MENTAL HEALTH FEATURE
Glasgow Psychological Trauma Service ( GPTS ) is a tertiary level mental health service that offers multidisciplinary psychologically informed interventions to clients who present with complex post-traumatic stress disorder ( CPTSD ) following experiences of complex trauma . The World Health Organisation ’ s International Classification of Disease ( version 11 ) describes complex post-traumatic stress disorder as including severe difficulties with affect regulation , persistent negative views of self and persistent relationship difficulties with others , in addition to core symptoms of post-traumatic stress disorder ( PTSD ), such as re-experiencing , avoidance and hyperarousal .
Ten years ago , based on the evidenced rewards of using nature to benefit health , the GPTS occupational therapist and Scottish Forestry ( previously known as Forestry Commission Scotland ) embarked on a jointly-facilitated 12-week pilot Branching Out programme ( https :// forestry . gov . scot / forests-people / health-strategy / branching-out ) for our service users from an asylum-seeking background .
The programme was successful and continues to be offered as part of occupational therapy treatment , with our remit now extended to include all GPTS service users .
Our clinical sessions take place in a large community park in the south of Glasgow city , with transport provided from a city centre location to and from the park . The content of sessions varies from week to week , including conservation activities ( bamboo clearing , tree surveys ), environmental art ( photography , willow weaving , clay work ), bush craft ( tool use , fire building , tree identification ), construction ( building benches and tables ), and physical exercise ( walking ).
Participants also worked towards completion of the John Muir Discovery Award during their engagement with the group . This is an environmental award scheme that involves the completion of four challenges within a wild space : discover a wild place ; explore it ; conserve it ; and share your experiences . The awards are issued by the John Muir Trust and are recognised internationally .
The sessions run for three hours once a week and are staffed by the occupational therapist , two Scottish Forestry staff , with interpreters provided as required through NHS Greater Glasgow and Clyde .
Our Branching Out group is designed to provide service users with a lived experience of something that is entirely opposite to their past trauma experiences , and we aim to provide :
• opportunities for relaxation , with a reduction in symptom acuity and levels of distress ;
• opportunities for pleasure and enjoyment through involvement in nature based activities ;
• opportunities to develop an enhanced sense of self , an increase in self confidence and self esteem ;
• opportunities for social interaction within a safe and supportive environment contributing to a widening of social contacts and reduction in feelings of isolation ;
• opportunities to reconnect with previously valued activities and roles ;
• opportunities to experience increased interpersonal and social competencies as a result of involvement in an activity focused group ; and
• opportunities to experience the health benefits of being close to nature . Various methods of evaluation have been employed over the years , with current measures being pre- and post-group CORE10 , IROC , and a qualitative post-group questionnaire created by the occupational therapist .
Outcome measures have demonstrated positive change over the course of the group , with some changes deemed statically significant .
A review of the comments made by participants as part of the evaluation provides an insight into the impact that Branching Out has on attendees . Participants spoke of finding hope , a sense of enjoyment and happiness , a reduction in levels of distress and trauma memories , increased social contact and a sense of belonging . Some described the group as feeling like a family .
When asked about how involvement in Branching Out could help people who have experienced complex trauma , respondents identified the following benefits :
• connectedness with self and others ;
• diversion and relief from negative thoughts ;
• a reduction in trauma memories ;
• the experience of happiness ;
• involvement in valued activities ;
• being treated with respect ; and
• restoration of a sense of self and of pride . All participants said they believed that Branching Out was a valuable experience , identifying positive changes in themselves as a consequence of being part of the group . They all thought that involvement in the group was helpful for individuals who have mental health problems linked to past trauma .
The group aims are congruent with the guidance given by Cloitre et al ( 2012 ) who recommend that treatment for CPTSD should include equal focus on reduction of symptoms and on ‘ improvement in key functional capacities for self-regulation and strengthening of psychosocial and environmental resources ’.
These aims also support occupational therapy best practice , with a focus on the therapeutic use of activity in order to develop health and wellbeing .
RCOT ( 2020 ) states : ‘ Occupational therapy provides practical support to empower people to facilitate recovery and overcome barriers preventing them from doing the activities ( or occupations ) that matter to them . This support increases people ’ s independence and satisfaction in all aspects of life .
Participant feedback suggests that involvement in the group allowed people to contemplate and attempt to re-engage in everyday activities and relationships in a safe environment , thus contributing to their ‘ increased sphere of engagement in the world ’ ( Herman 1992 ).
The particular benefits of the combination of being close to nature and being part of a group were also reinforced , with one respondent saying ‘ nature and the group together is the perfect partnership ’.
OTnews December 2020 49