Exploring the Double Bind in Psychosis: The Role of Nature-Based Interventions in Enhancing Differentiation of Self and Wellbeing

Exploring the Double Bind in Psychosis: The Role of Nature-Based Interventions in Enhancing Differentiation of Self and Wellbeing

Background and Rationale

Individuals with psychosis often navigate complex interpersonal and societal expectations that create double binds—situations where contradictory messages prevent effective action or response, exacerbating stress and symptoms. Concurrently, Nature-Based Interventions (NBIs)—such as therapeutic gardens, forest bathing, and community gardening—have been shown to reduce stress, improve cognitive functioning, and enhance emotional regulation.

However, there is limited research on how NBIs may interact with the double bind experience and whether they facilitate differentiation of self (the ability to maintain a sense of self while engaging in relationships). Understanding this relationship could provide innovative, non-pharmacological pathways to support mental health and recovery in psychosis.

Research Aims

1. Characterize the Double Bind

   • Identify common double bind situations experienced by individuals with psychosis in social, familial, and healthcare contexts.

2. Examine the Impact of NBIs

   • Investigate how engagement in NBIs affects stress, symptom severity, and differentiation of self.

3. Explore Mechanisms of Change

   • Determine whether NBIs alleviate the cognitive-emotional tension inherent in double binds, promoting agency and resilience.

Research Questions

1. What types of double binds are most frequently experienced by individuals with psychosis?

2. How do NBIs influence psychological and physiological markers of stress in this population?

3. Does participation in NBIs improve differentiation of self and decision-making capacity amidst double bind situations?

Hypotheses

1. Individuals with psychosis will report frequent experiences of double binds in interpersonal and institutional settings.

2. Engagement in NBIs will reduce perceived stress and symptom severity.

3. NBIs will enhance differentiation of self, allowing individuals to navigate contradictory demands more effectively.

Study Design

Mixed-Methods Approach:

• Phase 1 – Qualitative Exploration

  • Semi-structured interviews with 20–30 individuals diagnosed with psychosis to document double bind experiences.

  • Thematic analysis to identify patterns and contexts of double binds.

• Phase 2 – Quantitative Intervention Study

  • Participants: 60 individuals with psychosis, randomized into NBI and control groups.

  • Intervention: 8-week NBI program (e.g., weekly guided nature walks, therapeutic gardening, or forest bathing sessions).

  • Measures:

    • Psychological: Perceived Stress Scale (PSS), Brief Psychiatric Rating Scale (BPRS), Differentiation of Self Inventory (DSI)

    • Physiological: Heart rate variability, cortisol levels

    • Behavioral: Decision-making and social interaction tasks

• Phase 3 – Integration

  • Merge qualitative and quantitative findings to identify mechanisms through which NBIs impact the double bind experience.

Data Analysis

• Qualitative: Thematic coding using NVivo; double-coding for reliability.

• Quantitative:

  • Repeated measures ANOVA to assess pre-post intervention changes.

  • Correlation and regression analyses to explore relationships between NBI engagement, stress reduction, and differentiation of self.

• Mixed-Methods Integration: Use a convergent design to interpret how qualitative double bind experiences correspond to quantitative outcomes.

Ethical Considerations

• Ensure informed consent, with attention to comprehension given psychosis-related cognitive challenges.

• Implement trauma-informed procedures for interviews and interventions.

• Monitor for adverse events related to nature exposure or group interactions.

Significance and Impact

• Provides novel insights into the psychosocial experience of individuals with psychosis.

• Evaluates NBIs as a non-stigmatizing, low-risk approach to improving coping, agency, and wellbeing.

• Supports development of tailored interventions that reduce the negative effects of double binds in mental health care and social contexts.

Timeline

PhaseDurationActivities1Months 1–3Recruitment, qualitative interviews2Months 4–11NBI intervention and quantitative data collection3Months 12–14Data analysis, integration4Months 15–16Reporting, dissemination

Expected Outcomes

• Identification of specific double bind scenarios in psychosis.

• Evidence of NBIs reducing stress and improving differentiation of self.

• Practical recommendations for integrating NBIs into mental health services.