DISSERTATION GIVING LANGUAGE TO HORTICULTURAL THERAPY: FRAMING HORTICULTURAL THERAPY THROUGH THE LENS OF EMPIRICALLY SUPPORTED THERAPIES Submitted by Jaime M. Ascencio Department of Psychology In partial fulfillment of the requirements for the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Summer 2020 Doctoral Committee: Advisors: Kathryn Rickard Co-Advisor: Mark Prince Dan Graham Audrey Shillington Copyright by Jaime M. Ascencio 2020 All Rights Reserved ABSTRACT GIVING LANGUAGE TO HORTICULTURAL THERAPY: FRAMING HORTICULTURAL THERAPY THROUGH THE LENS OF EMPIRICALLY SUPPORTED THERAPIES Horticultural therapy, a plant-based intervention for reaching client goals, is an under-researched yet promising treatment modality for psychiatric disorders. This study aimed to forge a connection between empirically supported therapies (ESTs) and horticultural therapy’s interventions by describing how EST methods were used in horticultural therapy. A horticultural therapy proof-of-concept study incorporated behavioral, positive, and humanistic ESTs with youth with disabilities and at-risk youth. The largest positive impacts of the intervention were on clients’ prevocational skills, social skills, and gardening skills. No change was detected on measures of mindfulness, resilience, nature relatedness, or strengths use. The impact on depression yielded mixed results, and a small worsening was seen in the self-report of anxiety, strengths use, and emotion regulation. This study demonstrated that horticultural therapy utilizes components of a variety of ESTs and its impact can be quantitatively evaluated. ii TABLE OF CONTENTS ABSTRACT .................................................................................................................................... II INTRODUCTION .......................................................................................................................... 1 EMPIRICALLY SUPPORTED THERAPIES ................................................................... 1 HORTICULTURAL THERAPY........................................................................................ 3 ECOPSYCHOLOGY .......................................................................................................... 6 QUALITY OF CONTACT AND RELATIONSHIP WITH NATURE IS DECLINING. .............................................................................................. 6 HUMANS HAVE A DEEP, RECIPROCAL BOND WITH NATURE. ... 7 SOCIAL SYSTEMS CONTRIBUTING TO NATURE DECLINE MUST BE EXAMINED AND ALTERED. ........................................................... 8 SOCIAL JUSTICE AND SUSTAINABILITY ARE ESSENTIAL COMMITMENTS....................................................................................... 9 CONTACT WITH NATURE CONTRIBUTES TO HUMAN WELL- BEING. ..................................................................................................... 10 PHYSICAL BENEFITS. .......................................................................... 10 PSYCHOLOGICAL BENEFITS.............................................................. 11 SOCIAL BENEFITS. ............................................................................... 11 SPIRITUAL BENEFITS. ......................................................................... 12 THEORETICAL BASIS OF NATURE’S IMPACT ON HUMAN PSYCHOLOGICAL FUNCTIONING ............................................................................................................... 13 THE BIOPHILIA HYPOTHESIS. ........................................................... 13 ATTENTION RESTORATION THEORY. ............................................. 14 STRESS RECOVERY THEORY............................................................. 15 RESEARCHING ECOPSYCHOLOGY ........................................................................... 15 THE CALL TO RESEARCH HORTICULTURAL THERAPY ..................................... 16 THE NEED TO FURTHER INVESTIGATE HORTICULTURAL THERAPY AS A MENTAL HEALTH INTERVENTION .......................................................................... 18 HOLISTIC BENEFITS. ............................................................................ 18 CROSS-CULTURAL APPLICATIONS. ................................................. 19 ACTIVITY-BASED BENEFITS.............................................................. 20 INCORPORATION OF NATURAL ELEMENTS. ................................. 21 EMPIRICALLY SUPPORTED THERAPY COMPONENTS. ............... 22 USING PSYCHOLOGY’S EMPIRICAL BASE TO INFORM HORTICULTURAL THERAPY PRACTICES.................................................................................................. 22 THE THERAPEUTIC RELATIONSHIP IN HORTICULTURAL THERAPY. ............................................................................................... 23 THE THERAPIST. ................................................................................... 24 THE THERAPEUTIC RELATIONSHIP IN NATURE. ......................... 25 iii NATURE AS A THERAPEUTIC RELATIONSHIP. ............................. 26 FACTORS IMPACTING CLIENT CHANGE. ....................................... 26 EMPIRICALLY SUPPORTED COMPONENTS. ................................... 27 METHOD ..................................................................................................................................... 35 HYPOTHESIS AND AIM ................................................................................................ 35 PROCEDURE ................................................................................................................... 37 INTERVENTION. .................................................................................... 38 THE REVISED CHILDREN’S ANXIETY AND DEPRESSION SCALE- PARENT-SHORT VERSION (RCADS-P-SHORT VERSION) ............. 42 EMOTION REGULATION QUESTIONNAIRE FOR CHILDREN AND ADOLESCENTS ...................................................................................... 44 CHILD AND ADOLESCENT MINDFULNESS MEASURE (CAMM) 45 NATURE RELATEDNESS SCALE, SHORT VERSION (NR-6) .......... 45 PREVOCATIONAL AND SOCIAL SKILLS CHECKLIST .................. 46 STRENGTHS USE AND CURRENT KNOWLEDGE SCALE ............. 47 THE BRIEF RESILIENCE SCALE (BRS) .............................................. 47 YOUTH GARDENING PROGRAM PERFORMANCE ASSESSMENT ................................................................................................................... 49 YOUTH GARDENING PROGRAM STUDENT GARDENER EVALUATION......................................................................................... 49 DATA ANALYSIS ........................................................................................................... 49 RESULTS ..................................................................................................................................... 52 RESULTS BY MEASURE............................................................................................... 52 THE REVISED CHILDREN’S ANXIETY AND DEPRESSION SCALE- PARENT-SHORT VERSION (RCADS-P-SHORT). .............................. 53 THE REVISED CHILDREN’S ANXIETY AND DEPRESSION SCALE- CHILD-SHORT VERSION (RCADS-C-SHORT). ................................. 53 STRENGTHS USE AND CURRENT KNOWLEDGE SCALE. ............ 54 EMOTION REGULATION QUESTIONNAIRE FOR CHILDREN AND ADOLESCENTS. ..................................................................................... 54 CHILD AND ADOLESCENT MINDFULNESS MEASURE (CAMM). 55 THE BRIEF RESILIENCE SCALE (BRS). ............................................. 55 YOUTH GARDENING PROGRAM PERFORMANCE ASSESSMENT. ................................................................................................................... 55 NATURE RELATEDNESS SCALE, SHORT VERSION (NR-6). ......... 55 PREVOCATIONAL SKILLS CHECKLIST. .......................................... 55 SOCIAL SKILLS CHECKLIST............................................................... 55 ESTS APPLIED ................................................................................................................ 56 “CLOVER.” .............................................................................................. 67 SOCIAL SKILL: SPEAKING VOLUME. .................................. 67 “JODIE.” ................................................................................................... 68 STEREOTYPED BEHAVIOR. .................................................... 68 BODY AWARENESS. ................................................................. 69 iv “WALTER.” ............................................................................................. 70 PROSOCIAL BEHAVIORS. ....................................................... 70 FEEDBACK ORIENTATION. .................................................... 71 “AL.” ......................................................................................................... 71 LEADERSHIP. ............................................................................. 72 “MICHAEL.” ............................................................................................ 72 NEED TO BELONG. ................................................................... 73 IMPULSIVITY. ............................................................................ 73 KATIE....................................................................................................... 74 WANDERING. ............................................................................. 74 DISCUSSION 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