Nidotherapy

Nidotherapy, after nidus(Latin: nest) is the name of 'a collaborative treatment involving the systematic assessment and modification of the environment to minimise the impact of any form of mental disorder on the individual or on society' ¹. It was introduced for patients with severe mental illness, mainly schizophrenia, and personality disorders² who had failed to respond to conventional treatments and were usually antagonistic to services. The aim of nidotherapy is not to change the person but to create a better fit between the environment (in all its forms) and the patient. As a consequence the patient may improve but this is not a direct result of treatment but because a more harmonious relationship has been created with the environment ³ . An essential part of nidotherapy is a full environmental analysis carried out from the patient's standpoint and with their full cooperation (provided they have the capacity) so that any changes recommended and implemented (the nidopathway) are understood and preferably owned by the patient instead of being imposed. Although nidotherapy has been classed as a psychotherapy it differs in not trying to alter the patient, only the environment.

Nidotherapy has been used mainly in the treatment of severe mental illness in assertive community treatment and community mental health services ^4-6, where it has been shown to reduce greatly the use of hospital services ⁷, but it can also be applied to any form of long term mental illness that either has no known treatment or has failed to respond to standard ones. These include disorders within the autism spectrum, chronic depression or dysthymia, and learning disability, as well as chronic stress ⁸. Most treatment lasts from 6 months to a year ³.

Many health professionals engaged in mental health services have the potential to become good nidotherapists if they have the ability to persevere with understanding difficult problems from the perspective of sufferers who do not always articulate their wishes in a coherent and organised way. Psychiatrists, social workers, clinical psychologists, occupational therapists and nurses in community mental health teams can all be trained successfully. The principles can also be learned by people with these problems and self-nidotherapy practised without the need for external supervision.

References

1. Tyrer, P., Sensky, T., & Mitchard S (2003). The principles of nidotherapy in the treatment of persistent mental and personality disorders. Psychotherapy and Psychosomatics, 72, 350-356. PMID: 14526138

2. Tyrer, P. (2002). Nidotherapy: a new approach to the treatment of personality disorder. Acta Psychiatrica Scandinavica, 105, 469-471. PMID: 12059852

3. Tyrer, P. Nidotherapy: harmonising the environment with the patient. . London; RCPsych Press, 2009.

4. Tyrer, P. & Bajaj, P. (2005). Nidotherapy: making the environment do the therapeutic work. Advances in Psychiatric Treatment, 11, 232-238.

5. Byrne, P. (2007). Managing the acute psychotic episode. BMJ. ,334, 686-92. PMID: 17395949

6. Tyrer, P. & Kramo, K. (2007). Nidotherapy in practice. Journal of Mental Health, 16, 117 – 129. DOI: 10.1080/09638230601182102

7. Ranger M, Tyrer P, Milošeska K, Fourie H, Khaleel I, North B & Barrett B (2009). Cost-effectiveness of nidotherapy for comorbid personality disorder and severe mental illness: randomized controlled trial. Epidemiologia e Psichiatria Sociale, 18, 128-136.

8. Tyrer, P. (2003). Nidotherapy in the treatment of stress. Stress and Health, 19,127-128.