Exploring Changes in Depression and Meaning in Life through River Rafting for Veterans with PTSD
Keywords:river-rafting, veterans with PTSD, depression, meaning in life, nature-based program
As part of a larger research program examining the impacts of nature-based experiences on veterans with Post-traumatic Stress Disorder, this study focused on changes in their depression and meaning in life after participating in a four-day river rafting experience. Results showed that there were statistically significant improvements over time for both depression scores and meaning in life scores. Results also indicated a weak statistically significant, negative association between depression and presence of meaning in life. The study’s results are useful for practitioners who may be considering nature-based programs for their clients, as well as researchers seeking to better understand the psychological health benefits of river rafting.
Alimujiang, A., Wiensch, A., Boss, J., Fleischer, N. L., Mondul, A. M., McLean, K., Mukherjee,
B., & Pearce, C. L. (2019). Association between life purpose and mortality among US
adults older than 50 years. JAMA Network Open, 2(5).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books
Anderson, C. L., Monroy, M., & Keltner, D. (2018). Awe in nature heals: Evidence from military veterans, at-risk youth, and college students. Emotion, 18(8), 1195–1202. https://doi-org.libproxy.clemson.edu/10.1037/emo0000442.supp (Supplemental)
Arenson, M. B., Whooley, M. A., Neylan, T. C., Maguen, S., Metzler, T. J., & Cohen, B. E. (2018). Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study. Psychiatry research, 265, 224–230.
Armenta, R. F., Rush, T., LeardMann, C. A., Millegan, J., Cooper, A., Hoge, C. W., & team, for the M. C. S. (2018). Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry, 18(1), 48. https://doi.org/10.1186/s12888-018-1590-5
Berman, M. G., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with nature. Psychological Science, 19(12), 1207-1212. https://doi.org/10.1111/j.1467-9280.2008.02225.x
Blackburn, L., & Owens, G. P. (2014). The effect of self efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans. Journal of clinical psychology, 71(3), 219-228. https://doi.org/10.1002/jclp.22133
Bowersox, N. W., Saunders, S. M., & Berger, B. (2013). Post-inpatient attrition from care "as
usual" in veterans with multiple psychiatric admissions. Community mental health journal, 49(6), 694–703. https://doi.org/10.1007/s10597-012-9544-8
Braden, A., Overholser, J., Fisher, L., & Ridley, J. (2015). Life meaning is associated with
suicidal ideation among depressed veterans. Death studies, 39(1), 24–29. https://doi-org.libproxy.clemson.edu/10.1080/07481187.2013.871604
Britton, E., Kindermann, G., Domegan, C., & Carlin, C. (2020). Blue care: a systematic review of blue space interventions for health and wellbeing. Health Promotion International, 35(1), 50-69. https://doi-org.libproxy.clemson.edu/10.1093/heapro/day103
Burls, A. (2007). People and green spaces: Promoting public health and mental well-being through ecotherapy. Journal of Public Mental Health 6(3), 16.
Bryan, C., & Bryan, A. (2016). The state of knowledge about nature-based interventions for the treatment of posttraumatic stress among military personnel and veterans. In This Land Is Your Land: Toward a Better Understanding of Nature's Resiliency-Building and Restorative Power for Armed Forces Personnel, Veterans, and Their Families (1st ed., pp. 129-142). Urbana, IL: Sagamore Publishing.
Cordell, H. K. (2008). The latest on trends in nature-based outdoor recreation. Forest History Today, 4-10.
Corona, C. D., Van Orden, K. A., Wisco, B. E., & Pietrzak, R. H. (2019). Meaning in life moderates the association between morally injurious experiences and suicide ideation among U.S. combat veterans: Results from the National Health and Resilience in Veterans study. Psychological Trauma: Theory, Research, Practice & Policy, 11(6), 614–620. https://doi-org.libproxy.clemson.edu/10.1037/tra0000475
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues in clinical neuroscience, 2(1), 47-55.
DeViva, J. C. (2014). Treatment utilization among OEF/OIF veterans referred for psychotherapy
for PTSD. Psychological Services, 11(2), 179–184. https://doi.org/10.1037/a0035077
Dinosaur National Monument (U.S. National Park Service). (2020, August 7). Retrieved September 07, 2020, from https://www.nps.gov/dino/index.htm
Dustin, D. L., Bricker, K., Negley, S., Brownlee, M., Scwab, K. A., & Lundberg, N. (2016). This land is your land: Toward a better understanding of nature’s resiliency-building and restorative power for armed forces. Sagamore-Venture.
Dustin, D., Bricker, N., Arave, J., Wall, W., & Wendt, G. (2011). The promise of river running
as a therapeutic medium for veterans coping with post-traumatic stress disorder.
Therapeutic Recreation Journal, 45(4), 326-340.
Duncan, J., Clarke, N. D., Birch, S. L., Tallis, J., Hankey, J., Bryant, E., & Eyre, E. L. (2014). The effect of green exercise on blood pressure, heart rate and mood state in primary school children. International Journal of Environmental Research and Public Health, 11(4), 3678-3688.
Duvall, J., & Kaplan, R. (2014). Enhancing the well-being of veterans using extended group-based nature recreation experiences. Journal of Rehabilitation Research and Development, 51(5), 685-696.
Garg, R., Couture, R. T., Ogryzlo, T., & Schinke, R. (2010). Perceived psychosocial benefits associated with perceived restorative potential of wilderness river-rafting trips. Psychological Reports, 107(1), 213–226.
Gould, C. E., Rideaux, T., Spira, A. P., & Beaudreau, S. A. (2015). Depression and anxiety symptoms in male veterans and non-veterans: The health and retirement study. International journal of geriatric psychiatry, 30(6), 623–630. https://doi.org/10.1002/gps.4193
Hawkins, B. L., & Puymbroeck, M. V. (2014). Recreational therapy: An introduction (4th ed.). D. R. Austin, M. E. Crawford, B. P. McCormick, & M. V. Puymbroeck (Eds.). Sagamore Publishing.
Hawkins, B. L., Townsend, J. A., & Garst, B. A. (2016). Nature-based recreational therapy for military service members: A strengths approach. Therapeutic Recreation Journal, 50(1). https://doi.org/10.18666/trj-2016-v50-i1-6793
Held, R. F., Santos, S., Marki, M., & Helmer, D. (2016). Veteran Perceptions, Interest, and Use of Complementary and Alternative Medicine. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 33(9), 41–47.
Ho, M. Y., Cheung, F. M., & Cheung, S. F. (2010). The role of meaning in life and optimism in promoting well-being. Personality and Individual Differences, 48(5), 658-663. https://doi.org/10.1016/j.paid.2010.01.008
Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher, 33(7), 14–26.
Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, 169-182.
Keniger, L. E., Gaston, K. J., Irvine, K. N., & Fuller, R. A. (2013). What are the benefits of interacting with nature? International Journal of Environmental Research and Public Health, 10(3), 913–935. https://doi.org/10.3390/ijerph10030913
Kingsley, J., & Townsend, M. (2006). Dig in to social capital: Community gardens as mechanisms for growing urban social connectedness. Urban Policy and Research: An Australian and New Zealand Guide to Urban Affairs, 24(4), 525-537.
Krasny, M. E., Hess Pace, K., Tidball, K.G., Helphand, K. (2010). Nature engagement to foster resilience in military communities. In K. G. Tidball & M. E. Krasny (Eds.), Greening in the Red Zone. Springer.
Kuo, F. E. (2001). Coping with poverty: Impacts of environment and attention in the inner city. Environment and Behavior, 33(1), 5-34.
Kleiman, E. M., & Beaver, J. K. (2013). A meaningful life is worth living: Meaning in life as a suicide resiliency factor. Psychiatry Research, 210(3), 934-939. https://doi.org/10.1016/j.psychres.2013.08.002
Knowles, K. A., Sripada, R. K., Defever, M., & Rauch, S. (2019). Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans. Psychological Trauma: Theory, Research, Practice and Policy, 11(4), 451–458. https://doi.org/10.1037/tra0000383
Krejci, L. P., Carter, K., & Gaudet, T. (2014). Whole health. Medical Care, 52, S5-S8. https://doi.org/10.1097/mlr.0000000000000226
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kroenke, K. & Spitzer, R. L. (2002). The PHQ-9: A new depression and diagnostic severity measure. Psychiatric Annals, 32, 509-521. https://doi.org/10.3928/0048-5713-20020901-06
Luo, Y., Chen, X., Qi, S., You, X., & Huang, X. (2018). Well-being and Anticipation for Future Positive Events: Evidences from an fMRI Study. Frontiers in psychology, 8, 2199. https://doi.org/10.3389/fpsyg.2017.02199
McMahan, E. A., & Renken, M. D. (2011). Eudaimonic conceptions of well-being, meaning in life, and self-reported well-being: Initial test of a mediational model. Personality and Individual Differences, 51(5), 589-594. https://doi.org/10.1016/j.paid.2011.05.020
Moore, M., Townsend, M.., & Oldroyd, J. (2006). Linking human and ecosystem health: The
benefits of community involvement in conservation groups. EcoHealth, 3(4), 255-261.
National Center for PTSD. (2019, October 17). How common is PTSD in adults. Veterans Affairs. Retrieved July 12, 2020, from https://www.ptsd.va.gov/understand/common/common_adults.asp
National Center for PTSD. (2018, September 24). How common is PTSD in veterans? Veterans
Affairs. Retrieved July 12, 2020, from
Office of Patient Centered Care and Cultural Transformation. (2019). Personal Health Inventory.
U.S. Department of Veterans Affairs.
Office of Suicide Prevention. (2016). Suicide among veterans and other Americans. U.S.
Department of Veterans Affairs.
Onwuegbuzie, A., & Collins, K. (2007). A typology of mixed methods sampling designs in social science research. The Qualitative Report, 12(2), 281–316.
Outdoor Participation Report. (2017). The Outdoor Foundation. https://outdoorindustry.org/wp-content/uploads/2017/05/2017-Outdoor-Recreation-Participation-Report_FINAL.pdf
Owens, G. P., Steger, M. F., Whitesell, A. A., & Herrera, C. J. (2009). Posttraumatic stress disorder, guilt, depression, and meaning in life among military veterans. Journal of Traumatic Stress, 22(6), 654–657.
Park, N., Park, M., & Peterson, C. (2010). When is the search for meaning related to life satisfaction? Applied Psychology: Health and Well-Being, 2(1), 1-13. https://doi.org/10.1111/j.1758-0854.2009.01024.x
Sareen, J., Houlahan, T., Cox, B., & Asmundson, G. J. G. (2005). Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey. Journal of Nervous and Mental Disease, 193, 450-454. https://doi.org/10.1097/01.nmd.0000168263.89652.6b
Shanahan, D. F., Bush, R., Gaston, K. J., Lin, B. B., Dean, J., Barber, E., & Fuller, R. A. (2016). Health benefits from nature experiences depend on dose. Scientific Reports, 6.
Sinclair, S., Bryan, C. J., & Bryan, A. O. (2016). Meaning in life as a protective factor for the emergence of suicide ideation that leads to suicide attempts among military personnel and veterans with elevated PTSD and depression. International Journal of Cognitive Therapy, 9(1), 81-98. https://doi.org/10.1521/ijct.2016.9.1.87
Sneep, J. (2007). Ecopsychology: An introduction and Christian critique. Journal of Psychology and Christianity, 26(2), 166-175.
Stander, V. A., Thomsen, C. J., & Highfill-McRoy, R. M. (2014). Etiology of depression comorbidity in combat-related PTSD: A review of the literature. Clinical Psychology Review, 34(2), 87-98. https://doi.org/10.1016/j.cpr.2013.12.002
Starr, L. R., & Hershenberg, R. (2017). Depressive symptoms and the anticipation and experience of uplifting events in everyday life. Journal of Clinical Psychology, 73(10), 1442-1461. https://doi.org/10.1002/jclp.22447
Steger, M.F. (2010). The meaning in life questionnaire (MLQ). Michael F. Steger. Retrieved from http://www.michaelfsteger.com/wp-content/uploads/2013/12/MLQ-description-scoring-and-feedback-packet.pdf
Steger, M. F. & Shin, J. Y. (2010). The relevance of the meaning in life questionnaire to therapeutic practice: A look at the initial evidence. International Forum on Logotherapy, 33, 95-104.
Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The Meaning in Life Questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80-93. https://doi.org/10.1037/0022-0220.127.116.11
U.S. Department of Veterans Affairs. (2020, January 7). PTSD treatment basics. PTSD: National Center for PTSD. Retrieved July 12, 2020, from https://www.ptsd.va.gov/understand_tx/tx_basics.asp
Vella, E. J., Milligan, B., & Bennett, J. L. (2013). Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder: A pilot study. Military Medicine, 178(3), 254-260. https://doi.org/10.7205/milmed-d-12-00308
Völker, S., & Kistemann, T. (2011). The impact of blue space on human health and well-being – Salutogenetic health effects of inland surface waters: A review. International Journal of Hygiene and Environmental Health, 214(6), 449-460. doi:10.1016/j.ijheh.2011.05.001
Zayfert, C., Deviva, J. C., Becker, C. B., Pike, J. L., Gillock, K. L., & Hayes, S. A. (2005). Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice. Journal of traumatic stress, 18(6), 637–645. https://doi.org/10.1002/jts.20072
Sagamore Publishing LLC (hereinafter the “Copyright Owner”)
Journal Publishing Copyright Agreement for Authors
PLEASE REVIEW OUR POLICIES AND THE PUBLISHING AGREEMENT, AND INDICATE YOUR ACCEPTANCE OF THE TERMS BY CHECKING THE ‘AGREE TO THE TERMS OF THIS COPYRIGHT NOTICE’ CHECKBOX BELOW.
I understand that by submitting an article to Journal of Outdoor Recreation, Education, and Leadership, I am granting the copyright to the article submitted for consideration for publication in Journal of Outdoor Recreation, Education, and Leadership to the Copyright Owner. If after consideration of the Editor of the Journal of Outdoor Recreation, Education, and Leadership, the article is not accepted for publication, all copyright covered under this agreement will be automatically returned to the Author(s).
THE PUBLISHING AGREEMENT
Assignment of Copyright
I hereby assign to the Copyright Owner the copyright in the manuscript I am submitting in this online procedure and any tables, illustrations or other material submitted for publication as part of the manuscript in all forms and media (whether now known or later developed), throughout the world, in all languages, for the full term of copyright, effective when the article is accepted for publication.
Reversion of Rights
Articles may sometimes be accepted for publication but later be rejected in the publication process, even in some cases after public posting in “Articles in Press” form, in which case all rights will revert to the Author.
Retention of Rights for Scholarly Purposes
I understand that I retain or am hereby granted the Retained Rights. The Retained Rights include the right to use the Preprint, Accepted Manuscript, and the Published Journal Article for Personal Use and Internal Institutional Use.
All journal material is under a 12 month embargo. Authors who would like to have their articles available as open access should contact Sagamore-Venture for further information.
In the case of the Accepted Manuscript and the Published Journal Article, the Retained Rights exclude Commercial Use, other than use by the author in a subsequent compilation of the author’s works or to extend the Article to book length form or re-use by the author of portions or excerpts in other works.
Published Journal Article: the author may share a link to the formal publication through the relevant DOI.
- The Article I have submitted to the journal for review is original, has been written by the stated author(s) and has not been published elsewhere.
- The Article was not submitted for review to another journal while under review by this journal and will not be submitted to any other journal.
- The Article contains no libelous or other unlawful statements and does not contain any materials that violate any personal or proprietary rights of any other person or entity.
- I have obtained written permission from copyright owners for any excerpts from copyrighted works that are included and have credited the sources in the Article.
- If the Article was prepared jointly with other authors, I have informed the co-author(s) of the terms of this Journal Publishing Agreement and that I am signing on their behalf as their agent, and I am authorized to do so.