By Siang Yu Tham
Note: A Spanish version of this blog is available here.
Horticultural therapy is being increasingly offered as a psychosocial intervention designed to meet the needs of different population groups. Psychosocial interventions that address the needs of the whole person, a holistic approach, have been shown to provide unique benefits to both patients and their families. Studies have shown that they help to “normalize” the cancer treatment process, decrease the stigma of treatment, and help reduce the negative impact of the illness mainly on the people affected by cancer, but also on their family members and caregivers. Horticultural therapy is a treatment modality which not only addresses the different needs of participants, it respects individual preferences and choices, and offers a space to regain some “sense of control” which is lost during the treatment process.
Siang Yu Tham, MA, an instructor & research scholar in the Environmental Horticulture department at the University of Florida and program manager at Wilmot Botanical Gardens has been working with this population group and shares her experience in this article.
Siang Yu Tham received her Certificate in Horticultural Therapy from the University of Florida and is also a Certified Permaculture Designer. In 2019 she founded By Wind and Wave, a company in Singapore which conducts nature-based programs including guided walks and therapeutic horticulture programs.
Siang Yu shares with us in this blog her experience working with people affected by cancer.
Introduction and editing by Daniela Silva-Rodriguez Bonazzi
Therapeutic Horticulture at Wilmot Botanical Gardens
Since the Fall of 2016, Wilmot Botanical Gardens, situated at the University of Florida, has been conducting a therapeutic horticulture program for people affected by cancer. This includes individuals actively undergoing cancer treatment, individuals in remission, as well as their family members and caregivers. Once a week, participants meet to propagate and care for plants, and/or create plant-related art under the guidance of a program leader trained in horticultural therapy. The program takes place within a greenhouse, where tables and chairs are set up so that participants can work in a comfortable, temperature-controlled environment.
Horticulture for Cancer Patients
Cancer treatment has an impact not only on the physical health of patients, but diagnosis and treatment can also impact the emotional and psychological health of patients and their caregivers. According to Linden et al (2012), approximately 19% of cancer survivors showed symptoms of clinical anxiety and 12.9% were diagnosed with clinical symptoms of depression. A study by Johansen et al (2018) shows that cancer patients and their family caregivers may affect each other’s experiences of fatigue and depression. These are often contributed by low social support and self-efficacy. For example, some caregivers may display symptoms of depression, fatigue and caregiver burden as a result of the patient’s dependence on them for social support and other aspects of coping with the illness. On the other hand, patients who observe fatigue and depression in their caregivers may in turn worry about their caregiver, experience poor sleep and even guilt. Therefore, improving the emotional well-being of people affected by cancer is critical to their quality of life.
Therapeutic Considerations
Cancer and cancer treatment can affect the immune system of patients, leaving them with a higher risk of infection. For this reason, the therapeutic horticulture program took the following precautions to ensure a clean and pathogen free environment:
- Soilless potting mix: perlite, coco peat and bark
- LECA pebbles (expanded clay pebbles)
- Provided gloves
Additional precautions were taken during the COVID19 pandemic:
- Mandatory use of surgical masks.
- A 30-minute gap between the cancer group sessions and other visitors/participants sessions was put in place in the greenhouse.
- Seating in the greenhouse was arranged to maintain social distancing of 6 feet between participants.
- Volunteers and staff were kept to a small number to facilitate social distancing.
Program Goals
- Enhance sensory stimulation, cognitive and socialization function
- Reduce stress and anxiety
- Develop social support system
Therapeutic Benefits for Participants
Attending the greenhouse on a weekly basis offers family members and participants affected by cancer the following benefits:
- Maintain physical activity and agility
- Opportunity for attention restoration
- Time for personal self-care
- Develop autonomy and resilience by nurturing their plants
- Adopt plants which they can take home
- Acquire a new hobby which can be shared with family members
- Acquire horticultural techniques such as sowing seeds and propagation by cuttings, which boost their self-esteem and confidence.
- Social interaction and support system – e.g., through photo sharing of their plants.
The setting is ideal for participants to engage in conversation, asking for advice or recommendations about plants to other group members. Participants show a growing interest in horticulture, and are motivated to learn beyond what is taught during the therapeutic horticulture session.
- Relief (additional benefit for family members and caregivers aside from the above-mentioned benefits)
Caring for a family member with a medical condition can be physically and mentally exhausting. It can also require caregivers to take on responsibilities which they did not have previously.
Family members of participants who do not survive cancer not only adopt their love for plants but their plants, as a living memory of their loved one.
A Sense of Community
In Fall 2021, three mother-daughter pairs joined the cancer group. Their shared experiences and relationship quickly allowed a community to form where they were comfortable interacting with one another and sharing their lives. It was often the case that the mothers would be more interested in plants, but coming to the therapeutic horticulture program introduced their daughters to the joy of gardening and they now share a common interest. Some of them have even started or expanded their own gardens!
Apart from gaining a new hobby and being able to reduce stress and anxiety, the therapeutic horticulture program for the cancer group provided a support system for the participants. One of the participants commented that they enjoyed attending the therapeutic horticulture program because it was a group where they didn’t have to constantly explain themselves and their circumstances to people, because of their common lived experience. The community was also a place for them to share their struggles and successes.
For example, when J, one of the participants, experienced hair loss due to chemotherapy, another participant, B, shared photos from her own journey. It comforted J to know that she was not alone and the group was also in awe of how beautifully B’s hair had grown back. There was no need for patronizing or making comments like “Everything will be okay!”. Instead, the participants were able to empathize with one another and provide helpful words of encouragement.
Examples of Activities
| Horticultural activity | Horticulture + art |
| Growing flowers from seed | Fairy garden |
| Propagating herbs from stem cuttings | Kokedama |
| Vegetable gardening | Mounting a staghorn fern |
A popular activity among participants is propagation and transplanting. Also, growing plants using an hydroponic system where seedlings grow in LECA pebbles (expanded clay pebbles) instead of soil.
The use of soilless alternatives for plant growth lowers the risk of bacterial infections from exposure to soil.
During the COVID-19 pandemic, the program became even more important to the participants. Participants were seeking a safe space to meet and do something meaningful to spend time with friends without worrying about exposing themselves to risk as immunocompromised individuals.
References
- Gwenn G. Fried and Matthew J. Wichrowski, MSW, HTR (2008). Horticultural Therapy: A Psychosocial Treatment Option at the Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders. Primary Psychiatry. 2008;15(7):73-77
- Eva Katharina Masel et. al (2018). Vitamin “G”arden: a qualitative study exploring perception/s of horticultural therapy on a palliative care ward. Supportive Care in Cancer (2018) 26:1799–1805.
- Johansen, S., Cvancarova, M. & Ruland, C. (2018). The Effect of Cancer Patients’ and Their Family Caregivers’ Physical and Emotional Symptoms on Caregiver Burden. Cancer Nursing, 41 (2), 91-99. doi: 10.1097/NCC.0000000000000493.
- Linden, W., Vodermaier, A., MacKenzie, R., & Greig, D. (2012). Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. Journal of Affective Disorders, 141(2–3), 343–351. doi: 10.1016/j.jad.2012.03.025
