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Veterans’ perceptions of benefits and important program components of a therapeutic fly-fishing program.
Abstract
While evidence is emerging for therapeutic recreation programs for veterans with combat-related disabilities, minimal research has been done to understand participants’ perceptions of these programs. The intent of this study was to examine the perceptions of veterans with combat-related disabilities and their significant others following participation in a therapeutic fly-fishing program. Six focus group discussions were conducted and the constant comparison method of analysis was used to discover the two primary themes of Perceived Benefits and Important Program Components. Based on these findings, implications for therapeutic recreation practice are included.
... Seven qualitative studies had adequate quality [59][60][61][62][63][64][65] and were downgraded due to limitations in study design, sampling strategy, data collection, analysis, presenting conclusions, verifcation, and refexivity procedures. ...
... Ten studies were in military hospitals, GP practices, paediatric, and rehabilitation clinics [59-61, 64, 65, 68, 70, 72, 73, 74]. Veterans with hearing impairment, anxiety, depression, TBI, and PTSD were prescribed with fy-fshing by recreational therapists through signposting or direct referral [59,64,74]. Veterans with PTSD were directly referred to running, boating, kayaking, and paddling by a team of recreational therapist, nurse, psychologist, and social worker [60]. ...
... Participants had improvements in their physical activity [70,72], body weight [70], and mobility [61]. Others had improved symptoms of depression, anxiety, and PTSD; decreased loneliness and stress [65,72,73,74]; better sleep quality [74]; increased relaxation [64,72,74]; and self-efcacy [59,64,65]. Others had decreased intake of antidepressants and pain medications [60,61]. ...
Nature-based social prescribing such as “blue prescription” promotes public health and health improvement of individuals with long-term health conditions. However, there is limited evidence explaining the relationship of contexts, mechanisms, and outcomes of implementing blue prescription programmes (BPPs) in health and social care settings that could inform policy and practice. We conducted a systematic realist review by searching PubMed, Web of Science, PsycInfo, Scopus, MEDLINE, and CINAHL for articles published in English between January 2000 and June 2022 about health and social care professionals providing referral to or prescription of blue space activities (e.g., swimming, fishing, surfing, etc.) with health-related outcomes. Components and descriptions of BPP implementation were extracted and used to develop themes of contextual factors used to develop programme theories and a logic model demonstrating the mechanisms of BPP implementation. Sixteen studies with adequate to strong quality were included from 8,619 records. After participating in BPPs referred to or prescribed by health and social care professionals, service users had improvements in their physical, cognitive (mental), social health, and proenvironmental knowledge. Service user-related contextual factors were referral information, free equipment, transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multistakeholder collaboration, financing, and adequate service providers. Programme theories on service user enrolment, engagement, adherence, communication protocols, and programme sustainability explain the mechanisms of BPP implementation. BPPs could promote health and wellbeing if contextual factors and programme theories associated with service users’ characteristics and programme delivery are considered in the design, delivery, and evaluation of BPPs. Our study was registered with PROSPERO (CRD42020170660).
... • 269 and OIF deployment. Further, we designed this study to allow us to gain insight into combat veteran's perceptions of their regular, ongoing leisure, rather than focusing speci cally on responses to a particular intervention, such as sports programs and camps (e.g., Hawkins et al., 2011;Lundberg et al., 2011) or recreation activities such as y-shing (e.g., Bennett et al., 2014b;Mowatt & Bennett, 2011;Price et al., 2015) and river running (Dustin et al., 2011). To some, outdoor recreation and physical activity is leisure; to others, leisure encompasses other pursuits that can occur each day, such as having a cup of a favorite hot drink with one's spouse at a local co ee shop. is research study allows us to explore and increase our understanding of combat veterans' perceptions relative to leisure and the complex interpersonal dynamics in uenced by military life and combat deployment. ...
... Although writers have identi ed the restorative bene ts of nature (e.g., Kaplan, 1995;Kaplan & Kaplan, 1989;Mayer, McPherson Frantz, Bruehlman-Senecal, & Dolliver, 2009), only recently have studies been conducted examining e ects of outdoor recreation programs on veterans, especially with those identi ed as having PTSD. Positive results have been reported associated with such activities as y-shing (Bennett et al., 2014b;Mowatt & Bennett, 2011;Vella, Milligan, & Bennett, 2013) and river running (Dustin et al., 2011). Findings from this study regarding the theme e outdoors gets me o the grid are consistent with the perspective presented in Price et al. (2015) as they state, " ere I stood in the middle of nature... Gone were the images of the dead and dying… I was completely in the moment surrounded by a gentle breeze with the boat rocking beneath my feet… I felt peace" (p. ...
... Researchers have identi ed bene ts associated with speci c therapeutic programs for veterans; however, there is a dearth of research examining outcomes associated with their leisure experiences. One exception is a study conducted by Bennett et al. (2014b) who used focus group discussions with veterans and found support for the value of being in nature; the study identi ed the importance of the physical setting of the natural environment as a valued program component. One veteran participating in the Bennett et al. (2014b) study described the e ect of being in nature in the following way: "I think for some of us this is kinda like our element, you know. ...
Framed within the Theory of Planned Behavior, researchers examined the relationship between military life, deployment, and leisure engagement. Following a constant comparative analytic framework, we transcribed and coded semi-structured, in-depth individual interviews with 10 combat veterans of Operations Enduring Freedom and Iraqi Freedom and member check inter-views. Twenty-five themes emerged from the interviews, 10 of which were unique to the combat veterans. Military life both facilitated leisure by creating opportunities and providing resources, as well as constrained it by creating impermanence and imposing structure. Themes emerged about negative influences of deployment on veterans, and about a general sense of appreciation during reintegration post-deployment. There appears to be dialectical tension between constraints and facilitators of leisure. Researchers found the theory of planned behavior to be useful in interpreting results and exploring strategies to improve the well-being of combat veterans.
... The relationship between spending time in nature and well-being has been demonstrated throughout the literature (Annerstedt & Währborg, 2011;Capaldi et al., 2014;Hartig et al., 2014). Additionally, in previous adventure-based therapy studies, data have indicated that spending time with individuals from a similar background can promote open communication, which may help to establish social recognition (van der Velden et al., 2019) through validation, acceptance, or acknowledgement of experiences by peers (Bird, 2015;Bennett et al., 2014b;Burke & Utley, 2013). Through utilising peer-facilitation and a group format, social support and social recognition are key components of the Trojan's Trek program, and this may help contribute to improved mental health outcomes. ...
... Other components of the Trojan's Trek program including a focus on skills building and participation in adventurous activities, may have also contributed to positive psychosocial outcomes. For example, learning new psychological and physical skills has previously been reported to increase confidence and provide an outlet for coping with various difficulties (Bennett et al., 2014b). Correspondingly, this study demonstrated increased self-efficacy at posttrek and follow-up compared to pre-trek which may be associated with positive health outcomes (Cusack et al., 2019). ...
... These mental health benefits are often stronger in fishing relative to other leisure activities (Pretty et al. 2007). Recreational fishing can also provide a restorative measure for the social integration of people with physical and mental disorders or disabilities (Freudenberg and Arlinghaus 2009;Bennett et al. 2014). Thus, recreational fishers not only personally benefit from contact with aquatic spaces through their fishing activity, but the activity can act as a catalyst for social reform, inclusion, and integration. ...
Recreational fisheries involve an intimate connection between people, individual fish, and the environment. Recreational fishers and their health crucially depend on healthy fish and ecosystems. Similarly, fish and ecosystems can be impacted by the activities of people including recreational fishers. Thus, amplified by the global interest in recreational fishing, we posit that recreational fishing is particularly suited as an empirical system to explore a One Health perspective, with a goal of creating pathways to better manage such socio-ecological systems for the benefit of people, fish, and the environment. Although zoonoses are uncommon in fishes, fish can carry pathogens, biotoxins, or contaminants that are harmful to people. When captured and released, fish can experience stress and injuries that may promote pathogen development. Similarly, when humans contribute to environmental degradation, not only are fish impacted but so are the humans that depend on them for nutrition, livelihoods, culture, and well-being. Failure to embrace the One Health perspective for recreational fisheries has the potential to negatively impact the health of fish, fisheries, people, society, and the aquatic environment—especially important since these complex social–ecological systems are undergoing rapid change.
... Despite the popularity of recreational angling and its potential utility to address the rising levels of mental health problems in the UK [9,10], there is limited peer-reviewed research on the status of mental health and well-being related to recreational angling. Previous research has found that angling can be a form of stress relief [11,12], can improve social relations [13], and appears to be an accessible form of physical activity for those with disabilities [14], older adults, and individuals recovering from illness [15]. In addition, angling could be a useful modality for engaging more males to be physically active as it was highlighted that they are under-represented in most physical activity intervention studies [16]. ...
Exposure to aquatic environments (i.e., blue spaces) can lead to improved mental health and well-being. One meaningful way to spend time in blue spaces is through recreational angling, although limited scientific literature exists on this topic. The present study aims to examine the relationship between recreational angling and mental health and well-being in a sample of UK adult male anglers. A cross-sectional online survey asked questions about demographic characteristics, participation in recreational angling, physical activity levels, diagnosis of psychiatric disorders, and mental health and well-being. Relationships between angling status (i.e., how often and how long participants angled for) and mental health variables were determined using regression models adjusted for age. In total, 1752 participants completed the survey. The regression models found that those who took part in angling more regularly had reduced odds of having depression (p < 0.001), schizophrenia (p = 0.001), suicidal thoughts (p < 0.001), and deliberately self-harming (p = 0.012), in addition to having a higher mental well-being and lower symptoms of depression and anxiety compared to those taking part in angling less frequently. In general, the findings suggest that encouraging frequent participation in recreational angling could be a dual method strategy for promoting relaxation and positive mental health, as well as encouraging increased levels of physical activity in those with mental health issues.
... It is important to emphasize that no studies examined the modalities specifically in the context of the RT process, and a limited number of studies employed modalities that would be appropriate within the RT scope of practice. While the body of literature on RT and psychological trauma in general has increased (Adams & Page, 2020;Bennett et al., 2014;De Vries et al., 2017;Hawkins & Townsend, 2016;Mikal-Flynn et al., 2018) much of this literature is theoretical, or focused specifically on military-service posttraumatic stress disorders. Research specific to RT and IPV is still emerging. ...
The purpose of this scoping review was to examine the extant research on modalities that fall within the recreational therapy scope of practice. A systematic search of the literature was conducted following the PRISMA-ScR guidelines for scoping reviews. The original database search yielded 706 studies (with duplicates removed) and 22 studies were included in the final review. The scoping review included peer-reviewed intervention studies for survivors of intimate partner violence (IPV), with the purpose of addressing the following research questions: RQ1: What recreational therapy modalities have been used and researched for treating survivors of IPV? RQ2: What are the primary health outcomes measured for of recreational therapy modalities for survivors of IPV? RQ3: What are the biggest gaps within the research? Types of modalities used included mind-body interventions, creative expression, and physically active leisure. Outcomes measured were primarily depression, anxiety, and post-traumatic stress disorder symptoms. Future research directions include the need for interventions to be evaluated when run specifically in the recreational therapy context, the need for evaluation of current practices with intimate partner violence and trauma-informed care, and the need for more diverse sampling to establish culturally affirming interventions for people who identify as LGBTQIA+ or racial/ethnic minorities.
... It is important to emphasize that no studies examined the modalities specifically in the context of the RT process, and a limited number of studies employed modalities that would be appropriate within the RT scope of practice. While the body of literature on RT and psychological trauma in general has increased (Adams & Page, 2020;Bennett et al., 2014;De Vries et al., 2017;Hawkins & Townsend, 2016;Mikal-Flynn et al., 2018) much of this literature is theoretical, or focused specifically on military-service posttraumatic stress disorders. Research specific to RT and IPV is still emerging. ...
Evidence suggests physical activity (PA) improves sleep of typical children but benefits for children with autism spectrum disorders (ASD) are not established. We examined the effects of PA, particularly swimming, on the sleep behaviors of three children with ASD using objective and parent-report measures. Children participated in eight weeks of a specialized swim program. Parents completed sleep and behavior measures at the beginning and end of the eight-week program. Parents also completed a sleep log for one week while their child slept on a sleep sensor. Results showed variable response to the Sensory Enhanced Aquatics intervention. One child’s sleep and behavior were stable and/or improved, one child’s outcomes were variable, and one child’s sleep worsened. The sleep sensor revealed children fell asleep more quickly after swimming, but increased times out of bed for one child. Recreational therapists should use caution when recommending physical activity to improve sleep with this population and carefully monitor outcomes.
... The Angling Trust resource hub proposes that fishing is an inclusive activity which can be used to relieve long term health and wellbeing conditions as part of social prescribing initiatives [19]. Previous research has found fishing can be a form of stress relief [20][21][22], improve social relations [23,24] and is an accessible form of physical activity for older adults and people recovering from illness [15]. However, it is important to examine if there are significant differences in fishing participation patterns (i.e., frequency, duration, type of fishing, and fishing match engagement), between people with disabilities and people without disabilities. ...
Green social prescribing, which includes the referral of patients to nature-based activities, could exacerbate inequalities between people with disabilities and people without. Research suggests fishing could be more inclusive relative to other outdoor sports. To understand if fishing is an inclusive sport, and the potential benefits and barriers to prescribing fishing, the present study compared participation, motivators and barriers to fishing, between anglers with and without disabilities. UK adults were invited to participate in an online survey. Chi-square tests examined differences between anglers with and without disabilities regarding the type of fishing anglers engaged in, the frequency of fishing, the length of time spent fishing, motivators for fishing and barriers to fishing. Among 1799 anglers (97.5% male), 292 (16.2%) anglers reported having a disability. Most anglers with disabilities were over 55 years old (56.5%). There was no difference in fishing participation, or motivators for fishing, between anglers with and without disabilities; however, anglers with disabilities were more likely to report ‘costs’, ‘lack of transport’ and ‘having no one to go with them’ as barriers. Overall, there appeared to be no differences in fishing participation between anglers with versus without disabilities, although additional barriers to participation may exist.
... A small number of published articles highlight fly-fishing as a form of recreation therapy that appears to aid in alleviating symptoms, assist with stress management and instil a positive future focus among combat veterans diagnosed with PTSD. 7,8,9 Despite being discussed as a therapy for PTSD, a complex mental disorder, no researched form of therapeutic fly-fishing appears to be facilitated by licensed mental health professionals. Likewise, there seems to be no research that integrates evidencebased treatment for PTSD with therapeutic flyfishing. ...
Therapeutic fly-fishing is a nature-based intervention that is experiencing increased use to adjunct mental health treatment with current and former uniformed service professionals. While promising, literature suggesting the use of therapeutic fly-fishing with evidenced-based psychotherapy for posttraumatic stress disorder (PTSD), or any other mode of psychotherapy, does not appear to exist. This raises several questions regarding the ethics and fidelity of current uses of fly-fishing during a person's mental health care. Because of these concerns, the author explores literature surrounding the use of therapeutic fly-fishing for combat-related PTSD and offers a way to integrate fly-fishing directly within a well-researched and widely used PTSD treatment modality: Eye Movement Desensitization and Reprocessing (EMDR) therapy. The distinct phases of EMDR are demonstrated through a treatment protocol, followed by implementation suggestions for interested mental health professionals, organisations and other treatment providers worldwide. The author hopes that clinicians and treatment programs will better understand the importance of using trained psychotherapists to facilitate trauma treatment-with the model presented as one way to integrate the worlds of nature-based treatment and evidence-based practice easily. Finally, this paper serves as a call for research into the concept of Therapeutic Fly-Fishing with EMDR (TF-EMDR) and other such integrations of nature-and evidence-based PTSD treatment approaches.
... There are numerous efficacious programs for veterans that utilize nature-based interventions already. These programs include horticulture therapy (Detweiler et al., 2015;Lehmann et al., 2018), fishing (Bennett et al., 2017;Bennett et al., 2014), and sailing interventions (Gelkopf et al., 2013;Marchand et al., 2018). In one study, veterans participating in horticulture therapy showed lower cortisol levels and depressive symptoms compared with veterans participating in other occupational therapy activities such as ceramic painting, flower arranging, or leather belt construction (Detweiler et al., 2015). ...
Objectives:
Duration, frequency, and intensity of nature exposure link to different physical and psychological benefits. The present study aimed to determine how time outdoors affected military veterans' posttraumatic stress disorder (PTSD) symptomology during PTSD treatment.
Method:
Hypotheses regarding time outdoors and the effect of program duration on PTSD symptoms were examined using multilevel models. The authors hypothesized that hours outdoors, both within- and between-persons, would predict reduced PTSD symptomology, program duration would predict reduced PTSD symptomology, and that hours outdoors and program duration would be significant when accounting for the other.
Results:
The present study found that time outdoors correlated with participants' decreased PTSD symptomology: the more time participants spent outdoors, the greater the reduction in their PTSD symptoms.
Conclusion:
The effect of time outdoors was significant within-person, not between persons, suggesting that nature exposure may be used as an adjunct to traditional mental health treatment where exposure or dosage should be person-specific.
... Still utilized today as an intervention in many veteran's affairs treatment groups, the calmness and serene atmosphere of fly-fishing paired with the pride in catching a fish has been found to provide benefits to those who participate. Through distraction, focus, relaxation, and overcoming challenges and fears, veterans identified fly fishing as a potential coping mechanism for their PTSD (Bennett, Van Puymbroeck, Piatt & Rydell, 2014). Narrative accounts of participation in a therapeutic fly-fishing program revealed themes of camaraderie, reflection, and coping with regret as outcomes of involvement (Mowatt & Bennet, 2011;Price, Lundberg, Zabriskie & Barney, 2015). ...
Developing research, anecdotal evidence and a growing focus on non-pharmacological interventions for veterans with post-traumatic stress support the use equine-therapy as a therapeutic outlet; however, programmatic factors that contribute to veteran's desire to attend such programs are under-investigated. Furthermore, evaluative processes in equine therapy for this particular population are scare and vary greatly from program to program. The use of the Importance-Performance Analysis (IPA) tool when applied to social services yields direct, applicable feedback of program success and relevancy. In this study, interviews with the selected population informed the evaluation tool used to assess the importance, and subsequent performance, of various program factors in a national military-specific equine therapy program. Results of this study provided insight into key factors being sought after in similar equine therapy programs to inform the development and maintenance of programs serving the veteran population.
... Hignett et al. [(Hignett et al., 2017), p. 12] found that 'Surprisingly, there was no direct improvement in connectedness to nature or the beach as a result of the study overall'. Bennett et al. (Bennett et al., 2014) referred to the importance of the physical setting for restoration, including the sound of the river but did not provide any details on the quality or characteristics of the natural setting. Hayhurst et al. (Hayhurst et al., 2015) did not consider nature connectedness, but included a weather rating scale as part of a mix of measures assessing the effect of sail training on the resilience of young people. ...
There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.
... The impact of specific types of leisure on posttraumatic growth has also been explored. Research on adapted sports (Bennett, Townsend, Van Puymbroeck, & Gillette, 2014;Crawford, Gayman, & Tracey, 2014;Lundberg, Bennett, & Smith, 2011;Tasiemski, Kennedy, Gardner, & Taylor, 2005) and nature-based outdoor recreation activities such as fly fishing, hunting, river running, surfing, and other adventure activities (Bennett, Van Puymbroeck, Piatt, & Rydell, 2014;Caddick, Smith, & Phoenix, 2015;Dustin, Bricker, Arave, Wall, & Wendth, 2011;Hawkins, Townsend, & Garth, 2016;Rogers, Loy, & Brown-Bochicchio, 2016;Vella, Milligan, & Bennett, 2013) showed that these leisure activities played a significant role in posttraumatic growth. Caddick and Smith (2014) conducted a meta-analysis of several studies on posttraumatic growth through sport and outdoor recreation and found, across all studies, participation in these activities had a positive and lasting impact on subjective and psychological well-being, motivation, and posttraumatic growth. ...
... fly-fishing, river running, kayaking) has been associated with various beneficial outcomes for injured service members. These benefits include, but are not limited to, improved mood states (Lundberg, Bennett, & Smith, 2011), decreases in PTS, depression, and anxiety symptoms (Bennett, Piatt, & Van Puymbroeck, 2017;Caddick & Smith, 2014;Dustin, Bricker, Arave, Wall, & Wendt, 2011;Scherer, Gade, & Yancosek, 2014), increases in motivation, social support and camaraderie (Bennett, Van Puymbroeck, Piatt, & Rydell, 2014;Caddick & Smith, 2014;Duvall & Kaplan, 2013;Hawkins, Cory, & Crowe, 2011;Mowatt & Bennett, 2011;Rogers, Loy, & Brown-Bochicchio, 2016;Sporner et al., 2009), improved perceived health and perception of disability (Hawkins et al., 2011), increased marital satisfaction (Bennett, Lundberg, Zabriskie, & Eggett, 2014), improved psychosocial well-being (Vella, Milligan, & Bennett, 2013), and community reintegration (Hawkins et al., 2015). ...
Recreation-based health and wellness programs for military service members are currently a topic of significant interest in the recreation and health industries. This study examined the health outcomes associated with participation in Project Sanctuary, a week-long recreation-based health and wellness family retreat for injured military service members. Linear mixed modeling was used to examine changes in health outcomes over four time points, and considered multiple covariates. One-hundred twenty-seven service members participated. Statistically significant reductions in total scores for Post-Traumatic Stress Disorder Checklist (PCL) measures were found, as well as notable improvements in Depression, Anxiety, and Atress Scale (DASS) and mental health functioning immediately following the intervention. No changes were found in physical health functioning. Trends demonstrated that participants maintained the positive psychological health changes over the three and six month time points. Veteran's Administration (VA) disability rate was the only significant covariate associated with health outcome change across timepoints. Implications for future practice and research are discussed in the article.
... Who were my participants? The Discussion Themes Four discussion (research) themes from the thematic analysis The 'disabled' individual, their motivations and their enjoyment The 'disabled' individual, their motivations and their enjoyment (Aitchison, 2000Aitchison, , 2003Aitchison, , 2009 Blackshaw, 2010; Carr, 2002; Crouch, 1999 Crouch, , 2000 Dickinson and Robbins, 2009; Eichhorn et al, 2013; Hannam and Knox, 2010; Hibbert et al, 2013; McCabe, 2005; Obrador Pons, 2003; Ryan, 2003) The disabled should be seen as individuals (Aitchison, 2001; Bennett et al, 2014; Fullagar, , 2012 Kovic and Schultz-Krohn, 2013; Kunstler and Daly, 2010; Mayer and Anderson, 2014 Kovic and Schultz-Krohn, 2013; Robertson and Long, 2008) Leisure, the 'self' and the therapeutic benefits Conclusion Disability is not one thing. This brings major implications to how we look at disability within the leisure spectrum (leisure, sport, tourism, events, hospitality …. ...
Posttraumatic stress disorder (PTSD) diagnoses are on the rise, yet there is a lack of research on alternative methods of treatments. Recommendations for exercise and physical activity are common in the treatment of depression and anxiety (Dunn et al., 2005) and, due to similarities in symptoms, may be valuable for individuals with PTSD as well. To our knowledge, no study has been conducted interviewing individuals with PTSD about their present and past exercise habits and how these have affected their symptoms. The purpose of the present study was to understand different approaches to exercise and physical activity for individuals with PTSD and how exercise can ameliorate their associated symptoms. Participants were recruited through social media, flyers, and word of mouth. Ten participants with self-reported PTSD were interviewed about their exercise and physical activity habits and how it affects their symptoms. Findings included two themes: Exercise and Well-Being. Each theme was comprised of additional categories. Using these findings, a theoretical framework for exercise programming for this population is suggested. All participants reported that exercise/physical activity helped reduce the severity of their symptoms associated with PTSD. *This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Through all times, scholars interpreted the Quranic verses of water by emphasising on the essential role of water upon the physical formation of plants. This study aimed to extend this interpretation from a behavioural science background. Mix methods were used, systematic literature review and integrative analysis. With the blue-space theory, It concluded that water does not have a role in building the physical-form only. But, also the spiritual-creation. God mentioned in the Quran that water brings everything alive; it seemed that it was not limited to the physical form of a human, as mentioned by scholars. But also the spiritual form. Keywords: Blue-space; Water; Quran; Quality Of Life. eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i14.2195
The objective of this systematic review was to identify the rehabilitation programs used by armed conflict veterans and their approach to the Paralympic movement. The PRISMA protocol was followed by searching the following databases: ISI Web of Science ™, Scopus, SPORTDiscus and Periodical Capes. Of the 666 initial results found, 8 were selected from 2004 to 2018. Only 7% of the studies identified programs that had women. The average age of veterans attended ranged from 18 to 59 years. The main activities carried out by the rehabilitation programs involved sports and recreation programs, competitive sport programs and programs with outdoor activities. Other initiatives were also identified, reinforcing the need to combat the social isolation imposed by the acquired injury, to promote well-being and the development of an active and healthy life, whether in the social field or even in the sports field (athletic identity). In the case of veterans of armed conflict, the feeling that service to the country is not over is present, instead of defending the country in war, now represent the nation on the tracks, courts and fields of international sport, a different battlefield.
Canine-assisted interventions have emerged as an increasingly popular means to engage and assist veterans coping with military-associated trauma responses. The present study evaluates the use of a 14-week service dog training program for these trauma-impacted veterans. The service dog program guides veterans in small group cohorts on how to train their own dog to be their personal service animal. All 71 veterans participating in this investigation had been diagnosed with PTSD . Fifty-five veterans (77%) finished the entire 14-week program and took all pretests and posttests. Compared to pretest scores, participants reported significant decreases in self-disturbance, posttraumatic stress, externalization, and somatization after completing the program. Participants experienced significant reductions in a broad scope of psychological impacts associated with their PTSD including interpersonal difficulties and suicidality. Findings provide evidence that service dog training programs may be an effective therapeutic alternative to traditional approaches that PTSD -impacted veterans are willing to utilize.
Each data source contributes to the overall understanding of the phenomenon, and can be weaved together to deepen and enhance that understanding (Baxter and Jack 2008). [...]the case study approach applied here was both exploratory and descriptive, and applied multiple data source collections, including direct observation during the events, qualitative interviews with event organizers and support staff, quantitative surveys with event participants, and archival information about the events. Allen, chief of the NPS HPHP program, which collaborated in an advisory capacity during the event planning and development, stated, "Music at the Monument was designed intentionally to bring together youth and veterans and their families in this park atmosphere for health and healing." [...]Haley and others considered music to be an additional mechanism within the broader context of the HPHP initiative to create positive health outcomes. According to Haley, more than simply providing direct benefits to veterans and youth, event goals also aimed to indirectly serve these populations by increasing awareness of issues veterans and service members face, such as PTSD, reintegration following deployment, seeking and obtaining education and employment, and combating homelessness. According to Music at the Monument organizers and supporters, as well as NPS HPHP staff, the planning process should start early, with particular consider- ation for building partnerships, seeking funding, obtaining permits, scheduling performers or participant attractions, and avoiding dates that may conflict with potentially competing events.
The purpose of this study was to examine the outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities. A total of 40 veterans participated in the 4-day therapeutic fly-fishing program and this study. The outcomes examined included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional impairment (i.e., work, relationships, physical, and everyday life), increasing self-determination, and leisure satisfaction. Each research participant completed pretest, posttest, and 3-month follow-up questionnaires. Repeated measures MANOVA and ANOVA were conducted to examine the differences between the three time points on each outcomes. The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up. These results highlight the use of therapeutic recreation programming for veterans with disabilities as a holistic approach to treatment and recovery.
Previous research has recognized the need to better understand the experience of female veterans and their adjustment upon returning home, especially considering that a growing number of veterans are women. Their stories, particularly as they relate to combat and the associated wounds of war, largely remain untold. Therefore, the purpose of this project was to employ a theoretical sample from Grounded Theory methodology to determine if similar recreation opportunity structure patterns existed in the use of outdoor sports and recreation for a sample of female veterans, as had been found in previous research with individuals with physical disabilities. The investigation revealed findings that substantiated the way in which recreation opportunity structures provide novel environments where physical skills and emotional capacities could be developed through (a) establishing social networks and bonding, (b) facilitating a sense of freedom from constraints, and (c) by providing opportunities to redefine or recapture their identity.
Nature-based interventions have long been used as a strengths-based approach to aid in positive human development. The use of these interventions is underpinned by a strong knowledge base; however, little information exists with regard to the use of nature-based recreation therapy (RT) interventions as a strengths-based approach for working with military service members. This article provides an overview of typical treatment options for injured service members, explores the theoretical and conceptual foundations surrounding nature-based programming, reviews existing research literature on the use of nature with veterans, and offers a conceptual model for nature-based RT interventions for military service members. Recommendations and implications for practice and research are discussed.
Working within a framework of narratology (narrative theory), this study is a gathering and analysis of 67 letters of veterans as they concluded their participation in a therapeutic fly-fishing program in Dutch John, UT along the Green River. The program worked with female and male veterans with confirmed diagnoses of posttraumatic stress disorder that served overseas in each branch of the Armed Forces (except the Coast Guard) during Operation New Dawn, Operation Iraqi Freedom, Operation Enduring Freedom, Operation Desert Storm, Operation Desert Shield, and Vietnam. The collected narratives were analyzed based on a three-part process of reading: Explication; Explanation; and, Exploration. This analysis approach presented a uniquely constructed perspective of veterans as they participated in treatment. The study systematically analyzed the stories to present a narrative and four themes that would inform and guide future empirical studies on the realities of veterans, program experiences, and perspective on treatment.
A qualitative investigation of the illness experience of injured elite collegiate athletes illustrates the relevance of narrative to clinical practice. The article demonstrates a method for systematically assessing illness narratives and provides evidence that story patterns of clinical significance result. By adding a narrative approach to the biomedical one, it is argued, both the psyche and the pathophysiology of the sufferer can be the subjects of healing.
Negative life events, such as the unexpected loss of a loved one, a disabling accident or a natural disaster, are inevitably distressing and disruptive. Coping with and recovering from such events generally requires a variety of personal and social resources. Previous research on leisure and coping has suggested that leisure orientations and relationships can be important in reducing the likelihood that stress becomes debilitating in some way. But the results of that work are equivocal and generally do not distinguish leisure resources that make events less stressful from those that are employed in coping with stressful events after they occur. This analysis examines the leisure-coping literature as well as recent work on the dynamics of coping and the impact of pleasant events and concludes in identifying four distinguishable functions of leisure that relate to self-protection, self-restoration, and personal transformation.
In an effort to be responsive to the often complicated, multilayered family issues of people living with posttraumatic stress disorder, many well-intentioned therapists create a variety of family-based services--only to be discouraged when participation is very low. In the current project, 10 Vietnam veterans with posttraumatic stress disorder who were active in a stress recovery program and their live-in female partners completed separate semistructured interviews. Interviews explored each couple's perceptions about family participation in mental health treatment, including potential benefits and barriers. Findings revealed 9 key themes that elucidate many of the important issues in family engagement. The authors make 7 recommendations about how clinicians can overcome some of the possible obstacles to involving families in care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to examine whether and how leisure coping significantly influences immediate coping outcomes (operationalized by coping effectiveness, satisfaction with coping outcomes, and stress reduction), mental health, and psychological well-being, above and beyond the impact of general coping (not directly associated with leisure). University students participated in the research. Overall, the unique contributions of leisure coping were statistically significant for predicting all of the three outcome indicators. Leisure coping beliefs (dispositional coping resources developed through involvement in leisure) significantly contributed to greater immediate coping outcomes, lower mental ill-health, and higher psychological well-being. The other primary dimension of leisure coping, namely, leisure coping strategies (situation-specific behaviours or cognitions available through leisure pursuits), was found to significantly predict greater immediate coping outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The goals of rehabilitation after major limb loss include not only functional restoration but also a return to a high quality of life (QOL). Few studies have identified which factors are associated with QOL in veterans and servicemembers with combat-associated major limb loss. We enrolled Vietnam and Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans and servicemembers in a national survey on prosthetic device use. In the Vietnam group, multivariate analysis found multiple limb loss (adjusted odds ratio [aOR] = 3.1, 95% confidence interval [CI] = 1.57-6.02) and satisfaction with current prostheses (aOR = 1.2, 95% CI = 1.05-1.38) are associated with better overall QOL, while a higher amputation impact rank (aOR = 0.66, 95% CI = 0.59-0.74) and depression (aOR = 0.21, 95% CI = 0.08-0.54) are associated with worse overall QOL. In the OIF/OEF group, three factors are significantly associated with worse overall QOL: combat-associated head injury (aOR = 0.78, 95% CI = 0.61-0.99), combat-associated injury to the nonamputated limb (aOR = 0.71, 95% CI = 0.57-0.88), and assistance needed in daily living (aOR = 0.12, 95% CI = 0.02-0.72). Improving satisfaction with prosthetic devices, improving mental health care, and treating other combat-associated injuries may significantly improve the overall QOL for these veterans and servicemembers.
The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.
The importance of human-animal bonds has been documented throughout history, across cultures, and in recent research. However, attachments with companion animals have been undervalued and even pathologized in the field of mental health. This article briefly surveys the evolution of human-animal bonds, reviews research on their health and mental health benefits, and examines their profound relational significance across the life course. Finally, the emerging field of animal-assisted interventions is described, noting applications in hospital and eldercare settings, and in innovative school, prison, farm, and community programs. The aim of this overview paper is to stimulate more attention to these vital bonds in systems-oriented theory, practice, and research. A companion paper in this issue focuses on the role of pets and relational dynamics in family systems and family therapy (Walsh, 2009a).
The present literature review conceptualises landscape as a health resource that promotes physical, mental, and social well-being. Different health-promoting landscape characteristics are discussed.
This article is based on a scoping study which represents a special kind of qualitative literature review. Over 120 studies have been reviewed in a five-step-procedure, resulting in a heuristic device.
A set of meaningful pathways that link landscape and health have been identified. Landscapes have the potential to promote mental well-being through attention restoration, stress reduction, and the evocation of positive emotions; physical well-being through the promotion of physical activity in daily life as well as leisure time and through walkable environments; and social well-being through social integration, social engagement and participation, and through social support and security.
This scoping study allows us to systematically describe the potential of landscape as a resource for physical, mental and social well-being. A heuristic framework is presented that can be applied in future studies, facilitating systematic and focused research approaches and informing practical public health interventions.
Previous research has suggested that leisure assists in coping with and adjusting to negative life events in at least four different ways: by being diverting, by generating hope, by restoring some aspects of self, and by affording a context for personal transformation. An assault to the brain, whether due to a stroke, chronic disease, injury or trauma, would be such an event and would likely by served by leisure in the same way. This paper reviews the supporting evidence regarding the value and utility of leisure in coping with and adjusting to living with a disability. The concept of posttraumatic growth is then examined and related research is reviewed with particular attention to the relevance of leisure. Finally, considerations are offered for incorporating leisure as an aspect of treatment and care for those working in neurorehabilitation settings.
A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occurring model for traumatic exposure that is often associated with memory impairment.
We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group.
The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors--even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD.
The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of traumatic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired--or even old--traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.
As mental health recovery gains traction, many people have put forward varying definitions. Few attempts have been made to create a dimensional analysis of the recovery literature that assesses the growing consensus about what recovery is or what its definition should entail. This paper incorporates an ecological framework to take the individual's life context into account while emphasizing both the reestablishment of one's mental health (i.e., first order change) and the mitigation of the oppressive nature of barriers imposed by the greater community (i.e., second order change) so that people may experience social integration and community inclusion.
An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood.
We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries.
Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache.
Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.
This paper will attempt to illustrate the use of a kaleidoscope metaphor as a template for the organization and analysis of qualitative research data. It will provide a brief overview of the constant comparison method, examining such processes as categorization, comparison, inductive analysis, and refinement of data bits and categories. Graphic representations of our metaphoric kaleidoscope will be strategically interspersed throughout this paper.
Although most military personnel returning from recent deployments will readjust successfully to life in the United States, a significant minority will exhibit PTSD or some other psychiatric disorder. Practitioners should routinely inquire about war-zone trauma and associated symptoms when conducting psychiatric assessments. Treatment should be initiated as soon as possible, not only to ameliorate PTSD symptoms but also to forestall the later development of comorbid psychiatric and/or medical disorders and to prevent interpersonal or vocational functional impairment. If evidence-based practices are utilized, complete remission can be achieved in 30%-50% of cases of PTSD, and partial improvement can be expected with most patients. We can all look forward to future break-throughs that will improve our capacity to help people with PTSD.
Airmen serving in the U.S. Air Force have made significant contributions to the overall war efforts in Afghanistan and Iraq. Deployment, combat exposure, and subsequent combat-related mental health issues can have effects that extended beyond the airmen to the family. The primary aim of this study was to determine the path through which such effects occur within the context of risk and protective factors. The risk factors identified in this study were: deployment length and frequency and psychological symptomology. The construct of social support was also examined as an identified protective factor. This study examined the relationships between all of these variables using regression, moderation and mediation. Method: Secondary data were obtained from the Air Force Community Assessment, a large-scale, anonymous survey fielded in the spring of 2008 from a stratified random sample of active duty airmen. Results: Long and repeated deployments slightly increased the likelihood of the presence of both posttraumatic and depressive symptoms (.6% of variance explained in the variable deployment length and .5% in variable deployment frequency, p
Several ways in which leisure can help people cope with stress have been proposed and studied, but a comprehensive set of leisure stress-coping types or dimensions has not been identified. The purpose of this article is to propose a new conceptualization of leisure stress coping and identify different ways in which leisure may contribute to people's ability to cope with stress. The dimensions of leisure stress coping proposed (e.g., a self-determination disposition, leisure empowerment, leisure companionship, leisure palliative coping) are based on an integrative review of social psychological research and leisure research on stress and coping. As an initial attempt to explore a potential of the conceptual model, we developed new scales for measuring the dimensions of leisure stress coping. The examination of internal consistency and confirmatory factor analysis of the scales provided preliminary evidence for the scales' reliability and validity. Implications for future research regarding the conceptual model and the stress-coping scales are discussed.
Drawing on the author's multi-method research on the viability of specific ecotherapy practitioner training and curriculum design, this paper debates how the use of ecotherapeutic approaches can provide a two-pronged system to achieve both individual health (at micro level) and public and environment health outcomes (at macro level). The research sought the views of service users, practitioners and educationalists through use of interviews, focus groups, a nominal group, and an ethnographic case study group. This research raised other considerations: namely, that people seeking personal recovery also, through stewardship of green spaces, may achieve unanticipated social capital and natural capital outcomes and thereby meet current multi-disciplinary policy targets. This added social value has not been previously considered as an important dimension in people's well-being and recovery from ill health or social exclusion. Such outcomes emerge from the idea of green spaces becoming a ‘product’ delivered to the community by people whose pursuit of personal recovery also directly contributes to improved public mental health.
There is growing interest in positive aspects of the stress process, including positive outcomes of stress and antecedents that dispose individuals to appraise stressful situations more as a challenge than as a threat. Less attention has been given to the adaptational significance of positive emotions during stress or to the coping processes that sustain positive emotions. We review evidence for the occurrence of positive emotions under conditions of stress, discuss the functional role that positive emotions play under such conditions, and present three types of coping that are associated with positive emotion during chronic stress. These findings point to new research questions about the role of positive emotions during stress and the nature of the coping processes that generate these positive emotions.
Purpose:
Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post-traumatic stress disorder (PTSD).
Methods:
Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods.
Results:
Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms.
Conclusions:
The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.
This report presents difficult-to-find statistics regarding U.S. military casualties in Operation New Dawn (OND), Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF, Afghanistan), including those concerning post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), amputations, evacuations, and the demographics of casualties. Some of these statistics are publicly available at the Department of Defense's (DOD's) website, while others have been obtained through contact with experts at DOD.
Background:
Posttraumatic stress disorder (PTSD) is a chronic, debilitating anxiety disorder that is highly prevalent among U.S. military veterans. Yoga, defined to include physical postures (asana) and mindfulness and meditation, is being increasingly used as an adjunctive treatment for PTSD and other psychological disorders. No research or administrative data have detailed the use of these services in Department of Veterans Affairs' (VA) 170 PTSD treatment programs.
Methods:
One hundred twenty-five program coordinators or designated staff completed an 81-item survey of their program's use of complementary and alternative medicine modalities in the past year. This report describes data from a subset of 30 questions used to assess the prevalence, nature, and context of the use of yoga, mindfulness, and meditation other than mindfulness practices.
Results:
Results revealed that these practices are widely offered in VA specialized PTSD treatment programs and that there is great variability in the context and nature of how they are delivered.
Conclusions:
Understanding how yoga is used by these programs may inform ongoing efforts to define and distinguish yoga therapy as a respected therapeutic discipline and to create patient-centered care models that mindfully fulfill the unmet needs of individuals with mental health issues, including veterans with PTSD.
Background:
A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population.
Methods:
A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support.
Results:
Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure.
Conclusions:
These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans.
The constant comparative method (CCM) together with theoretical sampling constitutethe core of qualitative analysis in the grounded theory approach and in other types ofqualitative research. Since the application of the method remains rather unclear, researchers do not know how to `go about' the CCM in their research practice. This study contributes to a purposeful approach of the CCM in order to systematize the analysis process and to increase the traceability and verification of the analyses. The step by step approach is derived from and illustrated with an empirical study into the experience of multiple sclerosis (MS) by patients and their spousal care providers. In this study five different steps were distinguished on the basis of four criteria: (1) the data involved and the overall analysis activities, (2) the aim, (3) the results and (4) the questions asked. It is concluded that systematization of qualitative analysis results from the researcher using a sound plan for conducting CCM regarding these four aspects.
Directed attention plays an important role in human information processing; its fatigue, in turn, has far-reaching consequences. Attention Restoration Theory provides an analysis of the kinds of experiences that lead to recovery from such fatigue. Natural environments turn out to be particularly rich in the characteristics necessary for restorative experiences. An integrative framework is proposed that places both directed attention and stress in the larger context of human-environment relationships.
Self-determination theory (SDT) maintains that an understanding of human motivation requires a consideration of innate psychological needs for competence, autonomy, and relatedness. We discuss the SDT concept of needs as it relates to previous need theories, emphasizing that needs specify the necessary conditions for psychological growth, integrity, and well-being. This concept of needs leads to the hypotheses that different regulatory processes underlying goal pursuits are differentially associated with effective functioning and well-being and also that different goal contents have different relations to the quality of behavior and mental health, specifically because different regulatory processes and different goal contents are associated with differing degrees of need satisfaction. Social contexts and individual differences that support satisfaction of the basic needs facilitate natural growth processes including intrinsically motivated behavior and integration of extrinsic motivations, whereas those that forestall autonomy, competence, or relatedness are associated with poorer motivation, performance, and well-being. We also discuss the relation of the psychological needs to cultural values, evolutionary processes, and other contemporary motivation theories.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
The wars in Iraq and Afghanistan-Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF-have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.
Exposure to reminders of trauma underlies the theory and practice of most treatments for post-traumatic stress disorder (PTSD), yet exposure may not be the sole important treatment mechanism. Interpersonal features of PTSD influence its onset, chronicity, and possibly its treatment. The authors review interpersonal factors in PTSD, including the critical but underrecognized role of social support as both protective posttrauma and as a mechanism of recovery. They discuss interpersonal psychotherapy (IPT) as an alternative treatment for PTSD and present encouraging findings from two initial studies. Highlighting the potential importance of attachment and interpersonal relationships, the authors propose a mechanism to explain why improving relationships may ameliorate PTSD symptoms.
At a single U.S. Army installation from 1997 to 2005, domestic violence volunteer victim advocates assisted 1,417 clients in 1,380 physical and 301 verbal abuse incidents. The average soldier and spouse population during this time was slightly less than 10,000. Advocates went to the scene of the incident to talk to the victim to ensure that her/his rights were observed, to determine whether the victim was safe, was referred to the hospital social work service for assessment, and had the information necessary to negotiate the complex military and community systems. The advocate inquired of the victim the characteristics of the incident and risk factors in the history of the relationship. In many incidents, risk factors indicated a history of serious violence by the offender including an increasing level of violence, stalking, and assaults. Frequently reported precipitants of incidents were relationship problems, jealously, and infidelity. Spouses often reported previous attempts to leave and to get help. Advocates play an important role in gathering information uniquely available at the scene that can be useful in planning education and intervention programs to reduce domestic violence in the Army, the military services, and civilian society.
The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.
Psychological tests were administered to 24 participants of an inpatient posttraumatic stress disorder (PTSD) treatment program both immediately before and following completion of treatment. Responses were compared to a treatment/wait list comparison group composed of 24 subjects awaiting entry into the program. All treatment/wait list comparison group subjects received weekly PTSD outpatient group therapy. Significant improvements were found in the inpatient treatment group in areas of hopelessness, feelings of guilt and shame, loneliness, and emotional expressiveness. Other indices of psychological functional, including interpersonal skills, gender role stress, anxiety, anger, and PTSD symptomatology did not change significantly in response to treatment. No positive changes in any area of psychological function occurred in the treatment/wait list comparison group. Implications for PTSD and areas of future research are discussed.
There is a paucity of studies on Outward Bound Experiences (OBE) with adult psychiatric populations and, more notably, with trauma victims. This study evaluates the efficacy of OBE as an adjunct to specialized inpatient PTSD treatment with survivors of chronic combat-related PTSD (N = 219) at two Veterans Administration Medical Centers. On several measures of PTSD and general adaptation, results showed that the five-day OBE did not differ from standard treatment of PTSD survivors. Two other issues were addressed: identification of successful and non-successful subjects as a result of OBE, and exploration of objective versus subjective measures among this chronic group. Finally, as a post-study analysis, inferred curative components of the OBE were discussed as each appeared to impact on the participants.
This study examines the association between posttraumatic stress disorder (PTSD), in terms of the three main symptom clusters (intrusion, avoidance and arousal), and the self-report of family functioning of Vietnam veterans and the self-report of family functioning of their partners. A second objective was to determine if depression, anger and alcohol abuse mediated between PTSD symptoms and family functioning.
Vietnam veterans and their partners completed a series of questionnaires as part of their participation in the inpatient and outpatient PTSD treatment program, in the Veterans Psychiatry Unit, at the Austin and Repatriation Hospital.
Data from 270 veterans and partners were used in the final analyses. The PTSD subscales were initially correlated with family functioning for veterans and family functioning for partners. Then two path diagrams were constructed and analyzed using the statistical program AMOS to test for mediating effects between PTSD symptoms and family functioning. For veterans there were significant initial correlations with all three subscales of the PTSD measure. In the path analysis when the mediating variables were included only the avoidance subscale of the PTSD measure remained directly associated with family functioning. The arousal PTSD subscale was mediated by anger. The measures of depression and anger were significantly associated with poor family functioning and the anger and the avoidance subscales were significantly associated with depression. In the second set of analyses conducted on data from partners, the PTSD symptoms of avoidance and arousal were initially correlated with family functioning. When the test for mediation was conducted none of the PTSD subscales remained associated with partners' self-report of family functioning. Posttraumatic stress disorder arousal and alcohol abuse were mediated by anger for partners' self-report of family functioning.
Posttraumatic stress disorder symptoms of avoidance for veterans, and comorbid symptoms of anger and depression for veterans, and anger on its own for partners appear to be important in the self-report of family functioning. These findings suggest that veterans and their partners have similar difficulties as couples with distressed relationships in the community.
As of November 9, 2004, a total of 10,153 service members had suffered war injuries. Dr. Atul Gawande writes about a military medical system that has made fundamental and effective changes in the strategies and systems of battle care.
Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.
Combat exposure is associated with increased rates of mental health problems such as post-traumatic stress disorder, depression, and anxiety when Soldiers return home. Another important health consequence of combat exposure involves the potential for increased risk-taking propensity and unsafe behavior among returning service members. Survey responses regarding 37 different combat experiences were collected from 1252 US Army Soldiers immediately upon return home from combat deployment during Operation Iraqi Freedom. A second survey that included the Evaluation of Risks Scale (EVAR) and questions about recent risky behavior was administered to these same Soldiers 3 months after the initial post-deployment survey. Combat experiences were reduced to seven factors using principal components analysis and used to predict post-deployment risk-propensity scores. Although effect sizes were small, specific combat experiences, including greater exposure to violent combat, killing another person, and contact with high levels of human trauma, were predictive of greater risk-taking propensity after homecoming. Greater exposure to these combat experiences was also predictive of actual risk-related behaviors in the preceding month, including more frequent and greater quantities of alcohol use and increased verbal and physical aggression toward others. Exposure to violent combat, human trauma, and having direct responsibility for taking the life of another person may alter an individual's perceived threshold of invincibility and slightly increase the propensity to engage in risky behavior upon returning home after wartime deployment. Findings highlight the importance of education and counseling for returning service members to mitigate the public health consequences of elevated risk-propensity associated with combat exposure.
Returning wars' wounded, injured, and ill: A reference handbook
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