Content area
Full text
Increased attention to the needs of veterans with posttraumatic stress disorder (PTSD) has resulted in literature describing both first-line and adjunctive treatments. Complementary and alternative medicine approaches have gained popularity and may include the use of outdoor treatment modalities. This article will examine the evidence to support the use of outdoor approaches in treating PTSD in veterans. Although anecdotally these programs are often associated with positive and healing experiences, their use as a first-line treatment for PTSD should be questioned. A review of the literature and recommendations regarding outdoor programs in the treatment of PTSD in veterans will be presented.
Key words: outdoor treatment, posttraumatic stress disorder
Over the past twenty-five years, there has been a resurgence of interest and concern about the impact of trauma on military personnel and their families by government agencies, the public, and the mental health community in the United States (Hamblen et al., 2014; Hobfoll et al., 1991) and around the world (Bird, 2014; Boulos & Zamorski, 2013; Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). This concern began as a result of looking at war stress as the consequence of two factors: the amount of loss experienced and the extent of a person's resiliency (Hobfoll et al., 1991). Although Hobfoll and colleagues acknowledged that war stress can result in posttraumatic stress disorder (PTSD), they concluded that "the best treatment for PTSD has not been established" and that nontraditional treatments such as returning soldiers to combat should be explored (p. 850).
Recently, the focus has been on a more holistic model of PTSD rather than the global war stress paradigm (Vergun, 2012). According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), PTSD is characterized by exposure to trauma and symptoms from the following categories: intrusion, avoidance, negative changes in thoughts and mood, and changes in arousal and reaction. To qualify for a diagnosis of PTSD, an individual must have experienced symptoms for at least one month. Additionally, there must be significant impairment in daily functioning. Finally, symptoms cannot be primarily due to medications, substance use, or physical illness.
In the United States, the Veterans Administration (VA) identifies PTSD as a significant problem. Estimates suggest that between 11 and 20 percent...