With the final withdrawal US forces from the battlefield of Afghanistan bringing what appears to be an official end to the nation’s longest running conflict, the nation is faced with questions as to how to repay a debt of gratitude to those who served in this and other conflicts during what has come to be known as the Global War on Terror. In addition to reintegration and employment needs of 21.8 million American veterans, 3.8 million report a disability related to their military service. (Bennett, 2017). Many of those who report a disability suffer from one of the signature injuries of these modern conflicts, post-traumatic stress disorder, commonly referred to as PTSD. Prevalence rates of 16% to 32% have been reported among American Veterans (Greer, 2019).
Recent research has attempted to address the need for strong evidence to support the use of nature as a viable alternative or complementary intervention for treatment of Veterans, both in the US and in other countries, with PTSD. For example, a foundational pilot study sought to build a strong case for the correlation between immersion in the outdoors while pursuing a recreational activity and a decrease in symptomology of Veterans experiencing PTSD (Vella, 2013). A cursory review of relevant literature indicates that there is a need to provide a greater volume and broader variety of treatment for PTSD among Veterans, along with their comorbidities of depression, alcohol/substance abuse, and relationship struggles with family and friends. An important study of Veterans in Australia measured these comorbidities among Veterans who participated in peer-led adventure-based therapy. Depression, anxiety, and stress were measured, along with post-traumatic stress disorder symptoms. Relationships, self-efficacy, and quality of life were also measured. Findings of the research indicated significant short-term improvements in the various areas studied as well as the sustainment of the improvements over time (Theal, 2020). One important issue under consideration is whether the most effective intervention consists of immersion in nature itself, or immersion in nature paired with activities in the natural environment. An important study of Danish Veterans sought to understand the impact of both the nature setting and the nature-based activities upon the Veterans as treatment interventions. Nature-based activities included mindfulness, applied mindfulness, activities, and individual therapeutic sessions all conducted within a therapy garden located in a forest preserve (Poulsen, 2016). Consensus among many researchers is that the use of the outdoor, natural environment as an intervention is a growing but under researched topic of interest worthy of further investigation. Another consistent theme which emerged was the realization of the overall lack of strong research addressing the use of the outdoor, natural environment as a treatment modality for Veterans diagnosed with PTSD. This is particularly noticeable in comparison to more traditional pharmacological and psychological interventions which are routinely used to treat PTSD among Veterans. These insights reveal an overall theme of the vast potential for further rigorous research be it qualitative, quantitative, or mixed method studies which can address this need.
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