Horticultural therapy (HT)?

What on earth is that?

Don’t worry, it was new to me too and I first thought of the treatment of plants.

HT is said to be a “time-proven practice. The therapeutic benefits of garden environments have been documented since ancient times. In the 19th century, Dr. Benjamin Rush, a signer of the Declaration of Independence and recognized as the “Father of American Psychiatry,” was first to document the positive effect working in the garden had on individuals with mental illness. In the 1940s and 1950s, rehabilitative care of hospitalized war veterans significantly expanded acceptance of the practice. No longer limited to treating mental illness, horticultural therapy practice gained in credibility and was embraced for a much wider range of diagnoses and therapeutic options. Today, horticultural therapy is accepted as a beneficial and effective therapeutic modality. It is widely used within a broad range of rehabilitative, vocational, and community settings. Horticultural therapy techniques are employed to assist participants to learn new skills or regain those that are lost. Horticultural therapy helps improve memory, cognitive abilities, task initiation, language skills, and socialization. In physical rehabilitation, horticultural therapy can help strengthen muscles and improve coordination, balance, and endurance. In vocational horticultural therapy settings, people learn to work independently, problem solve, and follow directions. Horticultural therapists are professionals with specific education, training, and credentials in the use of horticulture for therapy and rehabilitation. Read the formal definition of the role of horticultural therapists.”

As always, the question is DOES IT WORK?

This systematic review and meta-analysis aimed to evaluate HT for general health in older adults. Electronic databases as well as grey literature databases, and clinical trials registers were searched from inception to March 2021. Randomized controlled trials (RCTs), quasi-RCTs (QRCTs), and cohort studies about HT for adults aged over 60 were included in this review. Outcome measures were physical function, quality of life, BMI, mood tested by self-reported questionnaire and the expression of the immune cells.

Fifteen studies (thirteen RCTs and two cohort studies) involving 1046 older participants were included. Meta-analysis showed that HT resulted in better quality of life (MD 2.09, 95% CI [1.33, 2.85], P<0. 01) and physical function (SMD 0.82, 95% [0.36, 1.29], P<0.01) compared with no-gardener; the similar findings showed in BMI (SMD -0.30, 95% [-0.57, -0.04], P = 0.02) and mood tested by self-reported questionnaire (SMD 2.80, 95% CI [1.82, 3.79], P<0. 01). And HT might be beneficial for blood pressure and immunity, while all the evidence was moderate-quality judged by GRADE.

The authors concluded that HT may improve physical function and quality of life in older adults, reduce BMI and enhance positive mood. A suitable duration of HT may be between 60 to 120 minutes per week lasting 1.5 to 12 months. However, it remains unclear as to what constitutes an optimal recommendation.

I have considerable problems with this review and its conclusion:

  • It is simply untrue that there were 13 RCTs; several of these studies were clearly not randomized.
  • Most of the studies are of very poor quality. For instance, they often did not make the slightest attempt to control for non-specific effects, yet they concluded that the observed outcome was a specific effect of HT.

My biggest problem does, however, not relate to methodological issues. My main issue with this paper is one of definition. What is a ‘therapy’ and what not? If we call a bit of gardening a ‘therapy’ are we not descending to the level of those who call a bit of shopping ‘retail therapy’? To put it differently, is HT superior to retail therapy? And do we need RCTs to answer this question?

What is wrong with encouraging people who like gardening to just do it? I, for instance, like drumming; but I do not believe we need a few RCTs to prove that it is healthy. Not every past-time or hobby that makes you feel good is a therapy and needs to be scrutinized as such.



11 Responses to Horticultural therapy: What is it? Does it work? And is it better than ‘retail therapy’?

  • I suppose this suggests that the reduction of utterly everything by medicalization is proceeding admirably!

  • I find gardening highly enjoyable and even therapeutic. I can watch it for hours on end.

  • Having a job where preparing statisitcal calculations is a large part, I know about the needs of doing statistics correctly. However, for some things I do not see a need for extensive statistics at all – as the discussed matter has strong dependencies everybody can detect in his own life and where rational connections between practice and the effect of it is clear.

    Regarding garden works I see its need in the fullfillment of people in terms of their need for being connected to nature, having some physical exercise and expecially for retired people: having a content in life that gives structure and prepares some structure in time (within a day but also within a year (seasonality)).

    Being a biologist, I am glad that I have a part of my work in the field. However, I also needs my photography to keep relatedness to nature as a source of joy in my life and strong connection to reality, truth and life in general. No virtual experience could replace it.

    Here is a paper about the need of connection to nature:

    Being a scientist, you may look at the impact and quality of the journal:

    Looks very close to “nothing”. However, they offer statistics and they are peer-reviewed. To me, this is a nice paper with a valuable content.

    The message I got from the paper you discuss and also from the paper I linked give a hint on: Do not forget to spend time in nature! It may not become the main reason why you stay healthy – but it could be a strong help to reach this target.

    • Whilst I agree whole-heartedly with Dr Ernst, I take delight in your approach as well. But wouldn’t it be better to write an essay on the joys of gardening or nature in general, instead of trying to torture statistics until they scream “uncle”?

  • It is reported that writer and critic Dorothy Parker, playing some word game that required her to make a sentence with “horticulture”, came up with “You can take a horticulture but you can’t make her think”……

  • In the context of useless attempts to change sexual orientation, I have seen USA psychologists who write books on “reparative therapy” (or similarly named) refer to reading their books as “Bibliotherapy”….

  • “The therapeutic benefits of garden environments have been documented since ancient times.”

    Japanese Zen and bonsai, for example.

    Mr. Miyagi teaches Daniel about bonsai trees: “Think only tree.”
    — The Karate Kid

    Now, where are the RCTs on Watching paint dry therapy?

  • “What is wrong with encouraging people who like gardening to just do it? I, for instance, like drumming; but I do not believe we need a few RCTs to prove that it is healthy. Not every past-time or hobby that makes you feel good is a therapy and needs to be scrutinized as such.”

    I agree.

    As someone who likes to keep my eye on novel developments in the field of mental health and psychotherapies I have noticed that many ordinary leisure activities have become “therapised”.

    Some examples include;

    Going for walks in nature becomes “nature therapy” or “forest bathing”.

    Horse riding becomes “equine therapy”.

    Singing in a group or choir becomes “voicework” or “vocal therapy”

    Improvised dancing becomes “movement therapy” or even “movement medicine”.

    Scratch the surface of the providers and controversial new religious movements (what many call “cults”) are usually involved. Appropriated / perverted symbols and ceremonies of oppressed tribal peoples are often involved, I suspect that this is in an attempt to convey an impression of authenticity and “ancient wisdom” to the gullible. To anyone familiar with these kinds of businesses these appropriated elements are huge red flags.

    The important question is why is this happening?

    Obviously there are multiple layers of businesses providing training in these various therapies. I use the word “layers’ because there are complex and confusing network connections between the people running the courses and their customers. People who run traning courses in eco-therapy, nature therapy, equine therapy, movement therapy etc. tend to attend each others courses.

    Many of these “therapists” and “healers” boast an astonishing array of qualifications in everything from Tachyon healing, Theta healing, sound healing, shamanic breathwork and the like in addiction to their novel therapy “qualifications”.

    Also there is a MLM element to the training courses. People who train as nature therapists usually go on to run their own training courses. The networks spread like a virus.

    The insurance company Balens provides insurance to many of these practitioners of novel therapies.

    An interview with David Balens can be viewed here if anyone is interested

  • a link of possible interest listing some of the therapies Balens covers

    Bach and Flower Remedies
    Craniosacral Therapy
    Crystal Healing
    Crystal Therapy
    Dry Needling
    Emotional Freedom Technique
    Herbal Medicine
    Hopi Ear Candles
    Indian Head Massage
    Kinesio taping
    Manual Lymphatic Drainage
    Music Therapy
    Reiki Master
    Spiritual Healing
    Traditional Chinese Medicine

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