At the 2019 SHIFT Festival, a workshop on Military Readiness examined the therapeutic effects of nature on our wounded and non-wounded active duty service members, their families and their caregivers; the ways nature contact can help reduce levels of stress, depression, and burnout; and how nature contact can support Total Force Fitness, thereby reducing the economic costs to the military healthcare system.
Moderated by William Marchand, MD, Associate Chief of Mental Health and Chief of Psychiatry, George E. Whalen Veterans Affairs Medical Center, the workshop included panelists:
Dr. Marchand was one of the principal authors of a study on safety and psychological impact of sailing adventure therapy among Veterans with substance use disorders.
Nick Otis collaborated with Dr. Kristen Walter at the Naval Medical Center on a randomized clinical trial of surf and hike therapy as an intervention for military veterans suffering from major depressive disorder.
Under the direction of Dr. Frederick Foote, The Green Road Project at the Walter Reed Medical Center studied the impact of time outside in a three-acre park on veterans, ascertaining positive correlations on PTSD and TBI.
Dr. Keith Tidball, Associate Professor at Cornell, has studied the impact of hunting and angling on depression among military veterans.
Following the workshop, Dr. Marchand, Mr. Otis and SHIFT Executive Director Christian Beckwith began to look at the development of a pilot study that examines the efficacy of hike therapy as an emotional wellness intervention for veterans while also identifying the gaps in the research necessary for a larger randomized clinical trial on the same intervention strategy for active-duty service members.
Decreasing suicide rates among active duty military members is a priority for the Department of Defense. While significant programming that addresses depression, PTSD and TBI among veterans exist—see here—no such studies have been made of active duty service members.
Evidence in civilian populations indicates that hiking, an activity widely available to most of the population, offers a low-cost, low-risk intervention that can improve mental and emotional health outcomes. However, more research is needed to create the justification for a randomized clinical trial to establish the efficacy of hike therapy interventions conclusively among active-duty service members.
A randomized clinical trial that determines the efficacy of hiking as a mental- and emotional-health intervention would provide the military with a novel mechanism for a prioritized issue. A pilot study that identified the gaps and needs necessary for such a trial would furthermore engage the military, one of the largest medical systems in the world, in the health benefits of nature contact, which in turn would facilitate the study of other nature-rich interventions that have proven to be effective in civilian populations, such as the ability of nature contact to improve cognitive performance.
Should a pilot study support the efficacy of hike therapy, it would have broader implications for both the military and civilian populations that experience stress, including first responders, police officers and intensive care unit health care providers.
In the Spring of 2020, the group was joined by Gary Wynn, MD, an Assistant Professor and Assistant Chair, Department of Psychiatry, Uniformed Services University and Scientist, Center for the Study of Traumatic Stress. With guidance from Dr. Wynn, the group evolved the concept as follows.
A Randomized Controlled Trial of Nature Exposure for Veterans with Posttraumatic Stress Disorder and Major Depressive Disorder
Hypotheses:
Specific aims:
Introduction:
Overview: This study will be a two-arm non-blinded randomized controlled trial. Participants will be randomized to the active intervention (NEH) + treatment as usual (TAU) or TAU only.
Intervention: NEH will consist of three, three-hour sessions conducted once per week over three successive weeks. Each session will include transportation from the VA Salt Lake City Health Care System (VASLCHCS) to the hiking trail and back to the facility after the hike. Transportation will require approximately 30 minutes pre- and post-hike with the actual hike lasting two hours. Hikes will occur on the Pipeline trail located in Millcreek Canyon, which is approximately 20 minutes from the VASLCHCS. The number of participants in each three-session intervention will be from five to ten. Two study staff members will accompany the participants on, and provide leadership for, each hike.
Study location: VA Salt Lake City Health Care System and surrounding foothills of the Wasatch Mountain range
Number of subjects: 60 Veterans total, 30 in NEH + TAU and 30 in TAU only
Inclusion criteria: Veterans aged 18 – 70 currently enrolled for services at the VA Salt Lake City Health Care System. Additionally, participants must have had at least one mental health service encounter within the preceding 12 months and have been diagnosed with PTSD and MDD by a clinician within the preceding 24 months.
Exclusion criteria: Veterans with diagnoses of a psychotic spectrum illness and/or cognitive impairment will be excluded. Veterans with a physical disability/mobility limitation that would prevent participation in a two hour hike on a flat trail will be excluded.
Instruments/Outcome Measures:
Data analyses:
Length of study: 1 year
Identification of potential participants: Electronic record review and advertising
