HT in the Medical Setting and Beyond: Living the Good Life · 2018-10-18 · HT in the Medical...
Transcript of HT in the Medical Setting and Beyond: Living the Good Life · 2018-10-18 · HT in the Medical...
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
Rusk Rehabilitation
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
2
Rusk Rehabilitation
Our Relationship with Nature
• Psycho-Evolutionary
• Cognitive Restoration
• Learning
3
Rusk Rehabilitation
Psycho-Evolutionary/Biophilia• Shelter
• Water
• Food
• Verdant Green
• Flowers/Color
• Sunlight
• Animals
• Open space
• Views/Vistas
• Diversity
• Aesthetics
4
Rusk Rehabilitation
The Restorative Effect• Feeling Away
• Compatibility
• Fascination
• Extent
• (Kaplan & Kaplan 1989)
Rusk Rehabilitation
Learning: The Effects of Learning onNature Appreciation
• Sensory
• Aesthetics
• Utilitarian
• Early Experiences
Rusk Rehabilitation
Components of Horticultural Therapy
Therapeutic use of self
Environment
HT
Activity
7
Rusk Rehabilitation
How it is Done-HT Practice at Rusk
• Group work
• rehabilitation
• psychiatric
• Bedside horticulture
• rehabilitation
• neurology/epilepsy
8
Rusk Rehabilitation
Physical Goals
• Activity tolerance
• Endurance
• Strength
• ROM
• Fine Motor Skills
9
Rusk Rehabilitation
Cognitive Domain
• Cognitive restoration
• Sequencing
• Memory
• Exercise problem solving and decision
making
• Frame situations positively
• Dispute irrational thoughts
• Re-definition of the self
Rusk Rehabilitation
Emotional Domain • Lower stress
• Improved mood
• Let patient contribute knowledge and
expertise
• Impact on self image/self concept/self
confidence
• Distract from pain
Rusk Rehabilitation
Emotional Benefits Cont.
• Challenge but don’t frustrate
• Provide just enough help
• Flow activities
• Allow patients to tell their tale
• Use humor when appropriate
Rusk Rehabilitation
Social Domain
• Therapeutic aspects of group
work(Yalom 1995)
• Cohesiveness
• Social support
• Instillation of hope
• Universality
• Socialization skills
• Altruism
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
Adaptations for Success• Grade activities
• Provide assistance
• Challenge but don’t frustrate
• Energy conservation
• Adaptive techniques
• Adaptive tools
17
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
Therapeutic Use of self
• Focus on the patient
• Listen to their story
• Empathize
• Connect
• Understand
• Reflect
• Now…You can help
20
Rusk Rehabilitation
Common Themes in Rehabilitation
• Therapeutic exercise
• Empowerment
• Redefining the self
• Social opportunity and competency
• Stress reduction
• Feeling good about ones
accomplishments
Rusk Rehabilitation
Needs Throughout the Lifespan• Infant/Toddler
• Child
• Adolescent
• Young Adult
• Middle Age Adult
• Geriatric
22
Rusk Rehabilitation
Exploring Concepts
Psychosocial Adjustment
Resiliency
Positive Psychology
Rusk Rehabilitation
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
Rusk Rehabilitation
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)
Rusk Rehabilitation
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)
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
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
Rusk Rehabilitation
The Health Continuum
Rehabilitation Health Wellness
Rusk Rehabilitation
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
Rusk Rehabilitation
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
33
Rusk Rehabilitation
Healthy Lifestyle
• Exercise
• Diet
• Stress reduction
• Sleep
• Social support
• Lifelong learning
• Forest bathing
• Biophillic design
• Meditations
• Community garden
• Teach your children
34
Rusk Rehabilitation
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
35
Rusk Rehabilitation
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
Rusk Rehabilitation
Cultivating Meaning
37
• 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
Rusk Rehabilitation
Cultivating Meaning in the Garden
• Forest bathing
• Mindfulness exercises
• Personal Meaning- treasures and conditioning
• Plant Knowledge
• Ethnobotany
• Connect with The Web of Life
38
Rusk Rehabilitation
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
Rusk Rehabilitation
And It All Can Be Done In The Garden
40
Rusk Rehabilitation
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.
Rusk Rehabilitation
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.
42
Rusk Rehabilitation
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.
43
Rusk Rehabilitation
Thank You!44