Why Research is Not Boring

Posted by Matt Hoag, Ph.D., Owner, Clinical Director and Therapist at Entrada on March 22, 2017

1matt resizedMany people hear words like research, statistics, and outcome and quickly become disinterested or stare blankly into space! Others get excited to hear about MANOVAS or degrees of freedom or significance levels. Research in psychology tends to be a bit more interesting, especially since it relates to human conditions that many of us can identify with in our own lives.

Wilderness therapy or Outdoor Behavioral Healthcare has arisen to fill a gap in mental health treatment. At Evoke we believe that evaluating outcomes is a vital part of our program and philosophy. We believe that providing feedback about how it works is a responsible part of running a program that focuses on helping people. In a society that often demands results, we wanted to better understand our meaningful yet anecdotal experiences with wilderness participants. As therapists and field guides we have many powerful moments as we help a young man untwist his thinking or a young woman 'bust' a flame. But what does it all mean?

We have been doing research at Evoke since 2007. We have consistently dedicated resources and people to considering questions relevant to our work. In hopes of making some of our research digestible and hopefully interesting, I want to share short summaries of our work from this past year. We have published 6 articles in the past year, something we are very excited about!

Following are brief summaries of three of these articles, each one examines outcome from a different perspective: young adults, parents, and adolescents.

Outdoor Behavioral Health Care: A Longitudinal Assessment of Young Adult Outcomes

In this article, we summarize a 3-year study of 186 young adults in the wilderness. We found that they made significant clinical changes while in treatment, participants demonstrated a decrease in distress and interpersonal difficulties, as well as an increased sense of purpose while they were in treatment. This finding is not surprising given that wilderness therapy utilizes physical activity, a routine and schedule, a healthy diet, and a highly supportive and emotionally safe environment; all of which have been found to positively influence depression, anxiety, and other mental health challenges. Further, these gains appeared to be maintained as participants integrated back into the community and faced the stressors and challenges of young adulthood.

We also evaluated these young adults 6 and 18 months after they finished the program. We found that treatment gains obtained in their work in the wilderness were maintained at these two follow-up points. Our results support Outdoor Behavioral Healthcare as an appropriate treatment for clients who have not responded to outpatient treatment and are in need of a higher level of care.

A Multilevel Model to Examine Adolescent Outcomes in Outdoor Behavioral Healthcare: The Parent Perspective

In this study, we evaluated outcome with adolescents between the ages of 13 and 17. We explored parent's perspective of change both during the program and through 18 months following them leaving the program. Parents of 659 adolescents participated in the study.

Parents suggested that their adolescent children entered treatment with clinically significant levels of emotional and behavioral dysfunction, were able to make significant changes during the program, and finished the program being within the "normal" range of functioning. These results continued to be demonstrated at 6 and 18 months following treatment.

Most published research regarding wilderness therapy evaluate through follow-up through six months, a few have done 12, but no other published study has evaluated outcome 18 months post discharge. Since many participants go on to other levels of therapeutic care that often last 12 months, we specifically chose an 18-months follow-up in order to evaluate clients when they would likely be out of therapeutic care settings.

This study suggests that clients are remaining healthy even when they are not in a therapeutic setting and for longer than what has previously been shown in the literature. The impact of parent perception of treatment gains and adoption as having an impact on outcome as well.

Adolescent Self-Assessment of an Outdoor Behavioral Health Program: Longitudinal Outcomes and Trajectories of Change

The final study I will summarize is from the perspective of the adolescent. Outdoor behavioral healthcare is an increasingly popular treatment modality for adolescents, and evidence suggests that it is effective for a wide range of complex issues. Of the 659 adolescents who took part in our study, 29 % were female, 18 % were adopted, and the average age was 16. Participants were invited to complete questionnaires four times during treatment and at 6 and 18 months post-discharge.

Results from the multilevel modeling demonstrate that these adolescents made significant changes during treatment and at 6 and 18 months post- treatment (similar to the studies described above). Further, female participants had a greater rate of change in treatment than males, and young people diagnosed with a depressive or anxiety disorder also changed more than those with other disorders. In other words, average female clients make improvements in functioning at a faster rate than males. Additionally, young people with depressive disorders entered the program with a higher rate of dysfunction than those without a mood disorder. Similar findings occurred with those with anxiety disorders. In one of our previous studies (Hoag et al., 2014), we found that mood disorders were the most common primary diagnoses of adolescents in outdoor behavioral healthcare. It is clear that the typical wilderness therapy client is becoming more complex as the field has become more sophisticated. This study shows that these increasingly complex cases are responding very well to this treatment modality. The smaller size of these groups in the wilderness, the emotional safety related through anecdotal reports by these young people, and the emphasis on collaboration and working together provide support for the young person with mood issues or challenges with anxiety.

This study is the first to examine trajectories of change in outdoor behavioral healthcare, to find diagnostic variables to be relevant and to examine self-report outcomes past 12 months post- discharge.

Feel free to click on any of the links above to read more about these studies. Please contact us if you have any questions at 866.411.6600.

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