Nature-based therapy in the UAE: leveraging ecosystems to alleviate depression and anxiety

Abstract

This review synthesizes current evidence on the relationship between natural ecosystems and mental health outcomes with a particular focus on arid and rapidly urbanizing contexts such as the United Arab Emirates (UAE). It introduces the Multi-Ecosystem Therapeutic Framework for Arid Urban Environments, which moves beyond generalized "nature exposure" models by systematically linking distinct environmental systems to mental health outcomes through identifiable psychological, physiological and social mechanisms. The framework is structured around three interconnected components: ecosystem types (urban green spaces, desert landscapes, mountain environments and blue spaces), mediating mechanisms (including psychological restoration, stress reduction, physical activity and social interaction) and mental health outcomes (such as reduced anxiety and depression and improved cognitive and emotional functioning). Unlike previous reviews that primarily synthesize evidence from temperate environments, this review integrates global evidence within the distinctive environmental, socio-cultural and policy context of the UAE, providing a context-specific framework for implementing nature-based mental health strategies in arid urban settings. Evidence from the literature is qualitatively stratified into strong, moderate and emerging levels of support, enabling differentiation between well-established and developing associations. Findings indicate that the mental health benefits of natural ecosystems are both outcome-specific and context-dependent. Coastal and mangrove-associated blue spaces demonstrate strong and consistent evidence for stress reduction and emotional restoration, while urban green spaces show robust support for population-level psychological well-being and social cohesion. Mountain environments exhibit moderate but growing evidence for cognitive restoration, whereas desert ecosystems remain comparatively underexplored, with emerging evidence suggesting culturally and environmentally mediated therapeutic benefits. Overall, the synthesis demonstrates that no single ecosystem is universally superior; rather, therapeutic effectiveness depends on environmental context and the targeted mental health outcome. In the UAE, urban green infrastructure and coastal blue spaces currently represent the most consistently supported and scalable interventions, while desert and mountain environments constitute complementary but underutilized therapeutic resources. The proposed framework provides an integrative and operational foundation to guide future research, inform evidence-based environmental health policies, and support the design of nature-based mental health interventions across the UAE and other arid regions.