The background

1. Green care – using the farm environment for rehabilitationCamilla IhlebækResearch group for Nature, health and quality of lifeNorwegian University of Life Sciences

2. The background • Change from diseases to illnesses • Lifestyle related diseases • Musculoskeletal pain • Psychological distress • High prevalence of sickness absence and disability pension • Increasing pressure on the health care system • Suffering and reduced quality of life

3. Voltaire, 1694-1778 • “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing”

4. The background • Need to develop complementary treatment and interventions • Focus on the patient’s possibilities, resources, and coping abilities

5. The background • The assumption of a beneficial effect of nature on health is not new • Ancient time: healing power of gardens • 1800: Sanatoriums and rehabilitation institutes built in scenic environment

6. The background • 1800 – Work an vocational training as therapy for psychiatric patients • 1980: Green care/care farming • 2001: ”Inn på tunet” • 2012: Approximately 1000 farms in Norway

7. Care farming (Social farming/green care farming): • the use of commercial farms and agricultural landscapes as a base for promoting human mental and physical health, social inclusion and educational benefits through normal farm activity (Sempik, 2008).

9. Therapeutic horticulture (TH): • “a process that uses plant-related activities through which participants strive to improve their well-being through active or passive involvement” • Animal-Assisted Interventions (AAI): • “any intervention that intentionally includes or incorporates animals as a part of a therapeutic or ameliorative process or milieu” • Vocational training and rehabilitation: • restoration and increased skills in order to return to work.

10. Gonzalez, Marianne T (2010) Therapeutic horticulture of clinical depression in a Green Care context: Prospective studies on mental health benefits, active components and existential issues. PhD thesis. Department of Plant and Environmental Science.Norwegian University of Life Sciences. • Main objective: To investigate the effect of TH on depression severity and perceived attentional capacity and rumination • Design: Single-group within subject design with multiple measurement points (N=46) • Participants: Adults (18-65) with major depressive disorder, dysthymia or depressiv phase of bipolar ll disorder with a Beck Depression Inventory (BDI) ≥15

11. Research settings

12. Findings • Significant beneficial changes for depression severity, anxiety, positive affects, perceived stress, perceived attentional functioning and rumination. • Being away and fascination mediated decline in both depression severity and perceived attentional capacity.

13. Berget, Bente (2006) Animal-assisted therapy: effects on persons with psychiatric disorders working with farm animals. PhD thesis. Department of Animal and Aquacultural Sciences. Norwegian University of Life Sciences. • Main objective: To investigate the effect of AAI on self-efficasy, quality of life, anxiety and depression. • Design: RCT (N=69) • Participants: Psychiatric patients (affective disorders, anxiety disorders, personality disorders, schizophrenia)

14. Findings • No effects at the end of the intervention • Moderat effects on self-efficacy and anxiety on the 6 month follow-up

15. Pedersen, Ingeborg (2011). Farm animal-assisted interventions in clinical depression. PhD thesis. Department of animal and aquacultural Sciences. Norwegian University of Life Sciences. • Main objective: To investigate the effect of AAI on depression. • Design: RCT (N=29) and qualitative interviews • Participants:Adults (18-65) with major depressive disorder and work status: Out of work, sick leave, rehabilitation, disability pension • Intervention: • Work and contact with dairy cattle • Twice a week for twelve weeks

16. Qualitative interview study 4 main topics or themes emerged from the text data: • 1. ORDINARY LIFE ” To feel useful; that you can be used for something”. ” They said that I helped them a lot, because when we were two persons milking we could share the work between us”. • 2. BEING SICK So we became very close. And I could always tell her if something were wrong or stupid or sad”. “If I have a bad day, so….the cows are there. It is always possible to get a little hug or …...just such small things”.

17. Conclusions qualitative interview study 4 main topics or themes emerged from the text data: • 3. FLEXIBILITY “It was very clear from the beginning that you do what you want, and manage and are able to. You don’t need to do anything else” . “You can still have a bad day when you are in contact with animals, because the cows don’t care if you are in a bad mood or if you haven’t put your make up on. So you knew you could go anyway”. • 4. COPING “It was the work tasks, to care for the calves alone, and manage, ………………all the time it was this experience of coping who builds up. It affects you”.

18. Pedersen I, Ihlebæk C, Kirkevold M. Important elements in farm animal-assisted interventions for persons with clinical depression: a qualitative interview study. Disabil Rehabil. 2012 Feb 11. [Epub ahead of print]

19. Findings RCT • A significant decline in depression and increase in self-efficacy in the intervention group at the farm, this was not seen in the control group • No significant differences were seen when the intervention group was compared with a waiting list control group

20. Dalskau, Lina (20??). PhD thesis. Department of animal and aquacultural Sciences.  Norwegian University of Life Sciences. • Main objective: • to systematically describe the content of Care farming for people out of work. • investigate the effect of Care farming on return to work. • Design: Cross-sectional survey to all farmers and participants in Norway. Follow-up with register data

21. Thanks to: • Bente Berget • Marianne T. Gonzalez • Ingeborg Pedersen • Lina Dalskau • The Norwegian Research Council