Impacting mental health: Adaptive snowsports as a therapeutic approach for veterans with combat-related disabilities and their significant others
DOI:
https://doi.org/10.5055/ajrt.0291Keywords:
adaptive sports, community reintegration, depression, family leisure, post-traumatic stress disorder, therapeutic recreation, veterans with combat-related disabilitiesAbstract
This study aimed to investigate the effects of adaptive snowsports programs on veterans with combat-related disabilities and their significant others. The study focused on outcomes related to the International Classification of Functioning, Disability, and Health (ICF) components, including body function, participation, and contextual factors. The variables examined encompassed post-traumatic stress disorder (PTSD), depression, family leisure involvement, community reintegration, and family functioning. Friedman tests were employed to compare pretest, post-test, and 1-month follow-up data for 18 veterans and 11 significant others. The results revealed significant reductions in the ICF component of body function, specifically in PTSD symptoms among veterans and depression symptoms among the significant others. These findings suggest that trip-type family therapeutic recreation programs for veterans with combat-related disabilities and their significant others have the potential to influence body functions. The study concludes by discussing implications for recreational therapists.
References
Wenger J, O’Connell C, Cottrell L: Examination of Recent Deployment Experience Across the Services and Components. Santa Monica, CA: RAND Corporation, 2018. DOI: 10.7249/rr1928.
Fischer H: US Military Casualty Statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Washington, DC: Congressional Research Service, 2010: 1-8.
Sigford BJ: Paradigm shift for VA amputation care. J Rehabil Res Dev. 2010; 47(4): xv-xix. DOI: 10.1682/jrrd.2009.02.0020.
Tanielian T, Jaycox LH: Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. 2008. Available at http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf. Accessed February 25, 2022.
Epstein RA, Heinemann AW, McFarland LV: Quality of life for veterans and service members with major traumatic limb loss from Vietnam and OIF/OEF conflicts. J Rehabil Res Dev. 2010; 47(4): 373-385. DOI: 10.1682/jrrd.2009.03.0023.
Schnurr PP, Lunney CA, Bovin MJ, et al.: Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev. 2009; 29(8): 727-735. DOI: 10.1016/j.cpr.2009.08.006.
Galovski T, Lyons JA: Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggress Violent Behav. 2004; 9(5): 477-501. DOI: 10.1016/s1359-1789(03)00045-4.
MacDermid Wadsworth M: Family risk and resilience in the context of war and terrorism. JMF. 2010; 72(3): 537-556.
Epstein NB, Bishop DS, Levin S: The McMaster model of family functioning. J Marital Fam Ther. 1978; 4(4): 19-31. DOI: 10.1111/j.1752-0606.1978.tb00537.x.
Evans L, Cowlishaw S, Forbes D, et al.: Longitudinal analyses of family functioning in veterans and their partners across treatment. J Consult Clin Psychol. 2010; 78(5): 611-622. DOI: 10.1037/a0020457.
Evans L, Cowlishaw S, Hopwood M: Family functioning predicts outcomes for veterans in treatment for chronic post-traumatic stress disorder. J Fam Psychol. 2009; 23(4): 531-539. DOI: 10.1037/a0015877.
Agate JR, Zabriskie RB, Agate ST, et al.: Family leisure satisfaction and satisfaction with family life. J Leis Res. 2009; 41(2): 205-223. DOI: 10.1080/00222216.2009.11950166.
Amato MP, Lundberg N, Ward PJ, et al.: The mediating effects of autonomy, competence, and relatedness during couple leisure on the relationship between total couple leisure satisfaction and marital satisfaction. J Leis Res. 2016; 48(5): 349-373. DOI: 10.18666/jlr-2016-v48-i5-7026.
Hodge CJ, Zabriskie RB, Townsend JA, et al.: Family leisure functioning: A cross-national study. Leis Sci. 2018; 40(3): 194-215. DOI: 10.1080/01490400.2016.1203847.
Townsend JA, Van Puymbroeck M, Zabriskie RB: The core and balance model of family leisure functioning: A systematic review. Leis Sci. 2017; 39(5): 436-456. DOI: 10.1080/01490400.2017.1333057.
Zabriskie RB, McCormick BP: The influences of family leisure patterns on perceptions of family functioning. Fam Relat. 2001; 50(3): 281-289. DOI: 10.1111/j.1741-3729.2001.00281.x.
Austin DR (ed.): Therapeutic Recreation: Processes and Techniques. Champaign, IL: Sagamore-Venture Publishing, 2018.
Shank J, Coyle C: Therapeutic Recreation in Health Promotion and Rehabilitation. State College, PA: Venture Publishing, 2002.
Dawson S, Gilbert K, Gilbert R, et al.: Family battle buddies program: A therapeutic program for reintegrating national guard families. Am J Recreat Ther. 2017; 15(2): 29. DOI: 10.5055/ajrt.2016.0103.
Poff RA, Zabriskie RB, Townsend JA: Modeling family leisure and related family constructs: A national study of US parent and youth perspectives. J Leis Res. 2010; 42(3): 365-391.
World Health Organization: International Classification of Functioning, Disability, and Health. Geneva: World Health Organization, 2001.
World Health Organization: Towards a Common Language for Functioning, Disability and Health. Geneva: World Health Organization, 2002.
Sivan M, O’Connor RJ, Makower S, et al.: Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. J Rehabil Med. 2011; 43(3): 181-189. DOI: 10.2340/16501977-0674.
Porter HR, Burlingame J: Recreational Therapy Handbook of Practice: ICF Based Diagnosis and Treatment. Enumclaw, WA: Idyll Arbor, Inc, 2006.
Porter HR, Van Puymbroeck M: Utilization of the international classification of functioning, disability, and health within therapeutic recreation practice. Ther Recreation J. 2007; 41(1): 47-60.
Van Puymbroeck M, Porter HR, McCormick B, et al.: The role of the International Classification of Functioning, Disability, and Health (ICF) in therapeutic recreation practice, research, and education. In Stumbo NJ (ed.): Professional Issues in Therapeutic Recreation: On Competence and Outcomes. Urbana, IL: Sagamore-Venture, 2009: 43-57.
Van Puymbroeck M, Smith R, Schmid A: Yoga as a means to negotiate physical activity constraints in middle-aged and older adults. Int J Disabil Hum Dev. 2011; 10(2). DOI: 10.1515/ijdhd.2011.029.
American Therapeutic Recreation Association: ATRA affirms support for ICF. 2005. Available at https://atraonline.site-ym.com/page/ICFWHO. Accessed February 25, 2022.
Vespa JE: Those who served: America’s veterans from World War II to the war on terror. 2020. Available at https://www.census.gov/content/dam/census/library/publications/2020/demo/acs-43.pdf. Accessed February 25, 2022.
Hoencamp R, Vermetten E, Tan ECTH, et al.: Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan. Injury. 2014; 45(7): 1028-1034. DOI: 10.1016/j.injury.2014.02.012.
US Department of Veteran Affairs: VA research on mental health. 2021. Available at https://www.research.va.gov/topics/mental_health.cfm#:~:text=according%20to%20the%20National%20Institute,mental%20health%20services%20to%20Veterans. Accessed February 25, 2022.
Johnson BS, Boudiab LD, Freundl M, et al.: Enhancing veteran-centered care: A guide for nurses in non-VA settings. Am J Nurs. 2013; 113(7): 24-39. DOI: 10.1097/01.NAJ.0000431913.50226.83.
Zoroya G: Military prodded on brain injuries. USA Today. March 7, 2007. Available at http://usatoday30.usatoday.com/news/Washington/2007-03-07-brain-injuries_N.htm. Accessed February 25, 2022.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (R)). 5th ed. Washington, DC: American Psychiatric Association Publishing, 2013. DOI: 10.1176/appi.books.9780890425596.
Schiraldi GR: The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth. 2nd ed. New York, NY: McGraw-Hill Contemporary, 2009.
Sayers SL, Farrow VA, Ross J, et al.: Family problems among recently returned military veterans referred for a mental health evaluation. J Clin Psychiatry. 2009; 70(2): 163-170. DOI: 10.4088/jcp.07m03863.
Berz JB, Taft CT, Watkins LE, et al.: Associations between PTSD symptoms and parenting satisfaction in a female veteran sample. J Psychol Trauma. 2008; 7(1): 37-45. DOI: 10.1080/19322880802125969.
Samper RE, Taft CT, King DW, et al.: Post-traumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans. J Trauma Stress. 2004; 17(4): 311-315. DOI: 10.1023/B:JOTS.0000038479.30903.ed.
Taft CT, Schumm JA, Panuzio J, et al.: An examination of family adjustment among operation desert storm veterans. J Consult Clin Psychol. 2008; 76(4): 648-656. DOI: 10.1037/a0012576.
Department of Veterans Affairs: Schedule for rating disabilities; evaluation of residuals of traumatic brain injury (TBI) diagnostic code 8045. 2008. Available at https://www.federalregister.gov/documents/2008/09/23/E8-22083/schedule-for-rating-disabilities-evaluation-of-residuals-oftraumatic-brain-injury-tbi. Accessed February 25, 2022.
Resnik L, Plow M, Jette A: Development of CRIS: Measure of community reintegration of injured service members. J Rehabil Res Dev. 2009; 46(4): 469-480. DOI: 10.1682/jrrd.2008.07.0082.
Bennett JL, Craig P, Aytur S, et al.: Community-based recreational therapy for veterans with behavioral health disorders: Impacts on quality of life, participation, and happiness. Community Ment Health J. 2022; 58(8): 1477-1486. DOI: 10.1007/s10597-022-00962-6.
Hawkins BL, Townsend JA, Garst BA: Nature-based recreational therapy for military service members: A strengths approach. Ther Recreation J. 2016; 50(1). DOI: 10.18666/trj-2016-v50-i1-6793.
Tysor DA, Isaacs LL, Bricker K: The social benefits of nature-based recreation for veterans: A scoping review. Am J Recreat Ther. 2020; 19(2): 15-33.
Wheeler M, Cooper NR, Andrews L, et al.: 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. PLoS One. 2020; 15(11): e0241763. DOI: 10.1371/journal.pone.0241763.
Bennett JL, Lundberg N, Zabriskie R, et al.: Addressing posttraumatic stress among Iraq and Afghanistan veterans and significant others: An intervention utilizing sport and recreation. Ther Recreation J. 2014; 48(1): 74-93.
Bennett JL, Piatt JA, Van Puymbroeck M: Outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities: A community-based rehabilitation initiative. Community Ment Health J. 2017; 53(7): 756-765. DOI: 10.1007/s10597-017-0124-9.
Bennett JL, Van Puymbroeck M, Piatt JA, et al.: Veterans’ perceptions of benefits and important program components of a therapeutic fly-fishing program. Ther Recreation J. 2014; 48(2): 169-187.
Dustin D, Bricker N, Arave J, et al.: The promise of river running as a therapeutic medium for veterans coping with post-traumatic stress disorder. Ther Recreation J. 2011; 45(4): 326-340.
Lundberg NR, Bennett JL, Smith S: Outcomes of adaptive sports and recreation participation among veterans returning from combat with acquired disability. Ther Recreation J. 2011; 45(2): 105-120.
Townsend J, Hawkins BL, Bennett JL, et al.: Preliminary long-term health outcomes associated with recreation-based health and wellness programs for injured service members. Cogent Psychol. 2018; 5(1): 1444330. DOI: 10.1080/23311908.2018.1444330.
Vella EJ, Milligan B, Bennett JL: Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder: A pilot study. Mil Med. 2013; 178(3): 254-260. DOI: 10.7205/milmed-d-12-00308.
Palmer C: A theory of risk and resilience factors in military families. Mil Psych. 2008; 20(3): 205-217.
Wood S, Scarville J, Gravino KS: Waiting wives: Separation and reunion among army wives. Armed Forces Soc. 1995; 21(2): 217-236. DOI: 10.1177/0095327x9502100204.
Burrell LM: Moving military families: The impact of relocation on family well-being, employment, and commitment to the military. In Britt TW, Castro CA, Adler AB (eds.): Military Life: The Psychology of Serving in Peace and Combat. Vol. 3. Westport, CT: Praeger Security International, 2006: 39-63.
Drummet AR, Coleman M, Cable S: Military families under stress: Implications for family life education. Fam Relat. 2003; 52(3): 279-287. DOI: 10.1111/j.1741-3729.2003.00279.x.
Flake EM, Davis BE, Johnson PL, et al.: The psychosocial effects of deployment on military children. J Dev Behav Pediatr. 2009; 30(4): 271-278. DOI: 10.1097/DBP.0b013e3181aac6e4.
Franklin K: The Impact of Deployment and Psychological Well-Being on Family Relationships: A Secondary Analysis of Air Force Community Assessment Data [doctoral dissertation]. 2010.
Johnson SJ, Sherman MD, Hoffman JS, et al.: The psychological needs of US military service members and their families: A preliminary report. Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families and Service Members. American Psychological Association, 2007. Available at https://www.apa.org/pubs/reports/military-deployment-summary.pdf. Accessed May 23, 2024.
Lincoln A, Swift E, Shorteno-Fraser M: Psychological adjustment and treatment of children and families with parents deployed in military combat. J Clin Psychol. 2008; 64(8): 984-992. DOI: 10.1002/jclp.20520.
Cozza SJ, Chun RS, Polo JA: Military families and children during operation Iraqi freedom. Psychiatr Q. 2005; 76(4): 371-378. DOI: 10.1007/s11126-005-4973-y.
Renshaw KD, Rodrigues CS, Jones DH: Psychological symptoms and marital satisfaction in spouses of operation Iraqi freedom veterans: Relationships with spouses’ perceptions of veterans’ experiences and symptoms. J Fam Psychol. 2008; 22(4): 586-594. DOI: 10.1037/0893-3200.22.3.586.
Goff BSN, Crow JR, Reisbig AMJ, et al.: The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. J Fam Psychol. 2007; 21(3): 344-353. DOI: 10.1037/0893-3200.21.3.344.
Evans L, McHugh T, Hopwood M, et al.: Chronic post-traumatic stress disorder and family functioning of Vietnam veterans and their partners. Aust N Z J Psychiatry. 2003; 37(6): 765-772. DOI: 10.1080/j.1440-1614.2003.01267.x.
Blais MC, Boisvert JM: Psychological and marital adjustment in couples following a traumatic brain injury (TBI): A critical review. Brain Inj. 2005; 19(14): 1223-1235. DOI: 10.1080/02699050500309387.
Klein DM, White JM: The systems framework. In Klein DM, White JM (eds.): Family Theories: An Introduction. Thousand Oaks, CA: Sage Publications, 1996: 117-142.
Miller IW, Ryan CE, Keitner GI, et al.: The McMaster approach to families: Theory, assessment, treatment and research. J Fam Ther. 2000; 22(2): 168-189. DOI: 10.1111/1467-6427.00145.
Sherman MD, Zanotti DK, Jones DE: Key elements in couples therapy with veterans with combat-related post-traumatic stress disorder. Prof Psychol Res Practice 2005; 36(6): 626-633. DOI: 10.1037/0735-7028.36.6.626.
Johnson HA, Zabriskie RB, Hill B: The contribution of couple leisure involvement, leisure time, and leisure satisfaction to marital satisfaction. Marriage Fam Rev. 2006; 40(1): 69-91. DOI: 10.1300/j002v40n01_05.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-4). 4th ed. Washington, DC: American Psychiatric Association Publishing, 1994.
Weathers FW, Litz BT, Henmin DS, et al.: The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Chicago, IL: International Society of Traumatic Stress Studies, 1993.
Kroenke K, Spitzer RL, Williams JB: The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9): 606-613. DOI: 10.1046/j.1525-1497.2001.016009606.x.
Epstein NB, Baldwin LM, Bishop DS: The McMaster family assessment device. J Marital Fam Ther. 1983; 9(2): 171-180. DOI: 10.1111/j.1752-0606.1983.tb01497.x.
Pett MA: Nonparametric Statistics for Health Care Research: Statistics for Small Sample and Unusual Distributions. Thousand Oaks, CA: Sage Publications, Inc, 1997.
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