Nature adventure rehabilitation for combat-related posttraumatic chronic stress disorder: a randomized control trial

Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members

Introduction

Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors.

Methods

The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention.

Results

Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition.

Conclusion

Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain.

Clinical trial registration

ClinicalTrials.gov, NCT03302611.

A cross-sectional study of sleep, mood, well-being, motivations, and perceived support in Ukrainian veterans and active-duty military personnel with disability, and their supporters, preparing for a sporting event

Purpose

The benefits of sports and exercise to the lives and rehabilitative journeys of military veterans with disabilities is increasingly well-documented but veteran sporting events remain underexplored. Addressing this topic, the current article seeks to provide insight into the health and well-being of Team Ukraine during a 5-week preparatory camp in the UK before attendance at the 2022 Warrior Games.

Materials and methods

Two surveys were run, one toward the beginning and one toward the end of the camp. Eighteen of the 55 veterans and serving personnel (with disability), support staff, and family members in attendance responded to both surveys. Data on sleep, mood, and competition-related emotions, motivations for participation and perceived support were gathered. Data were analysed descriptively, and sleep, mood, and competition-related emotion responses were categorised to explore improvements, maintenance, or worsening in these areas.

Results and conclusion

Sleep, mood, and competition-related emotions were relatively stable, although sleep duration was low, and there were some increases in daytime dysfunction, anxiety, nervousness, and feeling tense. Family was the most important source of support and representation of one's country and raising awareness of Ukraine's circumstances were the most important motivational factors. Findings offer insight into not only the health and well-being experiences associated with participation in this disabled veteran sporting event, but also the important role played by this event in meeting collective goals relating to this unique time in Ukraine's history.

A qualitative study of equine-assisted therapy for Israeli military and police veterans with PTSD-impact on self-regulation, bonding and hope

Equine-assisted therapy (EAT) is an increasingly popular form of treatment for people suffering from post-traumatic stress disorder (PTSD) who, for one reason or another, find psychotherapy and other traditional treatment approaches unsuitable or unhelpful. However, the concomitant growth of research in the field is yet to engage with key factors relating to EAT; specifically, there are few studies considering the phenomenological perspective of patients, and the embodied knowledge deriving from the lived experience of PTSD patients who participated in EAT-based intervention programmes. Based on a qualitative-phenomenological study, interviews were conducted with 12 PTSD patients who had completed an EAT-based intervention programme. From these, three main themes characterising the meanings they gave to participation in an EAT-based treatment programme were identified: the ability to relax (self-regulation); establishing a relationship (bonding) and transformation and hope for the future. The findings of this study point to a process whereby participation in an EAT-based treatment programme facilitates the ability to cope with PTSD symptoms in a way that bridges the patient's emotional, social and spiritual-existential dimensions. The findings suggest that EAT can contribute to the healing process of veterans suffering from PTSD.

Is exercise/physical activity effective at reducing symptoms of post-traumatic stress disorder in adults — A systematic review

Background

Exercise has been used to manage symptoms of post-traumatic stress disorder (PTSD). The effect of exercise on PTSD outcomes has been previously explored in several studies. However, it still remains unclear what type of exercise/physical activity, intensity and duration is most effective for reducing symptoms of PTSD. A systematic review was conducted to determine which forms of exercise or physical activity have the greatest effect on PTSD outcome scores including an evaluation of exercise frequency and volume.

Methods

The following electronic databases were systematically searched from January 1980 to June 2021: MEDLINE, PsycINFO, PubMed and Web of Science. Inclusion criteria were studies investigating adults aged 18 or over, reporting the effect of exercise and physical activities on PTSD symptom outcome scores. Two reviewers independently extracted information on study characteristics, exposure and outcomes. In total of 3,217 articles were screened and 23 full text articles further assessed, with 13 RCT's included in the review, covering seven exercise/physical activity interventions. The study protocol was registered prospectively with PROSPERO (CRD42021255131).

Results

Thirteen studies from four countries involving a total of 531 patients were selected for inclusion. Individual forms of exercise/physical activity examined showed some effect on reducing PTSD symptoms but combined exercises (resistance training, aerobic, strength and yoga) administered over a 12 week period, three times a week for 30–60 min showed greater effects on PTSD symptoms.

Conclusion

The limited evidence suggests that a combined exercise intervention has the best evidence for a having a beneficial effect on PTSD symptoms.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255131.

Student and Nature Interactions and Their Impact on Mental Health during the COVID-19 Pandemic

Passive and active interactions with nature reduce stress, anxiety, and depression. Populations that experience increased stress often have fewer interactions with nature due to many factors. More recently, the COVID-19 pandemic has created a new stressor for all populations due to sickness, isolation, financial burdens, or other factors. University students were particularly impacted due to the change to online modalities, which isolated them from other students. To assess if any negative or other consequences were experienced and if nature factors could mitigate them, we examined how plant interactions affected university students (N = 353) in an online learning environment. Two modified Depression Anxiety Stress Surveys (DASS; Depression Anxiety Stress and Academic Stress, DASA) were administered over two semesters in 2020 to survey students on these interactions with nature. During the two semesters, most students experienced extremely severe self-reported mental health adversities. Further correlations between DASA scores and responses about nature interactions, home environments, plant exposure, and plant access showed that outdoor interactions were positively related to better self-reported mental health scores. However, the concerning and lingering effects of the pandemic were evidenced in our research as DASA scores increased across the two semesters. Nevertheless, going outdoors and interacting with nature brings some benefits that lessen the severity of depression, anxiety, and stress.

Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA

OBJECTIVES

To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD).

DESIGN AND SETTING

A pilot randomised controlled trial conducted in the US Pacific Northwest.

PARTICIPANTS

Veterans with PTSD due to any cause.

INTERVENTIONS

Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13).

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up.

RESULTS

Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group.

CONCLUSIONS

This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes.

TRIAL REGISTRATION NUMBER

NCT03997344.

A model of consumer life-satisfaction amidst the COVID-19 pandemic: Evidence and policy implications

The COVID-19 pandemic has dramatically impacted the lives of consumers across the globe. What guidance can consumer researchers and policymakers provide consumers to elicit adaptive responses that contribute to their life-satisfaction under these adverse conditions? To this end, we develop and test an adaptive response model and demonstrate its impact on the life-satisfaction of the consumers experiencing the pandemic in Turkey. Our model suggests that amidst COVID-19, seeking emotional help triggers the positivity in people, which in turn increases life-satisfaction. Moreover, turning to religion to deal with the challenges of the pandemic leads to positivity and hope, which in turn positively affect life-satisfaction. Importantly, "escape" behaviors (such as excessive work or time spent in online shows/games) reduce positivity and hope in consumers, thus negatively impacting life-satisfaction. The paper discusses the conceptual and public policy implications of the results and offers recommendations for future research.

The effect of time outdoors on veterans receiving treatment for PTSD

OBJECTIVES

Duration, frequency, and intensity of nature exposure link to different physical and psychological benefits. The present study aimed to determine how time outdoors affected military veterans' posttraumatic stress disorder (PTSD) symptomology during PTSD treatment.

METHOD

Hypotheses regarding time outdoors and the effect of program duration on PTSD symptoms were examined using multilevel models. The authors hypothesized that hours outdoors, both within- and between-persons, would predict reduced PTSD symptomology, program duration would predict reduced PTSD symptomology, and that hours outdoors and program duration would be significant when accounting for the other.

RESULTS

The present study found that time outdoors correlated with participants' decreased PTSD symptomology: the more time participants spent outdoors, the greater the reduction in their PTSD symptoms.

CONCLUSION

The effect of time outdoors was significant within-person, not between persons, suggesting that nature exposure may be used as an adjunct to traditional mental health treatment where exposure or dosage should be person-specific.

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial

Exposure to the natural environment is increasingly considered to benefit psychological health. Recent reports in the literature also suggest that outdoor exposure that includes recreational pursuits such as surfing or fishing coupled with opportunities for social interaction with peers may be beneficial to Armed Forces Veterans experiencing Post-Traumatic Stress Disorder (PTSD). Two studies were conducted to evaluate this possibility. In particular, these studies aimed to test the hypothesis that a brief group outdoor activity would decrease participants’ symptoms as assessed by established measures of PTSD, depression, anxiety and perceived stress, and increase participants’ sense of general social functioning and psychological growth. Experiment one employed a repeated measures design in which UK men and women military veterans with PTSD (N = 30) participated in a group outdoor activity (angling, equine care, or archery and falconry combined). Psychological measures were taken at 2 weeks prior, 2 weeks post, and at 4 month follow up. We obtained a significant within participant main effect indicating significant reduction in PTSD symptoms. Experiment two was a waitlist controlled randomised experiment employing an angling experience (N = 18) and 2 week follow up. In experiment 2 the predicted interaction of Group (Experimental vs. Waitlist Control) X Time (2 weeks pre vs. 2 weeks post) was obtained indicating that the experience resulted in significant reduction in PTSD symptoms relative to waitlist controls. The effect size was large. Additional analyses confirmed that the observed effects might also be considered clinically significant and reliable. In sum, peer outdoor experiences are beneficial and offer potential to complement existing provision for military veterans with Post Traumatic Stress Disorder.

Exploring the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19

During the pandemic, people may experience various mental health problems. Psychological strengths may help them to cope with emerging challenges and foster mental health and well-being. This study examined the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19. A total of 220 participants from general public participated this study completing a battery of measures (134 men [M_age = 42.36 years, SD = 8.99, range = 18 to 60] and 86 women [M_age = 36.73 years, SD = 7.44, range = 18 to 51]). This cross-section study indicated that resilience mediated the relationship between hope and psychological health and subjective well-being. Results also showed that hope, and resilience had significant direct effects on psychological health, and subjective well-being while preventive behaviours did not manifest a significant effect on these two variables except on resilience. Preventive behaviours mediated the relationship between hope and resilience. The results suggest that we should more pay attention to hope and resilience for the development and improvement of well-being and psychological health during the times of crisis.

Non-pharmacological and non-psychological approaches to the treatment of PTSD: results of a systematic review and meta-analyses

BACKGROUND

Non-pharmacological and non-psychological approaches to the treatment of post-traumatic stress disorder (PTSD) have often been excluded from systematic reviews and meta-analyses. Consequently, we know little regarding their efficacy.

OBJECTIVE

To determine the effect sizes of non-pharmacological and non-psychological treatment approaches for PTSD.

METHOD

We undertook a systematic review and meta-analyses following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

RESULTS

30 randomised controlled trials (RCTs) of a range of heterogeneous non-psychological and non-pharmacological interventions (28 in adults, two in children and adolescents) were included. There was emerging evidence for six different approaches (acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation), somatic experiencing, transcranial magnetic stimulation, and yoga).

CONCLUSIONS

Given the level of evidence available, it would be premature to offer non-pharmacological and non-psychological interventions routinely, but those with evidence of efficacy provide alternatives for people who do not respond to, do not tolerate or do not want more conventional evidence-based interventions. This review should stimulate further research in this area.

Cognitive flexibility in PTSD individuals following nature adventure intervention: is it really that good?

Previous studies have found that PTSD is associated with hippocampal-related impairment in cognitive flexibility. However, little is known about this impairment following nature adventure interventions. The current ex post facto study aimed to examine the relationship between cognitive flexibility, sailing-based intervention and PTSD symptoms. Thirty-nine individuals with PTSD diagnosis (17 who engaged in sailing and 22 who did not engage in sailing) and 38 healthy control (18 who engaged in sailing and 20 who did not engage in sailing) completed a performance-based reversal learning paradigm to assess cognitive flexibility and were evaluated for PTSD, depressive and anxiety symptoms. The results revealed significantly lower levels of PTSD and trait anxiety symptoms in the PTSD-sailing group, compared to the PTSD-no-sailing group. In addition, both PTSD groups showed selective, though different, impairments in reversal learning. Specifically, PTSD-no-sailing individuals showed a selective impairment in reversing the outcome of a negative stimulus- they struggled to learn that a previously negative stimulus was later associated with a positive outcome. PTSD-sailing individuals, on the other hand, displayed a selective impairment in reversing the outcome of a positive stimulus- they had difficulty learning that a previously positive stimulus was later associated with a negative outcome. The results may suggest that although individuals who participated in a sailing-based intervention had lower clinical symptoms, their hippocampal related cognitive flexibility was mot improved, and the impairment exists in a different domain.

Immersive Nature-Experiences as Health Promotion Interventions for Healthy, Vulnerable, and Sick Populations? A Systematic Review and Appraisal of Controlled Studies

In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical, and social health promotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We defined health according to the World Health Organization's holistic and positive definition of health and included steady-state, intermediate, and health promotion outcomes. An electronic search was performed for Danish, English, German, Norwegian, and Swedish articles published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence for health promotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range of health promotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physical health, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience and health outcomes: (1) intervention and program complexity; (2) feasibility and desirability of randomization; (3) blinding of participants and researchers; and (4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language.

An Update of the Literature Supporting the Well-Being Benefits of Plants: A Review of the Emotional and Mental Health Benefits of Plants

Consumers have historically shown an inclination to purchase plants that enhance their quality of life, meaning they will purchase items that positively influence their social, physical, psychological, cognitive, environmental, and spiritual well-being. Plants in native and improved landscapes (and interiorscapes) have been documented to influence each of six quality of life constructs. This paper summarizes publications regarding the emotional and mental health benefits associated with plants, addressing reduced anxiety and stress, attention deficit recovery, fractals and visual response, decreased depression, enhanced memory retention, greater happiness and life satisfaction, mitigation of post-traumatic stress disorder (PTSD), increased creativity, enhanced productivity and attention, reduced effects of dementia, and improved self-esteem. This research should be strategically incorporated into both industry-wide and firm-specific marketing messages that highlight the quality of life value proposition in order to maintain the industry's sense of value and relevance to consumers of the future.

Index words: benefits of plants, emotional health, mental health.

Nature Contact and Human Health: A Research Agenda

BACKGROUND

At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding.

OBJECTIVES

We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.

DISCUSSION

We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science.

CONCLUSIONS

Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights. https://doi.org/10.1289/EHP1663.

Independent sailing with high tetraplegia using sip and puff controls: integration into a community sailing center

BACKGROUND

We are continually rediscovering how adapted recreational activity complements the rehabilitation process, enriches patients' lives and positively impacts outcome measures. Although sports for people with spinal cord injuries (SCI) has achieved spectacular visibility, participation by high cervical injuries is often restricted due to poor accessibility, safety concerns, lack of adaptability, and high costs of technology.

METHODS

We endeavor to demonstrate the mechanisms, adaptability, accessibility, and benefits the sport of sailing creates in the rehabilitative process. Our sailor is a 27-year-old man with a history of traumatic SCI resulting in C4 complete tetraplegia.

RESULTS

The participant completed an adapted introductory sailing course, and instruction on the sip-and-puff sail and tiller control mechanism. With practice, he navigated an on-water course in moderate winds of 5 to 15 knots.

DISCUSSION

Despite trends toward shorter rehabilitation stays, aggressive transdisciplinary collaboration with recreation therapy can provide community and natural environment experiences while inpatient and continuing post discharge. Such peak physical and psychological experiences provide a positive perspective for the future that can be shared on the inpatient unit, with families and support systems like sailing clubs in the community.

CONCLUSION

Rehabilitation theory directs a team process to achieve patient self-awareness and initiate self-actualization in spite of disablement. Utilization of local community sailing centers that have provided accessible assisted options provides person-centered self-realization of goals as assisted by family and natural supports. Such successful patients become native guides for others seeking the same experience.

Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients

Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported - but not behaviorally observed - DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, M_age=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p's<0.001), contributing between 5.0%-11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%-40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.

Nature-based therapy as a treatment for veterans with PTSD: what do we know?

Purpose

The purpose of this paper is to provide a comprehensive argument for nature-based therapy (NBT) for veterans with post-traumatic stress syndrome. It is the aim to generate an overview of the evidence for NBT to the target group. A review of available scientific literature within the field, has been comprehensively conducted. This work is the foundation for the recommendations to decision makers and politicians.

Design/methodology/approach

This paper provides a conceptual analyses and a general review of the literature. Following steps have been conducted. Based on the research question, relevant work (scientific papers) have been identified using search terms in English within the three areas the target group (veterans), the diagnosis (post-traumatic stress disorder, PTSD) and treatment (NBT). Study-quality and evidence level have been assessed and discussed.

Findings

The findings show a wide variation according to the interventions the nature setting, the length and frequency of the NBT session as well as the health outcome measures. The studies demonstrated a positive impact on the PTSD symptoms, quality of life and hope. None of the studies found negative impact of the interventions. Being in a group of other veterans facing the same problems was highlighted as well. Some studies measured the ability to return to workforce for the veterans and found NBT beneficial in that process.

Research limitations/implications

The limitation of the research due to the methods of identifying studies. The purpose of this was to give an overview of existing literature, and there can be studies, that are not found in this process. Including qualitative and quantitative methods are useful in a process of understanding the impact of NBT for veterans with PTSD. The quantitative studies, which unfortunately are few, can give information of the extent to which the treatment affects the symptoms of PTSD. Seen in the perspective of the burden for the veterans suffering from PTSD and the economic burden for society, the process of synthesizing the research in the field in order to generate a fundament seems necessary.

Practical implications

This policy papers are useful in order to make recommendations for politicians and decision makers as well as practitioners.

Social implications

The burden of suffering from PTSD is heavy for the veterans and their family. The society must drive forward the development of new and better evidence-based treatment programs for veterans with PTSD. NBT might be a step in the right direction of this.

Originality/value

It is well-known that there are an increase in the number of veterans diagnosed with PTSD. Generally the drop-out rate of the veterans is high in conventional treatment and it is found that veterans experience some side effects from medical treatment. NBT is, in existing research, found to have a positive impact on the veterans, and therefore, it should be part of future treatment programs for veterans with PTSD.

Optimism and Hope in Chronic Disease: A Systematic Review

There is a growing recognition that positive psychological functioning (which includes constructs such as optimism and hope) influences health. However, the understanding of these underlying mechanisms in relation to health is limited. Therefore, this review sought to identify what the scientific literature says about the influence of optimism and hope on chronic disease treatment. A search was conducted in the PsycINFO, Scopus, Pubmed, and Web of Science databases using the indexing terms optimism, hope, chronic diseases, randomized controlled trial, and treatment between 1998 and 2015. In the articles, we identified the most studied diseases in context, the assessment instruments used, the participant characteristics investigated, the results found, and the publication dates. From our analysis of the articles that met our inclusion criteria, it appears that the study of these constructs is recent and there is evidence that individuals with greater optimism and hope seek to engage in healthier behaviors, regardless of their clinical status, and that this contributes to chronic disease treatment. More research is needed so that targeted interventions can be carried out effectively in chronic disease treatment.

Efficacy of Fifteen Emerging Interventions for the Treatment of Posttraumatic Stress Disorder: A Systematic Review

Although there is an abundance of novel interventions for the treatment of posttraumatic stress disorder (PTSD), often their efficacy remains unknown. This systematic review assessed the evidence for 15 new or novel interventions for the treatment of PTSD. Studies that investigated changes to PTSD symptoms following the delivery of any 1 of the 15 interventions of interest were identified through systematic literature searches. There were 19 studies that met the inclusion criteria for this study. Eligible studies were assessed against methodological quality criteria and data were extracted. The majority of the 19 studies were of poor quality, hampered by methodological limitations, such as small sample sizes and lack of control group. There were 4 interventions, however, stemming from a mind-body philosophy (acupuncture, emotional freedom technique, mantra-based meditation, and yoga) that had moderate quality evidence from mostly small- to moderate-sized randomized controlled trials. The active components, however, of these promising emerging interventions and how they related to or were distinct from established treatments remain unclear. The majority of emerging interventions for the treatment of PTSD currently have an insufficient level of evidence supporting their efficacy, despite their increasing popularity. Further well-designed controlled trials of emerging interventions for PTSD are required.

Enhancing the well-being of veterans using extended group-based nature recreation experiences

Physical and mental health issues associated with military service persist as challenges for many veterans. This study draws on existing research showing the value of engaging in nature-based recreation to examine the effects of such experiences on veterans specifically. Four organizations, offering 12 different programs each lasting 4–7 d, were included in the study. Ninety-eight veterans were recruited and surveyed 1 wk before, 1 wk after, and approximately 1 mo after participating in these extended group-based outdoor experiences. In addition to background information, the survey instrument assessed changes in psychological well-being, social functioning, and life outlook. The results showed significant improvements in each of these domains 1 wk after the outdoor experience. Some improvements persisted over the next month, but to a lesser degree. The positive changes were particularly strong for veterans who initially reported more severe ongoing health issues. Overall, the findings suggest that extended group-based nature recreation experiences that bring veterans together can have significant positive effects on veterans struggling with serious health problems.

A community long-term hotline therapeutic intervention model for coping with the threat and trauma of war and terror

Long-term tele-counseling can potentially be a potent intervention mode in war- and terror-related community crisis situations. We aimed to examine a unique long-term telephone-administered intervention, targeting community trauma-related crisis situations by use of various techniques and approaches. 142 participants were evaluated using a non-intrusive by-proxy methodology appraising counselors' standard verbatim reports. Various background measures and elements in the intervention were quantitatively assessed, along with symptomatology and functioning at the onset and end of intervention. About 1/4 of the wide variety of clients called for someone else in addition to themselves, and most called due to a past event rather than a present crisis situation. The intervention successfully reduced posttraumatic stress symptoms and improved functioning. Most interventions included psychosocial education with additional elements, e.g., self-help tools, and almost 60% included also in-depth processes. In sum, tele-counseling might be a viable and effective intervention model for community-related traumatic stress.