Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial
Post-traumatic stress disorder (PTSD: DSM-5) is a disabling psychological condition comprising four main sets of symptoms: re-experiencing, hyperarousal, avoidance and negative changes in thoughts and mood. Re-experiencing refers to intrusive thoughts or images, flashbacks and/or nightmares. Hyper-arousal may be characterised by sleep disturbance, irritability, anger and hyper-vigilance for threat in the environment. People with PTSD tend to cope by avoidance of situations and social interactions and have difficulty in regulating emotions. Social maladjustment, phobia, anger, violent behaviour and family discord are often associated with combat-related PTSD. PTSD is also frequently comorbid with other mental health problems such as depression, anxiety, substance abuse and suicidal ideation. If left untreated, PTSD may become a chronically disabling condition associated with impaired occupational, relational and social functioning. It is notoriously difficult to estimate the numbers of military veterans with PTSD. A comprehensive review of evidence from multiple sources suggests a prevalence of between 2–17% amongst US veterans and 3–6% of UK veterans, with estimated rates affected by a range of methodological factors such as sampling strategy, measures, criteria employed to determine cases, as well as combat role and cultural background. Given that, in the UK for example, there are more than one million military veterans aged 20–69, and in the US approximately 20.1 million, these percentages translate into substantial numbers of men and women living with a condition that impacts upon their wellbeing and life quality, capacity to work, maintain personal and parental relationships and social connectedness, all of which incur substantial personal and public costs. While established evidence based psychological treatments exist for PTSD, evidence suggests that military veterans with PTSD in particular do not benefit adequately from such provision. The present paper reports upon the rationale, development and evaluation of a supplemental outdoor recreational experience approach to reach UK military veterans with PTSD.
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