Content uploaded by Rasul A. Mowatt
Author content
All content in this area was uploaded by Rasul A. Mowatt on Feb 04, 2021
Content may be subject to copyright.
War Narratives: Veteran Stories, PTSD Effects, and Therapeutic Fly-Fishing
Abstract
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]. ...
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. ...
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]. ...
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.
... Recreation activities and experiences such as naturebased or outdoor pursuits, sports, fitness, cultural arts, music, mind-body activities (i.e., yoga, meditation), and social activities, among others, are recognized for their therapeutic benefits and potential for instilling personal agency, and facilitating coping and healing among a variety of populations with disabilities, including those with behavioral health conditions (Benedek & Wynn, 2016;Iwasaki et al., 2005;Kearney et al., 2012;Kleiber et al., 2002Kleiber et al., , 2008Walsh, 2011). Recreational therapy interventions have shown promise in improving symptom management, strengthening social relationships, supporting physical health, and enhancing community reintegration among Veteran and military populations (Bennett et al., 2014;Craig et al., 2020;Lundberg, Bennett, et al., 2011;Lundberg, Taniguchi, et al., 2011;Mowatt & Bennett, 2011;Thompson et al., 2016;Vella et al., 2013;Wheeler et al., 2020). Further, there is a growing evidence-base for the efficacy of RT interventions in facilitating functional outcomes, coping, and posttraumatic growth for Veteran and military populations with PTSD and comorbid behavioral health conditions (Bennett et al., 2017;Duvall & Kaplan, 2013;Hawkins et al., 2016;Price et al., 2015;Rogers et al., 2016). ...
... Results from this study suggest that Northeast Passage's C-BRT™ program may be able to reduce these negative impacts and increase QOL, participation in the community and happiness among this population. This aligns with previous research examining the outcomes of community-based recreational therapy programs for Veterans with various disabilities (Bennett et al., 2014;Craig et al., 2020;Lundberg, Bennett, et al., 2011;Lundberg, Taniguchi, et al., 2011;Mowatt & Bennett, 2011;Thompson et al., 2016;Vella et al., 2013;Wheeler et al., 2020). ...
Identifying evidenced-based interventions that improve health outcomes for Veterans with behavioral health disorders is a national priority. Thus, this study examined the outcomes of a community-based recreational therapy (RT) program focused on health promotion for Veterans with behavioral health disorders. Fifty-five Veterans with disabilities completed pretest and posttest questionnaires that assessed Quality of Life (QOL), Participation, and Happiness. Significant improvements were found in Overall QOL, Environmental QOL, Psychological QOL, QOL Rated, Satisfaction with Health, Participation, and Happiness. Younger age and female gender were significantly associated with improved Overall QOL. Factors significantly associated with improved Environmental QOL included younger age and non-Caucasian race. Older age was significantly associated with improved Participation. Female gender was positively associated with improved Happiness, while being divorced/separated was negatively associated with Happiness. These results have important implications for the use and expansion of community-based RT health promotion programs for Veterans with behavioral health disorders.
... 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). ...
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. ...
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.
... For example, fly fishing has been found to promote camaraderie, reflection, and coping with regret, as well as improvements in attentiveness, mood, depression, anxiety, and stress. 26,27 Outcomes from adventure or challenge-based programs have shown increases in coping skills and self-efficacy, especially when programing was coupled with the emotional support from fellow service members. [28][29][30][31][32] Additionally, the controlled practice of deep-breathing and meditation in yoga has contributed to a reduction in post-traumatic stress disorder (PTSD) symptoms. ...
Equine-assisted therapy is being increasingly used as a therapeutic modality for veterans who have been injured during military service; however, little research has examined the quality of equine programs, especially from a veteran’s perspective. In this study, an Importance-Performance Analysis (IPA) was used to provide direct, applicable feedback of program quality and relevancy to a military-specific equine-assisted therapy program. Veteran participants in the program informed the IPA tool used to assess the importance and performance of various program factors. Results provided insight into the quality of the equine-assisted therapy program factors, shedding light on those specifically being sought by veterans. Some of the key program factors included the horse being central to the program, the program catering to veteran needs, and sessions being held in a relaxed setting. Full results may be considered for other veteran-serving equine-assisted therapy programs.
... Being part of a team was perceived as increasing veterans' sense of belonging, selfesteem, social and communication skills. Similar studies also highlighted the importance of team spirit in group alternative activities, especially when social support took the form of camaraderie with fellow veterans [47,48] and developed on the basis of their shared experiences [39]. Having a "shared" physical injury or disability helped veterans to connect with and inspire each other [39]. ...
Purpose:
Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans' subjective well-being and in turn determine if it improves the quality of their lives.
Methods:
This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis.
Results/conclusions:
Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans' physical and mental health.Implications for RehabilitationCompetitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans.Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle.Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans' physical and mental health while facilitating transition to civilian life.
... In addition, various studies have been conducted on military recrea-S INTERNATIONAL JOURNAL OF SPORT MANAGEMENT tion and its impact across bases worldwide including opportunities for outdoor recreation, fitness, military sports, outdoor excursions and clinical therapeutic recreation. Most of this research attests to the advantages of such alternative sources of treatment (Caddick & Smith, 2014;Hawkins et al., 2016;Hunt et al., 2014;Lundberg et al., 2016;Miller et al., 2014;Mowatt & Bennett, 2011;Rogers et al. 2016;Taff et al., 2016). This relatively recent approach to supporting military members is tempered by the fact that communities, including military communities across North America, are witnessing a decline in community services participation (e.g., recreation, sport). ...
Sense of community is believed to be greater when individuals are actively engaged in their communities. Attaining a sense of community for individuals working in the Canadian military can be challenging for a number of reasons including the high percentage of personnel who live off base, frequent moves, and continual deployments. Complicating these living conditions are concerns around alarming rates of increased mental health issues which encompass depression, suicidal thoughts, and traumatic brain injuries. Participating in recreation and sport activities can provide opportunities for engagement, thereby fostering a sense of community. However, scholars have noted that communities, including military communities across North America, are seeing a decline in community services participation (e.g., recreation, sport) which negatively impacts sense of community. The purpose of this research was to study the relationship between participation in recreational opportunities and sense of community in a Canadian military setting. Questionnaires were administered at a Canadian Armed Forces Base. Results indicated that three sense of community factors: voluntary action, common interest, and administrative consideration, predicted recreation participation among Canadian Armed Forces members. The results create a unique discussion for scholars and military personnel regarding the relationship among each of these factors, as these factors are all related to personal and group cohesion. Future research should explore sense of community in other military settings to further understand the role of recreation and sense of community. (133-150)
Due to the marginalizing effects of mental illness, the stories of individuals in early recovery from various mental health diagnoses are often invalidated. To address this concern, complementary modalities (e.g., massage therapy, naturopathy, arts-based therapy, horticulture therapy) have emerged alongside the fields of therapeutic recreation, psychotherapy, and outdoor-based practices. Less is known about how social/community approaches to practice are used within in-patient care settings to complement more traditional modalities (i.e., cognitive behaviour therapy (CBT), talk-based therapy, trauma exposure therapy, pharmaceutical medication etc.). The current research project aimed to understand individuals’ experiences and reflections of engaging in an outdoor experiential workshop while seeking in-patient care for post-traumatic stress disorder and substance-use disorder. Narrative inquiry was the methodological approach we used to illuminate the voice in the cracks (Jackson & Mazzei, 2005), voices that are often left out of dominant medical discourses, to be heard. Focus groups and in-depth semi-structured narrative life-experience interviews were used to story individuals’ reflections of early recovery while participating in an outdoor experiential workshop beyond the conventional boundaries and structures of medicine-focused in-patient care.
ResearchGate has not been able to resolve any references for this publication.