'An Embodied Journey Towards Recovery': A Grounded Theory of Mental Health Service Users' Experiences of a Nature-based Intervention.

Constructivist grounded theory (Charmaz) guided the design. Twenty of the 48 people who completed a 24-week nature-based intervention at a private farm-based rehabilitation centre in southern Sweden were purposively sampled and interviewed in depth on site. Seventeen were interviewed after the first 12-week phase; three after the second. The second author conducted all interviews using open-ended questions refined between sessions. The first author transcribed verbatim (noting embodied reactions such as sighs, tears, laughter), then performed iterative line-by-line and focused coding, with memos. The second and last authors independently analysed three and two interviews respectively for triangulation. Theoretical sampling continued until saturation. Member-checking was done with two former participants. NVivo 14 was used. The intervention itself was a 24-week, two-phase programme delivered in groups of about eight, on site 3 days/week (3 h/day) in phase 1 and 2 days/week (3 h/day) in phase 2, combining equine-assisted therapy, forest walks, farm work (mucking out, fence building), mindfulness exercises, and psychoeducational elements, all delivered outdoors or in the stable by a psychiatric nurse and a co-worker experienced in equine-assisted therapy, with cats and dogs also present.

The study produced a tentative theoretical model rather than a measured outcome. The core concept was 'a process of embodied recovery.' Under it, three concepts and seven categories were theorised: (1) Experiencing interconnection — staff support characterised by low demands, equality and 'heartful care'; a personal connection to the natural, animal and human environments; and building acceptance, trust and safety over time. (2) Processing inner connection — lowering one's guard and letting new experiences in; using all senses and feeling one's own emotions (participants described accessing moods they had not felt for a long time). (3) Feeling intra-connected — integrating self and body as a whole (a new sense of self grounded in accumulated embodied experiences); and integrating strategies into everyday life (new routines, nature in daily life, applying calming strategies at home). All 20 participants reported positive experiences; no negative side effects were mentioned. The authors note this uniform positivity as a limitation, suggesting it may reflect relief and gratitude rather than a balanced account.

The intervention is explicitly grounded in occupational therapy theory and the journal is the Scandinavian Journal of Occupational Therapy. The paper's central argument is that embodiment — the felt, sensory, bodily dimension of experience — is often neglected in OT clinical reasoning and that a 'body-up' approach (senses, movement, nature, animals) can support recovery in ways that 'head-down' talk-based approaches do not. For a practising OT, the practical takeaway is a descriptive model of how a client might experience recovery through multisensory, nature-based occupations: starting with low-demand, self-rewarding activities (resting by a brook, lying on a horse), gradually moving toward more concrete occupational tasks (farm work), with the client's own pace and choice central. The model is tentative and based on one site's 20 participants, so it should inform how you think about and frame sensory, nature-based options for clients with anxiety, depression or exhaustion disorder, not a protocol to adopt.

Qualitative design: the study produces themes and a tentative model, not evidence that the intervention causes recovery or outperforms other treatments. All 20 participants reported exclusively positive experiences; the authors acknowledge this may reflect relief and gratitude rather than a balanced account, and note it needs further exploration. The intervention bundled many components (horses, nature, farm work, mindfulness, staff support, group interaction, psychoeducation, cats and dogs), so the contribution of any single element cannot be separated. Interviews were conducted on site in the natural environment, which the authors note may have made participants more positive than they would have been elsewhere. The first author has extensive clinical and research experience in NBI and equine-assisted interventions, and the second author has conducted prior research at the same site with the same manager; both declare they were not involved in developing or delivering this specific programme. Single site, single country (Sweden), 20 participants from 48 who completed the programme; findings are a tentative model, not a generalisable effect. The analysis was performed after all interviews were conducted, rather than iteratively during data collection, which the authors note as a methodological consideration.

Funded by Ann Kern-Godal's Memorial Fund for Horse-Assisted Therapy and Lund University. The first author is a registered occupational therapist with several years of experience developing and providing NBI and equine-assisted activities in another region of Sweden. The second author has conducted research on previous nature-assisted rehabilitation interventions at the same site with the same manager. Both state they were not involved in developing or delivering the specific programme studied. The remaining three authors are researchers in mental health OT, personal recovery and sensory modulation with no personal connection to the programme.

Do not read the participants' uniformly positive accounts as evidence that this 24-week farm-based programme is effective for anxiety, depression or exhaustion disorder. This is a qualitative grounded theory study of 20 people's subjective experiences at a single site; it produced a descriptive model of how they experienced recovery, not a comparison with a control group or a measured outcome. The intervention bundled horses, nature, farm work, mindfulness, staff support and group interaction, so no single component can be credited. The authors themselves note that all participants reported only positive experiences and flag this as a limitation that needs further exploration.