Trauma and Resilience in Outdoor Therapy
Many of the clients in human service systems are known to be survivors of trauma (Elliott, Bjelajac, Fallot, Markoff, & Reed, 2005). Effects of trauma can vary depending on a person’s history, coping abilities, previous stress level, severity of traumatic experience, social supports, and other personal and environmental factors (Green & Myrick, 2014). The term resilience can be used to refer to either the healthy functioning after an exposure to a traumatic event or the protective factors that an individual possesses that allow them to adapt successfully in the face of trauma (Hamby & Banyard, 2015).
Unfortunately, many individuals will experience some sort of significant adversity within their lifetime possibly leading to lasting effects of trauma. For many, this can occur during childhood or adolescence. Rates of childhood exposure to violence and abuse are high in the United States, especially among urban communities (Fowler, Tompsett, Braciszekki, Jaques-Tura, & Baltes, 2009). In addition, many children who are exposed to one traumatic event are likely to be exposed to another (Finkelhor, Turner, Shattuck, and Hamby, 2015). Traumatic events during childhood can have significant effects on youth in ways that affect future development (Fowler et al., 2009). Therefore, when treating adolescents in the mental health field, practitioners must be aware of the symptoms of childhood trauma and ways to strengthen resilience among children and adolescents both as a way to protect children from future trauma and to assist children in coping with trauma that has occurred in their past. Outdoor therapies provide a unique structure fostering many elements important in strengthening resilience and may benefit adolescents with trauma histories.
Childhood and Adolescent Trauma
In the National Survey of Children’s Exposure to Violence (NatSCEV), completed by Finkelhor, Turner, Shattuck, and Hamby (2015), it was found that 24.5% of children surveyed had witnessed violence in the past year either the family or in the community. Community violence has been shown to be associated with higher levels of PTSD symptoms and of mental health effects especially among children and adolescents (Fowler et al., 2009). Of those surveyed in NatSCEV, 32% of children aged 14-17 had witnessed a family assault at some point during their lifetime and 18% of children aged 14-17 were physically abused by their caregiver at least once during their lifetime (Finkelhor et al., 2015). Fowler et al. (2009) found that exposure to community violence has strong immediate effects of PTSD and internalizing problems but externalizing problems are likely to occur over time in response to the cumulative effects of exposure to this violence. Given these numbers, it is easy to see the importance of trauma-informed practice when working with adolescents.
It is important to examine the effects of trauma on youth and design interventions that will aim to alleviate trauma symptoms and foster resilience among adolescents and children. Green & Myrick (2014) offer 7 domains of functioning that may be adversely affected in adolescents with trauma experiences including attachment, biology, affect regulation, dissociation, behavioral control, cognition, and self-concept. These effects can be both short-term and long-term on an adolescents functioning, sometimes lasting years into their future (Boxer & Sloan-Power, 2015). Symptoms of trauma can affect ones’ future outcomes sometimes leading to future mental illness, substance abuse, difficulty forming relationships, and lack of success in school or work (Elliott et al, 2005). Due to the prevalence of childhood trauma and the long lasting negative effects, it is incredibly important for clinicians and agencies alike to be trauma-informed when working with youth. Developing effective treatments for symptoms of trauma could drastically improve a clients’ functioning and future outcomes.
Strengthening Resilience as a Treatment to Trauma
Traditional treatments of trauma have included exposure therapy, revisiting memories, and practicing cognitive-behavioral skills (Burton, Cooper, Feeny & Zoelner, 2015). However, when dealing with adolescents with trauma, focusing on resilience can offer a more strengths-based, healing centered model rather than focusing exclusively on symptom reduction. Resilience can be looked at from a perspective of recovery or resistance to future harm (Burton et al., 2015). In this way, treatments that focus on fostering resilience allow clients to both heal and manage symptoms from past trauma while allowing them to build skills that will help them better adapt to future adverse situations. Fostering resilience can be a way to build coping skills that allow clients to buffer against both short-term and long-term negative outcomes for trauma (Boxter & Sloan-Power, 2013).
Grych, Banyard, & Hamby (2015) outline a Resilience Portfolio Model to describe strengths and protective factors often associated with well-being. They propose that for individuals to be resilient, they must have a “density and diversity” of resources available to assist with functioning during and after traumatic events. Resources that allow individuals to effectively cope can include personal and environmental factors. Prince-Embry (2015), proposes 3 important personal factors that can assist with resilience including a sense of mastery, sense of relatedness, and emotional reactivity. By strengthening these three factors in adolescents, they are more able to effectively cope with adverse events. Adolescents with these skills are able to feel competent, show an innate curiosity, display positive affect, develop connections with supports in their environments, control emotional arousal, and develop basic trust in others (Prince-Embry, 2015). In this way, clients who are able to strengthen resilience through treatment in addition to working on specific treatment goals to reduce symptoms are able to build lasting skills that will continue to serve them long after treatment is completed.
Resilience in Outdoor Therapy
Outdoor therapies have been shown to provide many positive outcomes in youth dealing with mental health disorders (Ungar, Dumond, & Mcdonald, 2005). Many programs utilize similar models and techniques in order to foster positive change within clients including the use of small groups, natural environments, positive and supportive atmospheres, healthy risk-taking, and relational supports (Ungar et al., 2005). Though limited research has been done directly associating increases in resilience with adventure-based treatments, current studies have been able to show positive outcomes (Ewert &Yoshino, 2011; Tucker, Javorski, Tracy, & Beale, 2013). Many of the foundations and beliefs that go into an adventure therapy program involve safety, challenge, trust, communication, and a sense of belonging which are all associated with fostering resilience (Alvarez & Stauffer, 2001).
Outdoor therapies use the small group setting as a way of building trust, cooperation, and social bonding among group members. Taylor, Segal, & Harper (2010) state that through this experience, group members develop a climate of trust that allows them to take greater risks. This encouragement to take risks can lead to increasing levels of trust which increases the group’s readiness to take on challenges and work for change (Taylor et al., 2010). These small groups can foster increased ability to build relationships and rely on outside supports that are associated with resilient children and youth (Ungar et al., 2005).
According to Prince-Embry (2015), developing a sense of relatedness to one’s self and those around them is one of the 3 factors associated with strong resilience. Outdoor therapies often utilize challenging environments to increase empathy and understanding for others (Taylor et al., 2010). In one study, Ewert & Yoshino (2011) found that short term adventure experiences were helpful in increasing confidence, self-awareness, personal achievement, and feelings of social support. By voluntarily committing to the wilderness experience, participants in another study were able to regain a better sense of self and sense of control over their future (Asher, Huffaker, & McNally, 1994). The challenging but supportive environment of outdoor therapy seems to suggest an opportunity for survivors of traumatic experiences to reduce symptoms of trauma and provide opportunities for healing and growth through the connection with others. Many outdoor therapy programs offer opportunities for clients to engage in problem-solving challenges that offer opportunities for collaboration, support among group members, and an increased sense of mastery (Ungar et al., 2005).
Stronger feelings of competence and ability are both associated with higher levels of resilience (Grych et al., 2015). Outdoor therapies offer healthy challenges which allow clients to try out new skills and react to natural consequences. These challenges are presented in ways that allow clients to achieve success. Challenges for participants include interpersonal relationships, adventure based challenges, natural elements, and the ability to work through these challenges throughout the program (Gelkopf, Hasson-Lhayon, Bikman, & Kravetz, 2013).
Emotional regulation is another key concept associated with resiliency (Grych et al., 2015). By allowing clients to experience the natural consequences of the outdoors, they are able to work through their feelings and emotions that occur in their day to day lives when experiencing stress. By facing small challenges, clients are able to gain confidence and practice emotional regulation in the face of difficult situations (Taylor et al., 2010). In addition, by practicing skills of emotional regulation in a safe, novel environment, clients are able to reflect on how they handle challenges and take skills they learn in the outdoors back with them after treatment.
Another key benefit to any outdoor therapy program is the natural environment. There is evidence to show that natural environments can provide potential healing and therapeutic qualities (Taylor et al., 2010). Participants in a wilderness experience often report feeling a sense of calm and peacefulness when in a natural environment (Asher et al., 1994). In addition, many programs encourage meaning-making by utilizing the outdoors as a metaphor for challenges participants may face in life (Taylor et al., 2010). Creating meaning is another feature associated with high levels of resilience among survivors of trauma (Prince-Embry, 2015). Clients who are able to eventually make meaning of their experience are more able to gain acceptance of that experience and move forward (Prince-Embry, 2015).
Outdoor therapies are often structured in ways which naturally foster many skills and attributes associated with strengthening resilience. Programs utilize small groups, the use of eustress, problem-solving challenges, natural and novel environments, and relationship building to promote change. As Eilliott et al. (2005) outlined, many of the clients involved in mental health services have exposure to trauma whether or not they are actively being treated for it. Grych, Banyard, & Hamby (2015) suggest that to develop strong resilience, individuals must develop a variety of personal and environmental resources they are able to tap into when faced with adverse situations. Clients participating in outdoor therapies are able to develop skills and experiences designed to increase one’s sense of mastery, sense of connectedness, and emotional regulation abilities. These three areas were defined by Prince-Embry (2015) as the three major areas in which influence an individual’s resilience. Therefore, outdoor therapies have the ability to intentionally develop programming that aims to strengthen resilience utilizing many techniques that already exist within programs. Creating a trauma-informed program and specifically designing aspects of outdoor therapy programs to foster skills connected to strengthening resilience can allow adolescents to benefit greatly especially if they have experienced past trauma that is not actively being treated.
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