# Motivation and emotion/Book/2023/Therapeutic recreation

* Multimedia presentation (3 min)

## Overview

* Figure 1. A recreational therapist playing a game with a patient.
* Imagine you are at either work or school and today has been stressful, with numerous hassles and trivial tasks that have done nothing but bore you, making you yearn for a break from whichever routine you may be trapped in. These stressors get worse and worse until you cannot take it anymore and you need to find a way to deal with the day’s challenges, [grammar?] would you assume that recreational activities in between these stressors would allow you to do so? If so, what might these look like?
“The primary goal of human being is creating meaningful, healthy life of their existence” (Wise, 2021).” The concept of meaning in this context is defined as a process of discovering and achieving meaning from participating in beneficial activities (Morgan & Farsides, 2009). Due to one’s leisure being inherently unique and defined compared to other aspects of life (Walker, Kleiber, & Mannell, 2019), it holds potential to for individuals to gain value in their personal life (see Figure 1).
Therapeutic recreation is designed to join recreation and medical treatment with the goal of improving clients’ wellbeing. This may be accomplished by improving the personal, spiritual, social or cultural aspects of the client’s life, each of which are key factors in what makes recreation meaningful altogether, thus the technic[say what?] is versatile in nature, allowing for specialisation on one or more of these categories depending on the needs and wants of those involved (Armstrong & Manion, 2013).
* Focus questions
* What is therapeutic recreation?
* How does therapeutic recreation work?
* What are the impacts of therapeutic recreation?

## What is therapeutic recreation?

[Answer the question - what is therapeutic recreation?] The multifaceted approach to patient care used in therapeutic recreation has been influenced by a range of psychological approaches over time. Originating from the medical model, it originally sought to "repair" patients by addressing perceived deficiencies or undesirable characteristics through personalised recreational activities aimed primarily at health enhancement (Mobily & Dieser, 2018; Austin & Van Puymbroeck, 2016). However, as psychological theories developed, therapeutic recreation has incorporated learnings from humanistic and social models, emphasising the emotional well-being of patients, the importance of leisure, and the social environment in which individuals live (Robertson & Long, 2020; Arai, Berbary & Dupuis, 2015).

### Medical model

The historical definition of therapeutic recreation focuses on the medical model, the presumption that something is “wrong” with the patient and thus require treatment to fix their illness in a personalised fashion as seen in Mobily & Dieser (2018) which focuses on repairing the individual (Mobily& Dieser, 2018). Austin and Van Puymbroeck (2016) provide another insight into this traditional model as the two conceptualise the treatment as a means of health maintenance through recreational activities which build upon a characteristic of the individual which is perceived as undesirable or unideal. This traditional model is the most common perspective of the treatment today and prioritises the health of the patient over the leisure which they may experience during said treatment (Austin & Van Puymbroeck, 2016). This initial view of therapeutic recreation shows that the treatment insinuates that for the patient to be involved with the treatment to begin with, one must be motivated to attain a different position post treatment that[grammar?] is considered desirable.

### Humanistic approach

Although the medical model has been described as the most common and influential in the contemporary field by Genoe et al (2021), where there is one perspective, it is human nature for there to be at least one other (Genoe et al, 2021). Robertson and Long (2020) explore a more humanistic approach in Foundations of Therapeutic Recreation which acknowledges that for the treatment to be effective, it must appropriately utilise leisure and positive experiences to improve an individual’s health, partly through improved well-being and greater overall quality of life (Roberston & Long, 2020). This perspective builds upon the previously mentioned medical model by acknowledging that the primary focus is medical betterment, the emotional side of the client must be addressed and acknowledged appropriately, thus concluding that without the understanding of the patient’s emotions and the impacts which the treatment may have, the primary mission of the therapeutic practice will be undermined (see figure 2).

### Social model

In recent years, different perspectives have risen following this acknowledgement of the patient’s emotional state by considering contemporary social justice. Arai, Berbary & Dupuis (2015) explore the social model of disability which focuses on changing the environment in which the patient finds themselves rather than directly treating their disability[Rewrite to improve clarity]. To treat the disability insinuates that there is something wrong with the patient, which the social model argues is not always the case(Arai, Berbay & Dupui, 2015). Although more prominent in recent years, this emotion-based approach was first explored by Haun (1965). The milieu approach to therapeutic recreation proposed a universal viewpoint of individuals with inseparable genetic, personal, and real-life influences, key aspects of the person which must be considered for treatment. Haun (1965) acknowledged that a comfortable community within which the patient felt they belonged, as well as appropriate support from medical professionals when required, were essential to creating a pathway for treatment, proposing that this was not possible without positive interaction, and positive emotion consequently (Haun, 1965).
Anderson (2021) further developed a personalised, emotional variant of the treatment by proposing an approach based on the strengths of the individual both internally and externally to further develop wellbeing for those affected by chronic conditions and disabilities in an individualised manner. This approach of course contradictory to the medical model, focuses on the emotional side of treatment and its ability to assist in personal development rather than “curing” a condition (Anderson, 2021).
Quiz
1
The social aspect of therapeutic recreation has surfaced primarily in recent years:
True
False
2
Therapeutic recreation is, by definition, a "one size fits all" treatment.
True
False :

## How does therapeutic recreation work?

Therapeutic recreation is a specialised approach designed to promote the well-being of individuals through engaging and meaningful leisure activities, offering interventions that are tailored to the strengths and needs of participants. It uses a strengths-based approach to create biopsychological changes that reinforce the positive outcomes of these interventions.

### Strengths-based therapeutic recreation

Sylvester (1992) pioneered a modern strengths-based approach to this treatment which was designed to allow for the development of autonomy and confidence for patients by engaging in activities designed to establish and build upon faith in the self. To do so, the therapist would assume the role of a promoter of everyday autonomy and designing therapeutic activities which develop the client’s autonomy to conclude on a course of action and the autonomy to carry out said actions in the real world, thus developing decision making, typically for what many would consider trivial everyday decisions. These may range from deciding which recreational leisure’s[spelling?] to take part in, how to dress and which dishes to make and eat. Developing these decision-making skills, as well as providing an environment in which the patient can carry out their decisions, allows for the development of self-actualisation and the ability to engage in everyday practices, more importantly however, the ability to make these decisions with confidence (Sylvester, 1992).
This was further developed by Anderson (2021) who built upon the strengths-based approach with their recreational practice referred to as “Flourishing through Leisure” which placed the patient, as well as their hopes, dreams, and aspirations, at the centre of the treatment process. Anderson (2021) propose[grammar?] a utilisation of the local environment and specialised therapeutic techniques to develop strengths in the form of emotional, cognitive, physical, social, and spiritual capabilities. The development of one or more of these strengths would allow the client to develop and therefore flourish. The situations in which these strengths develop are chosen by the participant and specialist, which allows for the specialist to create an individualised plan with enough versatility to adapt to the participant and the situations which they find themselves. This plan is also designed to produce leisure experiences for participant to allow for enjoyable pursuit of their goals and utilisation of whichever strength they are attempting to develop. While such development is occurring, the specialist encourages the participant to link different strengths and strength utilisations to different circumstances from various environment and contexts to better understand where and how these strengths may benefit the individual in everyday life. An example of this form of therapy is the utilisation of an adapted physical equipment in a safe environment to allow the patient to enhance their physical strength in a comfortable manner. Following the development of the patient’s strength, their self-efficacy and confidence should grow and allow them to engage in more meaningful leisure activities on their own accord, thus increasing their control over their lives and allowing for personal development (Anderson, 2021).

### Biopsychological aspects

[Provide more detail]

#### Serotonin

Models of therapeutic recreation are designed to exhibit desirable outcomes for the participants, however what exactly reinforces these outcomes and actions on a biological level is important to understand, to do so an investigation of neurotransmitters of the brain will be conducted (see figure 3). Matsunaga et al (2017) summarised serotonin as a neurotransmitter responsible for the regulation of mood, sleep and emotion and is found in higher quantities when an individual is engaging in activities which they find rewarding, challenging and for their own good. Serotonin imbalances can lead to mood imbalances and negative health outcomes, thus it is important to regulate the chemical to some extent, one method is of course achieving one’s potential – a key component of therapeutic recreation. Should the recreational therapy be fruitful for the participant and a challenge is faced, be it small or large in nature, serotonin will be regulated and flow, thus increasing their wellbeing (Matsungaga et al, 2017).

#### Dopamine

Serotonin does not work alone in the brain’s reward system however, it also works in conjunction with dopamine, the brain hormone responsible for the experience of joy, laughter and other positive emotions. As stated by Dfarhud, Malmir & Khanahmadi (2014), Dopamine can be released in a variety of circumstances, however the most relevant of which is fulfilling ones potential due to its nature of being tied to the reward system of the brain. On a neurological level, dopamine is produced in several areas of the brain including the substantia nigra, ventral tegmental area and the raphe nuclei, which also produces serotonin. Serotonin is also produced in enterochromaffin cells in the gastrointestinal tract which, although being far from the brain, still holds the ability to affect one’s mood and wellbeing (Dfarhud, Malmir & Khanahmadi, 2014).

### Achievement motivation theory

Although the relation of biopsychological aspects of therapeutic recreation and its benefits has been acknowledged, it is worth questioning what psychological theories coincide with these effects and explain one another. Therapy of any kind is known to show little results unless the patient *desires* to improve their state or the state of the world in some form, therefore they are showing a motivation to achieve a goal. McClelland (2005) explores achievement motivation theory, which claims that motivations, as well as their ability to affect behaviour, consequently, varies between individuals, along with the contexts in which they encounter these situations, be them environmental or social. This theory claims that, although said circumstances may differ, humans by nature are motivated to accomplish tasks which they perceive as worthwhile (McClelland, 2005). This ties into the key principles of therapeutic recreation as the activities which are engaged in by patient and practitioner are designed to challenge and further the development of the patient in some way. These activities are of course difficult to accomplish in solitude, hence the patient engaging in this form of healthcare to begin with, therefore accomplishing these tasks will lead to productions of dopamine and serotonin, thus motivating the patient to continue with their therapeutic journey, living with a higher quality of life consequently.
Quiz
1
Dopamine is responsible for :
Happiness and joy.
Doubt and fear.
2
Strengths-based therapeutic recreation focuses on:
Enhancing motivation.
Building self-efficacy and developing present talents. :

## What are the impacts of therapeutic recreation?

Therapeutic recreation is associated with improvements for various health conditions and emotional challenges. It can be effective in reducing symptoms of mood disorders like depression, assisting emotional regulation in those grieving, aiding recovery in chronic health conditions such as stroke and cardiovascular conditions, and contributing to the rehabilitation of cancer patients. Through diverse activities ranging from poetry to sports, therapeutic recreation offers a holistic approach to recovery and well-being.[factual?]

### Mood disorders: Depression

Dieser and Ruddell (2002) tested the effects of therapeutic recreation on 10 adolescents aged 14-17 who were diagnosed with major depressive disorder and found a positive link between recreation, positive feelings, and alleviation from depressive symptoms (see Figure 4). Although the results indicate a relationship is present, the limited sample size hinders its generalisability. Thus, findings of Johnson (1999) should also be referred. Johnson (1999) discovered therapeutic recreation was useful in alleviating depressive symptoms amongst elderly participants, particularly due to its potential to be individualised. Poetry, dancing, and art were some of the forms which this therapy took, all of which were effective. An important finding was therapeutic recreation’s ability to aid in the treatment of physical conditions such as arthritis, as symptoms and complaints relating to these conditions became scarcer as treatment progressed, indicating a potential connection between the treatment and physical health as well as mental (Johnson, 1999).

### Emotional regulation: Grief

Hanlon, Kiernan, and Guerin (2022) investigated the effects of therapeutic recreation on families who were struggling to engage in everyday activity following the death of one of their children from illness-related causes. 12 participants engaged in a three-camp program over a 12-month period, with a reunion camp 2 years later. The participants were encouraged to address their grief and allow for confrontation and acceptance of said grief with the goal of moving further past the loss of their child. Engagement with other families who lost a child, sharing experiences and understanding the gravity of their situations were the activities which the researchers encouraged. Results showed that participants unanimously felt the camp had aided in their grieving process, one of which told researchers the camp showed them “how to have fun again without forgetting [child] and others are going through the same” (Hanlon, Kiernan, and Guerin, 2022). Therapeutic recreation aiding in the recovery of loss was also found by King et al (2016) which saw participants who recently lost a family member engage in creative scrapbooking which involved poetry, mementos and photos. Participants reported the recreation allowed for an emotional outlet and allowed for grievances to be processed with less difficulty (King et al, 2016).

### Chronic health conditions

[Provide more detail]

#### Stroke

Williams et al (2007) conducted a study on the effects of therapeutic recreation on adolescents and adults recovering from stroke in hospital, spending a total of 74.4% of their time in treatment. Recreational therapy was found to be a strong indicator of recovery from stroke, as well as increased functional independence and motor function, indicating that recreational therapy engagement may be a predictor of recovery from severe health conditions (Williams et al, 2007). Bode, Heinemann, Semik, & Mallinson (2004) reported hospitalised patients spent 5% of time in therapeutic recreation, which was then reported to have little effect on the patient's recovery from stroke. This further solidifies the relationship between therapeutic recreation and recovery from physical conditions such as stroke (Bode, Heinemann, Semik, & Mallinson, 2004).

#### Cardiovascular conditions

Allsop, Negly and Sibthorp (2013) conducted a study on the effects of therapeutic recreation on 79 teenagers with neurofibromatosis. Neurofibromatosis is a rare genetic disorder which sees tumours grow on the end of nerve cells, which leads to other issues surfacing such as cardiovascular issues, bone density inconsistency and learning disabilities (Noll et al., 2007). Those affected by this condition often struggle with social interaction, resulting in lower self-efficacy in social situations, which is the primary focus of the treatment. The researchers constructed programs that promoted social engagement, leadership, and independence. The control summer camp which saw social-focused therapeutic recreation therapy took place over several weeks, which saw greater social capability and self-efficacy compared to a group who did not engage with the treatment. Indicating the treatment holds potential to affect the lives of children facing chronic health conditions (Allsop, Negly and Sibthorp (2013).

#### Cancer

Uth et al (2013) also used therapeutic recreation to treat men with prostate cancer diagnoses. The men were engaged in soccer training multiple times per week and were encouraged to socialise with one another before and after practice over a 12-week period (see figure 5). Following treatment, participants were found to be more physically capable in terms of stair climbing and knee extensions, and were found to have higher lean body mass and increased physical health such as bone mass and increased plasma (Uth et al. 2013). Thus indicating therapeutic recreation has an impact on the rehabilitation and flourishment of cancer patients.

##### Quiz

* Case Study:
* Imagine you are a recreational therapist and a patient comes to you asking how they might be able to socialise better, as they have struggled with doing so their whole life due to ASD and believe they do not have the ability to speak to "normal" individuals. They also state they might give up and accept their status as a social outcast. What might you do to encourage healthy social interactions between this person and others? Perhaps basic social skills training to begin with? Or helping them build enough confidence to join a club of their interest?

## Conclusion

Therapeutic recreation is a versatile form of therapy which may range from treatments of emotional instability to chronic health conditions for individuals across the lifespan. This form of therapy is designed to be moulded depending on their [who?] needs, desires and concerns in a way that typically promotes engagement, self-efficacy, health, and independence, allowing for an individual to both flourish in a medical sense, as well as the personal. Given the two are intertwined, it is of no surprise that therapeutic recreation builds upon one aspect of treatment to strengthen the other. Solo engagements between the patient and practitioner which may entail simple discourse to build social skills, or dancing to boost physical activity and capabilities, or group engagements that involve team sports such as soccer, or group discussions and interactions are some of the many forms which this therapy may take. A practitioner may weave the therapeutic technique to promote healthy brain chemistry also, [grammar?] perhaps to stimulate the development of dopamine to offset mood imbalances and combat chronic illnesses. Therapeutic recreation is not a form of treatment to be dismissed as impractical or ineffective, instead it is a medical doctrine which, like most therapies, is individualised, however more so due to its practical aspects and its design to produce desirable results which promote a healthy and enjoyable existence.