Adventure therapy

Adventure therapy, as a distinct and separate form of psychotherapy, has become prominent since the 1960s.^[1] Influences from a variety of learning and psychological theories have contributed to the complex theoretical combination within adventure therapy. The underlying philosophy largely refers to experiential education. Existing research in adventure therapy reports positive outcomes in effectively improving self-concept and self-esteem, help seeking behavior, increased mutual aid, pro-social behavior, trust behavior and more. Although there is considerable and growing research evidence indicating positive outcome there is some disagreement about the underlying process that creates these positive outcomes.^[2][3][4]

Definition

Many different terms have been used to identify the diverse methods of treatment in the wilderness environment. Ewert, McCormick, & Voight, (2001) distinguished between adventure therapy, wilderness therapy, and outdoor experiential therapy. According to them, adventure therapy uses outdoor activities involving risk and physical and emotional challenge. 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" (Ewert et al., 2001, p. 109). 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][5] 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 (Bandura, 1997). These increases may then be generalized to treatment outcomes within and across life domains (Bandura, 1997; Weitlauf, Cervone, Smith, & Wright, 2001; Cervone, 2005). 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 (Bandura, 1997, pp 50–54). Debriefing or processing provides a context for implementing therapeutic techniques related to the desired outcomes. It typically involves a discussion where facilitators lead a discussion to help participants internalize the experience and relate it to therapeutic goals.

Adventure therapy encompasses varying techniques and environments to elicit change. These include cooperative games, problem solving initiatives, trust building activities,high adventure (rock climbing/rappelling, ropes courses, peak ascents); and wilderness expeditions (backpacking, canoeing, dog sledding, sailing, etc.).^[3][6] Wilderness therapy, adventure based therapy, and long term residential camping are the most common forms of adventure therapy.^[3]

History

The use of adventure as a part of 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 therapy 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. This era influenced the 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 based in Dallas, Texas and 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."^[7] These ideas informed some adventure therapy programs

This period also saw the creation of Outward Bound in the 1940s by Kurt Hahn.^{[4][5][8][9][10][11]} 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 who 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.^[12] 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][13] Outward Bound programs in Colorado and 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 staff including Karl Rohnke are credited with developing many of the cooperative games, problem solving initiatives, trust activities, low elements, and high elements. Project Adventure emerged in Hamilton-Wenham High School in Massachusetts in 1972 with a principal named Jerry Pieh, son of Robert Pieh founder of the Minnesota Outward Bound School. Jerry Peih wanted to bring the concepts behind the Outward Bound schools, developing self-esteem and self-confidence through mentally and physically straining and stressful situations, to classrooms.^{[4][5][8][9][10][11][14][15][16]} Project Adventure programs were often used at part of the health curriculum in physical education programs.

Eventually Paul Radcliffe, a Project Adventure trained facilitator and school psychologist, Mary Smithy a Project Adventure staff member along with a social worker from Addison Gilbert Hospital, started a 2-hour weekly outpatient group. Eventually this model was incorporated into school psychological services and was called the Learning Activities Group.^[16] This later grew into Adventure-Based Counseling (ABC), a Project Adventure term that reflects the therapeutic use of adventure activities.^[14]

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.^[9][17][18] 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 through direct experience through challenge.^{[3][6][16][19][20][21][22][23][24]}

This theory, though, has been questioned extensively. These questions cover many issues. With all the importance that is placed upon adventure therapy as a therapeutic intervention, the research is restricted to cooperation and trust, and even less research examines therapeutic techniques with adventure therapy and outcomes on pathology.^[9] The adventure therapy research field is having difficulty answering the basic questions of how, what, when, where and who. Further research on the standards, requirements, education, and training for individuals conducting adventure therapy is required.^[9] The research is based upon the examination of self-concept and social adjustments.^[5] In a meta-analysis study to statistically integrate all the available empirical research on adventure therapy, 99 studies were found covering a 25-year span.^[25] Out of the 99 studies located, only 43 studies fit the criteria for analysis. Many of the studies excluded were dissertations and the authors stated that dissertation studies did not accurately represent the field of adventure programming. The 43 studies used varied in design, methods, and treatment goals. They report that the limited amount of studies for their meta-analysis is proof of the limitations in the research in adventure programming.

The major theme of these questions about adventure therapy is effectiveness. A group has emerged arguing that before any other question in adventure therapy can be answered the question what are the properties that influence the effectiveness of adventure therapy must be answered. This group argues that theory driven research instead of outcome driven research will answer this question. Outcome driven research means that outcomes are the source of explanations for AT theoretical structure.^[26] Outcome driven research has generated many conflicting findings that confuse theoretical structure and explanations of effectiveness.^[26][27] 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 psychological theories.^[27] When outcomes are tied to existing psychological theories within the 400 forms of therapy it is impossible to understand the underlying influences of AT.

With all the research to date and the numerous reports of positive outcomes, there is still little understanding of the underlying processes influencing these positive outcomes.^[26] 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][9][28] Several researchers have attempted to explain the underlying process to adventure therapy.^{[3][5][9][15][17][18][20][28][29][30][31]}

Adventure therapy is described as non-traditional therapy allowing for the pre-therapeutic adolescent to experience their mental health issues,^[28] 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) 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, and 7) requires a facilitator that models appropriate behaviors and guides the group towards adaptive self-regulation that is based upon appropriate behaviors.^[28]

Adventure therapy has normalizing effects on deficits in delinquent adolescent's developmental process,^[15] as a process of moving into formal operational thinking which is achieved through the experiential learning theories.^[15][30] A therapist holds the skills to make the adventure experience a therapy.^[15] 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.^[9][17][18] Experiential learning becomes adventure therapy when the activities are planned and implemented as vehicles for patients to address individual treatment goals.^[31] Adventure experiences molded into a more therapeutic group model ran by the therapist can have a more significant effect than the one-day intervention run by counselors.^[31] 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.^[5]

Baldwin, Persing, and Magnuson, though, report that many of these explanations are "…folk pedagogies…" that lack thorough empirical evidence.^[32] Adventure therapy research has focused on outcomes without exploring theoretical structure.^[33] The focus of AT research needs to concentrate on testing and validating theoretical structure.^[33] Adventure therapy's theoretical structure must be studied and documented.^[26] After a theoretical structure is validated then a discussion on outcomes can occur.^[33]

Effectiveness

Although some questions remain regarding the efficacy of adventure therapy, existing research suggests that adventure therapy is an effective modality for treatment.^[34] 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.^[35] 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). Participants self-report results large effects for wilderness-based programs (g = 0.72) and larger effects for non-wilderness programs (g = 0.89).^[36]

A meta-analysis of 36 studies of private-pay wilderness therapy programs found moderate effect sizes of approximately half a standard deviation (~0.50) across six outcome categories (self-esteem (g = 0.49), locus of control (g = 0.55), behavioral observations (g = 0.75), personal effectiveness (g = 0.46), clinical measures (g = 0.50) and interpersonal measures (g = 0.54), with some moderator effects that varied across outcome types.^[37]

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.^[38] Another study on adventure therapy effectiveness reports that adventure therapy is effective because specifically designed activities can bring about specific outcomes.^[39]

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.^[30] The effectiveness of adventure therapy with 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…."^[40] Adventure therapy as treatment is equally effective for adjudicated youth and other adolescent populations.^[25][30] 62% of adolescents who participated in an adventure therapy group are at an advantage for coping with adolescent issues than adolescents that did not.^[25] There is a 12% improvement in self-concept for adolescents who participate in adventure therapy.^[25] Adolescents are approximately 30% better off in their ability to cope with mental health issues than those that do not participate in a psychotherapeutic treatment making the implication that adventure therapy effectiveness is comparable to the effectiveness of psychotherapeutic treatment.^[25][41]

The concepts contributing to adventure therapy effectiveness are: increases in self-esteem, self-concept, self efficacy, self perceptions, problem solving, locus of control, behavioral and cognitive development, decreases in depression, decrease in conduct disordered behaviors, overall positive behavioral changes, improved attitude, and that adventure therapy generates a sense of individual reward. Further aspects that contribute to adventure therapy's effectiveness are that it: increases group cohesion, aids in diagnosing conduct disorders in adolescents, improves psychosocial related difficulties, is effective in treating drug addicted and juvenile youth, treats sensation seeking behaviors, improves clinical functioning, facilitates connecting participants with their therapist and treatment issues, and increases interpersonal relatedness.^{[4][5][9][10][11][14][17][29][29][42][43][44][45][46][47]}

When comparing the reduction in recidivism rates with traditional programs and programs with adventure therapy, programs using adventure therapy have lower recidivism.^[2] There is an increases in interpersonal relatedness, which has been described as the most important factor for improving mental health issues.^[5][9]

See also

• Outdoor education

References

Notes

Bibliography

External links

Wikiversity has learning resources about Adventure therapy

Look up adventure therapy in Wiktionary, the free dictionary.

• Adventure Therapy & Wilderness/Nature Therapy (wilderdom.com)
• Canadian Adventure Therapy Symposium(adventuretherapy.ca)
• Pet Adventure Therapy(PetAdventureTherapy.com)