Nidotherapy is a collaborative approach in which a treatment team (usually consisting of a therapist and individual suffering from mental illness or disability) systematically adjusts the environment of the individual with the intention of reducing his/her psychological distress. Nidotherapy originates from nidus, Latin for nest, and more literally, it refers to the individual’s social, physical, and more personal environment. Although nidotherapy does not immediately seem like a new approach to treatment – in fact, treatment teams have given much consideration to environment for decades – the novelty is in the formalization of the process. Furthermore, the team focuses more on creating a more harmonious fit between an individual and his/her surroundings than on changing the behavior and cognition of the individual. With a more systematic process in place for adjusting one’s environment, research can start to probe the effectiveness of such a strategy.
Nidotherapy consists of 5 principles, as identified by Tyrer: “collateral collocation, the formulation of realistic environmental targets, the improvement of social function, personal adaptation and control, and wider environmental integration involving arbitrage” (Tyrer et al., 2003). The next section breaks down each principle in more detail.
Collateral Collocation. This is the stage wherein priorities within the environment are established by viewing the individual’s surroundings through his/her perspective, withholding professional judgment while being open-minded to that which is important to the individual. After establishing the needs of the individual based on their own account, the nidotherapist may contribute ideas for change as well.
Formulation of Realistic Environmental Targets. After the initial assessment of the individual’s environment, the team compiles a list of needs in a prioritized order, discarding any needs that are unrealistic due to limited resources, location, etc. The team measures progress toward each of these identified needs, or targets, over a period of time.
Improvement of Social Function. By adjusting the environment, and thus creating a more harmonious fit for the individual suffering from chronic mental illness, it is expected that social functioning will improve over time. If the individual shows little to no improvement in social functioning, the team revisits the targets to determine whether they were in fact the best adjustments to the individual’s environment.
Personal Adaptation and Control. Nidotheraphy can be empowering for the individual in psychological distress, as he/she may feel little control over many aspects of his/her life, including symptoms of the illness itself. By taking a collaborative approach to treatment, the individual has an invested interest in the treatment, and may adapt better to maintaining the changed environment even after being discharged.
Wider Environmental Integration Involving Arbitrage. An arbiter is useful in keeping a mutually peaceful relationship between nidotherapists and the individual, especially when the needs identified by either party may be impractical due to various limitations. The arbiter should be on good terms with both the individual and the treatment team so that there is a healthy flow of communication between all involved.
History of Nidotherapy
Peter J. Tyrer, a professor of Community Psychiatry, founded nidotherapy in order to establish and implement a therapy for those whose persistent mental illness did not respond to traditional evidence-based therapies. Similary, because nidotherapy was not designed to treat behaviors, it was also suited for individuals resistant to treatment, including those suffering from schizophrenia, personality disorders, or psychosis. In fact, Tyrer (2002) initially used nidotherapy on populations with a range of personality disorders; Recently, however, the use of nidotherapy has been expanded to include all forms of chronic mental illness.
How Nidotherapy Works
Nidotherapy usually occurs over ten sessions, consisting of 5 phases.
Identifying Boundaries. During this initial phase the nidotherapist explains the process to the individual, making it clear that the therapy will focus on the individual’s environment rather than changing him/her.
Environmental Analysis. In collaboration with the individual, the treatment team determines the needs of the individual, in effect setting the stage to design a plan for adjusting the environment to reflect these stated needs.
The Nidopathway. The team designs a detailed plan to change the environment, including a timeline for each objective.
Tracking Progress. The nidotherapist moniters progress toward each objective in order to accurately evaluate whether the changes are having any effect on the social functioning of the individual.
Resetting the Nidopathway. If a target is determined to be ineffective, the team may need to revisit the plan to revise targets or decide on new ones. The individual’s agreement is imperative in whatever action is taken.
Benefits Of Nidotherapy
Nidotherapy is a new intervention that has yet to be supported by data. A recent study, conducted on patients with schizophrenia, found that nidotherapy was favored in social functioning over regular therapy in short and medium term trials; however, the results were not found to be statistically significant. Nidotherapy is still considered to be in its experimental stages, and further research is needed in order to determine the benefits of the practice.
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