Adventure therapy is a form of psychotherapy created as early as the 1960s. 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.
Definition
Many different terms have been used to identify the diverse methods of treatment in the wilderness environment. Adventure therapy and wilderness therapy are variations of outdoor experiential therapy.[1] Outdoor experiential therapy utilizes the outdoors as a treatment modality 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".[2] The latter may be part of a residential treatment program.[2]
According to Ewert, McCormick, and Voight, adventure therapy uses outdoor activities that involve some elements of adventure (such as perceived risk, actual risk, or uncertainty), and outdoor experiential therapy programs are "wilderness therapy" if they take place in any outdoor setting (although usually, programs using this term take place in "wilderness-type" settings).[2] Some use the term "adventure therapy" as an umbrella for a wide array of related approaches, including wilderness therapy.[3][4]
More recently, adventure therapy has evolved to include the use of adventure activities supported by traditional therapy. Often, adventure therapy is conducted in groups or families, although it is increasingly being used for individuals.[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[who?] 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. These increases may then be generalized to treatment outcomes within and across life domains.[6][7] 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.[8]:50–54 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
Adventure as a method of healing can be traced back to many cultures including Native American, Jewish, and Christian traditions.
Emerging in the early 1900s, tent therapy brought certain patients out of psychiatric hospitals and into tents on their lawns. A series of studies were carried out as many patients showed signs of improvement, although they failed to show efficacy due to a lack of evidence. Study and practice of this early version of adventure therapy lasted approximately twenty years and then seemed to have dropped off completely.[9]
In the mid-1900s, this approach reappeared mainly as camping programs designed for troubled youth.[9] The 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,[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."[9][11][5]:3 His ideas informed some adventure therapy programs.
This period also saw the creation of Outward Bound in the 1940s by Kurt Hahn.[5] 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 were more likely to survive because of their formative experiences on ships.[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 Colorado Outbound School.[5] The Colorado Outbound School uses Kurt Han's survival training program, which focuses on the idea that training through challenges produces better results than training for challenges. Josh Miner adopted Han's philosophy and became the founder of this program, the Colorado Outbound School Program. Since 1962, the Colorado Outbound School Program has been providing outdoor experiential learning for over a million students, through all walks of life.[13]
Other schools quickly began to use Outward Bound as an adjunctive experience working 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, surviving a sexual assault, and others. 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.[14][clarification needed]
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.[15]
Paul Radcliffe, a school psychologist, and Mary Smithy, a staff member, along with a social worker from Addison Gilbert Hospital, started a two-hour weekly outpatient group. This model was incorporated into school psychological services and was called the Learning Activities Group. It grew into Adventure-Based Counseling (ABC),[16] a Project Adventure term that reflects the therapeutic use of adventure activities.[17]
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 have also been credited with contributing to the main theories comprising experiential education. Experiential education is a theoretical component of adventure therapy. 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 and experiential movements for the progression of education. Adventure therapy is a cognitive-behavioral-affective approach that utilizes a humanistic existential base to strategically enact change via direct multi-sensory experiences.[18]
Most research on adventure therapy as a therapeutic intervention has focused on aspects of cooperation and trust, while other research examines therapeutic techniques with adventure therapy or outcomes on pathology. There remains a lack of follow-up data into the standards, requirements, education and training of individuals conducting adventure therapy. In a 1994 meta-analysis aimed at statistically integrating all the available empirical research on adventure therapy, 43 studies in a 25-year span were found to fit the criteria for analysis.
The major theme of these questions about adventure therapy is effectiveness, as outcome-driven research has generated conflicting findings.[19][20]
Several researchers have attempted to explain the underlying process influencing outcomes of adventure therapy. A comprehensive 2013 meta-analysis by Bowen and Neill, which reviewed 197 studies with over 17,000 participants, found a moderate short-term effect size (g = 0.47), with the strongest outcomes for clinical and self-concept measures. The study found that the effectiveness of adventure therapy was influenced by participant age and program structure, and that these positive effects were sustained over the long term, though further research is needed to fully understand the mechanisms behind these outcomes.[21]
Adventure therapy is described as nontraditional therapy allowing for the pre-therapeutic adolescent to experience their mental health issues, with several theoretical aspects:
It is a physical augmentation to traditional therapy for the purpose of a shared history with the participants and the therapist
There is a sense of natural and logical consequences in the activities
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
Participants will transfer their present attitudes and behaviors into the activities
Works with a small group of participants
Requires a facilitator that models appropriate behaviors and guides the group towards adaptive self-regulation that is based upon appropriate behaviors.
Adventure therapy has normalizing effects on deficits in delinquent adolescent developmental processes, as a way of moving into formal operational thinking, which is achieved through the experiential learning theories. 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. Experiential learning becomes adventure therapy when the activities are planned and implemented as vehicles for patients to address individual treatment goals. 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.
Baldwin, Persing, and Magnuson, though, report that many of these explanations are "...folk pedagogies..." that lack thorough empirical evidence.:172 Adventure therapy research has focused on outcomes without exploring theoretical structure. Some argue that the focus of adventure therapy research needs should be on testing and validating theoretical structure, and that discussion of outcomes should only come after a theoretical structure has been validated.
Effectiveness
The effectiveness of adventure therapy has been the subject of numerous studies. Research suggests that adventure therapy can be an effective treatment option for a range of mental health issues, including depression, anxiety, and substance abuse disorders.[22] Some research has also shown that adventure therapy can have a lasting impact on an individual's self-concept.[23]
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).[24]
Outdoor delinquency programs have a reduced recidivism rate compared to traditional indoor therapeutic programs. 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. 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..." Adventure therapy as treatment is equally effective for adjudicated youth and other adolescent populations.
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. There is a 12% improvement in self-concept for adolescents who participate in adventure therapy. 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.[25]
It is important to note that adventure therapy has many challenges and things that could limit its effectiveness. These include: "availability of studies, heterogeneity, generalizability, type of data provided by empirical studies, and the methodological quality of studies".[26] Additionally, though self-efficacy, self-esteem, and locus of control are often cited as primary topics of focus of adventure therapy, there is little research that verifies its effectiveness in any of those areas.[23] Furthermore, due to the limited scope of research, there is little accountability to ensure that programs implement the most effective and current interventions, allowing for approaches that are dated at best and may constitute malpractice at worst.[27]
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.
Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.
Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.
Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.
Experiential education is a philosophy of education that describes the process that occurs between a teacher and student that infuses direct experience with the learning environment and content. This concept is distinct from experiential learning, however experiential learning is a subfield and operates under the methodologies associated with experiential education. The Association for Experiential Education regards experiential education as "a philosophy that informs many methodologies in which educators purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills, clarify values, and develop people's capacity to contribute to their communities". The Journal of Experiential Education publishes peer-reviewed empirical and theoretical academic research within the field.
A behavior modification facility is a residential educational and treatment institution enrolling adolescents who are perceived as displaying antisocial behavior, in an attempt to alter their conduct.
Outdoor education is organized learning that takes place in the outdoors, such as during school camping trips. Outdoor education programs sometimes involve residential or journey wilderness-based experiences which engage participants in a variety of adventurous challenges and outdoor activities such as hiking, climbing, canoeing, ropes courses and group games. Outdoor education draws upon the philosophy, theory, and practices of experiential education and environmental education.
Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.
Acceptance and commitment therapy is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility.
Wilderness therapy, also known as outdoor behavioral healthcare, is a treatment option for behavioral disorders, substance abuse, and mental health issues in adolescents. Patients spend time living outdoors with peers. Reports of abuse, deaths, and lack of research into efficacy have led to controversy, and there is no solid proof of its effectiveness in treating such behavioral disorders, substance abuse, and mental health issues in adolescents.
Aspen Achievement Academy was a wilderness therapy program for adolescents, based in Loa, Utah.
A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.
Adventure education is the promotion of learning through adventure centered experiences.
Green exercise refers to physical exercise undertaken in natural environments. Physical exercise is well known to provide physical and psychological health benefits. There is also good evidence that viewing, being in, and interacting with natural environments has positive effects, reducing stress and increasing the ability to cope with stress, reducing mental fatigue and improving concentration and cognitive function. The concept of green exercise has therefore grown out of well-established areas such as the attention restoration theory within environmental psychology which have tended to focus on the psychological and physical effects of viewing nature and well-recognised work about the psychological benefits of physical exercise.
Expeditionary education is often associated with adventure education, outdoor education, environmental education or experiential education and refers specifically to learning associated with exploration and journey-based experiences or expeditions within these fields. Usually involving elements of challenge, adventure and leadership, expeditionary education can take place in a variety of settings including wilderness, classrooms and even virtual spaces. Participants in expeditionary education can be directly involved in the expedition, or may be linked to expeditions undertaken by others.
Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems.
The Youth Outcome Questionnaire is a collection of questions designed to collect data regarding the effectiveness of youth therapies. The Y-OQ is a parent report measure of treatment progress for children and adolescents receiving mental health interventions. The Y-OQ–SR is an adolescent self report measure appropriate for ages 12–18.
Compassion Focused Therapy (CFT) is a system of psychotherapy developed by Professor Paul Gilbert (OBE) that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion."
Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.
1 2 3 4 Parker, M. W. (1992). Impact of adventure interventions of traditional counseling interventions (ropes course). Unpublished doctoral dissertation, The University of Oklahoma, Oklahoma.
↑ Weitlauf, J. C.; Cervone, D.; Smith, R. E.; Wright, P. M. (2001). "Assessing generalization in perceived self-efficacy: Multidomain and global assessments of the effects of self-defense training for women". Personality and Social Psychology Bulletin. 27 (12): 1683–1691. doi:10.1177/01461672012712011. S2CID145553561.
↑ Newes, Sandra; Bandoroff, Scott (1 January 2004). "What is Adventure Therapy?". Coming of Age: The Evolving Field of Adventure Therapy. Association for Experiential Education. pp.1–30. ISBN978-0929361147.
↑ Cason, Dana; Gillis, H.L. "Lee" (1994) "A Meta-Analysis of Outdoor Adventure Programming with Adolescents", The Journal of Experiential Education, 17:1. pp 40-47. DOI 10.1177/105382599401700109
Blanchard, C. (1993). Effects of ropes course therapy on interpersonal behavior and self-esteem of adolescent psychiatric inpatients. Unpublished doctoral dissertation, New Mexico State University, New Mexico
Calver, R. (1996). ""Theory for practice: A frame work for thinking about experiential education. Journal of Experiential Education, 19 pp.8–13.
Davis-Berman, Berman and Capone (1994). "Therapeutic wilderness programs: A national survey". Journal of Experiential Education, 17 (2), 49–53.
Dickens, J., C. (1999) Behavioral indicators of conduct disorder in a ropes course initiative. Unpublished doctoral dissertation, The Union Institute, Cincinnati.
Gass, M. A. (1993). Adventure in therapy: Therapeutic applications of adventure programming in mental health settings. Boulder, CO: Association for Experiential Education.
Gillis, H.L. (2000) "Going around in circles research and program evaluation in therapeutic adventure and adventure in therapy". Paper presented at the Second International Adventure in Therapy Conference: Therapy Within Adventure 23 March 2000 – Augsburg / Germany.
Gillis, H. L. & McLeod, J. (October 1992) "Successful indoor adventure activities for treating substance abuse with adjudicated adolescents and incarcerated adults". Proceedings of the 20th International Conference of the Association for Experiential Education.
Hattie, J., Marsh, H. W., Neill, J. T., & Richards, G. E. (1997). "Adventure education and outward bound: Out-of-class experiences that make a lasting difference". Review of Educational Research, 67, 43-97
Maizell, R. S. (1988) Adventure-based counseling as a therapeutic intervention with court-involved adolescents. Dissertation Abstracts International, 50/06-B, 2628.
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Schoel, J. & Maizell, S. (2002). Exploring islands of healing: New perspectives on adventure based counseling. Project Adventure; Beverly, MA.
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