Why Randomized Trials Are Challenging Within Adventure Therapy Research

Gabrielsen, Leiv Einar; Fernee, Carina Ribe; Aasen, Gunnar Oland; Eskedal, Leif

doi:10.1177/1053825915607535

Cited by 19 publications

(18 citation statements)

References 21 publications

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“…Considering the complexity and multiple confounding variables, the appropriateness of RCTs for ecotherapy modalities is in question and should be further explored (Gabrielsen, 2016).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Randomised Controlled Trials on the Effectiveness of Ecotherapy Interventions for Treating Mental Disorders

Williams

Barnwell

Stein

2020

Preprint

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Background: Systematic reviews on ecotherapy interventions (i.e. environmental therapies and animal-assisted therapies) in the general population have demonstrated promising findings. However, there is a need for systematic assessment of the evidence for the use of these interventions in people living with mental disorders. Hence, we conducted a systematic review of randomised control trials (RCTs) on exposure to ecotherapy interventions (i.e. environmental therapy, animal-assisted therapy, wilderness therapy) for individuals with mental disorders. Methods: The search was completed in September 2019 and comprised: Science Direct, PubMed Central, EBSCOHOST (via Academic Search Premier), the Cochrane Library, and Google Scholar. The primary outcomes that were assessed include treatment efficacy (on the CGI-I or similar), symptom severity, and/or dropout rates. Secondary outcome measures assessed included self-efficacy, perceived control, hope, quality of life, life skills, and coping. Results: A total of 2415 reports were identified, of which 94 were assessed for eligibility. Eight environmental therapy trials (i.e. gardening, forest therapy, horticultural therapy, nature adventure rehabilitation, and adventure-based therapy) and ten animal-assisted therapy trials (i.e. dogs, horses or dolphins) were included in the review. Risk of bias assessment was conducted, and qualitative analysis performed to describe the efficacy of the RCTs. The findings suggest that environmental therapies or animal-assisted therapies are efficacious in reducing symptoms of anxiety, depressive, substance-related and addictive, schizophrenia-spectrum and trauma- and stress-related disorders. Conclusion: There is suggestive, but not conclusive, evidence for the efficacy of some eco-therapy interventions in mental disorders. In particular, there are four environmental therapy trials and five animal-assisted therapy trials for depression and/or anxiety; one environmental therapy trial for post-traumatic stress disorder; three environmental therapy and animal-assisted therapy trials for general psychiatric disorders; one environmental therapy trial and two animal-assisted therapy trials for substance use disorders; and, one environ-mental therapy and two animal-assisted trials for people living with a schizophrenia spectrum disorder. The use of standard reporting guidelines may improve evidence quality of future ecotherapy RCTs, and provide a foundation meta-analysis of the evidence.

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“…Considering the complexity and multiple confounding variables, the appropriateness of RCTs for ecotherapy modalities is in question and should be further explored (Gabrielsen, 2016).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Randomised Controlled Trials on the Effectiveness of Ecotherapy Interventions for Treating Mental Disorders

Williams

Barnwell

Stein

2020

Preprint

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“…The FT program was offered as a stand-alone, outpatient, and voluntary group treatment for adolescents aged 16 to 18 at a state-run public hospital in Southern Norway. FT translates as “therapy in the open air” (Fernee et al, 2015) and has previously been defined as follows (Gabrielsen, Fernee, Aasen, & Eskedal, 2016, p. 7): “A specialized approach to mental health treatment that combines individual and group-based therapeutic work with basic outdoor life, engaging participants through ecological, physiological and psychological processes.” The FT project was in its second year at the time of the study, and data were collected from the two first interventions that succeeded the pilot stage. In terms of treatment fidelity, the FT program followed a manual and there were frequent meetings between the therapist teams to strengthen treatment integrity (Tucker & Rheingold, 2010).…”

Section: Methods and Proceduresmentioning

confidence: 99%

Therapy the Natural Way: A Realist Exploration of the Wilderness Therapy Treatment Process in Adolescent Mental Health Care in Norway

et al. 2018

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Wilderness therapy has the potential to meet the specific needs of the current adolescent population by providing a rather unique outdoor group treatment. Wilderness therapy is not a new approach to mental health treatment, but its theoretical basis is not yet clearly delineated, in part because of the diversity found across programs and contexts. This article presents a critical realist exploration of a wilderness therapy program that was recently implemented as part of adolescent mental health services in Southern Norway. In this study, we combine fieldwork and interviews for an in-depth investigation of the treatment process, where the objective was to acquire a deeper understanding of the opportunities that arise in the wilderness therapy setting. The therapeutic mechanisms and influential contextual premises found across the ecological, physical, and psychosocial factors of this multidimensional approach to treatment are presented, and their underlying conditions are briefly discussed.

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“…Childhood cancer survivors and their parents should therefore always inquire about possible program-related costs before signing up to participate. In countries such as Norway, where the healthcare system is publicly funded, programs are in principle cost-free [76]. This usually requires the intervention in question to be evidence based and supported by a clear and unambiguous rationale for why it should be offered.…”

Section: Implication For Practicementioning

confidence: 99%

“…Performing RCTs is challenging. Wilderness-related programs occur in real-life contexts where randomization is often not feasible or desirable [76]. Blinding of participants to the intervention is not possible, and since participants are selfselected, they often have a strong treatment preference.…”

Section: Implication For Practicementioning

confidence: 99%

A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

et al. 2021

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Objectives Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors. Design Scoping review. Search strategy Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis. Results Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8–40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended. Conclusions This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.

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Why Randomized Trials Are Challenging Within Adventure Therapy Research

Cited by 19 publications

References 21 publications

A Systematic Review of Randomised Controlled Trials on the Effectiveness of Ecotherapy Interventions for Treating Mental Disorders

A Systematic Review of Randomised Controlled Trials on the Effectiveness of Ecotherapy Interventions for Treating Mental Disorders

Therapy the Natural Way: A Realist Exploration of the Wilderness Therapy Treatment Process in Adolescent Mental Health Care in Norway

A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

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