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Outcomes of a Therapeutic Fly-Fishing Program for Veterans with Combat-Related Disabilities: A Community-Based Rehabilitation Initiative

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Abstract

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.
Vol:.(1234567890)
Community Ment Health J (2017) 53:756–765
DOI 10.1007/s10597-017-0124-9
1 3
ORIGINAL PAPER
Outcomes ofaTherapeutic Fly-Fishing Program forVeterans
withCombat-Related Disabilities: ACommunity-Based
Rehabilitation Initiative
JessieL.Bennett1· JenniferA.Piatt2· MariekeVanPuymbroeck3
Received: 13 September 2016 / Accepted: 7 March 2017 / Published online: 16 March 2017
© Springer Science+Business Media New York 2017
Introduction
The United States has an estimated 21.8million veterans,
with 3.8 million of these veterans reporting a service-
connected disability (Census Bureau 2015). As the United
States continues in the War on Terror, the number of veter-
ans and those requiring rehabilitative services will continue
to increase. Operation Iraqi Freedom (OIF) and Opera-
tion Enduring Freedom (OEF) have been identified as the
most physically and psychologically destructive conflicts in
United States history (Aronson 2005; Warden 2006). Due
to the improvements in protective armor, medical care,
and evacuation procedures in the OIF/OEF wars, nine out
of ten people survive their initial injury in combat (Mea-
gher 2007). In addition, the two signature wounds from
these conflicts are posttraumatic stress (PTS) and traumatic
brain injury (TBI) (Tanielian and Jaycox 2008), and it is
estimated that 20% of OIF/OEF veterans experience PTS,
while 15–20% experience a TBI (Hoge etal. 2004).
PTS is a mental disorder originating from experiencing
a traumatic event (e.g., witnessing a violent act, sustaining
a debilitating physical injury, combat). The symptoms of
PTS cluster into three groups, last for more than 1 month,
and range in severity (American Psychiatric Association
2000). Re-experiencing, one cluster of symptoms, include
flashbacks, hallucinations, or nightmares. Hyperarousal,
another cluster of symptoms, include hyper-vigilance,
heightened startle response, or difficulty falling asleep.
Avoidance/emotional numbing, the last cluster of symp-
toms, include avoiding people or places that are reminders
of the trauma, reduced participation in activities, or pulling
away from loved ones. These symptoms make it difficult
for individuals with PTS to relax, enjoy, and participate in
activities with others due to the fear of triggering symp-
toms (Schiraldi 2009). PTS symptoms can lead to impaired
Abstract The purpose of this study was to examine the
outcomes of a therapeutic fly-fishing program for veter-
ans 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, per-
ceived stress, functional impairment (i.e., work, relation-
ships, physical, and everyday life), increasing self-determi-
nation, and leisure satisfaction. Each research participant
completed pretest, posttest, and 3-month follow-up ques-
tionnaires. 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 symp-
toms 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.
Keywords Fly-fishing· Mental health· Therapeutic
recreation· Veterans
* Jessie L. Bennett
Jessie.bennett@unh.edu
1 University ofNew Hampshire, 4 Library Way, Durham,
NH03824, USA
2 Indiana University, HPER Building 133, 1025 E. Seventh
Street, Bloomington, IN47405-7109, USA
3 Clemson University, 128 McGinty Court, 283 Lehotsky Hall,
Clemson, SC29634-0735, USA
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... Although limited, several studies have provided preliminary quantitative data supporting the positive influence of recreational and adaptive sports programs on psychological symptoms among veterans and service members. Engagement in various recreation programs, with activities such as fly-fishing, kayaking, and surfing, has resulted in reduced depression (Bennett et al., 2017;Crawford, 2016;Lundberg et al., 2011;Rogers et al., 2014;Walter et al., 2019), PTSD (Bennett et al., 2017;Crawford, 2016;Gelkopf et al., 2013;Rogers et al., 2014;Townsend et al., 2018;Vella et al., 2013;Walter et al., 2019), and anxiety symptoms (Townsend et al., 2018;Walter et al., 2019) following program participation. One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). ...
... Although limited, several studies have provided preliminary quantitative data supporting the positive influence of recreational and adaptive sports programs on psychological symptoms among veterans and service members. Engagement in various recreation programs, with activities such as fly-fishing, kayaking, and surfing, has resulted in reduced depression (Bennett et al., 2017;Crawford, 2016;Lundberg et al., 2011;Rogers et al., 2014;Walter et al., 2019), PTSD (Bennett et al., 2017;Crawford, 2016;Gelkopf et al., 2013;Rogers et al., 2014;Townsend et al., 2018;Vella et al., 2013;Walter et al., 2019), and anxiety symptoms (Townsend et al., 2018;Walter et al., 2019) following program participation. One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). ...
... One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). Other related psychosocial constructs have demonstrated similar improvements from pre-to postprogram including affect (Duvall & Kaplan, 2014;Walter et al., 2019), functioning (Bennett et al., 2017;Gelkopf et al., 2013;Townsend et al., 2018), social connectedness (Duvall & Kaplan, 2014), insomnia (Vella et al., 2013), and negative mood (e.g., Lundberg et al., 2011). Taken together, these studies offer initial evidence for psychological benefits following recreational and adaptive sports programs. ...
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Introduction Recreational and adaptive sports programs are often provided to veterans with a variety of psychological and physical conditions; however, limited data exist regarding the outcomes of these programs. The current study evaluated the psychological outcomes of attendees of the 2017 and 2018 National Veterans Summer Sports Clinic (NVSSC) in San Diego, California. Method Seventy-four veteran participants completed self-report assessments before and after the week-long program, as well as 3 months following program completion. In addition, participants completed brief assessments before and after each of the daily recreational activities (cycling, surfing, sailing, kayaking, and archery/pickleball). Results Findings showed that depression, anxiety, social functioning, and positive and negative affect significantly improved from pre-to postprogram, but returned to baseline levels at 3-month follow-up. Within sessions, depression/anxiety and positive affect significantly improved each day, with no differences in the amount of change across days. Depression/anxiety and positive affect also significantly improved within each activity, regardless of order, with no differences in the magnitude of change across activities. Conclusions The NVSSC produced significant changes in psychological outcomes among veteran participants within immediate and short-term time periods; however, gains were not maintained longer-term. Follow-on engagement in exercise activities is likely necessary for continued benefit; future research, including studies with control groups, would provide greater clarity.
... 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). Although this line of research is in its relative infancy, initial results and findings suggest that RT deserves continued investigation to evaluate its efficacy and implementation within the VA, DoD, and community-based RT settings serving Veterans and military personnel and behavioral health conditions (Townsend et al., 2018). ...
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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 delineation of the conceptual framework for the current study was built upon the ICF (10). Essential domains of health in relation to PTSD as conceptualized using a community-based inclusive development approach were delineated based on the literature (3,9,(13)(14)(15)(16)(17)(18)(19). ...
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Background Social unrest affects people's health and well-being. People's health-related needs during social unrest are concerns in both research and clinical practice. This study aimed to build and test a framework to describe and understand the health status and needs of people with post-traumatic stress disorder (PTSD) during social unrest. Methods This study was a cross-sectional survey. A total of 460 people who had experienced post-traumatic distress as a result of the social unrest in 2019 and 2020 were included. A conceptual model comprised four essential areas, namely posttraumatic distress symptoms, participation restrictions, perceived stigma and functional disability, was built from literature. Part 1 validated four instruments that evaluate and define the factor structure of these four areas, In Part II, structural equation modeling was used to test and validate a combined model. Results Factors underlying the four areas were defined. Analysis using structural equation modeling confirmed a best fit of the model. PTSD symptoms, perceived stigma and participation restriction during social unrest contributed significantly to functional disability; PTSD symptoms exerted a direct effect on participation restriction and perceived stigma; and the effect of PTSD symptoms on functional disability was mediated through its influence on perceived stigma during social unrest. Conclusions A community-based inclusive approach is essential to understand the holistic needs of people with PTSD during social unrest. To improve health and well-being in addition to evaluating mental health impacts, considering interactions with the rapid change and stressful social environment is essential.
... 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. ...
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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.
... These positive social interactions and emotional ties were also crucial for supporting veterans overcoming a pervasive sense of social isolation associated with mental or physical conditions [42]. Some studies which investigated the long-term effects of different alternative activities indicated that positive post-intervention effect was not sustained over time (e.g., 2, 3 or 6 months post-intervention) [49][50][51]. Nevertheless, current findings suggested that continuous participation steadily enhanced veterans' subjective well-being and in turn led to improvements in many aspects of their personal and professional lives. ...
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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.
... One environmental context that has received less attention is water-based physical activity, with researchers suggesting that swimming and other water-based activities (e.g., kayaking, surfing) may provide superior benefits for the promotion of human well-being due to greater affordances (Foley and Kistemann, 2015;Araujo et al., 2019). These activities have heightened the psychological benefits (e.g., reduced anxiety, depression, and perceived stress, increased positive affect, and increased quality of life) associated with exercise and nature among US war veterans (Lundberg et al., 2011;Bennett et al., 2017;Walter et al., 2019). Further, there is increasing evidence suggesting that participation in action and adventure sports, such as surfing, is meaningful and life-enhancing (Immonen et al., 2017). ...
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... [43][44][45][46][47][48] A number of studies have documented benefits from green exercise in Veteran populations and among individuals with PTSD. [45][46][47][48][49][50][51][52][53][54][55] The specific interventions studied (from care farming to river rafting), dose/duration and inclusion of additional, explicit therapeutic components vary substantially among studies. A 2019 systematic review that examined evidence for the proposed additive effects of exercise in the presence of nature observed some benefits (eg, lower perceived exertion and enjoyment). ...
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... Such interventions, provided by charitable organizations, are usually free of charge and may provide an opportunity to conduct expensive outdoor activities that participants would otherwise find unaffordable. For example, physical activity interventions in the form of fly-fishing (Bennett et al., 2017), horse riding (Gehrke et al., 2018), and outdoor recreation-based health and wellness programs (Townsend et al., 2018) may, as activities in themselves, provide incentives to participate. Practitioners may find the use of such activity-based incentives beneficial in the promotion of physical activity among WIS veterans. ...
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... It is important to mention that many anglers consider fly fishing to be a spiritual activity, referring to nature as something sacred to them [84]. Fly fishing can therefore be described as recreational but also personal identity activity, and has been so for at least two thousand years [85] with demonstrated healing benefits with PTSD patients and other traumas [86,87]. ...
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