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Therapeutic Environments—Existential Challenges and Healing Places

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 88941

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Special Issue Editors

Prof. Dr. Kirsten Kaya Roessler

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Guest Editor

Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
Interests: environmental psychology; health psychology; responding relationships; interventions; physical activity as treatment

Prof. Dr. Brady Wagoner

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Guest Editor

Department of Communication and Psychology, Aalborg University, 9220 Aalborg Ø, Denmark
Interests: cultural psychology; memory studies; social change; developmental processes; visual methods

Dr. Sofie Pedersen

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Guest Editor

Department of People and Technology, Roskilde University, 4000 Roskilde, Denmark
Interests: ecological psychology; developmental dynamics; social-psychiatry; youth development; social work

Dr. Mads Bank

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Guest Editor

Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
Interests: social work; counselling; drug-treatment,; medicine; general practice; affect

Special Issue Information

Dear colleagues,

Architecture and nature can support human health and well-being, as well as provide places for reflection and the creation of memories. In this way, environments are intimately entwined with our psychological processes. When people find themselves in difficult or challenging life situations, or are confronted with life changing events such as war, illness, or grief, they often start looking for places to help express and contain their emotions. One cultural way of dealing with existential challenges is physical movement, e.g. through pilgrimage or other forms of long-distance walks; another way is to seek out places of emotional or historical importance, such as memorials, churches or monasteries, or places designed for therapeutic, spiritual or physical transformation. Feeling secure and sheltered are crucial factors that support individual healing, transformation and well-being. People’s use of certain spaces in existentially challenging times is a common tendency, albeit often not integrated in our understanding of the processes of healing, psychological development, or transformation. This opens an array of questions concerning the meaning of spaces and places in relation to healing and health, along with questions of how spaces can be purposefully designed to support existential healing, and/or healthy and sustainable transformations on a psychological level.

The aim of this Special Issue is to identify environmental elements of importance when faced with existentially and culturally challenging life situations. We invite researchers from different fields (e.g., architects, psychology, health science, sociology) to explore the connection between culture, health and the surrounding environment.

Prof. Dr. Kirsten Kaya Roessler
Prof. Dr. Brady Wagoner
Dr. Sofie Pedersen
Dr. Mads Bank
Guest Editors

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Keywords

Healing environments
Public health
Existential challenges
Emotions
Space and place
Transformative processes

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Published Papers (11 papers)

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Research

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19 pages, 2915 KiB

Open AccessArticle

Memorials as Healing Places: A Matrix for Bridging Material Design and Visitor Experience

by Brady Wagoner and Ignacio Brescó

Int. J. Environ. Res. Public Health 2022, 19(11), 6711; https://doi.org/10.3390/ijerph19116711 - 31 May 2022

Cited by 6 | Viewed by 3674

Abstract

Memorials are increasingly used to encourage people to reflect on the past and work through both individual and collective wounds. While much has been written on the history, architectural forms and controversies surrounding memorials, surprisingly little has been done to explore how visitors experience and appropriate them. This paper aims to analyze how different material aspects of memorial design help to create engaging experiences for visitors. It outlines a matrix of ten interconnected dimensions for comparison: (1) use of the vertical and horizontal axis, (2) figurative and abstract representation, (3) spatial immersion and separation, (4) mobility, (5) multisensory qualities, (6) reflective surfaces, (7) names, (8) place of burial, (9) accommodating ritual, and (10) location and surroundings. With this outline, the paper hopes to provide social scientists and practitioners (e.g., architects, planners, curators, facilitators, guides) with a set of key points for reflection on existing and future memorials and possibilities for enhancing visitor engagement with them. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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26 pages, 12208 KiB

Open AccessArticle

Enabling Spaces; Rethinking Materiality and the Invitational Character of Institutional Environments

by Emma Nielsen and Sofie Pedersen

Int. J. Environ. Res. Public Health 2022, 19(9), 5577; https://doi.org/10.3390/ijerph19095577 - 4 May 2022

Cited by 2 | Viewed by 2092

Abstract

This article explores how physical surroundings may be integrated as a supportive measure in social work efforts. Drawing on ecological psychology and the concept of liminality, the article presents a case study of Kofoed’s School (KS), a social institution in Copenhagen, Denmark. In recent years, KS has undergone a major renovation, opening up previously sheltered workshops to the public. By creating liminal spaces of possibility, where students can take up “both/and” positions allowing for a multitude of ways to participate, students are experiencing increased support and inclusion, which contributes to a growing feeling of citizenship and well-being. Drawing on participant observations and interviews with students, staff members, as well as customers at the school’s shops, we explore how the architectural layout may facilitate students’ flexible and fluid movements between more or less sheltered positions and further discuss how this flexibility may become supportive for their personal development and well-being. We propose to think of such spaces of possibility as enabling spaces, where inclusive architecture contributes to the creation of new possibilities for participation for people in marginalized life positions. This, we suggest, holds a great potential for social work efforts for people experiencing complex social vulnerability. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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11 pages, 313 KiB

Open AccessArticle

Therapeutic Environments in Drug Treatment: From Stigmatising Spaces to Enabling Places. A Theory-Based Qualitative Analysis

by Mads Bank and Kirsten K. Roessler

Int. J. Environ. Res. Public Health 2022, 19(9), 5005; https://doi.org/10.3390/ijerph19095005 - 20 Apr 2022

Cited by 4 | Viewed by 1898

Abstract

Investigating therapeutic environments for young drug users is needed to avoid a high dropout rate due to a potential stigmatising effect of the structure of the space. In this article, we draw from three semi-structured interviews with young drug users. The interviews focused broadly on their experiences being on drug treatment and on how they experienced counselling and treatment in different spaces. The findings show that therapeutic spaces that were viewed as clinical and sterile were experienced as stigmatising, which discouraged young drug users from engaging in treatment and therapeutic processes. In contrast, therapeutic places with a homely atmosphere reduced the experience of stigmatisation, facilitated participation in treatment and helped users to relax and feel part of a community. In the analysis, we show how enabling therapeutic places with a homely atmosphere can be produced through materials, activities, and sensory processes. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

12 pages, 1342 KiB

Open AccessArticle

Can Rehabilitation in Nature Improve Self-Perceived Interpersonal Problems? A Matched-Control Study

by Martin Mau, Maria L. Vang, Anna Mejldal, Simon Høegmark and Kirsten K. Roessler

Int. J. Environ. Res. Public Health 2022, 19(6), 3622; https://doi.org/10.3390/ijerph19063622 - 18 Mar 2022

Cited by 1 | Viewed by 1910

Abstract

Self-perceived interpersonal problems are of central concern for researchers and individuals; they are at the basis of psychopathology and cause for subjective distress. In this study, we examine whether a group-based rehabilitation program in nature may reduce self-perceived interpersonal problems in a heterogeneous group of men declining participation in traditional rehabilitation offers. The intervention consisted of weekly meetings in nature, taking place over the course of nine weeks. Through a matched-control study including 114 participants in the intervention group and 39 in a treatment as usual group participating in traditional rehabilitation offers, we found that there was no statistically significant development in self-perceived interpersonal problems in the nature-based rehabilitation offer. Though promising with regards to a number of mental challenges, including relational challenges, nature-based group-rehabilitation may require a more elaborate and thoroughgoing intervention, including e.g., a therapist and more time to be an effective intervention against interpersonal problems. We conclude that perhaps due to the fundamental aspect of self-perceived interpersonal problems, exposure to nature, and being in a group of men in a similar situation for the duration that this intervention lasted, may not be enough to address such underlying perceptions of self. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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20 pages, 6714 KiB

Open AccessArticle

The Living Space: Psychological Well-Being and Mental Health in Response to Interiors Presented in Virtual Reality

by Nour Tawil, Izabela Maria Sztuka, Kira Pohlmann, Sonja Sudimac and Simone Kühn

Int. J. Environ. Res. Public Health 2021, 18(23), 12510; https://doi.org/10.3390/ijerph182312510 - 27 Nov 2021

Cited by 22 | Viewed by 19070

Abstract

There has been a recent interest in how architecture affects mental health and psychological well-being, motivated by the fact that we spend the majority of our waking time inside and interacting with built environments. Some studies have investigated the psychological responses to indoor design parameters; for instance, contours, and proposed that curved interiors, when compared to angular ones, were aesthetically preferred and induced higher positive emotions. The present study aimed to systematically examine this hypothesis and further explore the impact of contrasting contours on affect, behavior, and cognition. We exposed 42 participants to four well-matched indoor living rooms under a free-exploration photorealistic virtual reality paradigm. We included style as an explorative second-level variable. Out of the 33 outcome variables measured, and after correcting for false discoveries, only two eventually confirmed differences in the contours analysis, in favor of angular rooms. Analysis of style primarily validated the contrast of our stimulus set, and showed significance in one other dependent variable. Results of additional analysis using the Bayesian framework were in line with those of the frequentist approach. The present results provide evidence against the hypothesis that curvature is preferred, suggesting that the psychological response to contours in a close-to-reality architectural setting could be more complex. This study, therefore, helps to communicate a more complete scientific view on the experience of interior spaces and proposes directions for necessary future research. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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20 pages, 1848 KiB

Open AccessArticle

The Wildman Programme—Rehabilitation and Reconnection with Nature for Men with Mental or Physical Health Problems—A Matched-Control Study

by Simon Høegmark, Tonny Elmose Andersen, Patrik Grahn, Anna Mejldal and Kirsten K. Roessler

Int. J. Environ. Res. Public Health 2021, 18(21), 11465; https://doi.org/10.3390/ijerph182111465 - 31 Oct 2021

Cited by 6 | Viewed by 2717

Abstract

Men with health problems refuse to participate in rehabilitation programmes and drop out of healthcare offerings more often than women. Therefore, a nature-based rehabilitation programme was tailored specific to men with mental health problems, and long-term illnesses. The rehabilitation programme combines the use of nature, body, mind, and community spirit (NBMC) and is called the ‘Wildman Programme’. The presented study was designed as a matched-control study with an intervention group participating in the Wildman Programme (N = 114) compared to a control group receiving treatment as usual (N = 39). Outcomes were measured at baseline (T1), post-intervention (T2), and 6 months post-intervention (T3). The primary outcome was the participants’ quality of life measured by WHOQOL-BREF, which consists of four domains: physical health, psychological health, social relationships, and environment. The secondary outcomes were the level of stress measured by the Perceived Stress Scale (PSS), and the participants’ emotional experience in relation to nature, measured by the Perceived Restorativeness Scale (PRS). The intervention group improved significantly in the physical and psychological WHOQOL-BREF domains and in PSS at both follow-ups. The participants’ interest in using nature for restoration increased significantly as well. The only detectable difference between the control group and the intervention group was in the WHOQOL-BREF physical domain at the 6-month follow-up. For further studies, we recommend testing the effect of the Wildman Programme in an RCT study. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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20 pages, 35992 KiB

Open AccessArticle

The Parent–Child Patient Unit (PCPU): Evidence-Based Patient Room Design and Parental Distress in Pediatric Cancer Centers

by Tanja C. Vollmer and Gemma Koppen

Int. J. Environ. Res. Public Health 2021, 18(19), 9993; https://doi.org/10.3390/ijerph18199993 - 23 Sep 2021

Cited by 7 | Viewed by 4594

Abstract

Children with cancer are frequently hospitalized during diagnosis and treatment. Since the early 1980s, parents are co-admitted because their presence positively affects children’s adjustment to hospitalization and reduces post-traumatic stress. However, the size and overall architectural design of the rooms were never adapted to the doubling of the occupancy rate. Since studies show that many parents experience high levels of distress due to their child’s illness, the purpose of this study was to investigate the impact of the architecture of the aged patient rooms on parental distress. A video observation targeted parent–child interaction related to five architectural determinants: (a) function and place of interaction, (b) distance between parent and child, (c) used space, (d) withdrawal, and (e) duration of the interaction. A total of 22 families were included in two Dutch children’s hospitals. Results show a significant association between parental distress and three architectural determinants: The less anxious the parents were and the better they estimated their child’s well-being, the more distance they created between themselves and their child, and the more space, privacy, and withdrawal options were used. These findings are discussed within a new patient room typology, the parent–child patient unit (PCPU), which reacts to the evident association of parental distress and the design. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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Review

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25 pages, 684 KiB

Open AccessReview

Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review

by Veronica Murroni, Raffaele Cavalli, Andrea Basso, Erika Borella, Chiara Meneghetti, Andrea Melendugno and Francesca Pazzaglia

Int. J. Environ. Res. Public Health 2021, 18(18), 9595; https://doi.org/10.3390/ijerph18189595 - 12 Sep 2021

Cited by 35 | Viewed by 12640

Abstract

This paper is a systematic review of quantitative studies conducted on the benefits of visiting gardens and gardening therapy for people with dementia (PWD) in an effort to assess the effectiveness of such treatments and obtain information on the most appropriate garden design for this population. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. Four databases were searched (PubMed, Web of Science, PsycINFO, Scopus), with no time limits. Out of a total of 480 articles considered, 16 studies were selected for review. In all but two of the studies examined, gardening therapy and the use of therapeutic gardens induced psychophysiological improvements in PWD. The areas showing the greatest effects were Engagement, Agitation, Depression/Mood, Stress, and Medication. It also emerged that interest in this sphere has been growing in the last decade, but there is still a shortage of empirical evidence of the beneficial effects of therapeutic gardens in relation to the type and severity of dementia, and of garden design guidelines. Despite the limited number of studies investigated, the review confirmed the benefits of gardening and therapeutic gardens in PWD. There is nonetheless a need to conduct more quantitative research to support currently-available evidence and generate more information, focusing on garden design criteria, in-garden activities, the type and severity of dementia examined, and effects on caregivers as well as on PWD. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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22 pages, 787 KiB

Open AccessReview

Are Long-Distance Walks Therapeutic? A Systematic Scoping Review of the Conceptualization of Long-Distance Walking and Its Relation to Mental Health

by Martin Mau, Anders Aaby, Søren Harnow Klausen and Kirsten Kaya Roessler

Int. J. Environ. Res. Public Health 2021, 18(15), 7741; https://doi.org/10.3390/ijerph18157741 - 21 Jul 2021

Cited by 17 | Viewed by 9595

Abstract

Long-distance walking is an ancient activity practiced across cultures for many reasons, including the improvement of one’s health. It has even been suggested that long-distance walking may be considered a form of psychotherapy. This scoping review examined the relationship between long-distance walking and mental health among adults. Publication trends and definitions were also examined, and the reason why long-distance walking may have therapeutic effects was discussed. Systematic searches in three online databases were performed using a selection of long-distance walking terms. Both quantitative and qualitative studies were included if they examined associations between long-distance walking and mental health in an adult population. Mental health was conceptualized in broad terms, including descriptions of mental states as well as more specific measurements or notions of mental health. A total of 8557 records were screened and 26 studies were included, out of which 15 were quantitative, 9 were qualitative, and 2 were mixed. The findings showed that long-distance walking was positively related to mental health. This was most consistent with regard to emotional distress compared to somewhat inconsistent findings regarding well-being. Therefore, long-distance walking may be more appropriately used to counter some personal or emotional struggle rather than to achieve hedonic pleasure. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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16 pages, 10829 KiB

Open AccessReview

Effectiveness of Horticultural Therapy in People with Schizophrenia: A Systematic Review and Meta-Analysis

by Shan Lu, Yajie Zhao, Jianjiao Liu, Feng Xu and Zhiwen Wang

Int. J. Environ. Res. Public Health 2021, 18(3), 964; https://doi.org/10.3390/ijerph18030964 - 22 Jan 2021

Cited by 16 | Viewed by 8289

Abstract

Horticultural therapy is increasingly being used in the non-pharmacological treatment of patients with schizophrenia, with previous studies demonstrating its therapeutic effects. The healing outcomes are positively correlated with the settings of the intervention. This review aimed to evaluate the effectiveness of horticultural therapy on the symptoms, rehabilitation outcomes, quality of life, and social functioning in people with schizophrenia, and the different effectiveness in hospital and non-hospital environments. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We researched studies through PubMed, Embase, the Cochrane Library, Science Direct, and the China National Knowledge Infrastructure. We included randomized controlled trials (RCTs) and quasi-experimental studies about horticultural therapy for people with schizophrenia, from January 2000 to December 2020, with a total of 23 studies involving 2024 people with schizophrenia included in this systematic review. This study provided evidence supporting the positive effect of horticultural therapy. This review demonstrated that non-hospital environments have a better therapeutic effect on all indicators than hospital environments. The results also demonstrated the effectiveness of horticultural therapy on symptoms, rehabilitation outcomes, quality of life, and social functioning in patients in hospital and non-hospital environments, providing further evidence-based support for landscape design. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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Other

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16 pages, 1790 KiB

Open AccessViewpoint

Healthy Dwelling: Design of Biophilic Interior Environments Fostering Self-Care Practices for People Living with Migraines, Chronic Pain, and Depression

by Dorothy Day Huntsman and Grzegorz Bulaj

Int. J. Environ. Res. Public Health 2022, 19(4), 2248; https://doi.org/10.3390/ijerph19042248 - 16 Feb 2022

Cited by 24 | Viewed by 20096

Abstract

The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes. Full article

(This article belongs to the Special Issue Therapeutic Environments—Existential Challenges and Healing Places)

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