Wilderness Therapy Outcomes With Adolescents and Young Adults

The objective of this paper is to provide a literature review of the previous research studies conducted regarding the outcomes and effectiveness of wilderness therapy in adolescent and young adult populations. This literature review will specifically focus on mental health outcomes.

Search Methods

The sources and information included in this literature review were collected using the online,ne library databases PsycINFO and Academic Search Complete. Articles were located using the following search terms: “wilderness therapy,” o “outdoor behavioral healthcare” “adolescents, teenagers, or young adults,” and “mental health.

” The search was also limited to articles that were peer-reviewed and published after 2008. After duplicates were excluded, this, resulted in fifty-five articles. Articles that focused on adventure therapy were then excluded from the search, as this therapy is typically more short-term than wilderness therapy. Article content was then reviewed to ensure that the articles met the content criteria and specifically addressed the outcomes or effectiveness of wilderness therapy related to mental health. Lastly, articles that conducted research studies outside of the United States were excluded, resulting in the eight articles that will be discussed in this literature review.

Introduction

The emergence of wilderness therapy, which is also sometimes referred to as outdoor behavioral healthcare stems from a need to address the high levels of mental health diagnoses seen in adolescents and young adults. In this literature review, adolescents will be defined as those between the ages of 13-18, and young adults will be defined as being between the ages of 18-25. In the United States, 21% of adolescents are considered to be affected by some form of mental health disorder (Tucker, Smith, & Gass, 2014).

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Adolescents with mental health disorders may be at risk for long-term problems including higher risks of school drop-out, difficulty maintaining relationships with peers and family, increased chance of being involved in the juvenile justice system, substance abuse, and suicide (DeMille et al., 2018).

Wilderness therapy is a residential treatment model that is often utilized when traditional forms of treatment such as outpatient therapy, rehabilitation facilities, or psychiatric hospitals do not meet the needs of the client (Bettmann, Tucker, Behrens, & Vanderloo, 2017). The most common diagnoses seen in wilderness therapy programs include mood disorders, substance use, and anxiety (Roberts, Stroud, Hoag, & Massey, 2017). Wilderness therapy programs on average last about seven to nine weeks and clients are placed in groups with eight to twelve other participants of similar ages (Bettmann et al., 2017). Wilderness therapy programs may implement the following strategies: wilderness living experiences and adventure experiences, group living, individual therapy, and group therapy, and the guidance and support of a licensed mental health professional (DeMille et al., 2018).

The main difference between wilderness therapy programs and traditional residential programs is the setting of the wilderness, which has been described as serving, as an important part of the change process. The wilderness is utilized based on the theory that the wilderness and outdoors can serve as a contrast for participants to “gain a new perspective on old patterns that occurred in their familiar environment” (DeMille et al., 2018). A wilderness setting is used in combination with therapeutic interventions because a new and different environment allows for clients to separate themselves from distractions or self-destructive behaviors (Hoag, Massey, Roberts, & Logan, P., 2013). The intended outcomes for participants of wilderness therapy are that after discharge, there will be a decrease in symptoms, and an increase in healthy behaviors and social skills (Roberts et al., 2017). This literature review will analyze a portion of the available recent research studies that have been conducted to determine if wilderness therapy is an effective mode of therapy for adolescents and young adults and if the overall outcomes after discharge from wilderness therapy programs show improvement in individuals.

Review

The majority of the studies analyzed for this literature review utilized quantitative data to determine the outcomes of wilderness therapy on individuals. Within this data, several themes emerged including the results of meta-analyses, the effect of gender on wilderness therapy outcomes, and the effect of diagnoses on wilderness therapy outcomes.

Meta-Analysis Findings

Two studies conducted a meta-analysis of wilderness therapy programs (Bettmann, Gillis, Speelman, Parry, & Case, 2016; Gillis, et al., 2016). Bettmann et al. (2016) completed a study regarding the outcomes seen in individuals who complete private-pay wilderness therapy programs. This meta-analysis included thirty-six different studies and 1,209 wilderness therapy participants (Bettmann et al., 2016). The findings from this meta-analysis matched the research of others in its findings that all participants included in the study of pre and post-test results showed positive improvements in outcome measurements of clinical measures, interpersonal measures, self-esteem, behavioral observations, locus of control, and personal effectiveness (Bettmann et. al 2016). Gillis et al. (2016) additionally conducted a meta-analysis of outcomes from wilderness therapy programs and compared these results to those from traditional residential treatment programs. This meta-analysis reviewed seventy-six studies and 1,458 participants and utilized a Youth Outcome Questionnaire (Y-OQ), and a Youth Outcome Questionnaire Self-Report (Y-OQ-SR) to measure behavioral change pre and post-treatment (Gillis et al. 2016). These questionnaires have both been proven to have high levels of validity and reliability and are used during psychological treatments to measure the behavioral change in the areas of intrapersonal distress, somatic, interpersonal relations, social problems, behavioral dysfunction, and critical items (Gillis et al. 2016). Similar to the study conducted by Bettmann et al. (2016), Gillis et al. (2016) found that there are large treatment effects seen in participants of wilderness therapy. However, Gillis et al. (2016) observed that these treatment effects can also be seen in participants in rtms. Gillis et al. (2016) discovered that parents/guardians reported higher effects in wilderness therapy programs, whereas youth self-reported higher effects in other settings.

Gender as an Independent Variable in Treatment Outcome

Another important theme seen throughout research studies on wilderness therapy program outcomes is the differences in individuals demographically and how this affects them post-treatment. All studies reviewed included demographic information regarding the most common gender, age, and race seen in wilderness therapy participants. Overall, wilderness therapy programs tend to have about 70% male participants, an average age of 17, and 85% of participants are on average White (Bettmann et al. 2016). Four studies chose to use gender as an independent variable to determine if the outcomes of wilderness therapy vary by the gender of participants. Three out of four of these studies found female clients have been shown to report the most progress and improvement.

Combs, Hoag, Javorski, & Roberts (2016) studied adolescent self-assessments of wilderness therapy participants by using Y-OQ-SRs that were completed pre, during, and post-treatment. They found that female participants in wilderness therapy programs entered the program with higher levels of symptom severity, but female participants improved quicker than males and showed less symptom severity post-discharge (Combs et al. 2016). This finding was similar to research conducted by Hoag, Massey, Roberts, & Logan, (2013) which utilized Outcome Questionnaire 45 (OQ-45) and determined that female participants assessed their overall functioning as worse than male participants in pre-tests, but assessed their overall functioning as better than male participants in post-tests. A finding by Tucker, Smith, & Gass, (2014) also provides evidence that in Y-OQ reports of wilderness therapy participants, female clients have reported clinical change 3.5 times greater than male clients.

DeMille et al. (2018) found different results when comparing YO-Q results from wilderness therapy program participants to clients who did not participate in wilderness therapy and attended treatment as usual (TAU) through outpatient therapy. DeMille et al. (2018) found that gender was not a significant factor in clinical change and male and female participants showed equal improvements in post-tests following treatment. When gender is utilized as an independent variable to determine wilderness therapy outcomes, it is clear based on YO-Q results that female clients show improvement on an equal or greater level than male participants. This finding should serve to help wilderness therapy programs overcome gender differences and increase female client numbers in a therapy setting this has traditionally served more male clients (DeMille et al., 2018).

References

1. Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A meta-analysis of wilderness therapy outcomes for private pay clients. Journal of Child and Family Studies, 25(9), 2659–2673. https://doi.org/10.1007/s10826-016-0439-0
2. Bettmann, J. E., Tucker, A., Behrens, E., & Vanderloo, M. (2017). Changes in late adolescents and young adults’ attachment, separation, and mental health during wilderness therapy. Journal of Child and Family Studies, 26(2), 511–522. https://doi.org/10.1007/s10826-016-0577-4
3. 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 and Family Studies, 25(11), 3322–3330. https://doi.org/10.1007/s10826-016-0497-3
4. DeMille, S., Tucker, A. R., Gass, M. A., Javorski, S., VanKanegan, C., Talbot, B., & Karoff, M. (2018). The effectiveness of outdoor behavioral healthcare with struggling adolescents: A comparison group study a contribution for the special issue: Social innovation in child and youth services. Children & Youth Services Review, 88, 241–248. https://doi.org/10.1016/j.childyouth.2018.03.015
5. Gillis, H. L., Jr., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N., … Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the Y-OQ and Y-OQ-SR comparing wilderness and non-wilderness treatment programs. Child & Youth Care Forum, 45(6), 851–863. https://doi.org/10.1007/s10566-016-9360-3
6. Hoag, M. J., Massey, K. E., Roberts, S. D., & Logan, P. (2013). Efficacy of Wilderness Therapy for Young Adults: A First Look. Residential Treatment for Children & Youth, 30(4), 294–305. https://doi.org/10.1080/0886571X.2013.852452
7. Roberts, S. D., Stroud, D., Hoag, M. J., & Massey, K. E. (2017). Outdoor Behavioral Health Care: A Longitudinal Assessment of Young Adult Outcomes. Journal of Counseling & Development, 95(1), 45–55. https://doi.org/10.1002/jcad.12116
8. Tucker, A. R., Smith, A., & Gass, M. A. (2014). How Presenting Problems and Individual Characteristics Impact Successful Treatment Outcomes in Residential and Wilderness Treatment Programs. Residential Treatment for Children & Youth, 31(2), 135–153. https://doi.org/10.1080/0886571X.2014.918446