Nature-based interventions (NBIs) present a promising but underexplored approach in recreational therapy for improving the quality of life in individuals with eating disorders (EDs). Due to limited research, this scoping review focuses on strategies and techniques for implementing NBIs, including wilderness therapy, horticultural therapy, forest bathing, and adventure therapy. Based on theoretical frameworks such as the Biophilia Hypothesis, Attention Restoration Theory, and Stress Reduction Theory, this review suggests ways nature-based experiences may promote emotional regulation, mindfulness, self-efficacy, and social well-being. However, several practical and individual challenges must be addressed, including limited access to natural spaces, financial and logistical constraints, psychological resistance, and the need for culturally sensitive approaches. Additionally, the lack of standardized evaluation methods makes it difficult to measure the effectiveness of NBIs in ED recovery. Given these challenges, this paper offers recommendations for recreational therapists to adapt and integrate NBIs into treatment, emphasizing creative solutions and individualized approaches. By exploring the possibilities of NBI with people who have EDs, this paper contributes to the growing conversation on using nature-based strategies to enhance therapeutic outcomes.

ABSTRACT The aims of this paper were to (1) Explore the experiences of individuals with PSU in preparing for and conducting a Norwegian Kilimanjaro Expedition, and (2) Investigate the experiences of health and social professional leaders in planning and conducting the expedition. A prolonged, novel adventure therapy project framework was used regarding planning and conducting an expedition to the mountain of Kilimanjaro, Tanzania. Focus group interviews were conducted with expedition participants and leaders concerning their experiences, five years following the expedition completion. The results illustrate how a prolonged adventure therapy project framework, including social interactions and co-operation, led to experiences of personal achievements and agency that were useful for individuals’ PSU recovery processes, years after expedition completion. Follow-up services should aim to develop opportunities for individuals with PSU to experience agency and growth in outdoor arenas. Future research should focus on how adventure therapy and outdoor learning could impact human change.

Background: Latina women face mental health disparities, often exacerbated by cultural stigma and systemic barriers. Eurocentric therapeutic models frequently overlook the collectivist values and cultural nuances central to Latina identity, leading to ineffective or alienating treatment. There is a growing need for culturally relevant interventions that address trauma holistically and empower marginalized voices. Adventure therapy (AT), an experiential, nature-based approach, and testimonio, a method rooted in Latinx traditions, offer promising alternatives but remain underexplored within clinical mental health settings for Latina populations. Purpose: This study investigates the integration of AT and testimonio as a culturally adapted intervention for Latina women in residential treatment with co-occurring mental health and substance use disorders. It aims to explore how these methods support empowerment, resilience, and healing. Methodology: Using a qualitative, phenomenological design, data were collected from 11 Latina women and program staff through interviews, focus groups, and participant observation. Analysis was conducted using inductive thematic coding via NVivo 12. Findings: Four themes emerged: trauma and coping, holistic wellness, empowerment through AT, and reclaiming self-love through narrative. Participants emphasized the importance of cultural relevance and collective healing. Implications: The findings advocate for integrating culturally responsive, narrative-based interventions into mental health treatment and training programs.

This research aims to explore how adventure therapy can be incorporated into social work interventions with young people and to evaluate the effectiveness of this work by conducting adventure therapy-based psycho-educational group work. In the first phase of this qualitative research, the aim is to understand the needs of 14 social workers in order to use adventure therapy in their interventions and thematic analysis is used to analyze the data. In the second phase of the study, an adventure therapy-based psycho-education group study is conducted with 12 social workers according to the needs identified in the first phase. The effectiveness of this study is evaluated and a descriptive analysis of the data is conducted. Current research has shown that physical, environmental, structural, legal, academic support, and cooperation are needed to incorporate adventure therapy into social work interventions. Additionally, it has been suggested that social workers who receive training in adventure therapy activities will be able to work more effectively with young people. The study revealed that, when working with young people and conducting outdoor interventions, it is necessary for social workers to understand young people and be able to carry out outdoor activities. They must also be able to assess the existing conditions, opportunities and resources in institutions.

ABSTRACT Therapeutic adventure professionals employ adventure therapy (AT), a unique kinesthetic modality to assist in facilitating mental, emotional, and behavioural changes in participants. We explore this therapeutic process through a trauma-informed lens, emphasising the neurobiological mechanisms and cognitive processes that are activated during AT interventions that often take place in natural settings. Recent research suggests that nature's influence on attention and cognitive function plays a pivotal role in these therapeutic outcomes. Therefore, we propose that these effects are mediated by neurobiological processes that enhance resilience, attention, and overall mental well-being. We review key concepts such as embodiment, nervous system regulation, and the role of nature in AT through one case facilitated by the authors. Exploring each of these processes in the context of the therapeutic condition highlights Jenkin’s methodological vertex of context, which will provide clinicians and researchers additional theoretical foundations for contextualising participant processes.

ABSTRACTA meta‐analysis was conducted to assess the effectiveness of adventure therapy (AT) in the treatment of individuals with symptoms of anxiety‐related disorders. This study reports findings from a comprehensive literature search, including 15 databases/repositories and seven key journal‐specific searches. Studies were evaluated using standardized mean difference (SMD) and were assessed for risk of bias using funnel plot, fail‐safe N, and trim and fill analysis. Twelve studies, containing a total of 21 effect sizes, were evaluated to determine the effectiveness of AT in decreasing symptoms of anxiety‐related disorders (N = 2083), yielding a mean effect size of SMD = −0.56 (CI95 = −0.72, −0.39; PI95 = −1.25, 0.14). This meta‐analysis provides evidence suggesting the effectiveness of AT in reducing symptoms associated with anxiety‐related disorders. Support for AT as an evidence‐based practice informs legislative and insurance policies, funding mechanisms for programming, and counselor training and credentialing. Our findings suggest that AT programs are effective in reducing anxiety‐related disorder symptoms and underscore the need for increased support from legislative and insurance policies to increase client accessibility, an increase in funding mechanisms for AT programs across client settings, and the provision of more formal counselor training and credentialing.

ABSTRACT This pilot study explored the impact of Adventure Therapy (AT) groups on middle-school students’ (n = 40) social-emotional development. Using an experimental time-series design, researchers measured prosocial and behavior problems from student and teacher perspectives for participants randomly assigned to AT groups or a waitlist-control group that received school counseling services as usual during the study. Results suggested that students did not perceive any statistically significant differences in prosocial or problem behaviors. However, teachers reported that students in the AT groups had significantly lower behavior problems, specifically externalizing behaviors, based on effect sizes than those in the waitlist-control group. Implications for school counselors and future research are discussed.

ABSTRACTA clinician's theoretical orientation serves as a foundational guide that embodies their values and beliefs for creating therapeutic change. Adventure therapy (AT) is an experiential modality that uses kinesthetic experiences as metaphors to promote client growth. Due to its transtheoretical nature, AT practitioners often end up being atheoretical in their facilitation, thus decreasing the potential benefits to clients. In this manuscript, we propose the use of existential Theory to guide AT by integrating the existential givens and welts with key components of AT. A case example is provided to demonstrate guided application.

The South Eastern Health & Social Trust (SET) provides a service to a population of over 350,000. Central to improving health & wellbeing and contributing to reducing health inequalities is innovation, service improvement and excellence by working in partnership and collaboration both internal and external to the organisation. The SET Outdoors Service is one of SET key priorities in the Population Health Strategy 2021-24 which is underpinned by Regional Strategic Drivers such as Making Life Better: A Whole System Strategic Framework for Public Health 2013-23, Health and Wellbeing 2026: Delivering Together and the South Eastern H&SC Trust Quality 4 All Strategy 2021-26 South Eastern H&SC Trust Population Health Strategy three key priority areas: In December 2020 a steering group was established to design and implement a new and innovative service SET Outdoors The aim of SET Outdoors is to support SET staff who routinely deliver healthcare services to children, to improve the health, wellbeing and quality of life of service users via engagement in purposeful, nature-based and/or animal facilitated outdoor activities and/or outdoor therapy. This is achieved via the co-production of a variety of healthcare interventions that utilise outdoor, sports-based, nature-based and/or animal facilitated activities as a therapeutic medium. The Outdoor Mental Health Interventions Model Richards, Hardie & Anderson, 2019 SET Outdoors has collaborated with twenty outdoor and/or animal-facilitated activity providers to deliver programmes such as sailing, paddle boarding, sea swimming, athletics, adventure therapy, donkey, alpaca and equine therapy, drumming and forest school. Each programme has a set of quality measures evaluating the impact of the programme on the young people and also the healthcare staff. Outcome measures included the use of the Warwick Edinburgh Mental Health Scale (WEMWBS) participant surveys, parent surveys and staff feedback. The overall assessments revealed improvement in confidence, fitness, and ability to socialise, and attend mental health appointments. Staff reported young people being better to manage anxiety through the experience of outdoor activity and facing fears. Parents praised the programmes citing the connections their children made and new skills learnt. Other measurement tools used is the Beck Anxiety Inventory for Youth ( BAI) (Beck et al, 2005) is a self-reported tool widely used in research to monitor the responsiveness of interventions the BAI has been used in programme delivery with each participants at sessions 1 and after session 8 This programme highlights a holistic approach to health and wellbeing understanding the wider determinants of health and partnering across sectors to enrich service delivery across the South Eastern HSC Trust via nature-based therapeutic activity and therapy, but also to inspire individual staff and teams to establish permanent changes to core service delivery.

The combination of rehabilitation and education of young offenders in Canada who are incarcerated for serious offenses is generally less successful than for young offenders who are assigned to non-custodial diversion programs. This has become a matter of concern, especially as many young offenders are of Indigenous origin. Three current forms of education, however, point to distinct possibilities for enhancing the education of young detainees in the youth justice system. These are: (a) alternative schools that have long demonstrated the value of accommodating the unique psychological, social, and learning needs of students; (b) wilderness adventure therapy; and (c) Indigenous forms of teaching and learning. In this paper we present the case of a program for young offender detainees (ages 12–17), the Healing Outdoor Program and Education (HOPE), 1 which adopted a holistic approach to young offender rehabilitation by combining the attributes of alternative schooling with wilderness adventure therapy and Indigenous practices. Although the HOPE program has since been terminated, it nonetheless demonstrated the possibilities of coordinated approaches to education and therapeutic healing designed to prepare young offenders for effective transitions back to their own communities.

In my research, I investigated the potential of experiential learning-based outdoor methods, such as adventure therapy, in the university education of social workers. My research is based on qualitative methodology. I analyzed reflective essays written by undergraduate and master’s degree students in social work after participating in an experiential and adventure therapy course. I used data-driven categorization and text analysis to analyze the data. In addition to their methodological utility, outdoor courses in experiential and adventure therapy can also be useful parts of the university education of social workers, complementing the personality and skill development courses in the field. Lessons in the open air, in a natural environment, can also contribute to the mental well-being of students and teachers due to the positive effects of the natural environment. Further research into social work in natural environments can help us better understand the role of nature in people’s physical and mental well-being.

Background: Youth who have experienced cancer face challenges that include social isolation, increased psychological risks, and developmental interruptions. Adventure therapy may offer a tool to enhance resilience for this population. Purpose: This study sought to understand how adolescents with lived experiences of cancer perceive and experience their participation in a wilderness-based adventure therapy program. Method: This study used a mixed methods design with a qualitative thematic analysis of semi-structured interviews and quantitative descriptives and independent sample t -tests of Adventure Therapy Experience Scale (ATES) scores to assess two cohorts of youth ( n = 17), ages 13–17, who participated in the See You at the Summit program. Findings: Five themes emerged from the data; social support/connection, choice/autonomy, psychological growth/emotional development, overcoming challenges, and time in nature. Quantitative results found the highest impact on the ATES Interpersonal and Nature subscales and the lowest with challenge. There were significant differences between younger and older participants on engagement in nature. Implications: Triangulation between qualitative themes and ATES scores offered insight into participant perspectives of the impact of the adventure therapy experience. Practice implications include the need for programs that promote social support, choice and autonomy, and time in natural settings.

Abstract Outdoor-based interventions, like adventure therapy, have numerous positive benefits, yet current literature is inconclusive on this topic regarding older adult participants. Therefore, the purpose of this study is to explore health outcomes for older adults engaging in outdoor-based interventions, including adventure therapy. A scoping review was conducted using 20 databases and specific journals, and a staged blinded review. The resulting data was synthesized into three groups that align with the components of successful aging: Prevention of disease/disability, retaining good physical/cognitive functioning, and active engagement. From these findings, implications for allied health professionals and experiential educators are discussed, and future research directions are recommended.

Individuals with rare skeletal disorders like Multiple Osteochondromas and Ollier Disease often experience physical and psychological burdens. Adventure therapy, with activities like sailing in outdoor settings, promotes personal growth and psychological well-being, potentially improving health-related quality of life (HRQoL). This study aimed to evaluate the impact of a sailing program on health-related quality of life and participant satisfaction in individuals with Multiple Osteochondromas and Ollier Disease. A quasi-experimental one-group pre-post design was employed, with HRQoL assessed using the EQ-5D® instrument and participant satisfaction measured via a feedback survey. Data were collected before and after the five-day sailing program conducted in the Mediterranean Sea in 2022 and 2023, involving participants diagnosed with Multiple Osteochondromas and Ollier Disease. Statistical analyses were performed using the Wilcoxon signed-rank test and McNemar’s test for paired data. A significance level of p < 0.05 and p < 0.10 was considered. A total of 25 participants, predominantly male (52%), with a median age of 16 years (ranking from 11 to 31), were included in the study. The sailing program had mixed impact on HRQoL. Specifically, individuals who were female (p = 0.03), aged 16 and older (p = 0.04), with higher educational attainment (p = 0.10) or stronger self-management (p = 0.09), resilience (p = 0.01) and self-engagement (p = 0.09) skills experienced enhanced HRQoL. Conversely, other participants exhibited an increase in self-care difficulties (p = 0.02) and a trend towards worsening pain/discomfort (p = 0.38). Overall satisfaction with the program was high, with 90% of participants expressing satisfaction.This is the first study which examined HRQoL in Multiple Osteochondromas and Ollier Disease patients within an outdoor adventure therapy setting. Findings suggest that adventure therapy, integrated into healthcare strategies, may offer a valuable complement to conventional treatments for rare skeletal disorders. Future research, including randomized controlled trials, are necessary to confirm these results and develop robust interventions for improving the well-being in this population.

ABSTRACT Adverse childhood experiences (ACEs) have gained prominence in recent literature for their effects on the well-being of children. Children with ACEs often exhibit maladaptive behaviors, such as anxiety, depression, maladaptive relationships, drug usage, and school issues. Adventure therapy (AT) improves youth’s ability to form relationships, develop self-confidence, improve decision-making, and utilize effective coping strategies. This paper explores the use of AT as a primary, secondary, and tertiary intervention strategy to offset and/or prevent deleterious effects experienced by adolescents with ACEs and provides a case example to conceptualize the use of AT as an intervention for adolescents with ACEs. Considerations, limitations, and resources for conducting AT with lower-SES youths are discussed.

ABSTRACT Youth involved in the child welfare system need creative ways to meet their needs. One type of active group intervention, adventure therapy, is currently gaining momentum as an additional support for youth with trauma histories. The Ohio Adventure Therapy Coalition (OATC) developed an implementation model to support youth workers in facilitating adventure therapy groups across the state with a focus on trauma-informed care and involving providers in a parallel process, so they can personally understand the process of adventure therapy. A pilot study collected data from youth, parents and providers looking at overall mental health functioning and trauma symptoms. Overall, youth reported significant improvements in overall mental health functioning, while parents reported significant overall improvements as well as improvements on five subscales as measured by the Youth Outcomes Questionnaire. Providers reported significant decreases in youth trauma symptoms, behavioral and emotional needs and risk behaviors as captured by the CANS.

ABSTRACT Background It was considered useful to describe service-users’ and staff’s experience of Adventure Therapy (AT) in an Early Intervention for Psychosis (EIP) service, exploring the impact on personal wellbeing and feasibility of use. Method Focus groups were conducted with 14 participants, immediately following, and three months after a four day hiking trip. Transcripts were analysed using inductive thematic analysis. Questionnaires were administered pre and post trip to describe service-users’ physical activity, recovery and personal goals. Results A majority of participants reported progress towards personal goals on the AT trip and improvements in confidence and connectedness. Questionnaire items did not show improvements in physical activity and recovery measures at 3- and 6-month follow-up. Four key themes emerged from the focus groups. The themes centred around the social experience of being in relation to others and a more personal emotional experience: (a) social connectedness, (b) challenging perceptions of self-capabilities, (c) positive reaction to new experiences and (d) motivation for more. Discussion AT was positively experienced by both staff and service-users. Key areas of benefit were recognised and considered for utilisation in services in different ways. Further studies are warranted exploring maintaining and supporting benefits gained following AT.

ABSTRACT Despite the utilization of adventure therapy techniques in behavioral health disorder prevention programming, little is known about how providers become trained in adventure-based prevention practice. Additionally, limited literature examines how adventure therapy providers are trained. This exploratory qualitative study provides a starting point for understanding the education and lived experiences that prepared providers of adventure-based prevention for professional practice. A purposive sample of 23 clinicians and administrators participated in semi-structured interviews with the first author. Interviews were transcribed and analyzed using thematic analysis with first-cycle coding, second-cycle coding, and in-vivo coding. Strategies to ensure the trustworthiness of the data were utilized including researcher reflexivity, memoing, intercoder reliability, triangulation, in-vivo coding, and member checking. Primary themes were providers’ lived experiences leading to adventure-based work, education & training, and mentorship. Discussion of new findings about preparation and education for adventure-based prevention are offered. Implications are described for practice, policy, research, and education.

IntroductionA complex, Nature-, and Adventure Therapy - integrated Schema Therapeutic program (N-ABST) and a related efficacy study was launched in 2022 April at the Psychotherapy Department, at Semmelweis University. The participants had the opportunity of having outdoor, experience based group processes – seven full days in a month - in addition to the classic Schema Therapy (ST) sessions. According to the study design, 4-week long traditional thematic ST programs and 4-week long N-ABST programs were taken place alternately.ObjectivesOur aim was to compare the efficacy in a randomized, controlled design, short and medium terms. The participants of the programs and thus the target group of the research were adults, diagnosed mainly with Borderline Personality Disorder, inpatients in psychiatry.MethodsThis methodological innovation also meant the integration of two therapeutic teams in practice. When establishing the collaboration, we put emphasis on finding common points and understanding how N-AT contributes to schema therapy goals. During our joint work, it became clear that the elemental need for contact with nature enriched the schema therapy approach with a new basic need that was not included in it before. Measurements were taken before the start of the entire program and at the end of the 4-week cycle. Preliminary results are presented based on the Personality Inventory for DSM-5 - Hungarian Short Form (PID-5-HSF), and the Derogatis Symptom Checklist (SCL90).ResultsIn the N-ABST group (n=23) the PID5 “Dysinhibition” scale (p < .01, Cohen’s d = .636), and the “Negative Affectivity” scale (p < .05, Cohen’s d = .388) showed significantly lower scores after therapy. In the case of the “Detachment” we have found a tendency to decrease after the therapy. Regarding the comparison of the effectiveness of N-ABST and classical Schema Therapy - with the current state of analysis - there was a significant difference in the PID5 values for “Suspiciousness” and “Manipulativeness”. The former characteristic was reduced to a greater extent by the schema therapy, and the latter by the N-ABST therapy. Based on the SCL90, the N-ABST program resulted in a significant symptom reduction measured by the following subscales: somatization, obsessive compulsive, interpersonal sensitivity, depression, phobia. Global symptom severity also decreased significantly (p < .05, Cohen’s d = .588).ConclusionsAccording to our results, Nature- Adventure Therapy enhanced Schema Therapy seems to be an innovative and efficient method in the psychotherapy of personality disorders. Besides the effectiveness, there is a great challenge to design programs that are sustainable and therefore serves therapy long term as well.This study was supported by the National Research, Development and Innovation Office grant K 129195.Disclosure of InterestNone Declared

Combining acceptance and commitment therapy with adventure therapy to face vulnerability: Examples and insights from a sailing experience