Motivation and emotion/Book/2020/Horticultural therapy and psychosocial well-being

Overview


Horticultural therapy is a type of nature-based therapy:
 * Horticultural Therapy (HT) involves a trained therapist that helps clients (e.g., patients with PTSD or dementia) to achieve specific health goals using gardening-based activities and can be done one-on-one, within a group, indoors or outdoors.
 * Therapeutic Horticulture (TH) involves plants and gardening activities to help improve physical, psychological and spiritual well-being for all types of people in any location by active (e.g. weeding, flower arranging) or passive (e.g., viewing, listening to birds) means.
 * Both HT and TH are commonly used interchangeably along with "garden-based interventions", as horticultural therapy uses therapeutic horticulture/garden activities.

This chapter reviews both HT and TH activities for psychosocial well-being, in addition to general health benefits of gardening and nature.

How can horticultural therapy contribute to psychosocial well-being?

"it’s helped tremendously, just getting me out of myself and, mixing with other people, because apart from that, I don’t socialise at all. I don’t have any friends and these are the only people that I mix with” 

- Client reflection on horticultural therapy at Thrive, UK (Sempik, Alridge, & Becker, 2005)

What is the problem?

 * Urbanisation is projected to be 10 billion by 2050 (Roser, Ritchie, Ortiz-Ospina, 2013) with 70% of worlds population living in dense cities (Soga, Cox, Yamaura, Gaston, Kurisu, Hanaki, 2017). As we have just felt the beginnings of environmental and public health crisis such as the recent wildfires in the Amazon, California and Australia and global pandemic of COVID-19, the risk of further isolation is perpetuated by diseases exacerbated by climate change (Nabhan, Orlando, Monti, Aronson, 2020; Varanasi, 2020).
 * Nature is essential to the livelihood and survival of humankind. People have the power to reciprocate the healing to the earth and themselves (Nabhan et al., 2020); to conserve, restore and educate on more sustainable methods and promoting social cohesion (Varanasi, 2020). Activities such as gardening positively benefit physical and psychosocial well-being (Kasser 2009).

Did you know? Gardening was a popular pastime after the 20th century world wars caused food shortages and economic recession. Recently gardening has had a come back with COVID-19.

People (who have access to) have been embracing nature by gardening to help relax and enjoy their time through the state of emergency and lockdown. Plant sales soared at Bunnings, old hobbies renewed, kids learnt how to grow food and flowers, and public interest sparked in volunteering for environmental organisations (e.g. Greening Australia).



Evolutionary basis
From an evolutionary perspective, humans have an innate tendency to gravitate to the natural world - plants, animals, landscapes and bodies of water. Termed 'biophilia’ by Wilson (1984), a biologist crossing over to psychological theory, humans are not compatible to the biopsychosocial demands of modern lifestyles and when isolated from interacting with nature and each other, our physical and mental health deteriorates (Nabhan et al., 2020; Varanasi, 2020).

Historically, ancient civilisations would engage in horticulture (e.g., see Hanging Gardens of Babylon); from 2000BC in Mesopotamia gardens would be source of sustenance and sensory engagement, monastery gardens were designed to grow medicine and provide tranquil resting places for the unwell (Scott, 2017).

Over time, people have become increasingly disconnected from nature and many now spend most of their time indoors (Clatworthy, Hinds, & Camic, 2013). This overload of directed attentional capacity, requires nature to restore fatigue (Clatworthy, Hinds, & Camic, 2013). The restorative effects of nature in gardens (Scott, 2017) helps to facilitate intrinsic motivation (Deci & Ryan, 2000) and meet basic psychological needs of autonomy, competence and relatedness (Landon et al., 2020).

This might be from nature’s ability to reinvigorate human’s evolutionary predisposition to natural stimuli and physiologically induce relaxation by activating the parasympathetic nervous system (Clatworthy, Hinds, & Camic, 2013). The sense of ‘fascination’ and ‘being away’ (Kaplan, 1995), helps promote feelings of purpose and connectedness to something larger (Clatworthy, Hinds, & Camic, 2013).



Urban areas
Highly populated places have less nature, biodiversity and green spaces which are associated with higher psychosocial stress, depression, anxiety, crime, isolation, and poor physical health (Soga et al., 2017). Higher amounts of biodiversity in green spaces is associated with increased psychological well-being (Fuller et al., 2007). Cities have less chances for people to interact with each other in public green spaces, such as parks and gardens, the lack of social interaction decreases quality of life (Soga et al., 2017). Cities also have a “heat island effect” which occurs with urban development and commercialisation of green spaces reduces opportunities for people to interact with and engage with natures health benefits (Soga et al., 2017).

Learning how to be self-sufficient and grow own food can help with people’s need for safety and food security, potentially preventing conflict over resources such as clean water and food (Kasser, 2009). Increased plant and bird species can help improve mental health of urban dwellers by reconnecting people with nature, attachment to greenspaces, and restoring attentional fatigue (Fuller et al., 2007). With a growing population to feed, global warming rising and non-communicable diseases increasing, turning space into urban allotment sites and community gardens can help counteract and prevent the physical and mental health challenges that follow (Soga et al., 2017). Psychological well-being can be improved by incorporating sustainable urban allotments within cities (Kasser, 2009).

Therapeutic gardens


The garden can provide a safe environment that encourages a sense of belonging, a space to form meaningful connections to others and reconnect with nature (Diamant & Waterhouse, 2010). Therapeutic gardens can be designed to include aromatic plants, provide space for green exercise, attract bees, butterflies and birds (Scott, 2017). This can help reduce stress, anxiety and depression and improve memory (Scott, 2017).

Wander gardens can be designed for dementia patients in long term residential care facilities to have equal access to the psychological benefits of gardens, with nontoxic plants, sensory stimulation, enclosed and looping garden paths to explore to ensure safety (Scott, 2017). The garden can help build autonomy by choice of activity, methods of gardening (e.g. digging with tools, picking flowers) and whether to go to private or communal spaces for solitude or discussion (Diamant & Waterhouse, 2010). Gardens can also help dementia patients by triggering nostalgic memories of childhood gardens by the sight and smell of plants and to be a tranquil place to interact with others and family (Scott, 2017). This can foster social inclusiveness, develop social skills, restore attention by a sense of ‘fascination’ and ‘being away’ (Kaplan, 1995) which improves quality of life (Diamant & Waterhouse, 2010).



Mental health
Nature helps to foster agency, autonomy, and intrinsic motivation by engaging in physical and mental challenges (Landon et al., 2020). Studies have found HT improves psychosocial, emotional, cognitive and physical health (Scott, 2017). A study by Soga et al. (2017) found the main motivations from older adults to garden at allotment sites were to have a mental break, socialise, grow veggies to eat, be in nature and exercise.

A study done by Diamant and Waterhouse (2010) at Thrive gardens in the UK, over 8 weeks showed engaging in social therapeutic horticulture improved psychosocial well-being. A study done by Clatworthy, Hinds & Camic (2013) also at Thrive gardens, showed improvements in psychosocial well-being. HT offered marginalised people of all ages, abilities, backgrounds and mental health conditions a chance to build self-efficacy and feel a sense of belonging (Diamant & Waterhouse, 2010). Clatworthy, Hinds & Camic (2013) found reductions in anxiety, depression, and improved attentional capacity, social skills and networks.

In addition, Soga et al. (2017) found that gardeners at urban allotment sites generally had overall better health, improved attention, reduced stress and more social connections. Horticultural therapy for older adults can be a cost-effective intervention to improve quality of life (Scott 2017).

This adds to the evidence that garden-based interventions can be a holistic healthcare treatment, provides opportunities for people of various backgrounds to engage in meaningful activities and social interactions (Clatworthy, Hinds & Camic, 2013). HT is also useful for long term care facilities for providing an effective and feasible intervention on site (Scott 2017).

Case study

•	Survivors of the Tohoku earthquake disaster in Japan were still living with PTSD many years after the event.

•	Following the earthquake, horticulture therapy was used as an intervention for medium to long term rehabilitation.

•	Women and those with poorer social support systems, were identified to have increased vulnerability to PTSD symptoms.

•	Horticultural therapy was originally developed as a form of psychological rehabilitation for post-war veterans with PTSD in the 1940s.

•	HT was formed on the basis that exposure to nature helps to improve psychological, social, physical and cognitive health.

•	Post traumatic growth for the group improved after the horticultural therapy treatment.

•	This was measured by salivary cortisol levels showing reduced stress levels which remained lowered even a few months after the intervention.

•	Implications of this is to use horticultural therapy to provide support and build community resilience after natural disasters.

(Kotozaki, 2014)

Spiritual metaphors

Gardens can be used as symbolic metaphors for life transitions (seasons), sex (propagation) and death (lifecycle) to help one understand psychological processes (Clatworthy, Hinds & Camic, 2013). Concepts from plants can be used as metaphors to help people understand difficult concepts in life such as change, death and rebirth (Clatworthy, Hinds & Camic, 2013).



Physical health

 * Social and therapeutic horticulture can improve sleep (Clatworthy, Hinds & Camic, 2013; Scott, 2017) by exposure to fresh air, sunlight and exercise to help regulate circadian rhythms (Scott, 2017). Physical activity in gardens is considered ‘green exercise’ and gardening effects on BMI are culture dependent (Soga et al., 2017). Allotment gardens can increase nature engagement for people who live in apartments and an opportunity for to improve their health (Soga et al., 2017).
 * Viewing nature and being in a garden provides attentional restoration and relaxation, reduces cortisol, improves mood and gives time for ‘top down’ cognitive processing to restore attentional capacity (Scott, 2017). Participation in community gardening is linked with increased fruit and vegetable intake, nutritional knowledge, and less chronic diseases in older adults (Soga et al., 2017).
 * In addition, gardens designed for dementia patients can help reduce dependence on drugs for agitation and reduce perception of pain (Scott, 2017). HT can be adjusted to meet the abilities of the individual (Scott, 2017) and can also foster spiritual connection by a fascination with nature (Clatworthy, Hinds & Camic, 2013).

Case study

•	A Korean study on the neurobiological effects of gardening, found that after 12 weeks x 20 min of moderate intensity gardening activities (i.e. digging, raking, planting, transplanting, weeding, watering and harvesting) improved memory, cognition and brain nerve growth in older adults.

•	They measured BDNF (brain derived neurotropic factor) and PDGF (platelet derived growth factor) in older adults.

•	BDNF is a protein that was found to improve memory by neural cell growth and survival in the hippocampus and cortex.

•	PDGF also promoted neural survival and increased brain nerve cell blood vessel growth.

•	Exercise can induce neuroplasticity and increase the anterior hippocampal size which is associated with improved memory and reduction in disorientation for dementia patients.

•	This short-term gardening intervention helped to increase BDNF and PDGF.

•	Implications of this study can investigate the long-term neuroplasticity effects of gardening-based interventions in the lives of dementia patients.

(Park, Lee, Park, & Lee, 2019)

Self-determination theory
In order to flourish, humans need to feel safe, worthy, connected to others, and free to choose their own behaviours (Kasser, 2009). The self-determination theory (Deci & Ryan, 2000) is a framework to understand how natural places can promote well-being by meeting basic psychological need satisfaction (Landon et al., 2020). When people act out of own interest and values (oppose to external pressure and control), people show more persistence and increased well-being from free will (Kasser, 2009). Autonomous choice and self-determination helps to facilitate fascination in nature (Diamant & Waterhouse, 2010). Whilst nature itself already provides opportunities to be spontaneous, curious, and explore challenges with no external pressure or rewards (Landon et al., 2020); the need to express autonomy when interacting with nature can be achieved by finding a gardening activities fun, interesting, and reflective of own values (Kasser, 2009). Expression of agentic behaviour in the garden offers freedom to choose one’s own behaviour and feel a sense of independence (Landon et al., 2020), particularly if a loss of independence is from declined health.

Intrinsic goal pursuit is more rewarding for personal growth, the formation of meaningful relationships and to achieve a sense of belonging (Kasser, 2009). The identification with nature into the self, can become symbolic of this connection, and can hold meaning to all humans, not just indigenous communities (Landon et al., 2020). The “ecological self” facilitates the role of spirituality in nature connectedness which leads to positive well-being (Kamitsis & Francis, 2013). An environmental identity can help explain how a part of one’s concept of self-identity is embedded with nature and facilitates an individual’s sense of belonging to the natural world (Landon et al., 2020). This interconnectedness with nature embedded into the formation of one’s self-concept, can contribute to feelings of eudaimonic well-being (Kamitsis & Francis, 2013). Consequently, this human-nature relationship provides a sense of purpose and meaning in life (Kamitsis & Francis, 2013) and strong intrinsic values increase greater need satisfaction, which again leads to greater happiness (Kasser, 2009).

Intrinsic motivation emerges from the fulfilment of meeting psychological needs for autonomy, competence and relatedness (Landon et al., 2020). A way for the need for competence can be satiated is from learning how to be self-sufficient from gardening activities such as; how to grow food from seeds, composting, building a flower bed, harvesting and cooking with own organic fruits, herbs and vegetables from a home garden (Kasser, 2009). Nature helps to foster connection and communication in a safe space for people to face their personal difficulties. (Clatworthy, Hinds & Camic, 2013). The need for relatedness can be met in community gardens where people can build friendships, feel socially included and gain a sense of belonging to others (Kasser, 2009). In addition, social relationships help to facilitate intrinsic motivation (Landon et al., 2020). The self-determination theory and identification of nature into the “self”, can help identify why people want natural areas to be protected and why people enjoy engaging in horticultural activities (Landon et al., 2020).

Conclusion

 * Social therapeutic horticulture meets our basic psychological needs for autonomy, competence and relatedness.
 * Community gardens offer opportunities to build social connections.
 * Horticultural therapy improves psychological and physical health for all people.
 * Horticultural therapies are a gardening-based intervention which can facilitate reciprocal healing for humans and the environment.
 * Gardening activities can be done indoors or outdoors, in small or large spaces, alone or with others, and promotes psychosocial well-being.
 * Being in nature is just as important as nutrition and exercise is for health.
 * Nature connectedness is mediated by spirituality which leads to eudaimonic well-being.

Take home message: To flourish, reconnect with your biophilic roots and allow nature to foster your basic psychological needs.