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    Combating Depression With Green Care Therapies
    By Caitlin Kight | May 5th 2012 02:55 PM | 6 comments | Print | E-mail | Track Comments
    About Caitlin

    I am a research scientist who dabbles in freelance writing and editing, birding, cooking, indoor gardening, needleworking, various athletics, music...

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    Depression is thought to affect approximately 3-4% of the global population each year, and while traditional therapies can improve the mental health of many people, others find that these offer no relief. Thus, researchers have long explored alternative or complementary treatments that might benefit these patients, but the efficacy of many such techniques has not yet been rigorously tested.

    One example of a promising but under-studied therapy is "green care" or "care farming," a type of intervention that uses "nature and the natural environment to improve or promote health and well-being." Participants in green care programs are offered the opportunity to spend time volunteering on farms, where they learn new skills, interact with other workers, and come into contact with farm animals. These sorts of experiences, which can improve mood and outlook by increasing self-efficacy and self-esteem, are known to be individually beneficial in the treatment of depression, and so may have a positive synergistic effect as well.


    (image courtesy of http://www.welcome-to-lancaster-county.com/)

    In the only previous randomized control study of a green care program, researchers found no immediate differences in the mental health of patients engaged in this "alternative" therapy and those given more traditional treatments. However, green pare participants did seem to be doing better at the six-month follow-up period, suggesting that further research on this therapy might yield interesting results. Improvements were particularly marked among individuals with affective disorders, indicating that green care might be especially beneficial for patients with depression.

    These findings inspired a team of Norwegian scientists to perform a new study examining the effects of a 12-week animal-assisted intervention on clinically depressed patients. The study ultimately included 27 individuals, 16 of whom participated in green care activities and the other 13 of whom received traditional therapy. People in the former group visited one of 11 participating dairy farms for 1.5-3 hours twice weekly over a 12-week period. Because interactions with animals are known to improve mental health, participants were directed towards activities associated directly with dairy cows; despite this constraint, each individual could decide the exact form that interactions would take--for instance, grooming, mucking, feeding, caring for calves, or milking. 


     (Cow grooming)

    Over the course of the intervention, the researchers distributed questionnaires aimed at assessing severity of depression (the Beck Depression Inventory, or BDI), anxiety (the State-Trait Anxiety Inventory-State Subscale, or STAISS), and self-efficacy (the Generalized Self-Efficacy Scale, or GSES). Participants filled out all questionnaires at recruitment, the beginning of the intervention period, and at a three-month follow-up; they also filled out the BDI and GSE at four and eight weeks into the therapy.

    Individuals in both groups experienced "positive developments in all assessments." However, similar to the previous green care study, the current work did not reveal any significant differences in mental health between the green care and traditional therapy groups, both during the intervention period and at the three-month follow-up. Interestingly, though, depression levels declined significantly between two time points (recruitment and the end of the intervention) in green care participants, and then remained steady thereafter; self-efficacy was also found to markedly improve over the study period. A similar intensity of change was not observed among control individuals. Further, the official criteria for clinical improvement were met in nine of the green care individuals, but only three of the control participants; likewise, while six green care patients returned to "normal" levels on a scale of clinical depression, this was only true for one control individual. Thus, the alternative therapy appeared to be slightly more beneficial, and aid a larger number of people.

    (Previous research has indicated that people can form bonds with farm animals as well as more "traditional" pets, and that these relationships can help alleviate depression.)


    The researchers hypothesize that one of the main benefits of the dairy farm experience is an increase in self-efficacy, facilitated by the opportunity to learn new skills and adapt to a new environment; this likely combated feelings of "diminished self-worth and self-esteem" typical of many people with clinical depression. The green care experience probably also reduced inactivity, withdrawal, and avoidance of others--three other common characteristics (or even causes) of depression. Additionally, as found previously in other studies, interactions with animals seemed to have a soothing effect; many participants reported feeling calmer when in the presence of cows.

    Although this study again failed to find any significant difference between traditional and green care treatments, the authors suggest that the latter are still worthy of our attention. The current results suggest that green care is capable of achieving, at worst, similar improvements to those derived from traditional treatments. Thus, the authors suggest that this therapy may be a suitable substitute for patients for whom traditional treatments are not feasible or desirable. However, the researchers also point out several shortcomings of their study: the sample size was fairly low and the treatment period relatively short; further, each participant could engage in a number of different farm activities rather than following one consistent farming routine. Thus, the authors encourage further work that includes additional study participants, examines the state of their mental health over a longer period of time, and standardizes their routines or even explores more "complex and challenging" work tasks. In addition to potentially validating the technique of green care, this sort of information might enable therapists to tailor treatments for people with different characteristics or interests.

    Note: This piece is intended to solely to summarize recent scientific work and should not be used as a substitute for mental health care from a certified doctor.

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    Pedersen, I., Martinsen, E.W., Berget, B., and Braastad, B.O. 2012. Farm animal-assisted intervention for people with clinical depression: a randomized controlled trial. Anthrozoos 25(2):149-160.

    Comments

    Ms. Kight draws a conclusion not supported by the data:

    ....this therapy may be a suitable substitute for patients for whom traditional treatments are not feasible or desirable.

    She got this part right: 'Although this study again failed to find any significant difference between traditional and green care treatments, the authors suggest that the latter are still worthy of additional attention. Their sample size was fairly low, and their treatment period relatively short;...'

    The treatment may be worthy of additional attention --> that is additional studies, using a more standardized approach, a large enough number of subjects to make the results meaningful, and a control group that includes something more appropriate as a placebo (maybe non-stressful walks in the countryside, without working with animals).

    To be truthful, there is no actual treatment worthy of the name presented or tested in the study, just the general idea that depressed patients may feel better if they went to the farm a couple of times a week, and maybe interacted with animals. The farm visitors didn't really get better more than the traditional treatment patients (whatever treatment that may have been).

    Psychologists have long known that a changed environment for even a few hours a week, to a non-stressful place, and volunteering to 'help' (almost anywhere and with anything) are valid prescriptions for depression. Further, most temporarily depressed patients tend to improve, with or without treatment, over 3 to 6 months.

    There is no science in this study, or any cited previous studies, which would support recommending this 'treatment approach' for actual patients.

    specialagentCK
    Just a quick note to emphasize that I am not drawing any of my own conclusions from this work, or advocating/critiquing it in any way; I am merely offering my interpretation of the authors' comments.

    At the beginning of the paper, they discuss a subset of patients for whom traditional therapies do not work--for instance because of lacking funds, insurmountable distances required to travel to a treatment facility, poor reaction to medication, etc. For individuals such as these--who would either not get treatment at all, or would end up terminating other treatments prematurely--they cautiously suggest, in their concluding remarks, that green care treatments may be a good alternative. In other words, something is probably better than nothing; however, they also emphasize that more research is needed to verify this. Similar logic applies to their suggestion about coupling green care with traditional therapeutic techniques, but, again, they indicate a need for future studies in this area.
    NSF Postdoctoral Researcher, University of Exeter--Tremough Campus, UK. Personal website: http://www.caitlinkight.com
    Dr. Kight,

    I might suggest more care with attribution of opinion in pieces like this. It was not clear to me at all that this was not 'your' opinion.

    I am afraid that recommending an untested (barely glanced at?), unproven, vague treatment -- whether by the original authors of the study or by yourself -- in a 'popular science' fora (in which laypersons are the intended audience) on the basis of 'something is probably better than nothing' is not supportable under any version of medical ethics. The results of failed treatment for depression (or the possible negative result of an untested unproven alternate therapy) is often suicide. A high price to pay.

    specialagentCK
    As you yourself stated, this is a popular science site where people can come to read about the latest research, not a medical site where readers expect to find advice from practicing doctors. Throughout the piece, I repeatedly and directly refer to the authors/researchers and the fact that "they suggest" or "state" certain things--a deliberate attempt to emphasize the fact that I am summarizing their work rather than interpreting or supporting it myself. It is important to note that neither I nor the authors recommended any treatment. As I stated in my concluding paragraph, they indicated that this technique may be suitable for a subset of patients and should be studied further; I then relayed this opinion.

    Although I am more than a little offended at the insinuation that my article is irresponsible and could lead to someone's suicide, I also think there is no harm in taking every potential precaution avoid such a tragedy. I have reworked the concluding paragraph to, hopefully, better stress the drawbacks of the study and highlight the fact that research on this topic is still very preliminary. I have also added a disclaimer at the bottom of the page indicating that this piece is by no means a substitute for professional help.

    NSF Postdoctoral Researcher, University of Exeter--Tremough Campus, UK. Personal website: http://www.caitlinkight.com
    Dr. Kight,

    Thank you for taking my concerns seriously and reworking the piece. The result is much much better. I am sorry if my comment seemed accusatory - it was only meant to highlight the responsibility of health journalists in getting their stories exactly right.

    I follow the issue of health journalism as a sub-set of science journalism. A common fault in health reporting is the failure of some health journalists to translate 'researcher-ese' to common everyday English. In this case, the researchers say they feel the treatment '*may*' be a suitable substitute treatment for some patients, they mean something quite different than if your doctor told you you 'may' want to try a different treatment. The researchers mean that there is a possibility that, after future conformational studies, it might turn out to be suitable. If you doctor said it, one might take it as permission, or even advice. Language has a huge contextual attribute. As a scientist yourself, you may have used the 'may' in the 'there is a possibility' sense but it could easily have been received by depressed persons desperate for options as permission or advice. This is the journalists job....to make this differentiation.

    University PR departments, which write press releases about medical studies, often fail at this and end up 'advising' instead of warning.

    I do like the way you have handled this now.

    Health News Review covers some of these issues on health journalism at http://www.healthnewsreview.org/ .

    Bonny Bonobo alias Brat
    Depression is thought to affect approximately 3-4% of the global population each year, and while traditional therapies can improve the mental health of many people, others find that these offer no relief....
    Although this study again failed to find any significant difference between traditional and green care treatments, the authors suggest that the latter are still worthy of our attention. The current results suggest that green care is capable of achieving, at worst, similar improvements to those derived from traditional treatments. 
    I'm afraid it all still sounds rather depressing to me for these people, as there is still nothing much to report here, hopefully these proposed future studies will be more useful.
    My article about researchers identifying a potential blue green algae cause & L-Serine treatment for Lou Gehrig's ALS, MND, Parkinsons & Alzheimers is at http://www.science20.com/forums/medicine