Module 3 - Nidotherapy

Question 1

What is nidotherapy?

Answer 1

Named after nidus, nest - environment that will adjust to any shape that is placed within it.
“the collaborative systematic assessment and modification of the environment to minimise the impact of any form of mental disorder on the individual or on society” - Tyrer, Sensky, Mitchard 2003

1. All people have the capacity to improve their lives when placed in the right environment
2. Everyone should have the chance to test themselves in environments of their own choosing
3. When people become distressed without apparent reason the cause can often be found in the immediate environment
4. A person’s environment includes not only place but also other people and self
5. Seeing the world through another’s eyes gives a better perspective than your eyes alone
6. What someone else thinks is the best environment for a person isn’t necessarily so
7. All people, no matter how handicapped, have strengths that can be fostered
8. A person’s environment should never be regarded as impossible to change
9. Every environmental change involves some risk but this is not a reason to avoid it
10. Mutual collaboration is required to change environments for the better

Reverse Darwinism - create highly specific, often artificial environment for those unadapted for natural environments so they can thrive and prosper.

By changing environment, patient is more involved and therefore more likely to make changes required.
People also often want environmental change but are unable to achieve it by themselves - nidotherapist is an environmental advocate for the patient.

Question 2

What is the process of nidotherapy?

Answer 2

After selecting patient
[Recommended for (in order) ID, ASD, PD, dementia, depression, dependence, SZ, ADHD, OCD, phobias, PTSD, AN, panic disorder, BD because treatment-rejecting and treatment-seeking]
Best response in PD + substance dependence + psychosis because no other treatment to be shown of real value here.

Decide on individual,
Does person or environment need treatment/change? Does the patient have treatable pathology? Been given evidence-based treatments appropriately, for right length of time? Is patient engaged? Is environment a problem? Group treatment (eg. ID often thrive more in groups with more supervision) or individual (Asperger’s case who wanted to work as a night security guard and avoid too much contact with people, stable position)?

Components of treatment:
Environmental analysis (analyse with patient, physical, social and personal environment) (don't pressure person to change, promote partnership, environmental judgement and advocacy, dissolves boundaries between people but still remain professional, just available to help with environment when needed), creating a nidopathway, setting timetables, monitoring and modifying the nidopathway

Slight overlap with CBT, problem-solving therapy, behavioural analysis and therapy, social skills training, person centred planing but they’re all still aimed at people.

Question 3

What evidence is there for nidotherapy?

Answer 3

Randomised trial of nidotherapy + assertive outreach therapy vs. assertive outreach alone in severe mental illness and personality disorder - nidotherapy saved £250,000 on average via reduced hospital costs (majorly) and medication (slightly).

Chamberlain 2012 Cochrane - further research required

Compared to Enhanced Care Programme Apprach (ECPA) - not statistically significant apart from nidotherapy at 13 months but then not again at 15.