Background: Skepticism of therapy and stigma are significant barriers for veterans with mental health issues. Therapeutic adventure shows promise in addressing veterans’ mental health needs while circumventing the stigma many veterans face in initiating treatment. Purpose: Given the small group model of therapeutic adventure programs, such programs may be ideal to provide social support for veterans and reduce mental health symptomology. The present study investigated: can a brief peer-led therapeutic adventure program modify veterans’ mental health symptoms? Methodology/Approach: The study's sample included 56 participants attending one Sierra Club Military Outdoors trip lasting at least three days and two nights and involving camping. Participants completed study measurements assessing depression, anxiety, stress, Post-Traumatic Stress Disorder symptoms, substance misuse symptoms, and suicidality at pre-trip, post-trip, one-month post trip, six-months post trip, and 12-months post trip. Six-month and 12-month post-trip data was collected during the COVID-19 pandemic. Findings/Conclusions: Results indicated significant reduction in mental health symptomology from pre-trip to post-trip, but showed few longer-term changes in mental health symptomology. Implications: The present study's findings are consistent with research suggesting improvements in overall psychological well-being immediately following a nature-based intervention and suggest the need for on-going, community-based interventions to support optimally military veterans’ mental health.
BanerjeeD.KosagisharafJ. R.RaoT. S. (2021). ‘The dual pandemic’ of suicide and COVID-19: A biopsychosocial narrative of risks and prevention. Psychiatry Research, 295, 113577. https://doi.org/10.1016/j.psychres.2020.113577
2.
BastiaensL.GalusJ. (2017). The DSM-5 self-rated level 1 cross-cutting symptom measure as a screening tool. Psychiatric Quarterly, 89(1), 111–115.
3.
BennettL. W.CardoneS.JarczykJ. (1998). Effects of a therapeutic camping program on addiction recovery: The algonquin haymarket relapse prevention program. Journal of Substance Abuse Treatment, 15(5), 469–474. https://doi.org/10.1016/S0740-5472(97)00222-5
4.
BergerR.McleodJ. (2006). Incorporating nature into therapy: A framework for practice. Journal of Systemic Therapies, 25(2), 80–94.
5.
BettmannJ. E.ScheinfeldD. E.PrinceK. C.GarlandE. L.OvromK. V. (2019). Changes in psychiatric symptoms and psychological processes among veterans participating in a therapeutic adventure program. Psychological Services, 16(4), 525–534. https://doi.org/10.1037/ser0000213
6.
BirdK. (2014). Peer outdoor support therapy (POST) for Australian contemporary veterans: A review of the literature. Journal of Military and Veterans’ Health, 22(1), 4–23.
7.
BlanchardE. B.Jones-AlexanderJ.BuckleyT. C.FornerisC. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behavioral Research & Therapy, 34(8), 669–673. https://doi.org/10.1016/0005-7967(96)00033-2
8.
BlevinsC. A.WeathersF. W.DavisM. T.WitteT. K.DominoJ. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059
9.
BovinM. J.MarxB. P.WeathersF. W.GallagherM. W.RodriguezP.SchnurrP. P.KeaneT. M. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391. https://doi.org/10.1037/pas0000254
10.
BrittT. W.JenningsK. S.CheungJ. H.PuryC. L. S.ZinzowH. M. (2015). The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel. Psychiatric Rehabilitation Journal, 38(2), 142–149. https://doi.org/10.1037/prj0000120
11.
BrooksA. TLòpezM. MRanucciA.KrumlaufM.WallenG. R. (2017). A qualitative exploration of social support during treatment for severe alcohol use disorder and recovery. Addictive Behaviors Reports, 6, 76–82. https://doi.org/10.1016/j.abrep.2017.08.002
12.
BrownN. B.BruceS. E. (2016). Stigma, career worry, and mental illness symptomatology: Factors influencing treatment-seeking for operation enduring freedom and operation Iraqi freedom soldiers and veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 8(3), 276–283. https://doi.org/10.1037/tra0000082
13.
CacioppoJ. T.AdlerA. B.LesterP. B.McGurkD.ThomasJ. L.ChenH.-Y.CacioppoS. (2015). Building social resilience in soldiers: A double dissociative randomized controlled study. Journal of Personality and Social Psychology, 109(1), 90–105. https://doi.org/10.1037/pspi0000022
14.
CaddickN.SmithB. (2014). The impact of sport and physical activity on the well-being of combat veterans: A systematic review. Psychology of Sport and Exercise, 15(1), 9–18. https://doi.org/10.1016/j.psychsport.2013.09.011
15.
CaddickN.SmithB.PhoenixC. (2015). The effects of surfing and the natural environment on the well-being of combat veterans. Qualitative Health Research, 25(1), 76–86. https://doi.org/10.1177/1049732314549477
16.
CarlsonK. F.NelsonD.OrazemR. J.NugentS.CifuD. X.SayerN. A. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury: Psychiatric diagnoses among war veterans screened for traumatic brain injury. Journal of Traumatic Stress, 23(1), 17–24. https://doi.org/10.1002/jts.20483
17.
CorriganP. W.RaoD. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. The Canadian Journal of Psychiatry, 57(8), 464–469. https://doi.org/10.1177/070674371205700804
18.
CrawfordE. F.ElbogenE. B.WagnerH. R.KudlerH.CalhounP. S.BrancuM.Straits-TrosterK. A. (2015). Surveying treatment preferences in U.S. Iraq-Afghanistan veterans with PTSD symptoms: A step toward veteran-centered care. Journal of Traumatic Stress, 28(2), 118–126. https://doi.org/10.1002/jts.21993
19.
Davis-BermanJ.BermanD.BermanN. D. (2018). Outdoor programs as treatment for posttraumatic stress disorder in veterans: Issues and evidence. Best Practices in Mental Health, 14(2), 9–20.
20.
DicksteinB. D.VogtD. S.HandaS.LitzB. T. (2010). Targeting self-stigma in returning military personnel and veterans: A review of intervention strategies. Military Psychology, 22(2), 224–236. https://doi.org/10.1080/08995600903417399
21.
DietrichZ. C.JoyeS. W.GarciaJ. A. (2015). Natural medicine: Wilderness experience outcomes for combat veterans. Journal of Experiential Education, 38(4), 394–406. https://doi.org/10.1177/1053825915596431
22.
DustinD.BrickerN.AraveJ.WallW.WestG. (2011). The promise of river running as a therapeutic medium for veterans coping with post-traumatic stress disorder. Therapeutic Recreation Journal, 45(4), 326.
23.
DuvallJ.KaplanR. (2014). Enhancing the well-being of veterans using extended group-based nature recreation experiences. Journal of Rehabilitation Research and Development, 51(5), 685–696. https://doi.org/10.1682/JRRD.2013.08.0190
24.
EwertA. (2014). Military veterans and the use of adventure education experiences in natural environments for therapeutic outcomes. Ecopsychology, 6(3), 155–164. https://doi.org/10.1089/eco.2013.0035
25.
EwertA.FrankelJ.Van PuymbroeckM.LuoY.-C. (2010). The impacts of participation in outward bound and military service personnel: The role of experiential training. Journal of Experiential Education, 32(3), 313–316. https://doi.org/10.1177/105382590903200318
26.
EwertA.YoshinoA. (2011). The influence of short-term adventure-based experiences on levels of resilience. Journal of Adventure Education & Outdoor Learning, 11(1), 35–50. https://doi.org/10.1080/14729679.2010.532986
27.
ForsythA.LysaghtR.AikenA.CrammH. (2020). Wilderness adventure program may help combat perceptions of stigma among veterans. Ecopsychology, 12(1), 8–18. https://doi.org/10.1089/eco.2019.0031
28.
FultonJ. J.CalhounP. S.WagnerH. R.SchryA. R.HairL. P.FeelingN.ElbogenE.BeckhamJ. C. (2015). The prevalence of posttraumatic stress disorder in operation enduring freedom/operation Iraqi freedom (OEF/OIF) veterans: A meta-analysis. Journal of Anxiety Disorders, 31, 98–107. https://doi.org/10.1016/j.janxdis.2015.02.003
29.
FuruyashikiA.TabuchiK.NorikoshiK.KobayashiT.OriyamaS. (2019). A comparative study of the physiological and psychological effects of forest bathing (shinrin-yoku) on working age people with and without depressive tendencies. Environmental Health and Preventive Medicine, 24(1), 46–46. https://doi.org/10.1186/s12199-019-0800-1
GelkopfM.Hasson-OhayonI.BikmanM.KravetzS. (2013). Nature adventure rehabilitation for combat-related posttraumatic chronic stress disorder: A randomized control trial. Psychiatry Research, 209(3), 485–493. https://doi.org/10.1016/j.psychres.2013.01.026
32.
GoetterE. M.BuiE.OjserkisR. A.ZakarianR. J.BrendelR. W.SimonN. M. (2015). A systematic review of dropout from psychotherapy for posttraumatic stress disorder among Iraq and Afghanistan combat veterans: Dropout from PTSD treatment in OEF/OIF veterans. Journal of Traumatic Stress, 28(5), 401–409. https://doi.org/10.1002/jts.22038
33.
GreerM.Vin-RavivN. (2019). Outdoor-based therapeutic recreation programs among military veterans with posttraumatic stress disorder: Assessing the evidence. Military Behavioral Health, 7(3), 286–303. https://doi.org/10.1080/21635781.2018.1543063
34.
GromatskyM.SullivanS. R.MitchellE. L.SpearsA. P.EdwardsE. R.GoodmanM. (2021). Feasibility and acceptability of VA CONNECT: Caring for our nation's needs electronically during the COVID-19 transition. Psychiatry Research, 296, 113700. https://doi.org/10.1016/j.psychres.2020.113700
35.
HattieJ.MarshH. W.NeillJ. T.RichardsG. E. (1997). Adventure education and outward bound: Out-of-class experiences that make a lasting difference. Review of Educational Research, 67(1), 43–87. https://doi.org/10.3102/00346543067001043
36.
HenryJ. D.CrawfordJ. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.
37.
HogeC. W.CottingC. A.MesserS. C.McGurkD.CottingD. I.KoffmanR. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351(1), 13–22. https://doi.org/10.1056/NEJMoa040603
38.
HundtN. E.HelmA.SmithT. L.LamkinJ.CullyJ. A.StanleyM. A. (2018). Failure to engage: A qualitative study of veterans who decline evidence-based psychotherapies for PTSD. Psychological Services, 15(4), 536–542. https://doi.org/10.1037/ser0000212
39.
HundtN. E.RobinsonA.ArneyJ.StanleyM. A.CullyJ. A. (2015). Veterans’ perspectives on benefits and drawbacks of peer support for posttraumatic stress disorder. Military Medicine, 180(8), 851–856. https://doi.org/10.7205/MILMED-D-14-00536
KitchinerN. J.LewisC.RobertsN. P.BissonJ. I. (2019). Active duty and exserving military personnel with post-traumatic stress disorder treated with psychological therapies: Systematic review and meta-analysis. European Journal of Psychotraumatology, 10(1), 1684226. https://doi.org/10.1080/20008198.2019.1684226
42.
LeeI.ChoiH.BangK. S.KimS.SongM.LeeB. (2017). Effects of forest therapy on depressive symptoms among adults: A systematic review. International Journal of Environmental Research and Public Health, 14(3), 321. https://doi.org/10.3390/ijerph14030321
43.
LovibondS. H.LovibondP. F. (1995). Manual for the depression anxiety stress scales (2nd Ed.). Psychology Foundation.
44.
LuckstedA.McNultyK.BrayboyL.ForbesC. (2009). Initial evaluation of the peer-to-peer program. Psychiatric Services, 60(2), 250–253. https://doi.org/10.1176/ps.2009.60.2.250
45.
MahoneyM. R.FarmerC.SinclairS.SungS.DehautK.ChungJ. Y. (2020). Utilization of the DSM-5 self-rated level 1 cross-cutting symptom measure-adult to screen healthy volunteers for research studies. Psychiatry Research, 286, 112822. https://doi.org/10.1016/j.psychres.2020.112822
46.
MarchandW. R.KlingerW.BlockK.VerMerrisS.HerrmannT. S.JohnsonC.ShubinE.SheppardS. (2018). Safety and psychological impact of sailing adventure therapy among veterans with substance use disorders. Complementary Therapies in Medicine, 40, 42–47. https://doi.org/10.1016/j.ctim.2018.07.013
47.
MariniC. M.Pless KaiserA.SmithB. N.FioriK. L. (2020). Aging veterans’ mental health and well-being in the context of COVID-19: The importance of social ties during physical distancing. Psychological Trauma, 12(S1), S217–S219. https://doi.org/10.1037/tra0000736
48.
McCoyC. E. (2017). Understanding the intention-to-treat principle in randomized controlled trials. Western Journal of Emergency Medicine, 18(6), 1075. https://doi.org/10.5811/westjem.2017.8.35985
49.
McKeeA. C.RobinsonM. E. (2014). Military-related traumatic brain injury and neurodegeneration. Alzheimer’s & Dementia, 10(3S), S242–S253. https://doi.org/10.1016/j.jalz.2014.04.003
50.
MilanakM. E.GrosD. F.MagruderK. M.Brawman-MintzerO.FruehB. C. (2013). Prevalence and features of generalized anxiety disorder in department of veteran affairs primary care settings. Psychiatry Research, 209(2), 173–179. https://doi.org/10.1016/j.psychres.2013.03.031
51.
MoserD. A.GlausJ.FrangouS.SchechterD. S. (2020). Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data. European Psychiatry, 63(1), E58. https://doi.org/10.1192/j.eurpsy.2020.56
52.
NarrowW. E.ClarkeD. E.KuramotoS. J.KraemerH. C.KupferD. J.GreinerL.RegierD. A. (2013). DSM-5 field trials in the United States and Canada, part III: Development and reliability testing of a cross-cutting symptom assessment for DSM-5. American Journal of Psychiatry, 170(1), 59–70. https://doi.org/10.1176/appi.ajp.2012.12071000
53.
National Academies of Sciences, Engineering, and Medicine (2018). Evaluation of the department of veterans affairs mental health services. The National Academies Press. https://doi.org/10.17226/24915
54.
NilesB. L.PolizziC. P.VoelkelE.WeinsteinE. S.SmidtK.FisherL. M. (2018). Initiation, dropout, and outcome from evidence-based psychotherapies in a VA PTSD outpatient clinic. Psychological Services, 15(4), 496–502. https://doi.org/10.1037/ser0000175
55.
OsmanA.BaggeC. L.GuitierrezP. M.KonickL. C.KooperB. A.BarriosF. X. (2001). The suicidal behaviors questionnaire – revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(5), 443–454. https://doi.org/10.1177/107319110100800409
56.
OsmanA.WongJ. L.BaggeC. L.FreedenthalS.GutierrezP. M.LozanoG. (2012). The depression anxiety stress scales-21 (DASS-21): Further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology, 68(12), 1322–1338. https://doi.org/10.1002/jclp.21908
57.
PietrzakR. H.JohnsonD. C.GoldsteinM. B.MalleyJ. C.RiversA. J.MorganC. A.SouthwickS. M. (2009). Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom: The role of resilience, unit support, and post-deployment social support. Journal of Affective Disorders, 120(1), 188–192. https://doi.org/10.1016/j.jad.2009.04.015
58.
PoulsenD. V.StigsdotterU. K.DjernisD.SideniusU. (2016). ‘Everything just seems much more right in nature’: How veterans with post-traumatic stress disorder experience nature based activities in a forest therapy garden. Health Psychology Open, 3(1), 2055102916637090.
ScheinfeldD. E.RochlenA. B.BuserS. J. (2011). Adventure therapy: A supplementary group therapy approach for men. Psychology of Men & Masculinity, 12(2), 188–194. https://doi.org/10.1037/a0022041
61.
ScheinfeldD. E.RochlenA. B.RussellM. L. (2017). The impact of outward bound programming on psychosocial functioning for male military veterans. Psychology of Men & Masculinity, 18(4), 400–408. https://doi.org/10.1037/men0000066
62.
ShieldsD. M.KuhlD.WestwoodM. J. (2017). Abject masculinity and the military: Articulating a fulcrum of struggle and change. Psychology of Men & Masculinity, 18(3), 215–225. https://doi.org/10.1037/men0000114
63.
SinclairS. J.SiefertC. J.Slavin-MulfordJ. M.SteinM. B.RennaM.BlaisM. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of U.S. Adults. Evaluation & the Health Professions, 35(3), 259–279. https://doi.org/10.1177/0163278711424282
64.
SledgeW. H.LawlessM.SellsD.WielandM.O'ConnellM. J.DavidsonL. (2011). Effectiveness of peer support in reducing readmissions of persons With multiple psychiatric hospitalizations. Psychiatric Services, 62(5), 541–544. https://doi.org/10.1176/ps.62.5.pss6205_0541
65.
StarninoV. R.SullivanW. P.AngelC. T.DavisL. W. (2019). Moral injury, coherence, and spiritual repair. Mental Health, Religion & Culture, 22(1), 99–114. https://doi.org/10.1080/13674676.2019.1589439
TracyK.BurtonM.MiescherA.GalanterM.BabuscioT.FrankforterT.NichC.RounsavilleB. (2012). Mentorship for alcohol problems (MAP): A peer to peer modular intervention for outpatients. Alcohol and Alcoholism (Oxford), 47(1), 42–47. https://doi.org/10.1093/alcalc/agr136
68.
VankaneganC.TuckerA. R.McmillionP.GassM.SpencerL. (2019). Adventure therapy and its impact on the functioning of youth in a community setting. Social Work with Groups, 42(2), 127–141. https://doi.org/10.1080/01609513.2018.1478761
69.
VellaE. J.MilliganB.BennettJ. L. (2013). Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder: A pilot study. Military Medicine, 178(3), 254–260. https://doi.org/10.7205/MILMED-D-12-00308
70.
WeathersF. W.LitzB. T.KeaneT. M.PalmieriP. A.MarxB. P.SchnurrP. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Retrieved fromwww.ptsd.va.gov
71.
WesselmannE. D.IspasD.OlsonM. D.SwerdlikM. E.CaudleN. M. (2018). Does perceived ostracism contribute to mental health concerns among veterans who have been deployed?PLOS ONE, 13(12), e0208438. https://doi.org/10.1371/journal.pone.0208438
72.
WilsonG.HillM.KiernanM. D. (2018). Loneliness and social isolation of military veterans: Systematic narrative review. Occupational Medicine, 68(9), 600–609. https://doi.org/10.1093/occmed/kqy160
