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Adventure Based Counseling and Treatment Outcomes

2251 words (9 pages) Essay in Psychology

18/05/20 Psychology Reference this

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Abstract

Research based evidence has grown in the past decade related to the therapeutic potential and positive outcomes associated with Adventure Based Counseling (ABC) for children, adolescents and adults. This review identifies and articulates the extant literature of adventure based counseling programs and their effect on treatment outcomes found between 2007 and 2019. It will explore research specific to the treatment effectiveness of adventure based counseling. The purpose of this study is to identify if individuals who participate in ABC have lower levels of mental health symptoms after treatment. The terms wilderness therapy, adventure therapy, adventure based counseling and therapeutic adventure will be used interchangeably.

 Keywords: adventure based counseling, mental health outcomes, treatment effectiveness

 

Adventure Based Counseling and Treatment

Adventure Based Counseling (ABC) is a widely utilized treatment modality that provides alternatives for individuals seeking a change to the more traditional individual or group counseling models. This treatment modality can be defined according to Gass, Gillis, and Russell (2012), as the use of adventure experiences by mental health professionals in a natural setting used to engage clients on cognitive, affective and behavioral levels. ABC is an integrative therapeutic tool that can be adapted to almost any setting and to a wide variety of populations.

The unique characteristics of ABC include its applicability in multiple treatment formats and the noted unique therapeutic relationship between clients and practitioners. Facilitators provide environments that are both supportive and challenging with the underlying understanding that too little challenge can lead to apathy or boredom, whereas too much challenge can lead to a negative experience for the individual. However, numerous research studies have varied regarding the treatment characteristics, client characteristics and the processes associated with ABC and potential links to effecting changes in problem severity for individuals.

Furthermore, exploration of the literature has revealed that most of what is accepted as important to the process of achieving outcomes in Adventure Based Counseling is based on theory, not research. Things such as physical environment, use of activities, processing, group, and instructors have all been considered to affect the process of change; however, few studies have specifically targeted these areas in enough detail to be able to outline the specific qualities that promote change. In addition, professionals that have engaged in ABC, have stressed the need for more methodologically sound, quantitative studies that look at the processes behind the change.

Review of the Literature

Personal and Social Skills

 Gass et al. (2012) summarizes that Adventure Based Counseling uses various forms of experiential learning activities within the environment of the outdoors for assessment and intervention at either the individual or group level, in order to effect psychological or behavioral change in individuals. Hill (2007) suggests that programs that integrate individual and group counseling enhance the impact of the curative factors of nature and group initiatives. In comparison, Schell, Cotton and Luxmoore (2012) hypothesized that outdoor adventure experiences would contribute to increases in self-esteem, social connectedness compared to those who participated in other outpatient groups. Results in the domain of self-esteem revealed that “there was significant improvement in self-esteem for the outdoor adventure group (P=0.005) but not for the controls (P=0.789)” (p.410). Another study conducted by Paquette and Vitaro (2014) sought to evaluate the impact of adventure based counseling on antisocial behaviors and socio-professional status. Results indicated that antisociality levels in both groups diminished from pre-test levels, while socio-professional status, interpersonal skills and accomplishment motivation improved. This showed a positive correlation between antisocial level and poor socio-professional status, while high interpersonal skills and accomplishment motivation were found to be correlated with low antisocial level and better socio-professional status. Similarly, Bowen, Neill, and Crisp (2016) suggest that individuals who participate in these activities derive meaning and these meanings are intended to be incorporated back into the participant’s personal and social world. It was hypothesized by these authors that adventure counseling would be associated with significant short-term improvements in psychological and behavioral symptoms and these changes would be maintained for a three month follow-up period. Their study found that the short-term ESs were statistically significant for the subscale of the social domain and non-significant for the subscales of home/parents, general and school/academic. The results by Bowen et al. (2016) suggest that adventure based activities can help individuals improve coping strategies, inadequate problem-solving methods, and to develop greater resilience long term. In addition, research from Bettmann, Tucker, Behrens and Vanderloo (2017) emphasized the positive impact that adventure counseling experiences have on significant improvements in interpersonal relationships and symptom distress. Although the study was unable to draw conclusions about changes in specific mental disorders from their scores, it did find that participants’ attachment relationships improved significantly from intake to discharge. Bettmann, et al. (2017) reported increases in participant’s belief that “others can be depended upon, as well as greater sense in comfort in their intimate and close relationships” (p. 518).

Finally, Picton, Moxham and Patterson (2016) sought to show the positive benefits of therapeutic recreation for people living with mental illness. Five subthemes and one overall theme were identified which revealed that self-determination, participation, extending self, relationships and positive change were all interrelated with the experience and strengthened the overall theme of empowerment. These findings indicated that therapeutic recreation is an effective intervention which enhances wellness while also encompassing the principles of mental health recovery.

Stress and Coping Skills

 Research has substantiated that time spent in nature is an effective intervention to reduce mental health symptomology and promote psychological well-being (Bratman, Hamilton, & Daily, 2012). Adventure therapy modalities have emerged that can positively augment other therapeutic approaches by improving coping skills and assisting clients in managing stress. Research by Koperski, Tucker, Lung and Gass (2015) measured how adventure therapy impacts self-reported levels of stress and varied forms of coping skills in adult participants. Their findings supported that participants decreased stress and increased coping skills over the course of treatment, with total perceived stress scores reduced by a mean 13.6 points from intake scores of 25.4 to discharge from the program.

Several promising factors that might be explained through therapeutic adventure include sense of life purpose, self-confidence, attitudes toward seeking professional psychological help, psychological mindedness, and initiatives toward personal growth and reduction of emotional suppression. Of equal importance, Bettmann, Scheinfeld, Prince, Garland and Ovrom (2018), obtained scores from pre to post tests that showed participants involved in the therapeutic adventure program reported significant improvement in life purpose, satisfaction and self-confidence during stressful situations.

Mental Health Symptoms

 Wilderness therapy is a treatment that seems to be well suited to those who have not been successful with other mental health systems, such as psychiatric hospitals, rehabilitation programs and outpatient treatment. The overall goal of this treatment modality is for participants to learn adaptive behaviors in a therapeutic setting within nature while being away from the distractions of other life settings such as home, school, and their communities. Tucker, Javorski, Tracy and Beale (2013) study focused on determining whether or not adventure therapy was an effective treatment modality compared to traditional counseling. According to their findings, it appeared that type of counseling was significantly related to decreases in problem severity. Specifically, “participants in AT combined with psychological counseling had significantly higher decreases in problem severity than participants who received psychological counseling only” (p. 167). Similarly, Bowen et al. (2016) results suggested that wilderness adventure therapy may be especially well suited to the treatment of participants with clinical psychological symptoms, but less well suited for prevention and early intervention. In addition, Bettmann et al. (2018) findings appear congruent with existing research showing participation in therapeutic adventure is associated with improvements in psychological well-being.

Demographic Factors

 Research has been done to look at the predictors of change and outcomes in adventure therapy but not necessarily client or program characteristics related to those outcomes (Tucker, Smith, & Gass, 2014). In a study completed by Roberts, Stroud, Hoag and Combs (2016) the aim was to fill gaps in the literature by examining how age, gender, primary diagnosis, therapist assignment, and length of treatment influence the overall well-being of participants in outdoor behavioral health programs. Results of this study suggested all participants benefitted similarly from their participation in an outdoor behavioral health intervention regardless of these characteristics outlined above. Equally important is research completed by Combs, Hoag, Javorski and Roberts (2016) showed that average female clients entered treatment with greater symptom severity than their male counterparts, but improved faster and ended up with lower symptom severity than males for an average length of stay in an outdoor behavioral health program.

Research Question and Design

 In order to seek to establish a cause-effect relationship between mental health symptoms and participation in an adventure based counseling experience this research will seek to answer the following question: Do individuals who participate in Adventure Based Counseling (ABC) have lower levels of mental health symptoms after treatment? . This study will seek to contribute to the literature by exploring the trajectory of change during treatment and investigate predictors of change related to mental health symptoms pre and post treatment. Research design will be a quasi-experimental design with the two variables identified as mental health symptoms and adventure based counseling treatment. Type of data to be collected will be interval-ratio data in order to obtain the levels of mental health symptomology (i.e., anxiety, depression) in pre and post treatment. The importance of this research question is to stress the need for more methodologically sound, quantitative studies that look at the process of change in relation to adventure based counseling. Gass and Young (2007) stress that “greater consistency in the delivery of program elements linked to treatment effectiveness is a growing expectation of education and mental health programs” (p. 10). ABC is developing into a significant area of counseling interventions and must be supported in order to create evidence based practices to gain further credibility as a legitimate field of practice. This will further aid in the identification of adventure based counseling as a primary type of intervention rather than an adjunctive one.

References

  • Bettmann, J. E., Scheinfeld, D. E., Prince, K. C., Garland, E. L., & Ovrom, K. V. (2018). Changes in psychiatric symptoms and psychological processes among veterans participating in a therapeutic adventure program. Psychological Services, 1-10. http://dx.doi.org/10.1037/ser0000213
  • Bettmann, J. E., Tucker, A., Behrens, E., & Vaderloo, M. (2017). Changes in late adolescents and young adults’ attachment, separation, and mental health during wilderness therapy. Journal of Child & Family Studies, 26, 511-522. doi: 10.1007/s10826-016-0577-4
  • Bowen, D. J., Neill, J. T., & Crisp, S. J. (2016). Wilderness adventure therapy effects on the mental health of youth participants. Evaluation and Program Planning, 58, 49-59.
  • Bratman, G. N., Hamilton, J. P., & Daily, G. C. (2012). The impacts of nature experience on human cognitive functioning and mental health. Annals of the New York Academy of Sciences, 1249, 118-136. http://dx.doi.org/10.1111/j.1749-6632.2011.06400.x
  • Combs, K. M., Hoag, M. J., Javorski, S., & Roberts, S. D. (2016). Adolescent self-assessment of an outdoor behavioral health program: Longitudinal outcomes and trajectories of change. Journal of Child & Family Studies, 25, 3322-3330. doi: 10.1007/s10826-016-0497-3
  • Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research and practice. New York, NY: Routledge.
  • Gass, M., A., & Young, M. (2007). Dealing with the issues or program effectiveness, cost benefit analysis, and treatment fidelity: The development of the NATSAP research and evaluation network. Journal of Therapeutic Schools and Programs, 2(1), 8-24.
  • Hill, N. R. (2007). Wilderness therapy as a treatment modality for at-risk youth: A primer for mental health counselors. Journal of Mental Health Counseling, 29(4), 338-349.
  • Koperski, H., Tucker, A. R., Lung, M., & Gass, M. (2015). The impact of community based adventure therapy on stress and coping skills in adults. The Practitioner Scholar: Journal of Counseling and Professional Psychology, 4(1), 1-16.
  • Paquette, J. & Vitaro, F. (2014). Wilderness therapy, interpersonal skills and accomplishment motivation: Impact analysis on antisocial behavior and socio-professional status. Residential Treatment for Children & Youth, 31, 230-252.
  • Picton, C., Moxham, L., & Patterson, C. (2016). Therapeutic recreation for people with a mental illness is beneficial. Australian Nursing & Midwifery Journal, 23(10), 39.
  • Roberts, S. D., Stroud, D., Hoag, M. J., & Combs, K. M. (2016). Outdoor behavioral health care: Client and treatment characteristics effects on young adult outcomes. Journal of Experiential Education, 39(3), 288-302. doi: 10.1177/1053825916655445
  • Schell, L., Cotton, S., Luxmoore, M. (2012). Outdoor adventure for young people with mental illness. Early Intervention in Psychiatry 6, 407-414.
  • Tucker, A. R., Javorski, S., Tracy, J., & Beale, B. (2013). The use of adventure therapy in community-based mental health: Decreases in problem severity among youth clients.               Child Youth Care Forum, 42, 155-179. doi: 10.1007/s10566-012-9190-x
  • Tucker, A. R., Smith, A., & Gass, M. (2014). How presenting problems and individual characteristics impact successful treatment outcomes in residential and wilderness treatment programs. Residential Treatment for Children & Youth, 31, 135-153. doi: 10.1080/0886571X.2014.91844
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