Adventure therapy

Adventure therapy is a form of psychotherapy created as early as the 1960s.[1] It is influenced by a variety of learning and psychological theories. Experiential education is the underlying philosophy. Existing research in adventure therapy reports positive outcomes in improving self-concept and self-esteem, help-seeking behavior, increased mutual aid, pro-social behavior, trust behavior, and more. There is some disagreement about the underlying process that creates these positive outcomes.[2][3][4]

Wilderness therapy programs often use backpacking trips as a way to help people grow.

Definition

Many different terms have been used to identify the diverse methods of treatment in the wilderness environment. Ewert, McCormick, and Voight distinguish between adventure therapy, wilderness therapy, and outdoor experiential therapy. According to them, adventure therapy uses outdoor activities involving risk and physical and emotional challenges. Wilderness therapy usually refers to the use of primitive methods in wilderness contexts requiring adaptation or the ability to cope. Outdoor experiential therapy is outdoor treatment to promote "rehabilitation, growth, development, and enhancement of an individual's physical, social, and psychological well-being through the application of structured activities involving direct experience".[5] The latter may be part of a residential treatment program. More recently, adventure therapy has evolved to include the use of adventure activities supported by traditional therapy. Often, adventure therapy is conducted in a group or family context, though increasingly, adventure therapy is being used with individuals.[4][6] Adventure therapy approaches psychological treatment through experience and action within cooperative games, trust activities, problem-solving initiatives, high adventure, outdoor pursuits, and wilderness expeditions. Some believe that in adventure therapy, there must be a real or perceived psychological and or physical risk, generating a level of challenge or perceived risk. Challenge can be viewed as significant in eliciting desired behavioral changes. Positive behavior changes, which are synonymous with psychological healing, can occur through a variety of processes. For example, through the use of vicarious experience, verbal persuasion, and overwhelming mastery experiences, participants' efficacy in the adventure activity may be increased.[7] These increases may then be generalized to treatment outcomes within and across life domains.[8] Five factors can be used to promote generalization of efficacy across domains: overwhelming mastery experiences, identification of similar sub-skills, co-development of sub-skills, cognitive restructuring of efficacy beliefs, and generalizing sub-skills.[9] Debriefing or processing provides a context for implementing therapeutic techniques related to the desired outcomes. It typically involves facilitators leading a discussion to help participants internalize the experience and relate it to therapeutic goals.

History

The use of adventure as part of a healing process can be traced back in history to many cultures including Native American, Jewish, and Christian traditions.[4] Tent therapy emerged in the early 1900s. This practice brought certain psychiatric patients out of hospital buildings and into tents on the hospital's lawn. Many patients showed improvement during this treatment that prompted a series of studies, which failed to present enough evidence to support efficacy. Literature on this therapy lasted approximately 20 years and then dropped off completely.[2]

In the late 1930s, this approach reappeared mainly as camping programs designed for troubled youth. The era influenced present-day use and extent of adventure therapy programs with adolescents. The format for these programs utilized observation, diagnosis, and psychotherapy. One of the first of these programs was Salesmanship Club Camp,[10] based in Dallas, Texas, founded by Campbell Loughmiller in 1946. His philosophy of adventure in therapy included the theory that the "…perception of danger and immediate natural consequences for [a] lack of cooperation on the part of [participants]…[after confronting danger] built self-esteem, [while] suffering natural consequences taught the real need for cooperation."[11] His ideas informed some adventure therapy programs.

This period also saw the creation of Outward Bound in the 1940s by Kurt Hahn.[4][6][12][13][14][15] Outward Bound was a direct response to Lawrence Holt, part owner of the Blue Funnel Shipping Company, who was looking for a training program for young sailors. These sailors seemed to have lost the tenacity and fortitude needed to survive the rigors of war and shipwreck, unlike older sailors who, because of their formative experiences on sailing ships, were more likely to survive.[16] In this way, Outward Bound was engaging in a form of adventure therapy – intervening in the lack of tenacity through the use of challenging adventure training.

In the 1960s, Outward Bound came to the United States through the Outward Bound school in Colorado.[4][17] Other schools quickly began to use Outward Bound as an adjunctive experience work with adjudicated youth and adults (one of the first programs in 1964 offered recently released prisoners a job at Coors Brewery if they completed a 23-day course). In the late 1970s, Colorado Outward Bound developed the Mental Health Project. Courses were offered to adults dealing with substance abuse, mental illness, being a survivor of sexual assault, and other issues. In 1980, Stephen Bacon wrote the seminal adventure therapy The Conscious Use of Metaphor in Outward Bound, which linked the work of Milton Erickson and Carl Jung to the Outward Bound process.

Project Adventure adapted the Outward Bound philosophy for school environments and used ropes course activities developed at the Colorado Outward Bound School into use at schools. Project Adventure emerged in Hamilton-Wenham Regional High School in Massachusetts in 1972 with a principal named Jerry Pieh, son of Robert Pieh, founder of the Minnesota Outward Bound School.

Paul Radcliffe, a school psychologist, Mary Smithy, a staff member, along with a social worker from Addison Gilbert Hospital, started a 2-hour weekly outpatient group. This model was incorporated into school psychological services and was called the Learning Activities Group.[18] It grew into Adventure-Based Counseling (ABC), a Project Adventure term that reflects the therapeutic use of adventure activities.[19]

Theory

Adventure therapy theory draws from a mixture of learning and psychological theories. The learning theories include contributions from Albert Bandura, John Dewey, Kurt Hahn, and Kurt Lewin. These theorists also have been credited with contributing to the main theories comprising experiential education. Experiential education is a theoretical component of adventure therapy.[13][20][21] The ideas and thinking of Alfred Adler, Albert Ellis, Milton Erickson, William Glasser, Carl Jung, Abraham Maslow, Jean Piaget, Carl Rogers, B.F. Skinner, Fritz Perls, and Viktor Frankl all appear to have contributed to the thinking in adventure therapy. Adventure therapy is a cognitive-behavioral-affective approach which utilizes a humanistic existential base to strategically enact change via direct experience through challenge.[3][22][18][23][24][25][26][27][28]

Most research on adventure therapy as a therapeutic intervention has focused on aspects of cooperation and trust, and other research examines therapeutic techniques with adventure therapy or outcomes on pathology.[13] Further inquiry into the standards, requirements, education, and training for individuals conducting adventure therapy is needed.[13] In a meta-analysis aimed at statistically integrating all the available empirical research on adventure therapy, only 43 studies in a 25-year span were found to fit the criteria for analysis.[29] The authors of that meta-analysis report that the limited amount of studies demonstrates the limitations in the research on adventure programming.

The major theme of these questions about adventure therapy is effectiveness. A group has emerged arguing that before any other question can be answered, the properties that influence the effectiveness of adventure therapy must be answered. This group argues that theory-driven research instead of outcome-driven inquiry will answer this question.[30] Outcome-driven research has generated many conflicting findings that confuse theoretical structure and explanations of effectiveness.[30][31] The outcomes in adventure therapy research are linked to existing psychological theories of change to explain, modify, or validate AT theory. The theories of change have upwards of 400 forms of therapy and related practices that have emerged from a conglomeration of ideas within psychology.[31]

There is still little understanding of the underlying processes influencing therapeutic outcomes of adventure therapy.[30] This has caused extensive discussion concerning why adventure therapy appears effective in treating a multitude of DSM-related mental disorders in children, adolescents, and adults.[3][13][32] Several researchers have attempted to explain this underlying process.[3][6][13][33][20][21][24][32][34][35][36]

Adventure therapy is described as non-traditional therapy allowing for the pre-therapeutic adolescent to experience their mental health issues,[32] with several theoretical aspects:

  1. it is a physical augmentation to traditional therapy for the purpose of a shared history with the participants and the therapist
  2. there is a sense of natural and logical consequences in the activities
  3. social environment should be structured into the activities
  4. a participant perceives risk, stress, and anxiety so that they can problem-solve and generate their own sense of community for feedback and behavior modeling
  5. participants will transfer their present attitudes and behaviors into the activities
  6. works with a small group of participants
  7. requires a facilitator that models appropriate behaviors and guides the group towards adaptive self-regulation that is based upon appropriate behaviors.[32]

Adventure therapy has normalizing effects on deficits in delinquent adolescent developmental processes,[33] as a way of moving into formal operational thinking, which is achieved through the experiential learning theories.[33][35] The theoretical basis of adventure therapy describes the participant as a learning being who achieves their greatest learning outside the classroom, through challenge and perceived risk, promoting social skills through experiencing a group challenge mixed with affect, cognition, psychomotor activity, and formal operational thinking generated through metaphor.[13][20][21] Experiential learning becomes adventure therapy when the activities are planned and implemented as vehicles for patients to address individual treatment goals.[36] Adventure experiences molded into a more therapeutic group model run by the therapist can have a more significant effect than the one-day intervention run by counselors.[36] It is important to have the clinician as an integral part of the adventure therapy process so that there can be a strong transference of the adventure experience to other aspects of the therapeutic process.[6]

Baldwin, Persing, and Magnuson, though, report that many of these explanations are "…folk pedagogies…" that lack thorough empirical evidence.[37] Adventure therapy research has focused on outcomes without exploring theoretical structure.[38] Some argue that the focus of AT research needs should be on testing and validating theoretical structure,[38] and that discussion of outcomes should only come after a theoretical structure has been validated.[38]

Effectiveness

Although some questions remain regarding the efficacy of adventure therapy, existing research suggests that it is an effective modality for treatment.[39] For example, a meta-analytic review of 197 studies of adventure therapy participant outcomes (2,908 effect sizes, 206 unique samples) found that the short-term effect size for adventure therapy was moderate (Hedges' g = .47) and larger than for alternative (.14) and no treatment (.08) comparison groups.[40] There was little change during the lead-up (.09) and follow-up periods (.03) for adventure therapy, indicating long-term maintenance of the short-term gains.

A meta-analysis of 26 studies of psychological intervention programs for youth at risk which used a version of the Youth Outcomes Questionnaire found very large positive effect sizes for wilderness-based programs according to observers (g = 1.38), which was larger than the changes according to observers for non-wilderness programs (g = 0.74). Participant self-report results showed large effects for wilderness-based programs (g = 0.72) and larger effects for non-wilderness programs (g = 0.89).[41]

A study of the effects of adventure therapy on 266 high-risk youth in rural areas reported lasting improvement in behavior over a six-month period.[42] Another study on adventure therapy effectiveness reports that it is effective because specifically designed activities can bring about specific outcomes.[43]

Outdoor delinquency programs have a reduced recidivism rate compared to traditional indoor therapeutic programs.[2] Adventure therapy is further viewed as effective because of the apparent positive effects in treating developmental issues with juvenile offenders and adolescent offenders with drug abuse and addiction issues.[35] The effectiveness of adventure therapy on offenders with drug abuse and addiction issues in mental health treatment is related to the characteristics present in addicted offenders. They "…(1) need more structure, [and] (2) they work better with an informal, tactile-kinesthetic design…."[44] Adventure therapy as treatment is equally effective for adjudicated youth and other adolescent populations.[29][35]

A 1994 meta-analysis found that 62% of adolescents who participated in an adventure therapy group were at an advantage for coping with adolescent issues than those who did not.[29] There is a 12% improvement in self-concept for adolescents who participate in adventure therapy.[29] Adolescents are approximately 30% better off in their ability to cope with mental health issues than those who do not participate in a psychotherapeutic treatment, leading to the implication that adventure therapy effectiveness is comparable to the effectiveness of psychotherapeutic treatment.[29][45]

The concepts contributing to adventure therapy's effectiveness are: increases in self-esteem, self-concept, self efficacy, self perceptions, problem solving, locus of control, decrease in conduct disordered behaviors, overall positive behavioral changes, improved attitude, and that adventure therapy generates a sense of individual reward. Further aspects indicate that it increases group cohesion and interpersonal relatedness.[4][6][13][14][15][19][20][34][46][47][48][49][50][51] It is important to note that AT has many challenges and things that could limit its effectiveness. These include: "availability of studies, heterogeneity, generalisability, type of data provided by empirical studies, and the methodological quality of studies."[52]

See also

References

Notes
  1. Google Ngram Viewer
  2. Berman & Davis-Berman 1995
  3. Gass 1993
  4. Parker 1992
  5. Ewert, McCormick & Voight 2001
  6. Ziven 1988
  7. Bandura, 1997
  8. Bandura, 1997; Weitlauf, Cervone, Smith, & Wright, 2001; Cervone, 2005
  9. Bandura 1997, pp 50–54
  10. Bryon, Nelson. "Salesmanship Club of Dallas". Salesmanship Club of Dallas. Bryon Nelson. Retrieved 4 April 2016.
  11. Berman & Davis-Berman 1995, p. 3
  12. Aghazarian 1996
  13. Blanchard 1993
  14. Dickens 1999
  15. Glass 1999
  16. Outward Bound International n.d.
  17. see Outward Bound USA
  18. Schoel, Prouty, & Radcliffe 1988
  19. Gillis & Simpson 1992
  20. Moote & Woodarski 1997
  21. Davis, Berman, & Capone 1994
  22. Itin 1995
  23. Calver 1996
  24. Gillis & Thomsen 1996
  25. Kimball & Bacon 1993
  26. Nadler 1993
  27. Schoel & Maizell 2002
  28. West-Smith 1997
  29. Cason & Gillis 1994
  30. Baldwin, Persing, & Magnuson 2004
  31. Ringer & Gillis 1996
  32. Gillis 2000
  33. Maizell 1988
  34. Gillis n.d.
  35. Gillis & Mcleod 1992
  36. Hatala 1992
  37. Baldwin, Persing, & Magnuson 2004 p. 172
  38. Hattie, Marsh, Neill, & Richards 1997
  39. Neill 2003
  40. Bowen & Neill 2013
  41. Gillis, Speelman, Linville, Bailey, Kalle, Oglesbee, Sandlin, Thompson & Jensen 2016
  42. Davis, Ray & Sayles 1995
  43. Haris, Mealy, Mathews, Lucan, & Monczygemba 1993
  44. Gillis & Mcleod, 1992, p. 151
  45. Smith, Glass & Miller 1980
  46. Baucom, Gillis, Durden, Bloom & Thomsen 1996
  47. Gillis 1992
  48. Burney 1992
  49. Gillis, Simpson, Thomsen & Martin 1995
  50. Newberry & Lindsay 2000
  51. Teaff & Kablach 1987
  52. Bowen, Daniel J.; Neill, James T. (30 September 2013). "A Meta-Analysis of Adventure Therapy Outcomes and Moderators". The Open Psychology Journal. 6 (1): 28–53. doi:10.2174/1874350120130802001. ISSN 1874-3501.

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