Recreational Therapy: What Are Its Benefits in Rehab?

“Can you provide a definition of recreational therapy?” We were talking to Adam Lazarus. Lazarus is the recreational therapist at FHE Health and had agreed to be interviewed as part of our expert interview series.

“Recreational therapy is a way to utilize recreation to help clients find purpose, meaning and joy in their lives,” Lazarus said. He explained that this type of therapy “looks a bit different depending on the population,” then referenced another population that he has worked with as an example:

In geriatrics, you’re often working on those fine motor skills to regain physical functioning after a stroke, fall, or head injury; you’re also combatting loneliness as people get older, keeping up their social skills, and helping them laugh and find some levity in life.

Recreational Therapy … in Rehab?

“Recreational therapy looks a little different with the substance abuse and mental health population,” Lazarus continued. In this case, much of the work involves helping clients “utilize effective coping skills,” “find a balanced life,” and, in the wake of substance use, develop “replacement activities” to fill the void left by drugs and alcohol.

Before Lazarus became a recreational therapist, he was a psychotherapist. He ultimately ended up pursuing a vocation in recreational therapy for two reasons: He preferred the therapeutic approach, which focused on personal strengths; and he wanted to be more physically active in his day job.

The Benefits of Recreational Therapy in Mental Health and Addiction Recovery

When the conversation turned to the benefits of recreational therapy in mental health and addiction recovery, Lazarus emphasized the importance of fun and play, according to the evidence:

Research shows that when someone doesn’t have any leisure activities or hobbies, or when their foundation is so weak in terms of their interests, they are going to resort back to drugs and will have an uptick in mental health symptoms … When you have nothing to do, or when you are in treatment and there is too much down time, those old thought patterns and behaviors come up again. All those symptoms can come back again.

One of Lazarus’ goals, therefore, is to help clients identify their hobbies and develop a realistic plan for pursuing them: “With most of our clients, I have them write down all their interests and barriers to these hobbies, whether financial, physical (pain/stiffness/lack of movement), low motivation, etc.”

Another goal is to ensure that clients are having fun. “If I have a group of clients who have been in rehab for 30 days processing emotions and all the typical things that come along with group therapy, they can get to a point where they’re so exhausted,” Lazarus said. “When they see me, they have the expectation that they’re going to have fun—and something in their brain changes.” (More precisely, pleasurable experiences trigger the release of feel-good endorphins and neurotransmitters like dopamine.)

Finally, the “person-first,” “positive psychology” approach that defines recreational therapy and differentiates it from other modalities is also worth noting in a discussion of its benefits. “We tend to really only focus on all of the things that a person can do,” Lazarus explained. “Any negative aspects we don’t really focus on a whole lot. If someone had a stroke, for example, we’ll focus on all the areas of bodily function that are still there that can be built upon and fortified.”

Exercises in Recreational Therapy

Recreational therapy at FHE Health can encompass a range of fun activities. One example is “Family Feud,” a game that Lazarus uses “with mental health clients.” When “they get really involved, their eyes light up,” Lazarus said. “They’re collaborating with teammates, pumping each other up to get the answer, working on impulse control, and working through some anxiety when they come up to the chair.”

The next phase may be devoted to processing: “We will talk about working through the social anxiety or impulse control,” Lazarus said. “We may talk about the importance of having fun and turning down the intensity of things.” (With a sedentary activity, Lazarus said he typically will process it with the group afterwards; a physical activity, on the other hand, does not usually involve this added reinforcement.)

Types of Recreational Therapy – The “Five Domains”

Are there different types of recreational therapy, and if so, which are available at FHE Health? Lazarus said a quality recreational program will cover “the five domains”—namely, the physical, spiritual, social, cognitive, and emotional aspects of the individual. Lazarus tries to represent these domains with the activities that he chooses. Some examples:

• Emotional domain – Karaoke, a game of charades, or an exercise in creative writing
• Physical domain – A game of volleyball or basketball
• Spiritual domain – Meditation or journaling

With each activity, Lazarus, who has a master’s degree in social work, likes to incorporate “the clinical tie-in” where appropriate. “I tie it in because I know how important it is,” he said. “This helps to strengthen the approach.”

What Research Supports Recreational Therapy

There is “a lot of research” to support recreational therapy in mental health and addiction treatment settings, according to Lazarus. A study in January 2019 surveyed individuals with mental illness at a community mental health center to better understand what they saw as the benefits of recreational therapy. Their answers revealed at least seven benefits of recreational therapy, including:

• Providing a safe place
• Promoting hope
• Finding balance
• Developing self-wisdom
• Increasing enjoyment
• Building confidence
• Encouraging self-determination

Earlier research at Brigham Young University found that recreational therapy increased the intrinsic motivation and holistic functioning of patients in addiction rehab. (Both intrinsic motivation and holistic functioning are key predictors of success in recovery from substance abuse.)

One explanation for why recreational therapy increases motivation in early recovery harkens back to what Lazarus said earlier in our interview. Fun and play cause a surge in the pleasure neurotransmitter dopamine. Meanwhile, dopamine plays a critical role in motivation, such that higher levels of dopamine correlate with higher levels of motivation.

Tips for How to Access Recreational Therapy in a Rehab Program?

“Not a lot of rehabs have the position of recreational therapist,” Lazarus said. (He suggested the American Therapeutic Recreation Association as a resource for more information about recreational therapy programs.) Still, despite this scarcity of recreational therapists in rehab centers nationwide, Lazarus was able to end on an optimistic note. With greater awareness about mental health issues in recent years, he said, it is just a matter of time before more such programs become available.