The focus of this study was on the longitudinal outcomes and trajectories of change of an outdoor behavioral health (OBH) program for adolescents. OBH programs – often referred to as wilderness or adventure therapy – combines the healing value of nature with therapeutic programming. Such programs typically serve adolescents with emotional and behavioral disorders and substance-related issues.
Data for this study was collected from 659 adolescents participating in an OBH program. The average age of participants was 16, and the average length of stay in the program was 10.4 weeks. The four most common diagnoses were behavior disorders, mood disorders, substance-related issues, and anxiety disorders. All of the participants remained in the wilderness setting (forest or high-desert environment) throughout the duration of their OBH program and participated in such “wilderness-related” activities as hiking, cooking over an open flame, and building shelters. The treatment program also included cognitive behavioral therapy, choice therapy, family systems, mindfulness techniques, and a focus on diet, physical exercise, and working together. The wilderness itself was also considered to be a critical therapeutic tool.
The Youth Outcome Questionnaire® Self-Report (Y-OQ-SR) instrument was used to measure the psychological and behavioral symptoms as well as social functioning of adolescent participants. This self-report instrument has 64 items divided into six categories: interpersonal distress, somatic symptoms, interpersonal relations, critical items, social problems, and behavioral dysfunction.
Results indicated dramatic positive changes from intake to discharge for the adolescent participants. While these results are consistent with previous research, contributions of this study to the OBH literature relate to findings from data collected during and after treatment. This data allowed for an investigation of the trajectory of change and predictors of change during treatment and an assessment of outcomes up to 18 months post-treatment. The presence of a mood or anxiety disorder compared to other types of behavioral concerns, as well as being female, predicted greater rates of change during treatment. The authors conclude that OBH is an especially good fit for adolescents with mood and anxiety disorders and that, in general, diagnosis and gender should be considered in development of treatment guidelines.
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