HT in the Medical Setting and Beyond: Living the Good Life

Matthew j. Wichrowski MSW HTR

Sr. Horticultural Therapist

Clinical Assistant Professor

Rusk Rehabilitation

NYU Langone Hospital Center

Editor -In-Chief Journal of Therapeutic Horticulture

Rusk Rehabilitation

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Overview

• Relationship with nature

• Horticultural therapy model

• Clinical domains and goals

• Common themes in rehabilitation

• Theories which inform HT practice

• Health and wellness for patients and

ourselves

• Healthy ageing

• Living the good life

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Our Relationship with Nature

• Psycho-Evolutionary

• Cognitive Restoration

• Learning

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Psycho-Evolutionary/Biophilia• Shelter

• Water

• Food

• Verdant Green

• Flowers/Color

• Sunlight

• Animals

• Open space

• Views/Vistas

• Diversity

• Aesthetics

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The Restorative Effect• Feeling Away

• Compatibility

• Fascination

• Extent

• (Kaplan & Kaplan 1989)

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Learning: The Effects of Learning onNature Appreciation

• Sensory

• Aesthetics

• Utilitarian

• Early Experiences

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Components of Horticultural Therapy

Therapeutic use of self

Environment

HT

Activity

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How it is Done-HT Practice at Rusk

• Group work

• rehabilitation

• psychiatric

• Bedside horticulture

• rehabilitation

• neurology/epilepsy

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Physical Goals

• Activity tolerance

• Endurance

• Strength

• ROM

• Fine Motor Skills

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Cognitive Domain

• Cognitive restoration

• Sequencing

• Memory

• Exercise problem solving and decision

making

• Frame situations positively

• Dispute irrational thoughts

• Re-definition of the self

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Emotional Domain • Lower stress

• Improved mood

• Let patient contribute knowledge and

expertise

• Impact on self image/self concept/self

confidence

• Distract from pain

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Emotional Benefits Cont.

• Challenge but don’t frustrate

• Provide just enough help

• Flow activities

• Allow patients to tell their tale

• Use humor when appropriate

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Social Domain

• Therapeutic aspects of group

work(Yalom 1995)

• Cohesiveness

• Social support

• Instillation of hope

• Universality

• Socialization skills

• Altruism

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More about Social Support• Opportunity to Socialize

• Social Skills

• Social Support

• Normalization

• Buffers chronic stress and other health

indicators

• Increases immune function

• Helps re-define the self

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Some Thoughts on Goals

• Personally important, personally committed

• Congruent with values

• Self-determined and pursued for intrinsic

reasons

• Clear, specific, sub-goals

• Environment and resources support goals

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What Makes a Good Activity?Prescribed Exercise

• Meets the therapeutic needs of the patient

• Multi-step, gradable, and adaptable for diff.

levels

• Familiar and comfortable or unique and exotic

• Interesting subject with relevant information

• Sensory involvement

• Challenging yet attainable for age and ability

• Offers opportunities for socialization

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Adaptations for Success• Grade activities

• Provide assistance

• Challenge but don’t frustrate

• Energy conservation

• Adaptive techniques

• Adaptive tools

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Environmental Medicine

• Create a Therapeutic Environment

• Applied Biophilia and Restorative Effect

• Sensory interest (appeal to all the senses)

• Have something of interest throughout the

year

• Cultural significance

• Quiet space and group space

• Wildlife or pets

• Ease of culture

• Ease of propagation

• Screen view or noise

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Therapist Mediated Benefits• Modelling

• Understand accommodation dynamics

• Warmth, non-judgemental acceptance, and listening skills

• Realistic and optimistic outlook (look at the bright side)

• Benefit finding

• Be here now

• Acceptable, graduated, recovery goals

• Point out progress however slight

• Point out positive qualities

• Be supportive

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Therapeutic Use of self

• Focus on the patient

• Listen to their story

• Empathize

• Connect

• Understand

• Reflect

• Now…You can help

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Common Themes in Rehabilitation

• Therapeutic exercise

• Empowerment

• Redefining the self

• Social opportunity and competency

• Stress reduction

• Feeling good about ones

accomplishments

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Needs Throughout the Lifespan• Infant/Toddler

• Child

• Adolescent

• Young Adult

• Middle Age Adult

• Geriatric

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Exploring Concepts

Psychosocial Adjustment

Resiliency

Positive Psychology

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Psychosocial Adjustment

• Def.-Adaptive adjustment during the

course of the lifespan, especially after

significant changes in functional ability

• Biopsychosocial

• Biopsychosocialspiritual

• Premorbid personality

• Developmental level

• Symbolic meaning of the loss

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Resiliency

• Qualities that allow the individual to flourish in

the face of adversity (Driver & Warren 2008)

• Process of constructive human growth and

development emerging from successful

adaptability and healthy coping skills. It is

one’s ability to overcome stressors, misfortune

or unforeseen circumstances (Thompkins &

Schwartz 2009)

• Internal force that drives each individual to

seek wisdom, self-actualization, altruism, and

inner peace (Richardson 2002)

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Resiliency Includes• Includes psychological and dispositional

attributes

• Personal competence- Ind. Belief in ability,

accomplishments, determination, and realistic

perspective

• Social competence- Ability in social

situations, communication skills, and social

adaptability

• Personal structure-Ability to plan and

organize daily activities

• The skills associated with resiliency are

ordinary in nature, not heroic or superhuman

• The skills are modifiable and can be learned

• Therefore, resiliency is not a trait that

someone either has or doesn’t, but involves

behaviors, thoughts, and actions that can be

developed by almost anyone

(APA Help Center 2006)

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Treatment Recommendations Promoting Resilience

• A person is much more than a diagnosis

• Explore assets and abilities to

encourage growth

• Its not what you can’t do…its what you

can

• Help develop a sense of purpose

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What it is Techniques

Positive Psychology

• Positive psychology explores factors

that make life worth living and the

human strengths that enable individuals

to confront challenges, appreciate

others, and regard daily experiences as

meaningful (Dunn & Dougherty 2005)

• Counterbalances disease model

approach

• Focus is on what one can do, not what

one can’t

• Cultivating the “Good Life”

• Finding meaning

• Benefit finding

• Altruism

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Being Positive

• Positive mood may be elevated through

physical, social, and mental activities

that encourage an outward focus and

active engagement in one’s environment

(Watson 2002).

• Encourage optimism

• Cultivate realistic hope

• Appreciate beauty

• Flow activities

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Positive Adjustment Outcomes

• Better return to pre-morbid function

• Greater independence

• Rehabilitation outcomes enhanced

• Greater resistance for future events

• Positive adaptation

• Higher quality of life

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The Health Continuum

Rehabilitation Health Wellness

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Health and Wellness• Medical definition-return to neutral

(homeostasis)

• World Health Organization-a state of complete

physical, mental, and social well-being

• High level wellness-flourishing, self-actualization

• The “good life” promoting those qualities that

contribute to a satisfying, fulfilling, and well-lived

existence including positive connections to

others, positive personal qualities, and life

regulation qualities

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Healthy AgeingKeeping those Telomeres Long and Strong• Physical Activity

• Low incidence of disease

• High physical function

• High cognitive function

• Active Engagement in Life

• Healthy Eating

• Managing Stress

• Stay in Control

• Meaningfulness

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Healthy Lifestyle

• Exercise

• Diet

• Stress reduction

• Sleep

• Social support

• Lifelong learning

• Forest bathing

• Biophillic design

• Meditations

• Community garden

• Teach your children

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Biophillic Design

• Biophilic Design for Yard, Home and

Office

• Views of nature- cultivate vistas in and out

• Houseplants

• Aquariums/Pets

• Nature Walks

• Natural Shapes and Forms

• Small doses of nature during day

• Add meaning, practice mindfulness and

condition health promoting response

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Spiritual Domain

• Be open minded

• Validate other’s beliefs

• Cycles of life

• Creativity

• Point out wonders of nature and the web

of life

• Stewardship

• Ecopsychology

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Cultivating Meaning

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• Representation of relationship among

things, events, and relationships

• Making sense of one’s experiences

• Understanding and integration

• Developing purpose and direction

Results include:

• Higher psychological well-being

• Lower levels of depression

• Increased quality of life

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Cultivating Meaning in the Garden

• Forest bathing

• Mindfulness exercises

• Personal Meaning- treasures and conditioning

• Plant Knowledge

• Ethnobotany

• Connect with The Web of Life

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Living The Good Life

• Hedonic

• Eudemonic

• Making connections

• Developing positive traits

• Life regulation properties

• Purposeful acts for self and others

• Recognizing beauty

• Acquiring knowledge

• Enjoying friendship

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And It All Can Be Done In The Garden

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References• Aspinwall, L.G. & Tedeschi, R.G. (2010). The value of positive psychology for health psychology. Annals of

Behavior Medicine 39, 4-15.

• Berman, M.G., J. Jonides & S. Kaplan. 2008. The cognitive benefits of interacting with nature. Psychological Science.

19, 1207–1212.

• Bonanno, G.A. (2004). Loss, trauma, and human resilience. American Psychologist 59, 20-28.

• Bratman, G.N., Hamilton, P, Hahn, K.S., Daily, G.C. & Gross, C. (2015). Nature experience reduces rumination and

subgenual prefrontal cortex activation. Proceedings of National Academy of Sciences,

www.pnas.org/cgi/doi/10.1073/pnas.1510459112.

• Dunn, D.S. & Brody, C. (2008). Defining the good life following acquired disability. Rehabilitation Psychology 53, 413-

425.

• Eliot, T.R. (2002). Determining our common ground to reach new horizons. Rehabilitation Psychology 47, 131-143.

• Gonzalez, M.T., Hartig, T., Patil, G.G., Martinsen, E.W. and Kirkevold, M. (2011a), “A prospective study of

existential issues in therapeutic horticulture for clinical depression”, Issues in Mental Health Nursing, Vol. 32

No. 1, pp. 73-81.

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References• Kaplan, S, & Kaplan, R. (1989). The experience of nature. New York: Cambridge University Press.

• Kellert, S., Heerwagen, J. & Mador, M. (2008). Biophilic Design; Theory, and Practice of Bringing Buildings to Life.

Hoboken, New Jersey: John Wiley & Sons.

• Kellert, S. & Wilson, E.O. (1994) Biophilia hypothesis. Washington, DC: Island Press.

• Lent, R.W. (2004). Toward a unifying theoretical and practical perspective on well-being and psychosocial adjustment.

Journal of Counseling Psychology 51, 482-509.

• Lopez, S & Snyder, C.R. (2009). Oxford Handbook of Positive Psychology. New York: Oxford University Press.

• Magyar-Moe, J.L. (2009). Therapist’s Guide to Positive Psychological Interventions. New York: Elsevier.

• Quale, A.J. & Schanke, A.K. (2010). Resilience in the face of coping with a severe disability: a study of trajectories of

adjustment in a rehabilitative setting. Rehabilitation Psychology, 55, 12-22.

• Saleebey, D. (2002). The Strengths Perspective in Social Work Practice. Allyn & Bacon: Boston.

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References Continued• Seligman, M. & Czikszentmihaly, M.(2000) Positive psychology: An introduction. American Psychologist , 60, 410-421.

• Sin, N.L. & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive

psychology interventions; a practice friendly meta-analysis. Journal of Clinical Psychology, 65, 467-487.

• Wells, N.M. & G.W. Evans. (2003). Nearby nature.: A buffer of life stress among rural children. Environment and

Behavior, 35(3),311–330.

• White, B., Driver, S., & Warren, A. (2008). Considering resilience in the rehabilitation of people with traumatic

disabilities. Rehabilitation Psychology, 53, 9-17.

• Wichrowski, M., Whiteson, J.,Haas,F., Mola, A., & Rey, M. (2005). The effects of horticultural therapy on mood

• and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation. Journal of Cardiopulmonary

• Rehabilitation ,25, 270-274.

• Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Harper Collins.

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Thank You!44