More than Just Meds: Does Adjunct Adventure/Recreation Based Group Therapy Improve Physical and Psychological Health in Clients with First Episode Psychosis?

Both nationally and internationally research has shown that weight gain is a major factor in deteriorating physical health. For people with mental health disorders this problem is compounded by the use of anti-psychotic medications. That is, while anti-psychotic medications play a significant role in the treatment of psychosis they can also cause significant weight gain for the individuals using them. This means that strategies that assist in maintaining a healthy body weight need to be considered alongside other treatments for people with psychotic disorders (Alvarez-Jimanez, MartÃnez-GarcÃa, Parez-Iglesias, Ramarez, Va¡zquez-Barquero & Crespo-Facorro 2009). Early Intervention Services (EIS) are a specific model introduced to treat young people with psychosis early in the critical period of psychotic illness. Early Intervention is an international model with similarities in treatment throughout the world. Treatments generally include intensive psycho/social treatment from multi discipline teams and the use of psychotropic medications. As Addington et al (2005) argue this model has proven to be effective in treating psychosis. Totara House, an EIS based in Christchurch New Zealand, uses the Early Intervention in Psychosis Model (Turner 2002). As part of treatment Totara House also offers a recreation group. This Group is based on concepts contained in Adventure Therapy where, by using the outdoor environment, activities with perceived risks can be undertaken. Through these activities clients can generalise learning to a real life situations. One of the few studies to evaluate the effectiveness of Adventure Therapy (Voruganti et al, 2006) found it to be an effective intervention for people in early intervention for Psychosis. The study reported here attempts to add to that body of research by evaluating the benefits of the Totara House recreation group for a sample of young people taking anti-psychotic medication. The underlying premise is that participation in the recreation group will assist members to maintain a healthy body weight by increasing their physical activity, which in turn will improve their overall physical health. Using several measures, this study compared the scores of 78 clients who attended the Totara House recreation group with 206 clients who do not attend the group. This included using physical measures such as Body Mass Index, Fasting Glucose (Glucose), Total Cholesterol, High Density Lipoprotein (HDL) cholesterol, Low Density Lipoprotein (LDL) and Triglycerides. The Psychological measures used were Health of the Nation Outcome Scale (HONOS), Positive and Negative Syndrome Scale (PANSS), Quality of life, Substance Use, Self-report insight scale (Insight) and Compliance. The results showed that High Density Lipoprotein was close to significance with this result being strongest in the last year of treatment. It also found that the majority of clients attended the recreation group early in their two years of treatment and that more left the recreation group for positive reasons rather than negative ones. It was also found that the recreation group attracted a sub group of clients, clients attending the group were more likely to be Maori and male and have higher Health of the Nation Outcome Scale scores. The data was further analysed by splitting the sample into clients who attended the recreation group for less than five sessions (n=37) with those who attended five or more sessions (n=41). While being Maori then became non-significant, being male continued to predict attendance. Quality of life and Health of the Nation scores were significant predictors of attendance. Overall, it was found that in this study although the recreation group, as an adjunct intervention, did not appear to be as effective as it had been in the Voruganti et al (2006) study, for a subgroup of Totara House clients it had definite benefits. This was particularly apparent for Maori and other clients who are severely affected by psychotic disorders. In this way this study has made a contribution to the knowledge base in regard to positive models for working with clients in early intervention psychosis. Such a model is also very much in keeping with social work practice in mental health services.