Adventure Therapy for Adolescents with Complex Trauma: A Scoping Review and Analysis

Abstract

Background: Childhood adversity is linked with mental health concerns, including complex trauma (CT), whereas positive experiences may be restorative. Treatment for CT with adolescents commonly uses therapies administered indoors. Yet outdoor adventure, being rich in positive experiences, may also be appropriate. Purpose: This article examines how adventure practices may be healing for adolescents with CT. Methodology/Approach: A scoping review of literature since 2014 on adventure therapy (AT) for 12- to 18-year-olds with CT was undertaken. Refining searches from six databases identified six texts which met inclusion criteria. A seventh paper was added manually. Findings/Conclusions: CT-informed adventure tended toward a tri-phasic approach: safety, processing, and integration. Adventure benefits included improvements in attachment, skills, schemas, and stress management. An ecological approach was identified, through the analysis, as were some well-intended but harmful practices that a human rights-based practice framework may help avoid. Implications: Adopting an ecological and human rights-based approach as frames for AT research and practice may yield new insights and enhance program effectiveness for youth with CT. This should apply to adventure generally and specifically to AT; however, more research is needed given the paucity of available texts.

The dissociative mechanism of change in wilderness and adventure therapy; Psychological harm and possible malpractice

“…Extensive criticism has been directed towards WT for the use of involuntary admission (Magnuson et al, 2022) and coercive treatment (Pringle et al, 2022). Involuntary admission can be violent (https://www.youtube.com/watch?v=L_kiav0p5Iw).…”

“…The reinforcers described above seem particularly coercive, and survivors share experiences about inadequate hygiene, ill-fitting clothing like boots and bra's causing chaff and blisters, restrictive diet, and restrictive practices such as being tied to staff and being wrapped in tarpaulins to prevent escape at night. Additionally, there are frequent breaches of confidentiality to peers in pursuit of direct daily feedback (Dobud, 2021;Mater, 2022;Pringle, 2022;Stull, 2020). One of us (INSERT AUTHOR INITIALS) described their experience in a podcast: we had no basic comforts there and there was this attitude among the staff of … if you wanted something that wasn't necessary to literally keep you physically alive, then you were a spoiled brat and you were being dramatic.…”

“…Approximately 45% of the WT cohort may consist of young people with CT (Bettman et al, 2014) who may be already prone to dissociative coping (ISSTD, 2023b; Kate et al, 2023). The use of coercion in WT programs may (re)trigger dissociative responses to threat merely from disempowering experiences (Katz, 2022;Pringle et al, 2022). The allencompassing and inescapable nature of coercion, along with the magnitude of threat, would significantly influence whether a dissociative response will be triggered.…”

Nature-based allied health: current practice, challenges and opportunities

“…There is increasing evidence that supports the health benefits of exposure to nature [1][2][3][4][5][6][7][8][9][10][11][12][13], and engaging in nature-based activities [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals (AHPs) can play an important role in improving people's access to and use of nature, by working with individual patients/clients, communities and from a broader public health perspective, including advocacy for and input into the design of public natural environments.…”

“…While there has been a shift away from healthcare settings in nature, there has been an increase in research into the benefits of exposure to nature (e.g. green [1][2][3][4][5][6][7][8][9][10][11][12][13] and blue spaces [2,10,13]), and nature-based activities to improve health and wellbeing [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals are well placed to integrate NBAs -by encompassing outdoor and indoor nature-based activities which may be recommended or directly engaged in with the patient/ client, and advocacy for or the provision of improvements to natural spaces -into their practice.…”