Mar 12, 2026
Version 2
Nature-based play therapy: A protocol for a scoping review V.2
- Gabriel Garcia Fabrini1,
- Nevin Harper1,
- Zahra Premji1,
- Jacqueline Swank2
- 1University of Victoria;
- 2University of Missouri
- Gabriel's workspace
Protocol Citation: Gabriel Garcia Fabrini, Nevin Harper, Zahra Premji, Jacqueline Swank 2026. Nature-based play therapy: A protocol for a scoping review. protocols.io https://dx.doi.org/10.17504/protocols.io.n2bvjew6bgk5/v2Version created by Gabriel GGF Garcia Fabrini
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: February 21, 2026
Last Modified: March 12, 2026
Protocol Integer ID: 243794
Keywords: play therapy intervention, outcomes of play therapy intervention, based play therapy intervention, centered play therapy intervention, play therapy, play therapy integrate, based play therapy integrate, based play therapy, reduced outdoor play, outdoor play, exposure to natural environment, youth mental health, including intervention, therapy approach, intervention design, natural environment, including nature, changes in children, daily activity, therapy, intervention feature, mental health, social development, nature, such as park, park, regarding child, objective of this scoping review, children, reviewed study, scoping review, child, natural setting
Abstract
Objective: The objective of this scoping review is to describe the scope of evidence on nature-based play therapy interventions. This review aims to examine the populations included, study designs, implementation characteristics, and reported outcomes of play therapy interventions delivered in outdoor or natural environments.
Introduction: Nature-based play therapy integrates play therapy approaches with outdoor or natural environments, such as parks, forests, and green spaces, to support children’s emotional, cognitive, and social development. Concerns regarding child and youth mental health have increased in recent decades, alongside changes in children’s daily activities, including increased screen time and reduced outdoor play. Evidence suggests that both play therapy and exposure to natural environments are associated with positive psychological outcomes; however, studies combining these approaches remain limited and heterogeneous. The existing literature varies in terminology, intervention design, settings, and outcomes, and has not yet been comprehensively synthesized.
Inclusion criteria: This review will use the Population, Concept, and Context (PCC) framework. The population will include children and adolescents aged 0 to 21 years, with studies involving other age groups considered where relevant to support discussion. The concept will include play therapy and child-centered play therapy interventions implemented in outdoor or natural settings, including nature-based play therapy and related approaches. The context will be broad, including interventions conducted in schools, clinics, or other settings, with no restrictions on country or setting.
Methods: This scoping review will follow the framework proposed by Arksey and O’Malley, with enhancements by Levac et al., and will be conducted in accordance with JBI guidance and PRISMA-ScR reporting standards. Searches will be conducted in APA PsycInfo, CINAHL, and ERIC (on EBSCOhost); MEDLINE (on Ovid); Global Index Medicus; SciELO (on Web of Science); and OpenAlex, using predefined keywords limited to titles and abstracts. Peer-reviewed studies published in English, Portuguese, and Spanish will be included, encompassing qualitative, quantitative, and mixed-methods designs. All eligible studies will be imported into Covidence and screened by two independent reviewers. Data will be extracted to summarize study characteristics, intervention features, and reported outcomes. Results will be synthesized using descriptive numerical analysis and narrative mapping to identify key patterns and gaps in the literature.
Troubleshooting
General Information
Authors: Harper N, Fabrini G, Premji Z, Swank J.
Background
Nature-based play therapy is an emerging therapeutic approach that integrates play therapy techniques with natural or outdoor environments such as forests, parks, and green spaces to support children’s emotional, cognitive, and social development. Play therapy has long been recognized as a developmentally appropriate intervention for children, using play as a medium through which they can express emotions, process experiences, and foster psychosocial growth (Koukorikos et al., 2023). When combined with exposure to natural environments, this approach is theorized to amplify therapeutic benefits by drawing on psychological and physiological effects of nature contact.
In recent decades, concerns about child and youth mental health have intensified. A report by Waddell and Shepherd indicated that approximately 15% of children and youth in British Columbia experience mental health disorders, including depression, anxiety, and attention-deficit/hyperactivity disorder, representing nearly 140,000 young people (as cited in Beames et al., 2025). Similar trends have been observed across Western societies, with rising prevalence rates over the past decade (McGorry et al., 2025). At the same time, children’s daily activities have shifted markedly, with increased screen time replacing outdoor play and face-to-face social interaction. Evidence suggests that children now spend less time outdoors per week than the amount of time they spend on screens each day, a pattern associated with negative psychological outcomes (Oswald et al., 2020).
A growing body of literature highlights the mental health benefits of exposure to natural environments. Studies have shown that time spent in nature is associated with reduced stress, improved mood, enhanced emotional regulation, and restoration of attentional capacity (Kaplan, 1995; Olafsdottir et al., 2018; Kotera et al., 2021). Nature-based interventions, including structured activities such as mindfulness and nature-connection practices, have also demonstrated extended health benefits across physical and psychological domains (Kelly et al., 2018; Nguyen et al., 2023). Nature therapy has been broadly defined as a set of practices aimed at promoting physiological relaxation and preventing disease through exposure to natural stimuli (Song et al., 2016).
Despite increasing interest in nature-based and outdoor interventions for children’s mental health (Sugiyama et al., 2023; Walker et al., 2024), the literature on interventions that combine play therapy with outdoor settings remains fragmented. Existing studies vary widely in terminology, intervention design, settings, and targeted outcomes, and are predominantly situated within school contexts. Moreover, there is limited synthesis regarding how these interventions are implemented, which populations are included, and what outcomes are reported. Given this heterogeneity and the emerging nature of the field, a scoping review would be useful to systematically map the extent, characteristics, and gaps in the existing evidence on nature-based play therapy interventions.
Research Question
What is the scope of evidence on nature-based play therapy interventions, including their population, designs, implementation, and reported outcomes?
Inclusion Criteria
To address the inclusion criteria, the Population, Concept and Context (PCC) approach will be used as recommended by the JBI group (Peters et al., 2024).
Population
The review will include study participants that have children and adolescents aged 0 to 21 years old. Insights on studies with different age groups might be included to enrich de discussion.
Concept
Studies that had play therapy as the main concept or as intervention for the population in outdoor settings will be included. Known approaches include nature-based play therapy, but studies that relate outdoor settings with play therapy will also be included.
Context
This review will include every approach that focuses on children and adolescents, meaning that the context is flexible and could include interventions implemented in or out of schools or clinics.
Method
Study design
This scoping review will follow the Arksey and O'Malley (2005) 5-step framework with the addition of Levac et al. (2010) enhancements.
Search strategy
The search strategy will consist of specific keywords in determined databases. The search will limit the keywords to titles and abstracts to filter studies that do not have nature-based play therapy as one of the main topics. The databases selected for this study include APA PsycInfo, CINAHL, and ERIC (on EBSCOhost); MEDLINE (on Ovid); Global Index Medicus; SciELO (on Web of Science); and OpenAlex. See Appendix A for the initial search strategy for APA Psycinfo.
Peer-reviewed studies published in English, Portuguese and Spanish will be included in the review. Articles' publish date will have no restriction. Qualitative, Quantitative and mixed studies will be included.
Additionally, during the screening process we might include studies that fit the criteria found in the references of the included articles.
Data extraction
All the found eligible studies will be imported to Covidence software and then screened by two independent researchers. Using the software’s tools, Data extraction will be performed by the same two researchers to provide key information from the studies.
Following Arksey & O'Malley (2005) framework for scoping reviews, this study will extract data about the study design, year of publication, type of therapeutic intervention (how researchers name the intervention and description of the environment where it was applied), characteristics and context of the population, country where study was conducted, aims of the study, methodology and main outcomes.
A data extraction template can be found in Appendix B.
Synthesis of results and reporting guidelines
Extracted results will be synthesized, analyzed, and reported through three steps: data analysis, reporting, and applying meaning to the results (Arksey & O’Malley, 2005). Reporting will adhere to PRISMA-ScR reporting guidelines (Page et al., 2021). To address this proposal's objective and contribute to the legitimacy of scoping study methodology, this study will include implications of the findings in the broader context, meaning that the Results section will present insights into how future researchers could better describe the implementation of the play-therapy into natural environments, and provide suggestions to how gaps could be addressed in future studies.
References
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Beames, S., Bentzen, M., Bratland-Sanda, S., Harper, N., & Richards, K. (2025). Nature-based programs and youth mental health: What do we know and what do we need to know? Journal of Outdoor Recreation, Education, and Leadership. https://doi.org/10.18666/jorel-2025-12627
Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15(3), 169–182. https://doi.org/10.1016/0272-4944(95)90001-2
Kelly, P., Williamson, C., Niven, A. G., Hunter, R., Mutrie, N., & Richards, J. (2018). Walking on sunshine: Scoping review of the evidence for walking and mental health. British Journal of Sports Medicine, 52, 800–806. https://doi.org/10.1136/bjsports-2017-098827
Kotera, Y., & Van Gordon, W. (2021). Effects of self-compassion training on work-related well-being: A systematic review. Frontiers in Psychology, 12, Article 630798. https://doi.org/10.3389/fpsyg.2021.630798
Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An overview of play therapy. Materia Socio-Medica, 33(4), 293–297. https://doi.org/10.5455/msm.2021.33.293-297
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, Article 69. https://doi.org/10.1186/1748-5908-5-69
McGorry, P., Gunasiri, H., Mei, C., Rice, S., & Gao, C. X. (2025). The youth mental health crisis: Analysis and solutions. Frontiers in Psychiatry, 15, Article 1517533. https://doi.org/10.3389/fpsyt.2024.1517533
Nguyen, P.-Y., Astell-Burt, T., Rahimi-Ardabili, H., & Feng, X. (2023). Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: A systematic review. The Lancet Planetary Health, 7, e313–e328. https://doi.org/10.1016/S2542-5196(23)00025-6
Ólafsdóttir, H. F., Bush, D., & Barry, C. (2018). The role of hippocampal replay in memory and planning. Current Biology, 28(1), R37–R50. https://doi.org/10.1016/j.cub.2017.10.073
Oswald, T. K., Rumbold, A. R., Kedzior, S. G. E., & Moore, V. M. (2020). Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review. PLOS ONE, 15(9), e0237725. https://doi.org/10.1371/journal.pone.0237725
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2024). Scoping reviews. In E. Aromataris, C. Lockwood, K. Porritt, B. Pilla, & Z. Jordan (Eds.), JBI manual for evidence synthesis. JBI. https://doi.org/10.46658/JBIMES-24-09
Song, C., Ikei, H., & Miyazaki, Y. (2016). Physiological effects of nature therapy: A review of the research in Japan. International Journal of Environmental Research and Public Health, 13(8), Article 781. https://doi.org/10.3390/ijerph13080781
Sugiyama, M., Tsuchiya, K. J., Okubo, Y., Rahman, M. S., Uchiyama, S., Harada, T., Iwabuchi, T., Okumura, A., Nakayasu, C., Amma, Y., Suzuki, H., Takahashi, N., Kinsella-Kammerer, B., Nomura, Y., Itoh, H., & Nishimura, T. (2023). Outdoor play as a mitigating factor in the association between screen time for young children and neurodevelopmental outcomes. JAMA Pediatrics, 177(3). https://doi.org/10.1001/jamapediatrics.2022.5356
Walker, K. L. A., & Ray, D. C. (2024). Outdoor child-centered play therapy: A pilot study on outcomes. International Journal of Play Therapy, 33(1), 52–63. https://doi.org/10.1037/pla0000213
Appendix A
APA Psycinfo search strategy
| # | Query | Results | |
| S1 | TI ("Outdoor Child-Centered Play Therapy: A Pilot Study on Outcomes" OR "Nature-based child-centered play therapy: An innovative counseling approach" OR "Initial Investigation of Nature-Based, Child-Centered Play Therapy: A Single-Case Design" OR "Indoor nature-based play therapy: Taking the natural world inside the playroom" OR "Nature-based child-centered group play therapy and behavioral concerns: A single-case design") | 6 | |
| S2 | DE "Play Therapy" | 4,973 | |
| S3 | (DE "Doll Play" OR DE "Pretend Play" OR DE "Educational Toys" OR DE "Games" OR DE "Children's Games" OR DE "Role Playing Games" OR DE "Childhood Play Behavior" OR DE "Gamification" OR DE "Toys") AND (DE "Psychotherapy" OR DE "Adlerian Psychotherapy" OR DE "Adolescent Psychotherapy" OR DE "Brief Psychotherapy" OR DE "Child Psychotherapy" OR DE "Client Centered Therapy" OR DE "Educational Therapy" OR DE "Emotion Focused Therapy" OR DE "Experiential Psychotherapy" OR DE "Expressive Psychotherapy" OR DE "Group Psychotherapy" OR DE "Individual Psychotherapy" OR DE "Integrative Psychotherapy" OR DE "Interpersonal Psychotherapy" OR DE "Psychoanalysis" OR DE "Psychotherapeutic Counseling" OR DE "Psychotherapeutic Techniques" OR DE "Supportive Psychotherapy" OR DE "Psychotherapeutic Processes") | 657 | |
| S4 | TI ( "sandplay*" OR "sandtray*" OR "theraplay" ) OR AB ( "sandplay*" OR "sandtray*" OR "theraplay") OR KW ( "sandplay*" OR "sandtray*" OR "theraplay" ) | 1,044 | |
| S5 | TI ( (("play" OR "playing" OR "playful" OR "playgroup*" OR "creative expression*" OR "Filial" OR "sand" OR "teret") N4 (therapy OR therapies OR therapeutic* OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*"))) OR AB ( (("play" OR "playing" OR "playful" OR "playgroup*" OR "creative expression*" OR "Filial" OR "sand" OR "teret") N4 (therapy OR therapies OR therapeutic* OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*"))) OR KW ((("play" OR "playing" OR "playful" OR "playgroup*" OR "creative expression*" OR "Filial" OR "sand" OR "teret") N4 (therapy OR therapies OR therapeutic* OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*"))) OR (SO "play therapy") | 8,788 | |
| S6 | TI ( (("play-based") N4 ("approach*" OR "intervention*" OR "program*" OR "technique*")) ) OR AB ( (("play-based") N4 ("approach*" OR "intervention*" OR "program*" OR "technique*")) ) OR KW ( (("play-based") N4 ("approach*" OR "intervention*" OR "program*" OR "technique*")) ) | 451 | |
| S7 | TI ( (("toy" or "toys" OR "game" OR "games" OR "puzzle*") N5 ("therapy" OR "therapies" OR "therapeutic*" OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*")) ) OR AB ( (("toy" or "toys" OR "game" OR "games" OR "puzzle*") N5 ("therapy" OR "therapies" OR "therapeutic*" OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*")) ) OR KW ( (("toy" or "toys" OR "game" OR "games" OR "puzzle*") N5 ("therapy" OR "therapies" OR "therapeutic*" OR "therapist*" OR "psychotherap*" OR "specialist*" OR "psychoanaly*" OR "counsel*")) ) | 1,339 | |
| S8 | S2 OR S3 OR S4 OR S5 OR S6 OR S7 | 11,719 | |
| S9 | DE "Nature (Environment)" OR DE "Environmental Effects" OR DE "Nature Connectedness" OR DE "Green Space" OR DE "Nature-Based Interventions" | 15,675 | |
| S10 | TI ( ("ecotherapy" OR "eco therapy" OR "forest" OR "forests" OR (("green" OR "blue") N2 (space* OR time)) OR nature OR (natural N2 (environment* OR material* OR world)) OR outdoor* OR (("play*" OR "time*" OR "being") N2 ("outside"))) OR "park" OR "parks" ) OR AB ( ("ecotherapy" OR "eco therapy" OR "forest" OR "forests" OR (("green" OR "blue") N2 (space* OR time)) OR nature OR (natural N2 (environment* OR material* OR world)) OR outdoor* OR (("play*" OR "time*" OR "being") N2 ("outside")) OR "park" OR "parks" )) OR KW ( ("ecotherapy" OR "eco therapy" OR "forest" OR "forests" OR (("green" OR "blue") N2 (space* OR time)) OR nature OR (natural N2 (environment* OR material* OR world)) OR outdoor* OR (("play*" OR "time*" OR "being") N2 ("outside")) OR "park" OR "parks" )) | 282,481 | |
| S11 | S9 OR S10 | 293,445 | |
| S12 | S8 AND S11 | 661 | |
| S13 | AG ("Childhood" OR "Preschool Age" OR "School Age" OR "Adolescence") | 968,057 | |
| S14 | TI ( ("child*" OR "infant*" OR "baby" OR "babies" OR "toddler*" OR school*" OR "preschool*" OR "teen*" OR "preteen*" OR "Tween*" OR "youth*" OR "adolescen*" OR "girl" OR "girls" OR "boy" OR "boys" OR "kid" OR "kids" OR "young adult*" OR "young person*" OR "young people*" OR "underage*" OR "minors") ) OR AB ( ("child*" OR "infant*" OR "baby" OR "babies" OR "toddler*" OR school*" OR "preschool*" OR "teen*" OR "preteen*" OR "Tween*" OR "youth*" OR "adolescen*" OR "girl" OR "girls" OR "boy" OR "boys" OR "kid" OR "kids" OR "young adult*" OR "young person*" OR "young people*" OR "underage*" OR "minors") ) OR KW ( ("child*" OR "infant*" OR "baby" OR "babies" OR "toddler*" OR school*" OR "preschool*" OR "teen*" OR "preteen*" OR "Tween*" OR "youth*" OR "adolescen*" OR "girl" OR "girls" OR "boy" OR "boys" OR "kid" OR "kids" OR "young adult*" OR "young person*" OR "young people*" OR "underage*" OR "minors") ) | 924,393 | |
| S15 | S13 OR S14 | 1,361,810 | |
| S16 | S12 AND S15 | 416 |
Appendix B
Data extraction template sample.PNG6KB