Abstract
Identifying evidenced-based interventions that improve health outcomes for Veterans with behavioral health disorders is a national priority. Thus, this study examined the outcomes of a community-based recreational therapy (RT) program focused on health promotion for Veterans with behavioral health disorders. Fifty-five Veterans with disabilities completed pretest and posttest questionnaires that assessed Quality of Life (QOL), Participation, and Happiness. Significant improvements were found in Overall QOL, Environmental QOL, Psychological QOL, QOL Rated, Satisfaction with Health, Participation, and Happiness. Younger age and female gender were significantly associated with improved Overall QOL. Factors significantly associated with improved Environmental QOL included younger age and non-Caucasian race. Older age was significantly associated with improved Participation. Female gender was positively associated with improved Happiness, while being divorced/separated was negatively associated with Happiness. These results have important implications for the use and expansion of community-based RT health promotion programs for Veterans with behavioral health disorders.
Similar content being viewed by others
References
Adams, C. (2013). Millions went to war in Iraq, Afghanistan, leaving many with lifelong scars. Wounds that don't heal. Retrieved from http://www.woundsthatdontbleed.com/millions-went-to-war-in-iraq-afghanistan-leaving-many-with-lifelong-scars/.
American Psychiatric Association. (2017). Clinical practice guideline for the treatment of Posttraumatic Stress Disorder. Retrieved from http://www.apa.org/ptsd-guideline/treatments/index.aspx
American Therapeutic Recreation Association. (2021). FAQ about Recreational Therapy (RT). Retrieved from https://www.atra-online.com/page/faq?&terms=%22faq%22.
Anderson, L., & Heyne, L. (2013). A strengths approach to assessment in therapeutic recreation: Tools for positive change. Therapeutic Recreation Journal, 47(2), 89–108.
Ariss, J. J., Gerlach, A., Baker, J. B., Barry, K., Cooper, L., de Vries, T. L., Halligan, K., & Lacroix, M. (2019). Community-based recreation therapy and mental health recovery: A mixed-media participatory action research study. Progress in Community Health Partnerships: Research, Education, and Action, 13(2), 161–170. https://doi.org/10.1353/cpr.2019.0016
Ashton-Shaeffer, C., Gibson, H. J., Autry, C. E., & Hansen, C. S. (2001). Meaning of sport to adults with physical disabilities: A disability sport camp experience. Sociology of Sport Journal, 18, 95–114. https://doi.org/10.1123/ssj.18.1.95
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147.
Bandura, A. (1986a). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
Bandura, A. (1986b). The explanatory and predictive scope of self-efficacy theory. Journal of Clinical and Social Psychology, 4, 359–373.
Bandura, A. (1988). Perceived self-efficacy: exercise of control through self-belief. In J. P. Dauwalder, M. Perrez, & V. Hobi (Eds.), Annual series of European research in behavior therapy (Vol. 2, pp. 27–59). Swets & Zeitlinger.
Benedek, D. M., & Wynn, G. H. (2016). Posttraumatic stress disorder. In D. M. Benedek & G. H. Wynn (Eds.), Complementary and alternative medicine for PTSD (pp. 203–217). Oxford University Press.
Bennett, J. L., Lundberg, N. R., Zabriskie, R. B., & Eggett, D. L. (2014). Addressing posttraumatic stress among Iraq and Afghanistan veterans and significant others: An intervention utilizing sport and recreation. Therapeutic Recreation Journal, 48(1), 74–93.
Bennett, J. L., Piatt, J. A., & Van Puymbroeck, M. (2017). Outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities: A community-based rehabilitation initiative. Community Mental Health Journal, 53(7), 756–765. https://doi.org/10.1007/s10597-017-0124-9
Ben-Shalom, Y., Tennant, J. R., & Stapleton, D. C. (2016). Trends in disability and program participation among US veterans. Disability and Health Journal, 9(3), 449–456.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.
Coll, J., Weiss, E., & Yarvis, J. (2011). No one leaves unchanged: Insights for civilian mental health care professionals into the military experience and culture. Social Work in Health Care, 50, 487–500.
Craig, P. J., Alger, D. M., Bennett, J., & Martin, T. (2020). The transformative nature of fly-fishing for veterans and military personnel with PTSD [Special issue on mental health]. Therapeutic Recreation Journal, 54(2), 150–172. https://doi.org/10.18666/TRJ-2020-V54-12-9965
Craig, P. J., Wilder, A., Sable, J., & Gravink, J. (2013). Promoting access, transition, and health: A community-based approach to managing chronic health conditions. ATRA Annual in Therapeutic Recreation, 21, 45–62.
Department of Veterans Affairs & Department of Defense. (2017). VA/DOD clinical practice guidelines for the management of posttraumatic stress disorder and acute stress disorder. Department of Veterans Affairs & Department of Defense.
Dobson, A. J., & Barnett, A. (2008). An introduction to generalized linear models. CRC Press.
Duvall, J., & Kaplan, R. (2013). Exploring the benefits of outdoor experiences on Veterans. Report for the Sierra Club Military Families and Veterans Initiative.
Fox, A. B., Meyer, E. C., & Vogt, D. (2015). Attitudes about the VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans. Psychological Services, 12(1), 49–58. https://doi.org/10.1037/a0038269
Harding, S. (2017). Self-stigma and Veteran Culture. Journal of Transcultural Nursing, 28(5), 438–444. https://doi.org/10.1177/1043659616676319
Hawkins, B. L., Townsend, J. A., & Garst, B. A. (2016). Nature-based recreational therapy for military service members. Therapeutic Recreation Journal, 50(1), 55–74.
Hutchison, P., & McGill, J. (1992). Leisure, integration, and community. Leisurability Publications.
Institute of Medicine. (2014). Treatment for posttraumatic stress disorder in military and Veteran populations: Final assessment. National Academies Press. https://doi.org/10.17226/18724
Iwasaki, Y., Mactavish, J., & MacKay, K. (2005). Building on strengths and resilience: Leisure as a stress survival strategy. British Journal of Guidance and Counseling, 33(1), 81–100.
Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a Veteran sample. Journal of Clinical Psychology, 68(1), 101–116. https://doi.org/10.1002/jclp.20853
Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R., & Poulsney, M. A. (2015). Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 107. https://doi.org/10.1037/tra0000065
Kleiber, D. A., Hutchinson, S. L., & Williams, R. (2002). Leisure as a resource in transcending negative life events: Self-protection, self-restoration, and personal transformation. Leisure Sciences, 24, 219–235.
Kleiber, D. A., Reel, H. A., & Hutchinson, S. L. (2008). When distress gives way to possibility: The relevance of leisure in adjustment to disability. NeuroRehabilitation, 23, 321–328.
Lundberg, N., Bennett, J., & Smith, S. (2011). Outcomes of adaptive sports and recreation participation among veterans returning from combat with acquired disability. Therapeutic Recreation Journal, 45(2), 105–120.
Lundberg, N., Taniguchi, S., McCormick, B., & Tibbs, C. (2011). Identity negotiating: Redefining stigmatized identities through adaptive sports and recreation participation among individuals with a disability. Journal of Leisure Research, 43(2), 205–225. https://doi.org/10.1080/00222216.2011.11950233
Lyubomirsky, S., & Lepper, H. S. (1999). A measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research, 46, 137–155.
Maguen, S., & Burkman, K. (2013). Combat-related killing: Expanding evidence-based treatments for PTSD. Cognitive and Behavioral Practice, 20, 476–479.
Miller, S. M., Pedersen, E. R., & Marshall, G. N. (2017). Combat experience and problem drinking in veterans: Exploring the roles of PTSD, coping motives, and perceived stigma. Addictive Behaviors, 66, 90–95.
Mowatt, R. A., & Bennett, J. (2011). War narratives: Veteran stories, PTSD effects, and therapeutic fly-fishing. Therapeutic Recreation Journal, 45(4), 286–308.
National Academies of Sciences, Engineering, and Medicine. (2018). Evaluation of the Department of Veterans Affairs Mental Health Services. The National Academies Press. https://doi.org/10.17226/24915
National Center for Complementary and Integrative Health. (2015). Report of the working group on strengthening collaborations with the U.S. Department of Defense and U.S. Department of Veterans Affairs: Effectiveness research on mind and body interventions. Retrieved from https://nccih.nih.gov/sites/nccam.nih.gov/files/Council_Working_Group_Final_Report_2015-01-27.pdf.
National Council for Behavioral Health. (2012). Meeting the behavioral health needs of veterans: Operation Enduring Freedom and Operation Iraqi Freedom. Retrieved from http://www.thenationalcouncil.org/wp-content/uploads/2013/02/Veterans-BH-Needs-Report.pdf.
National Council for Behavioral Health. (2014). Veterans. Retrieved from http://www.thenationalcouncil.org/topics/veterans/
National Institute of Mental Health. (2016). Mental health medications. Retrieved from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16(2), 172–180.
Porter, H. (2016). Recreational therapy and the international classification of functioning, disability, and health. Idyll Arbor.
Price, W. D., Lundberg, N. R., Zabriskie, R. B., & Barney, K. W. (2015). I ties flies in my sleep: An autoethnographic examination of recreation and reintegration for a veteran with posttraumatic stress disorder. Journal of Leisure Research, 47(2), 185–201.
Reisman, M. (2016). PTSD Treatment for Veterans: What’s working, what’s new, and what’s next. P & T: A Peer-Reviewed Journal for Formulary Management, 41(10), 623–634.
Rogers, S. D., Loy, D., & Brown-Bochicchio, C. (2016). Sharing a new foxhole with friends: The impact of outdoor recreation on injured military. Therapeutic Recreation Journal, 50(3), 213–227. https://doi.org/10.18666/TRJ-2016-V50-13-2837
Rutz, W. (2003). The European WHO mental health programme and the World Health Report 2001: Input and implications. The British Journal of Psychiatry, 183(1), 73–74.
Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29(8), 727–735.
Schwarzer, R., & Fuchs, R. (1996). Self-efficacy and health behaviours. In M. Conner & P. Norman (Eds.), Predicting health behaviour: Research and practice with social cognition models (pp. 163–196). Open University Press.
Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37, 144–162. https://doi.org/10.1093/epirev/mxu012
Strauss, J. L., Coeytaux, R., McDuffie, J., Nagi, A., & Williams, J. W. (2011). Efficacy of complementary and alternative therapies for Posttraumatic Stress Disorder: VA Evidence-based Synthesis Program. Department of Veteran Affairs, Veterans Health Administration, Health Services Research and Development Service.
Surìs, A., Lind, L., Kashner, T. M., & Borman, P. D. (2007). Mental Health, Quality of Life, and Health Functioning in Women Veterans: Differential Outcomes Associated with Military and Civilian Sexual Assault. Journal of Interpersonal Violence, 22(2), 179–197. https://doi.org/10.1177/0886260506295347
Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. RAND Corporation.
Thompson, C. V., Bennett, J. L., Sable, J. R., & Gravink, J. (2016). Northeast Passage PATH™ program: A strengths-based recovery oriented approach for veterans who experience mental health issues. Therapeutic Recreation Journal, 50(2), 138–154.
Townsend, J., Hawkins, B., Bennett, J., Hoffman, J., Martin, T., Sotherden, E., & Bridges, W. (2018). Preliminary long-term health outcomes associated with recreation-based health and wellness programs for injured service members. Cogent Psychology, 5(1), 1–17. https://doi.org/10.1080/23311908.2018.1444330
Turchik, J. A., & Wilson, S. M. (2010). Sexual assault in the U.S. Military: A review of the literature and recommendations for the future. Aggression and Violent Behavior, 15(4), 267–277.
Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., Saxena, S., von Korff, M., & Pull, C. (2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88(11), 815–823.
VA Patient Centered Care. (2017). Whole Health. Retrieved from https://www.va.gov/PATIENTCENTEREDCARE/explore/about-whole-health.asp.
Vella, E. J., Milligan, B., & Bennett, J. L. (2013). Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder: A pilot study. Military Medicine, 178(3), 254–260.
Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. https://doi.org/10.1037/a0021769
Walton, G., Schleien, S. J., Brake, L. R., Trovato, C., & Oakes, T. (2012). Photovoice: A collaborative methodology giving voice to underserved populations seeking com- munity inclusion. Therapeutic Recreation Journal, 46(3), 168–178.
Wenger, J. W., O’Connell, C., & Cottrell, L. (2018). Examination of recent deployment experience across the services and components. RAND Corporation.
Wheeler, M., Cooper, N. R., Andrews, L., Hughes, J. H., Juanchich, M., Rakow, T., & Orbell, S. (2020). Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomized controlled trial. PLoS ONE, 15(11), 1–22.
WHOQoL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.
Wilder, A., Craig, P. J., Sable, J. R., Gravink, J., Frye, J., & Carr, C. (2011). The PATH-way home: Promoting access, transition, and health for Veterans with disabilities. Therapeutic Recreation Journal, 45(4), 268–285.
Williams, D. M., & Rhodes, R. E. (2016). The confounded self-efficacy construct: Conceptual analysis and recommendations for future research. Health Psychology Review, 10(2), 113–128. https://doi.org/10.1080/17437199.2014.941998
World Health Organization. (2001). The World health report: 2001: Mental health: New understanding, new hope. Retrieved from http://apps.who.int/iris/bitstream/10665/42390/2/WHR_2001_gre.pdf?ua=1.
World Health Organization. (2002). ICF beginners guide. Towards a common language for functioning, disability and health: ICF The International Classification of Functioning, Disability and Health. World Health Organization.
World Health Organization. (2013). Mental health action plan 2013–2020. World Health Organization. Retrieved from http://www.who.int/mental_health/action_plan_2013/bw_version.pdf?ua=1.
Zabriskie, R., Lundberg, N., & Groff, D. (2005). Quality of life and identity: The benefits of a community-based therapeutic recreation and adaptive sport program. Therapeutic Recreation Journal, 39(3), 176–191.
Funding
This implementation of the community-based recreational therapy program was funded by the Bob Woodruff Foundation; Operation Hat Trick; and VA Adaptive Sports Grant.
Author information
Authors and Affiliations
Contributions
JLB, TT, PC, and JG contributed to the study conception and design. All authors contributed to material preparation, data collection and analysis. The first draft of the manuscript was written by JLB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to declare that are relevant to the content of this article.
Ethical Approval
The questionnaire and methodology for this study was approved by the Human Research Ethics committee of The University of New Hampshire (Ethics approval number: 6175).
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bennett, J.L., 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 58, 1477–1486 (2022). https://doi.org/10.1007/s10597-022-00962-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-022-00962-6