Floral arrangement as a cognitive training tool for schizophrenia

It's the hallucinations and delusions associated with schizophrenia that typically attract discussion and research. However, patients with a diagnosis of schizophrenia also exhibit deficits in memory and perception and, importantly, the severity of these is predictive of quality of life, social functioning and autonomy. How can these cognitive deficits be helped? Researchers have found some success with computer-based training but patient motivation can be problem. Now a team of researchers led by Hiroko Mochizuki-Kawai at the delightfully named National Institute of Floricultural Science in Japan have tested out the benefits of floral arranging. 'The use of natural materials may reduce tension and anxiety' they predicted.

Ten patients (six men) with a diagnosis of schizophrenia or schizoaffective disorder agreed to undertake four one-hour sessions of flower arranging, supported by staff, over two weeks. The arranging involved following simple written instructions, holding them in memory one at a time, and placing flowers and leaves into the correct slots in an absorbent sponge. Two patients failed to attend; average attendance for the remainder was 3.1 sessions.

Before the intervention, the flower arranging patients' performance on the 'block-tapping' measure of non-verbal working memory was the same as that displayed by ten controls. After two weeks' flower arranging, however, the flower patients' performance had improved and was now superior to the controls. The block tapping task involves observing blocks being touched one at a time and then reproducing that same order from memory. On another test, which involved copying a complex figure from memory, the flower arranging patients were again no better than controls at the study outset but were superior to controls after the two weeks of training (although this was because the controls had deteriorated at the task rather than because the flower arrangers had improved).

This was only a pilot study and it has obvious short-comings including the small sample sizes, the lack of any comparison intervention for the control group, and no way of measuring the impact of cognitive gains on quality of life. However, the researchers were upbeat in their conclusion: 'We believe that the findings of the present study may contribute to the improvement of cognitive rehabilitation in schizophrenic patients'.

ResearchBlogging.orgMochizuki-Kawai, H., Yamakawa, Y., Mochizuki, S., Anzai, S., & Arai, M. (2010). Structured floral arrangement programme for improving visuospatial working memory in schizophrenia. Neuropsychological Rehabilitation, 20 (4), 624-636 DOI: 10.1080/09602011003715141
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