Wilderness Therapy Program Research Articles

How adolescents view the role of the wilderness in wilderness therapy: “I am in the middle of nowhere and that is okay”

Wilderness therapy (WT) has become recognized as an innovative treatment option for struggling adolescents. Several WT studies identify the unique elements of WT programs, examining how they contribute to outcomes. What has not been clearly determined is the role of the wilderness in a WT program. The current study was conducted at a wilderness therapy program in southern Utah and explores the role of the wilderness for adolescents who completed the program. Participants graduating from this program were recruited to participate in phenomenological focus group interviews to gather data. An inductive thematic analysis found four themes related to the wilderness setting including: being removed from prior distractions, the novel environment, challenging experiences, and feelings of awe in the wilderness. These findings support previous research by Russell and Gillis (2017) while also highlighting young participant’s perspectives of the role of wilderness in their treatment process.

Readiness to Change, Trait Emotional Intelligence, and Client Fit in Wilderness Therapy

Youth (aged 12–30) are the most likely age group to experience problematic substance abuse, yet this population experiences relatively low rates of success in treatment and limited research and understanding exists regarding “client fit.” This study explored how youth participation in one Canadian wilderness therapy program affects trait emotional intelligence (TEI) and readiness to change (RC) and how pretreatment client-level variables—presenting problems, sex, age, funding, digital interference in everyday life, or substance abuse severity—moderate these relationships. A case study design was engaged, and the intervention was found to produce statistically significant increases in RC but not in TEI. Relative to pretreatment client-level variables, participants who experienced interference in their everyday life due to video games or online activity before treatment had larger TEI change scores, while participants who experienced interference in their everyday life due to virtual relationships had larger changes in RC. No client-level pretreatment variables in this study significantly predicted increases in RC following wilderness therapy.

Emerging stories of self: long-term outcomes of wilderness therapy in Norway

ABSTRACT This paper is a twelve-month follow-up study that explores perceived outcomes from participation in a Norwegian wilderness therapy program. Through a critical realist approach, the authors performed an in-depth analysis of individual interviews with ten adolescent participants. Long-term outcomes included the transfer and adaptation of calming and nature-supported strategies to the participants’ home environments, improvements in mood and emotional regulation, and increased social interaction. Overall, the adolescents seemed to exert greater independence and agency in their lives at twelve months post-treatment. This ability appeared to be facilitated by underlying processes that entailed insight, awareness, and acceptance of oneself and one’s situation. The authors suggest that these emerging stories are fragile, yet conditioned by a fundamental (re)connection with the self and address this cautious proposition in the discussion. Finally, a more precise theoretical framework should be developed to support future in-depth explorations.

"The Lived Experience of Mental Health Providers in Wilderness Therapy Programs"

"The Lived Experience of Mental Health Providers in Wilderness Therapy Programs"

Therapy the Natural Way: A Realist Exploration of the Wilderness Therapy Treatment Process in Adolescent Mental Health Care in Norway.

Wilderness therapy has the potential to meet the specific needs of the current adolescent population by providing a rather unique outdoor group treatment. Wilderness therapy is not a new approach to mental health treatment, but its theoretical basis is not yet clearly delineated, in part because of the diversity found across programs and contexts. This article presents a critical realist exploration of a wilderness therapy program that was recently implemented as part of adolescent mental health services in Southern Norway. In this study, we combine fieldwork and interviews for an in-depth investigation of the treatment process, where the objective was to acquire a deeper understanding of the opportunities that arise in the wilderness therapy setting. The therapeutic mechanisms and influential contextual premises found across the ecological, physical, and psychosocial factors of this multidimensional approach to treatment are presented, and their underlying conditions are briefly discussed.

Healing Fears, Conquering Challenges: Narrative Outcomes From a Wilderness Therapy Program

ABSTRACTDespite the number of studies containing evaluations of the effectiveness of wilderness therapy, in the extant literature there is little research regarding participant views that account for the successful outcomes reported. This qualitative study contains an investigation of the narratives of staff and residents at a youth-focused therapeutic community who took part in a wilderness program. The researchers of this study seek to identify what the participants consider meaningful and the most significant change that took place within the participants as a result of taking part in the wilderness program. Data analysis reveals a sequential stage-model emphasizing the importance of relationship to: (a) professional staff; (b) nature as a healing modality; (c) peers; and (d) self, with all four categories contributing to improved mental health in specific ways. Links bridging these relationships and the factors influencing the strength of those links are also discussed. Findings inform design and practice of future wilderness programs, staff training, and directions for further research.

Psychology Versus Therapy: Implications for the Practice and Supervision of Therapy in Residentail Treatment and Wilderness Therapy Programs

Psychology Versus Therapy: Implications for the Practice and Supervision of Therapy in Residentail Treatment and Wilderness Therapy Programs

Outdoor Behavioral Health Care: A Longitudinal Assessment of Young Adult Outcomes

This article details a 3‐year outdoor behavioral health care outcome study. Hierarchical linear modeling was used to analyze data from 186 young adults in a wilderness therapy program. Participants completed the Outcome Questionnaire–45.2 (Lambert et al., ) 6 times from Week 1 to 18‐month postdischarge follow‐up. Results indicated that clinically and statistically significant change occurred in treatment. Rates of change varied, and posttreatment scores remained stable, thus demonstrating that in‐treatment gains were maintained. Implications and recommendations for future research are discussed.

Changes in Late Adolescents and Young Adults’ Attachment, Separation, and Mental Health During Wilderness Therapy

The study explored changes in young adults’ mental health, attachment, and separation from parents during a seven-week wilderness therapy program. Utilizing a longitudinal one-group design, the study examined outcomes of 157 young adults in one wilderness therapy program. From pre to post treatment, participants reported significant improvement in mental health symptoms and interpersonal relationships, as well as increases in the belief that others can be depended upon. Participants reported less resentment and anger towards mothers from pre to post treatment, but an increase in their needs for approval from fathers. The study details a link between young adults’ attachment, independence from parents, and improvement in mental health, suggesting that treatment which targets these links may provide more effective intervention.

A Meta-analysis of Wilderness Therapy Outcomes for Private Pay Clients

Wilderness therapy is becoming a more widely used intervention for adolescents, but there have not been any meta-analyses focused solely on its clinical effectiveness for private pay clients. This study’s objective was to conduct outcome-based meta-analyses of private-pay wilderness therapy programs, benchmark primary features of this approach, and educate the clinical community as to its effectiveness. The authors conducted a review of all available databases, as well as manual searches. Searches resulted in a meta-analysis based on 36 studies, totaling 2399 participants receiving wilderness therapy. Our meta-analyses found medium effect sizes for all six constructs assessed: 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). Subgroup analyses included age of participants, duration of program, open or closed model, presence of a mental health practitioner, and publication year.

Longitudinal Outcomes for Youth Transported to Wilderness Therapy Programs

Purpose: Due to the ethical concern around involuntary treatment, this study sought to investigate if youth participants in wilderness therapy who were transported to the program experienced different rates of change than those not transported. Methods: Multilevel modeling techniques were used to investigate rates of change for youth between transported and nontransported youth over 5 points until 6 months postdischarge. In addition, repeated measures analyses of variance investigated parent reports of change over time across transport status, gender, and diagnosis. Results: The findings showed no differences between transported and nontransported youth in changes over time. Overall, all youth improved significantly with changes maintained postdischarge regardless of transport status. Discussion: This study shows that transporting youth to treatment does not appear to interfere with the treatment outcome; however, more research is needed to understand clients’ perception of the transport process.

Descending from the Summit: Aftercare Planning for Adolescents in Wilderness Therapy

Despite substantial gains adolescents and families can make in the intensely therapeutic and structured environment of wilderness therapy, regression is still a significant risk at the time of discharge. Accordingly, intentional and comprehensive aftercare planning is crucial to support adolescents and families internalize the changes begun in wilderness therapy. Wilderness therapy is a powerful and focused intervention, but it is not the solution. This article describes why most adolescents leaving wilderness therapy programs transition to longer-term, residential therapeutic schools and programs upon discharge. Although intentional separation of parents and children might appear counterintuitive, these settings often provide the least-restrictive environment. Their therapeutic benefit is explained using Bowen theory and the trans-theoretical model of change. Considerations for a successful aftercare plan are identified, including the importance of the family therapeutic process in supporting adolescent clinical growth, and when going home upon discharge is recommended. Lastly, suggestions are offered for treatment providers to support families making difficult aftercare decisions.

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.

Why Randomized Trials Are Challenging Within Adventure Therapy Research

There are few high-quality studies using randomized controlled trials (RCTs) in the adventure and wilderness therapy literature. Thus, a unison call is heard for more such studies to be carried out. This article presents a Norwegian wilderness therapy research project that planned to incorporate this “gold standard” that is regarded as the most scientific and rigorous approach available. We did not succeed. Mounting challenges led us to discard the RCT altogether and select other methodologies. Here, we account for the ethical, health outcome, practical, and empirical obstacles that we encountered when attempting to randomize at-risk adolescents into experiment and control groups. Our conclusion is that although RCTs may be superior in some aspects, they hold the potential to become bad science when the interventions are as complex and multi-faceted as adventure and wilderness therapy programs.

The Role of Transport Use in Adolescent Wilderness Treatment: Its Relationship to Readiness to Change and Outcomes

Background Considering the sensitive ethical issues related to involuntary treatment of adolescents, research investigating youth transport practices and treatment outcomes is clearly needed. Youth transport is common practice in many private pay programs, including wilderness therapy programs.

An Exploration of Gender, Client History, and Functioning in Wilderness Therapy Participants

This article explored differences by gender in client mental health history, presenting issues, and current functioning among adolescents in wilderness therapy. The study used a random sample of 401 youth in wilderness therapy programs, utilizing data from archival psychological evaluations conducted during wilderness treatment. Results showed that females were more likely to have participated in outpatient treatment prior to a wilderness therapy program. Additionally, analysis indicated that females were more likely than males to participate in self-harming behaviors and suicide attempts. Males were more likely to have been significantly involved with criminal activity prior to treatment. Analysis provided a deeper understanding of the current population of wilderness therapy participants in an effort to inform current wilderness therapy practices. It is imperative for clinicians to have a better understanding of gender differences when considering wilderness therapy as a treatment option.

Wilderness Therapy, Interpersonal Skills and Accomplishment Motivation: Impact Analysis on Antisocial Behavior and Socio-Professional Status

Wilderness therapy is an alternative to more traditional interventions for antisocial youth. It has the potential to broaden their existing, and often poor, repertoire of personal and social skills, heightening the possibilities of desistence from an antisocial path. In this study, the impact of participation in a wilderness therapy program for adjudicated youth was observed. An experimental and prospective design, with pre-test and post-tests at three and six months, was used to evaluate the influence of the length of the program on the antisocial behavior and socio-professional status of young offenders. The potential impact of interpersonal skills and accomplishment motivation as mediators was also observed. A sample of 220 young offenders was used, which was divided at random into two conditions; a program lasting between 8 to 10 days or one lasting between 17 and 20 days. Length of program had no direct and significant influence on participants’ antisocial behavior or socio-professional status. However, length had a positive indirect effect on lowering the level of participants’ antisociality, through the development of some interpersonal skills and accomplishment motivation.

How Substance Abuse Recovery Skills, Readiness to Change and Symptom Reduction Impact Change Processes in Wilderness Therapy Participants

Previous research has demonstrated that wilderness therapy is effective, yet very few studies have attempted to discern quantitative factors responsible for change that occur during wilderness therapy. This study aimed to tease apart specific factors that impact client progress and outcome. A sample of 189 adolescent clients in a wilderness therapy program completed the Youth Outcome Questionnaire Self-Report, the University of Rhode Island Change Assessment (URICA), and the Adolescent Relapse Coping Questionnaire (ARCQ) at pre-treatment, post-treatment, and follow-up intervals. Analysis of the complete data sets of 41 adolescents indicated that client Y-OQ scores improved significantly at post and follow-up assessments. URICA scores were not significantly related to such changes, while the ARCQ subscale of abstinence-focused coping strategies accounted for a significant proportion of the variance in Y-OQ change. These results indicate that clients in wilderness therapy do not necessarily need to want to change in order to do so. Furthermore, helping adolescents in wilderness therapy settings gain abstinence-focused coping strategies may be the most effective tool to improve treatment outcomes.

Effects of Program Differences With Wilderness Therapy and Residential Treatment Center (RTC) Programs

Organizations within the National Association of Therapeutic Schools and Programs differ on a variety of programmatic attributes. The purpose of this research was to examine the relationship between individual characteristics, programmatic use of adventure therapy, and YOQ-30 scores of participants attending Outdoor Behavioral Healthcare and Residential Treatment Centers (RTCs). No statistical relationship was found between length of treatment and type of program as measured by client scores, while gender, involvement in individual adventure therapy, percentage of time spent on expedition, and admission scores were significantly related to changes in client scores. Characteristics associated with recovery in both treatment environments are discussed.

Adolescents in Wilderness Therapy: A Qualitative Study of Attachment Relationships

Characterized by acute changes in attachment relationships, adolescence is a time of balancing autonomy and attachment needs. For adolescents in wilderness therapy programs, the setting often challenges their understanding of their own attachment relationships. The current study evaluates the narratives of 13 adolescents in a wilderness therapy program in an attempt to understand their attitudes toward parents, therapists, and other adult figures. Results showed that while participants cited the importance of trusting adults in their lives, they also reported a general lack of trust between parents and themselves. The majority of participants reported rebelling against boundaries set by parents. They also described relationships with mothers negatively, characterizing mothers as controlling and strict. The findings of this study provide insight into working with adolescents by pointing to what are often unseen relational dynamics in treatment. Findings illustrate the need for relational interventions in wilderness therapy that support the formation of adolescents' healthy relational dynamics.