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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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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.
Community Ment Health J (2017) 53:756–765
DOI 10.1007/s10597-017-0124-9
1 3
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
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
Keywords Fly-fishing· Mental health· Therapeutic
recreation· Veterans
* Jessie L. Bennett
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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... These results suggest that both Surf Therapy and Hike Therapy can provide benefits beyond the reduction of depression symptoms in service members with MDD, and that Surf Therapy may provide enhanced immediate effects on positive affect and pain. Results were consistent with prior research reporting postprogram improvements in psychological and functional outcomes for outdoor exercise and recreation programs (Lundberg et al., 2011;Duvall and Kaplan, 2014;Rogers et al., 2014;Bennett et al., 2017;Crawford, 2017;Townsend et al., 2018;Walter et al., 2019Walter et al., , 2021Walter et al., , 2023. Though, in the current study, improvements in negative affect and social functioning were contingent on the number of sessions attended, with a greater number of sessions yielding stronger effects. ...
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... Furthermore, physical benefits such as increased mobility, strength, and aerobic capacity (Addison et al., 2019;Briggs and Oursler, 2021), weight loss and increased fitness (Brittain et al., 2022), and reductions in the symptomology of mental health conditions such as post-traumatic stress disorder (PTSD) have been identified in veterans with disabilities, traumatic injuries or chronic illness (Walter et al., 2021). Outdoor and nature-based activities, such as fishing, water and snow sports, riding, and archery, have been found to provide a wide range of benefits to veterans, including facilitating positive mood and establishing new coping methods through motivation and challenge (Bennett et al., 2017;Craig et al., 2020), opportunities for social bonding (Lundberg et al., 2016), as well as reductions in PTSD symptomology (Gelkopf et al., 2013;Crawford, 2016;Wheeler et al., 2020). ...
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Purpose The benefits of sports and exercise to the lives and rehabilitative journeys of military veterans with disabilities is increasingly well-documented but veteran sporting events remain underexplored. Addressing this topic, the current article seeks to provide insight into the health and well-being of Team Ukraine during a 5-week preparatory camp in the UK before attendance at the 2022 Warrior Games. Materials and methods Two surveys were run, one toward the beginning and one toward the end of the camp. Eighteen of the 55 veterans and serving personnel (with disability), support staff, and family members in attendance responded to both surveys. Data on sleep, mood, and competition-related emotions, motivations for participation and perceived support were gathered. Data were analysed descriptively, and sleep, mood, and competition-related emotion responses were categorised to explore improvements, maintenance, or worsening in these areas. Results and conclusion Sleep, mood, and competition-related emotions were relatively stable, although sleep duration was low, and there were some increases in daytime dysfunction, anxiety, nervousness, and feeling tense. Family was the most important source of support and representation of one’s country and raising awareness of Ukraine’s circumstances were the most important motivational factors. Findings offer insight into not only the health and well-being experiences associated with participation in this disabled veteran sporting event, but also the important role played by this event in meeting collective goals relating to this unique time in Ukraine’s history.
... Additional passive activities, such as fishing, took place on the canal. 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.
... 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.
We examine the relationship of home food procurement (HFP) during COVID-19 to emotional eating and stress using a statewide representative survey (n = 600) in Vermont. Women and people with a job change since COVID-19 were more likely to experience higher stress and emotional eating. Engaging in HFP, especially gardening, is associated with less emotional eating. However, people who fished, hunted, or canned more since the pandemic began were more likely to eat for emotional reasons and experience higher stress. These results suggest that gardening, even during a pandemic, may contribute to stress reduction, more so than other nature-based food production activities.
Outdoor activity benefits veterans’ sense of well-being, coping skills and affective experience while improving physical and mental health. Understanding military veterans’ motivation for and barriers to outdoor recreation allows healthcare providers to design interventions that help veterans achieve their healthcare objectives through outdoor activity, which may enhance treatment engagement and clinical outcomes. Veterans were surveyed about their reasons for and barriers to participation in outdoor recreational activities. Veterans’ motivations for engaging in their preferred outdoor activities were: 1. keep fit and healthy, 2. meet new people, 3. learn something new, 4. feel in harmony with nature, and 5. achieve spiritual fulfilment. Veterans with mobility challenges more frequently pursued outdoor activities when it was important for them to keep fit and healthy. Veterans without mobility challenges more frequently pursued outdoor activities when it was important for them to: 1. experience challenge and excitement, 2. meet new people, 3. learn something new, 4. feel harmony with nature, and 5. achieve spiritual fulfilment. The most common barriers to outdoor recreation were health problems, crowded facilities, family time, and feeling too tired. Veterans’ motivations for outdoor recreation were stronger drivers of their actual outdoor recreation participation than barriers to that activity.
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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.
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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.
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.
I: Background.- 1. An Introduction.- 2. Conceptualizations of Intrinsic Motivation and Self-Determination.- II: Self-Determination Theory.- 3. Cognitive Evaluation Theory: Perceived Causality and Perceived Competence.- 4. Cognitive Evaluation Theory: Interpersonal Communication and Intrapersonal Regulation.- 5. Toward an Organismic Integration Theory: Motivation and Development.- 6. Causality Orientations Theory: Personality Influences on Motivation.- III: Alternative Approaches.- 7. Operant and Attributional Theories.- 8. Information-Processing Theories.- IV: Applications and Implications.- 9. Education.- 10. Psychotherapy.- 11. Work.- 12. Sports.- References.- Author Index.
This paper reviews the literature on the social context of health to identify the ways in which leisure might contribute to health. Considerable evidence has demonstrated that stressful life circumstances induce physical and mental illnesses. However, this impact has been shown to be moderated by various coping processes including leisure participation. The paper argues that leisure participation facilitates coping with life stress in two ways. First, one of the most effective sources of relief from life stress has been shown to be the perception that social support is available. Leisure has been demonstrated to be highly social in nature and to facilitate development of friendships. Companionship in shared leisure activity appears to provide effective relief for people as they deal with excesses of daily life stresses. In addition, many leisure experiences have the capacity to provide feelings of support. Second, dispositions reflecting self-determination (e.g. hardiness, locus of control) have also been shown to contribute to people's coping capacities and health. Perceptions of freedom, control, competence and intrinsic motivation that are central to many leisure experiences are believed to induce these stable beliefs in self-determination.
Employing multiple regression analysis, a set of six variables explained 39% of the variance in life satisfaction (leisure satisfaction, satisfaction with standard of living, satisfaction with family relations and activities, satisfaction with health, leisure participation, and marital status). Leisure satisfaction showed the greatest contribution, accounting for 20% of the variance in life satisfaction (more than 50% of the total variance explained). Also, it was found that: 1) the higher the frequency of participation in leisure activities, the higher the life satisfaction; 2) the more the leisure participation, the higher the leisure satisfaction; 3) the greater the leisure satisfaction, the greater the life satisfaction; and 4) all six leisure satisfaction components correlated positively with life satisfaction.-from Authors
Some of the determinants of leisure participation were identified and investigated. Among those determinants were leisure attitude, age, and sex. Studies investigating the relationships among leisure satisfaction and leisure participation and leisure attitude had not been conclusive. In this study, utilizing step-wise analysis and correlation of coefficient satisfaction was found to be the strongest contributor and predicator of leisure participation, more than any other variables, such as; leisure attitude, income, age, mode of employment, or length of marriage. Years of education and sex were found to be additional determinants of participation. Moreover, leisure satisfaction was the only variable which contributed to leisure attitude. Six categories of leisure were utilized. Leisure satisfaction associated with those categories in this order, the strongest relation was with hobbies, then cultural activities, sports activities, social activities, outdoor activities, and mass media activities.