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

Abstract

ObjectivesTo 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 settingA pilot randomised controlled trial conducted in the US Pacific Northwest.ParticipantsVeterans with PTSD due to any cause.InterventionsTwenty-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 measuresFeasibility 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.ResultsOf 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.ConclusionsThis 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 numberNCT03997344.

Can mask mandates boost nature-based tourism? The role of escapism and travel anxiety

“…Research across several domains has recognized the positive effect of nature connectedness on the recovery of physiological and psychological distress generated by outbreaks and social or economic crises. For instance, Littman et al [ 47 ] explored how nature contact improves psychological and physical health for military veterans with post-traumatic stress disorder. Sachdeva et al [ 48 ] stated that nature has restorative elements after times of collective stress, such as the negative psychological and social consequences of the Great Recession in the United States.…”

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

“…Research in various populations has shown that outdoor exercise interventions are associated with improved mental health outcomes, such as reductions in tension, anger, hostility, hopelessness, and suicidal ideation ( Morita et al, 2007 ; Lundberg et al, 2011 ; Thompson Coon et al, 2011 ; Sturm et al, 2012 ; Frumkin et al, 2017 ). Within military populations, outdoor exercise interventions demonstrated benefits for psychological health, including increased positive affect and decreased negative affect, anxiety, and PTSD symptoms (e.g., Gelkopf et al, 2013 ; Rogers et al, 2014 ; Crawford, 2017 ; Townsend et al, 2018 ; Greer and Vin-Raviv, 2019 ; Walter et al, 2019 ; Bettmann et al, 2021 ; Littman et al, 2021 ; Walter et al, 2021 ). Although research on outdoor exercise interventions for overall psychological health is growing, less is known about the effects of outdoor exercise on physical and social functioning, which are essential for operational readiness and effectiveness.…”

Context, classification and study methodologies in research into nature-based therapies: protocol for a scoping review

“… 3 As medicine has evolved, so have NBI. For example, treating tuberculosis with fresh air in the countryside has transformed into treating an array of maladies, including, but not limited to, high blood pressure, 4 psychosomatic disorders 5 and post-traumatic stress disorder 6 in a variety of settings ranging from city parks 7 to wildland areas. 4 8 With the emergence of NBI in the modern era, researchers are currently working to build empirical support and guidance for these interventions, including the NBI locations, outcomes and dose–response relationship.…”