquake survivors or things like that, that there are these acts of generosity that we're more likely to engage in after we've had these de-stressing moments of beauty and connection outside, and that really surprised me. So in this way, nature, it turns out is really good for civilization. And I hadn't really ever thought of it that way. I really thought it was separate from civilization or something different.

Chris Russo:  Takes it out of the individual and brings it more to a larger collective, right?

Florence Williams:  Right. And we know that that sense of community is profoundly impactful for mental health. And so many of us are combating loneliness right now. And of course loneliness is bad for your health, not just your mental health, but it's bad for your physical health. And so, we are as human animals, we are really wired of course, to be not only social, but hyper social and our bodies feel pretty threatened in this very subconscious way if we spend too much time alone or feeling alone. It's a subjective feeling. You can be in a marriage, but still feel alone. And so being in nature is one of the ways we can really feel less alone.

Chris Russo:  So it's been five plus years since you started diving into The Nature Fix stuff. Where is your journey taking you? You have this upcoming book, Heartbreak, A Scientific and Personal Journey?

Florence Williams:  Yeah. Heartbreak. So after I wrote The Nature Fix, which by the way I said, I looked at doses of nature and I really only got up to the three-day effect in The Nature Fix. But I then went through my own personal emotional trauma which was a divorce of a 25 year marriage. And couldn't believe how much that hurt and also seemed to be affecting my physical health. And so I thought, "Well, maybe I need a much bigger dose of nature now." And so at the core of the book is actually a 30 day river trip, including some of it alone. And I was really trying to see if that would help me feel better. And it did in a lot of ways, and in some ways it wasn't enough.

And so I talk a lot about the science of that in the book. And I talk a lot about the science of the immune system. I worked with an immunogeneticist at UCLA, and we actually tested my blood samples for genetic markers of stress and threat and loneliness at various time points after the divorce. But there's also a lot of, like in The Nature Fix, I think pretty user friendly ideas and tools for feeling better.

Chris Russo:  Yeah. It sounds like you kind of... You talk about Attention Restoration Theory and Stress Reduction Theory and I think Nature Fix maybe focused a bit on that, whereas this sounds like it really dives into grief, right?

Florence Williams:  Yeah. It dives into, so specifically trauma and grief and loneliness. So I sort of pick apart the pieces of heartbreak and talk about how to feel better and the urgency to feel better, because really of the significant health effects associated with loneliness, and the adverse effects, not just for yourself but for your family and for your community. If you can learn to really have a sense of purpose and extract meaning from your experience, then that does help you feel more connected to other people. But to do that, you also have to figure out how to calm down, how to calm your nervous system, and that's where nature can be super helpful. So I think it's a piece of the recovery puzzle, it's not the whole thing.

Chris Russo:  Yeah. So as someone who has spent some in-depth time researching, writing personal experiences through all of this, curious if there's any recommendation or advice for folks that might listen or watch this.

Florence Williams:  Yeah. I have this like really simple little coda, which is go outside, go often, bring someone with you or not and breathe. And beyond that coda, I would say if there are people listening who aren't necessarily really comfortable with spending a lot of time outside, start small. Just have your cup of tea in a place where you can see some clouds and really think about your senses, cue into your senses. And it's great to work with professionals and clinicians like yourself who can help people do that and understand the power of it. So thanks for the work that you're doing, Chris.

Chris Russo:  Well, thanks for bringing so much attention to it.

Florence Williams:  You bet.

Chris Russo:  And thank you for taking time to meet with me and chat about some of this work. It's exciting stuff and cool to learn about what's so immediately available. It doesn't have to be a 30-day back packing trip somewhere. Here in Seattle, we're so fortunate that we have so many green spaces. I know even in Washington, DC, you've got Rock Creek park that runs through. It's like there's a lot of stuff that is nearby that-

Florence Williams:  There really is.

Chris Russo:  We see some great benefits from as well.

Florence Williams:  Yeah. And even when the weather is crummy, by the way, the benefits are still there scientifically. So you still feel a little bit revived, a little more alert, a little more energetic.

Chris Russo:  So for a gray rainy Saturday... or Seattle days. Yeah.

Florence Williams:  Yeah. Just go anyway. The first 15 minutes are kind of miserable, but then it's great.

Chris Russo:  Well, thank you again for sharing all of your insights and reflections on this work.

Florence Williams:  My pleasure. Thanks so much for having me.

For more information, click here to access our article in “The Seattle Psychiatrist” Magazine: The Need for Ecotherapy in Our Overstimulated, Over-Industrialized World.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.


Editor: Jennifer (Ghahari) Smith, Ph.D.