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December 12, 2024

Combining Cognitive Behavioral Therapy and Farm-Based Therapy for Schizophrenia Treatment

By Kelly M. DiTurno, MSSA, MNO, LSW

Schizophrenia is a complex mental health disorder characterized by symptoms including delusions, hallucinations, cognitive impairments, and emotional dysregulation. Traditional treatments primarily focus on medication, but integrating therapies such as Cognitive Behavioral Therapy (CBT) and Farm-Based Therapy (FBT) can offer a more holistic approach to treatment. The great task of Hopewell (and farm-based programs like it) is to continue to explore and refine how these two therapies can be used in tandem to aid individuals with thought disorders.

Cognitive Behavioral Therapy (CBT)

• Cognitive Behavioral Therapy is a structured, short-term psychotherapy that aims to change negative thought patterns and behaviors associated with mental health disorders. For individuals with thought disorders like Schizophrenia and Schizoaffective Disorder, Hopewell clinical staff practice the tenants of CBT toward several targeted ends:
• Reality Testing: CBT assists patients in distinguishing between reality and their delusions or hallucinations. Therapists work with individuals to challenge distorted thinking and replace it with more rational thoughts.
• Coping Strategies: The therapy equips individuals with tools to manage symptoms and stressors. Skills developed can include mindfulness, problem-solving, and relaxation techniques.
• Social Skills Training: CBT can improve interpersonal relationships by enhancing communication skills and reducing social anxiety.
• Relapse Prevention: By identifying triggers and developing coping strategies, CBT can help prevent relapses, promoting long-term stability.

Farm-Based Therapy (FBT)

Farm-Based Therapy, also known as horticultural therapy, involves therapeutic activities conducted in a farm or garden setting. The benefits of FBT for individuals with schizophrenia include:

• Connection to Nature: Engaging with nature can have calming effects, reduce anxiety and promote emotional well-being. The sensory experiences in a farm environment can help ground individuals and provide a sense of peace.
• Physical Activity: Farming activities often involve physical labor, which has been shown to boost mood and improve overall health. Exercise releases endorphins that can mitigate symptoms of depression and anxiety.
• Routine and Structure: Farming provides a daily routine, which can be beneficial for individuals with schizophrenia. Having a structured schedule can help create a sense of normalcy and predictability.
• Social Interaction: FBT often involves group work, fostering socialization and teamwork, which can combat isolation—a common issue for those with schizophrenia.
• Skill Development: Engaging in farm-based tasks can enhance cognitive functioning and self-esteem through the acquisition of new skills and responsibilities.

Integrating CBT and FBT

Integrating CBT and FBT creates a comprehensive, dynamic and personalized treatment plan for each resident that addresses and provides adaptive support for both psychological and environmental factors affecting individuals with thought disorders. Some examples of how these two evidence-based models therapies can be applied to maximize benefit to the resident-in-community are often observed as follows:

• Skill Application: Coping strategies learned in CBT can be applied in the farm setting. For instance, mindfulness techniques can be practiced while engaging in gardening, helping individuals stay present and manage anxiety.
• Reinforcing Reality Testing: Farm activities can provide opportunities for individuals to practice reality testing in a safe, supportive environment. For example, if a patient experiences hallucinations while working on a task, therapists can help them process these experiences immediately afterward.
• Building Social Skills: Group-based FBT can complement the social skills training aspect of CBT. As individuals interact with peers in a non-threatening environment, they can practice and reinforce social skills learned during CBT sessions.
• Emotional Regulation: Both therapies can focus on emotional regulation. While CBT provides strategies to manage emotions, the calming effects of nature in FBT can enhance emotional stability, creating a synergistic effect.
• Goal Setting: CBT emphasizes setting and achieving personal goals. In a farm context, individuals can set goals related to their farming tasks, allowing them to experience success and build confidence, which can improve their overall mental health.
• Holistic Wellness: Combining physical activity in FBT with the cognitive strategies of CBT promotes overall wellness. Mind-body approaches can lead to improved mental health outcomes, including reduced symptoms of schizophrenia.

Practical Implementation

To effectively combine CBT and FBT, treatment programs like Hopewell utilize a specific set of clinical, administrative systems:Multidisciplinary Team: Involve professionals from various fields, including psychiatrists, psychologists, occupational therapists, and farm managers, to create a supportive environment that addresses diverse needs.

• Multidisciplinary Team: Involve professionals from various fields, including psychiatrists, psychologists, occupational therapists, and farm managers, to create a supportive environment that addresses diverse needs.
• Individualized Plans: Each individual with schizophrenia has unique experiences and needs. Tailoring the combination of CBT and FBT to fit these needs is essential for effective treatment.
• Regular Monitoring: Continuous assessment of symptoms and progress through both therapies can help in adjusting the treatment plan as necessary. This ensures that the individual is receiving the most beneficial support.
• Education and Training: Educating both the healthcare providers and the individuals involved in therapy about the benefits and techniques of both CBT and FBT can enhance engagement and outcomes.
• Community Involvement: Involving families and community members in the therapy process can provide additional social support and reduce stigma, fostering an inclusive environment for recovery.

The combination of Cognitive Behavioral Therapy and Farm-Based Therapy in the Hopewell model presents a promising approach to treating individuals with schizophrenia. By addressing the cognitive, emotional, and environmental dimensions of the disorder, this integrated approach can enhance the overall effectiveness of treatment, improve quality of life, and promote recovery. Through careful implementation and personalizing the therapeutic process, healthcare providers can offer comprehensive support to individuals on their journey toward mental wellness.