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War Narratives: Veteran Stories, PTSD Effects, and Therapeutic Fly-Fishing

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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.
... 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]. ...
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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).
... One factor, social interaction, is associated with improved psychological health [30] and alleviation of depressive symptoms [28]. In service members, the connections made during sports programs may provide normalization of shared experiences and motivation to improve relationships [31][32][33][34]. Additionally, physical activity that occurs in the natural environment has a larger effect on depressive symptoms than physical activity indoors [35]. ...
... Activity-based therapies provide individuals with the opportunity to exercise, socialize, engage with the natural environment, and experience respite from their psychological symptoms [31,32,34,69]. Study results suggest that surf and hike therapies can facilitate recovery from MDD among service members. ...
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Background Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment. Methods This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session. Results Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015). Limitations The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context. Conclusions Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions. Trial registration Clinical trials registration number NCT03302611; First registered on 05/10/2017.
... Participants enjoyed experiencing the quietness of the canal, which allowed one person to "listen to my music quite happily" 148 and two others described it as "peaceful" 70,135 . Spaces are often experienced and negotiated differently by different sections of the population. ...
... Therapeutic fly-fishing programs for veterans with combat-related disabilities have been found to reduce PTSD symptoms, perceived stress, depressive symptoms and functional impairment and increase leisure satisfaction [69]. Fly-fishing can be meditative with the rhythmic patterns of casting back and forth [70]. ...
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Urban blue spaces are defined as all natural and manmade surface water in urban environments. This paper draws on how the concepts of experienced, symbolic, social, and activity space combine to position urban blue spaces as therapeutic landscapes. We conducted 203 intercept interviews between 12 October 2019 and 10 November 2019. Although safety concerns had health-limiting impacts, interacting with the Glasgow Canal and surrounding landscape was predominantly perceived as health-enhancing. Our findings build on current evidence, which has suggested that urban blue spaces, particularly canals, may foster therapeutic properties, contributing to healthier city environments. Further research is required to understand better the interconnectedness of urban blue spaces and health and how such spaces can be best developed and managed to improve the health outcomes of local populations.
... Similarly, ecotherapeutic programmes involving prolonged time outdoors, meditation, and exercise have been useful for individuals with hearing impairment, brain injury, certain personality disorders, and post-traumatic stress disorder (Luckner, 1989;Thomas, 2004;Dustin et al., 2011;Mowatt & Bennett, 2011;Sibthorp & Jostad, 2014). Although in some cases no significant impact on the clinical picture has been detected (Hyer et al., 1996;Eikenaes et al., 2006;Bettmann, 2007;Hough & Paisly, 2008). ...
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Na zdravljenje z naravo oz. ekoterapijo lahko gledamo kot na eno izmed ekosistemskih storitev, ki jih ponuja narava, pojmujemo pa jo lahko tudi kot pomembno komplementarno metodo v sklopu integrativnega medicinskega pristopa. Koncept ekoterapije v globalnem smislu ni nov, v slovenskem prostoru doslej o tem še ni bilo veliko napisanega, vključevanje različnih ekoterapevtskih metod v naše zdravstvo pa je šele v povojih. Pregled znanstvene literature na temo ekoterapije za obravnavo nekaterih pogostih motenj telesnega in duševnega zdravja je bil izveden v spletni podatkovni bazi PubMed. V izbranih člankih smo pregledali tudi navedene reference in izmed njih izbrali dodatne članke, relevantne za obravnavano temo. Tako smo v analizo vključili skupno 58 člankov. Izbrani članki so bili pregledani in urejeni glede na hierarhijo dokazov ter analizirani glede na obravnavano komponento zdravja oz. klinično indikacijo. Zbrani dokazi kažejo učinkovitost in uporabnost ekoterapevtskih pristopov pri različnih skupinah bolnikov, čeprav je še veliko vrzeli v razumevanju osnovnih fizioloških mehanizmov, ki se odvijajo v človeškem telesu ob različnih ekoterapevtskih intervencijah.
... The social nature of group-based outdoor exercise has been purported to be an active therapeutic ingredient in these interventions that is supported by qualitative research (Caddick et al., 2015;Marshall et al., 2020). Furthermore, quantitative research studies support enhanced social engagement and support in various populations following outdoor exercise interventions (Lundberg et al., 2011;Mowatt and Bennett, 2011;Thompson Coon et al., 2011;Mason and Holt, 2012;Carless et al., 2013;Gelkopf et al., 2013;Hignett et al., 2018;Britton et al., 2020). In military samples, increased social engagement following exercise-based interventions has been linked to improvements in mood (Carless et al., 2013) and perceived reductions in isolation (Marshall et al., 2020). ...
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Introduction Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors. Methods The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention. Results Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition. Conclusion Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain. Clinical trial registration ClinicalTrials.gov, NCT03302611.
... Schachter (1959) furthered this work through the discovery that motivation for social comparison is heightened during times of uncertainty. Social comparisons in illness were then found to be highly important and therapeutic for those with disabilities, illnesses, or life stressors (Dibb & Yardley, 2006;Huebner & Mancini, 2005;Mowatt & Bennett, 2011). For instance, upward positive comparisons can provide hope and inspiration for those seeking to have similar attitudes and outcomes. ...
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Oncology support group leaders may benefit from the narratives of their patients coupled with the use of theory. In the case of this analytic auto-ethnography, professionals will gain insights into the process and value of post-traumatic growth as well as the usefulness of opportunities to socially compare with peer oncology patients. The following is an auto-ethnographical account of the first author’s personal journey with cancer through the review of a journal kept during and after treatment. This approach allowed for both depth and breadth of understanding from a personal experience with illness coupled with the application and understanding of theory applied to that personal journey. Two major themes emerged centered on the value of social comparison opportunities with others that are experiencing cancer as well as the evolution of emotions leading to post traumatic growth. Implications for practice center on developing therapeutic recreation-based oncology support programs using the theoretical lenses of post traumatic growth as well as social comparisons in illness.
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Outdoor recreation provides individuals with the opportunity to experience positive emotional and physiological outcomes, such as enhanced life satisfaction, excitement, improved flexibility, and better cardiovascular health (Zwart & Ewert, 2022). Therapeutic recreation, which contributes to personal development in health preservation and renewal, aids individuals by facilitating adjustment to reality and supporting the establishment of balance in life through the use of leisure activities (Austin & Crawford, 1991). The goal of outdoor therapies is to empower individuals, build resilience, reduce stress, restore focus, develop coping strategies, enhance social skills, resolve trauma, transform behavior, and reduce resistance to change (COTH, 2021). Participants benefit directly from improvements in their health, including physical, emotional, mental, cognitive, social, behavioral, and spiritual well-being (Gass et al., 2020).
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Post-traumatic stress disorder (PTSD) severely disrupts the daily lives of veterans and active duty personnel and may influence their suicidal behaviour. This study provides insight into existing research on PTSD in veterans through a narrative review. Exercise was found to reduce PTSD symptoms in veterans at both psychological and physiological levels, which in turn inhibits their suicidal tendencies. At the psychological level, exercise improved veterans’ Subjective Well-Being and Psychological Well-Being, and at the physiological level, it improved veterans’ brain structure, neuroendocrine system, and immune system. By combing these mechanisms in detail, we hope to provide theoretical support for the implementation of exercise interventions in the treatment of veterans with PTSD. However, it is important to note that the specifics of the exercise program, such as the optimal type, dosage, and duration to alleviate PTSD symptoms, remain unclear and require further research and exploration.
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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.
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