Wilderness as Therapy
A Case for Wilderness as Therapy for the Successful Re-entry of Combat Veterans
For some, there is the added challenge of physical wounds. For others, there are the moral wounds left from making impossible decisions about life and death in the living hell of a war zone. It is hard for us, as civilians, to comprehend the magnitude of the struggles our returning heroes face.
This has led to disturbing trends. Veterans suffer from mental illness at extreme rates. More than a quarter of veterans are diagnosed with at least one form of mental illness or psychological disorder when they return to civilian life (Seal et al., 2007; Trivedi et al., 2015). In the worst cases this can have deadly consequences; 20 veterans commit suicide every day in the United States (Veteran Affairs, 2016).
For some, there is the added challenge of physical wounds. For others, there are the moral wounds left from making impossible decisions about life and death in the living hell of a war zone.
The Veterans Health Administration (VHA) offers conventional therapy services to help veterans dealing with these challenges, but there is not enough capacity to deal with the magnitude of the problem. More creative options are needed, and wilderness therapy holds great promise for helping returning vets find help. It’s a powerful, inexpensive, and underutilized tool that has the potential to change the lives of many.
Wilderness Therapy in Brief
Wilderness therapy is built on two simple premises: spending time in nature is positive to human well-being (Shanahan et al., 2016), and people learn and adjust best when they can experience things for themselves (Fenwick, 2000). The two sections below expand on these premises.
Time in Nature Brings Health and Psychological Benefits
It is well-known that exercise plays an important role in promoting physical and mental health. Physical activity has been linked to lower rates of cardiovascular disease, obesity, diabetes, cancer, and sexual dysfunction (Penedo & Dahn, 2005). Further, exercise appears to have a protective effect against depression and a range of anxiety disorders (Ernst, 2006).
But where we spend our time matters too. Long and frequent visits to wilderness areas lower depression and high blood pressure; people who spend just 30 minutes of green-space time a week are 10% less likely to develop either condition (Shanahan et al., 2016). These benefits come thanks to all five of our senses. It is not only seeing nature that helps, but smelling it, hearing it, touching it, and even tasting it (Franco et al., 2017). Our brains get a boost, too. Nature experiences improve creative thinking (Atchley et al., 2012) and appear to increase working memory performance (Bratman et al., 2015a).
Long and frequent visits to wilderness areas lower depression and high blood pressure; people who spend just 30 minutes of green-space time a week are 10% less likely to develop either condition.
The potential benefits for PTSD sufferers are great. Nature experiences increase our positive feelings while also decreasing negative ones (Bratman et al., 2015a). And time in nature has been shown to decrease rumination, revisiting (often negative) thoughts over and over again (Bratman et al., 2015b). This makes nature especially useful for people dealing with mood swings, anxiety, or depression, as it leads to better overall emotional control. In a study called “Outward Bound Experience” VHA researchers found that participants with less extreme forms of PTSD found significant benefits from the therapy (Hyer et al., 1996).
Therapy Works Best When Participants Shape Their Own Experience
Wilderness therapy is grounded on a long history of psychological research into how the human brain works, and in particular on what psychologists call experiential learning. The main idea behind experiential learning goes back to the mid-20th century: that people learn best by experiencing things for themselves, not just by talking about them (e.g. Dewey, 1938; Piaget, 1964; Vygotsky, 1978). For therapists, this means incorporating interventions like goal-setting, interaction in groups, and hands-on participation into therapy sessions (Hatala, 1992), each of which lets the client play a more direct and active role in their own treatment.
The first applications of experiential learning in therapy—generally called experiential therapy—were in addiction treatment at Bowling Green University. Researchers at the university’s adolescent center proved experiential therapy to be effective in enhancing existing treatment options for addicted youth and in accelerating their recovery (Hatala, 1992). In the years since, experiential therapies have been successfully applied to address a range of conditions, including anxiety and depression (Elliott et al., 2004; Greenberg & Watson, 1998).
What makes experiential therapies so effective is their ability to let participants address their emotions in real-world situations. Past research has shown that heightened emotions are important to making progress in confronting them in therapy (Pos et al., 2017). And the real-world situations that experiential therapies (and wilderness therapy in particular) rely on are especially effective in arousing emotions in participants by getting them out of their comfort zone and moving them more quickly along the path to treatment (Pos et al., 2017).
What makes experiential therapies so effective is their ability to let participants address their emotions in real-world situations. Past research has shown that heightened emotions are important to making progress in confronting them in therapy.
Experiential therapy is a well-developed field today, with a body of scientific literature on best practices and cutting-edge techniques (Elliott et al., 2004). Wilderness therapy fits squarely in this tradition. The first wilderness therapy organizations, stemming from the work of Kurt Hahn and his Outward Bound organization (Miner & Boldt, 1981), is just one application of experiential therapy.
Wilderness therapy is distinguished from other experiential therapies by taking the additional stance that experiencing nature is especially powerful. Project- and task-based activities in nature help participants address their anxiety and emotions in a concrete environment, speeding the treatment process.
Wilderness Therapy is Effective, Inexpensive, and Underused
Wilderness therapy is an effective approach to addressing the central psychological challenges associated with veteran re-entry into civilian life. The research discussed above testifies to that. But what’s more, giving people nature experiences through wilderness therapy is not expensive. On the contrary, even relative to other treatment options, wilderness therapy participants face relatively low costs. In the past few years, the number of helping agencies offering wilderness therapy has skyrocketed to address the magnitude of the challenges our veterans are facing. The Summit Warrior Project is happy to be numbered among them.
R.A. Atchley et al. (2012). “Creativity in the Wild: Improving Creative Reasoning through Immersion in Natural Settings.” PLOS One, 7(12): 1–3.
G.N. Bratman et al. (2015a). “The Benefits of Nature Experience: Improved Affect and Cognition.” Landscape and Urban Planning, 138: 41–50).
G.N. Bratman et al. (2015b). “Nature experience reduces rumination and subgenual prefrontal cortex activation.” PNAS, 112(38): 8567–8572.
J. Dewey. (1997 ). Experience and Education. New York: Simon & Schuster.
R. Elliott et al. (2004). Emotion-Focused Therapy: The Process-Experiential Approach to Change. Washington, DC: American Psychological Association.
Ernst, C. (2006). “Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis?” Journal of Psychiatry and Neuroscience, 32(2): 84-92.
T.J. Fenwick. (2000). “Expanding Conceptions of Experiential Learning: A Review of the Five Contemporary Perspectives on Cognition.” Adult Education Quarterly, 50(4): 243–272.
L.S. Franco et al. (2017). “A Review of the Benefits of Nature Experiences: More Than Meets the Eye.” International Journal of Environmental Research and Public Health, 14: 864–893.
L. Greenberg & J. Watson. (1998). “Experiential Therapy of Depression: Differential Effects of Client-Centered Relationship Conditions and Process Experiential Interventions.” Psychotherapy Research, 8(2): 210–224.
E. Hatala. (1992). “Experiential Learning and Therapy.” In G.M. Hanna, Celebrating Our Tradition Charting Our Future: Proceedings of the International Conference of the Association for Experiential Education. Banff, Canada: Association for Experiential Education.
L. Hyer et al. (1996). “Effects of Outward Bound Experience as an Adjunct to Inpatient PTSD Treatment of War Veterans.” Journal of Clinical Psychology, 52(3): 263–278.
J.L. Miner and J. Boldt. (1981). Outward Bound USA. New York: Morrow.
F.J. Penedo and J.R. Dahn. (2005). “Exercise and well-being: A review of mental and physical benefits associated with physical activity.” Current Opinion in Psychiatry, 18(2): 189–193.
Pew Research Center. (2011). “The Difficult Transition from Military to Civilian Life.” Report by R. Morin.
J. Piaget. (2010 ). “Development and Learning.” In M. Gauvain and M. Cole, Readings on the Development of Children, pps. 25–33. New York: Worth Publishers.
A.E. Pos et al. (2017). “How does client expressed emotional arousal relate to outcome in experiential therapy for depression?” Person-Centered & Experiential Psychotherapies, 16(2): 173–190.
K.H. Seal et al. (2007). “Bringing the War Back Home: Mental Health Disorders Among 103788 US Veterans Returning From Iraq and Afghanistan Seen at Department of Veterans Affairs Facilities.” Arch Intern Med., 167(5): 476–482.
D.F. Shanahan. (2016). “Health Benefits from Nature Experiences Depend on Dose.” Nature Scientific Reports, 6(28551): 1–10.
R.B. Trivedi et al. (2015). “Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans.” American Journal of Public Health, 105(12): 2564-2569.
Veteran Affairs. (2016). “2016 Suicide Data Report.” Retrieved from <www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf>.
L. Vygotsky. (2010 ). “Interaction Between Learning and Development.” In M. Gauvain and M. Cole, Readings on the Development of Children, pps. 34–42. New York: Worth Publishers.
Wiles, T. (2015). “Wilderness as Therapist.” High Country News, Feb. 15.