Effects of Horticultural Therapy on Cancer Patients' Psychological Well-being in Different Therapeutic Environments

Cancer has topped the leading causes of death in Taiwan for the past three decades. The disease induces not only physical symptoms, but also serious psychological problems. For cancer patients, horticultural therapy with conventional therapy has been utilized to improve psychological status. Anecdotal evidence has demonstrated that contact with nature is good for human health and well-being. Horticultural therapy in therapeutic environments, such as outdoor gardens, might extend general health benefits without serious side effects. Few empirical studies, however, have reported on the effects of horticultural therapy in different therapeutic environments. The purpose of this study is to assess the psychological well-being of patients receiving horticultural therapy and compare the benefits of horticultural therapy across different therapeutic environments for cancer patients.

Cancer patients from Formosa Cancer Foundation in Taiwan were invited to join a horticultural therapy program. The study examined four groups in different environments, including one control group and three experimental groups: the original indoor classroom (control), an indoor classroom with the view of a mountain photograph (experiment 1), an indoor classroom with the view of a garden photograph (experiment 2), and an outdoor garden (experiment 3). The four groups participated separately in the same six-week horticultural therapy program in different environments from 2011 to 2013. All groups responded to pre- and post-test questionnaires. The State Anxiety Inventory was used to assess participants' positive and negative emotions. In addition, participants were asked to write down three adjectives describing the activity environment.

The results revealed that cancer patients expressed more positive emotions after the six-week horticultural therapy program in all four groups of cancer patients; also, their negative emotions decreased, except for the experiment 2 groups in an indoor classroom with the view of a garden photograph. The experiment 1 groups in an indoor classroom with the view of a mountain photograph showed the best effect of increasing positive emotions and decreasing negative emotions. Most participants in the four groups used adjectives expressing peaceful feelings to describe their activity environment, including relaxing, tranquil, comfortable, pleasant, and etc. Finally, the experiment 3 groups in the outdoor garden expressed more vital feelings than the other three groups, using such words as novel, exciting, and delightful.