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Therapeutic
Recreation
Journal
Therapeutic Recreation Journal Vol. lIV, No. 2 • pp. 150–172 • 2020
https://doi.org/10.18666/TRJ-2020-V54-I2-9965
Patti J. Craig is an associate professor in the Department of Recreation Management and
Policy at the University of New Hampshire.
Dustin M. Alger is in the Residential Substance Abuse/Post-Traumatic Stress Unit at the
Boise Veterans Aairs Medical Center (VAMC) in Boise, Idaho.
Jessie L. Bennett is an assistant professor at the University of New Hampshire.
Tamar P. Martin is a counseling psychologist and certied rehabilitation counselor in pri-
vate practice in New York City, NY. She is also an adjunct instructor at Hunter College, CUNY,
Programs in Counselor Education, and at New York University, Department of Applied Psychol-
ogy, New York City, NY.
Please send correspondence to Patti J. Craig, [email protected]
The Transformative Nature of Fly-Fishing
for Veterans and Military Personnel with
Posttraumatic Stress Disorder
Qualitative Paper
Abstract
Grounded in the leisure-coping framework (Kleiber et
al., 2002; 2008), this phenomenological study utilized a
focus group method to explore the meaning of y-sh-
ing for veterans and military personnel with PTSD. is
study also explored ways in which y-shing may serve
as a coping resource in transcending negative life events,
such as PTSD, as it helps move veterans and military
personnel toward personal transformation and posttrau-
matic growth (PTG). A total of nine participants from
the Project Healing Waters Fly-Fishing program partici-
pated in two focus groups to understand how y-shing
impacts PTSD symptom management and to identify as-
pects of the program that may be responsible for symp-
tom reduction and growth among this population. Four
themes emerged from the data, suggesting y-shing: (a)
serves as a breather from the negative impact of PTSD,
(b) sustains coping eort and commitment, (c) restores
control by alleviating PTSD symptoms, and (d) can serve
as a context for personal transformation and posttrau-
matic growth. Implications for practice are provided.
Keywords
Complimentary and integrative health, y-shing, nature-
based recreation, posttraumatic stress disorder, posttrau-
matic growth, stress-coping theory, veterans and military
personnel
Patti J. Craig
Dustin M. Alger
Jessie L. Bennett
Tamar P. Martin
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Fly-fishing for Veterans and Military Personnel
Introduction
Since 2001, the United States (U.S.) has been engaged in the Global War on Terror,
with over 2.77 million service members serving overseas (Wenger, O’Connell, & Cot-
trell, 2018). Approximately 1.6 million service members have experienced multiple de-
ployments with shorter rest periods in between, and have been exposed to the extreme
stressors of combat, including roadside bombs, suicide bombers, and human death
and violence which led to increased risk for posttraumatic stress disorder (PTSD) and
major depression (Burnam et al., 2009). Further, over 50,000 troops from the Global
War on Terror have experienced severe combat injuries such as limb loss, spinal injury,
blast injuries, traumatic brain injury (TBI), depression, generalized anxiety disorder,
and PTSD (Defense Casualty Analysis System, 2017). With the extreme forces used
in combat and the resulting physical and psychological trauma, it is logical that PTSD
remains a signicant health concern for veterans, military personnel, and their families
(Institute of Medicine [IOM], 2014).
According to the U.S. Department of Veterans Aairs (VA) and the Department of
Defense (DoD) (VA & DoD, 2017), approximately 10.6% of all veterans receiving care
in the Veterans Health Administration have a diagnosis of PTSD. e estimated cost
of PTSD treatment is staggering; for example, in 2012 alone, the VA spent $3 billion,
and the DoD spent $294 billion in the treatment of PTSD (IOM, 2014). ese statistics
suggest PTSD is a prevalent, debilitating, and costly condition for veterans and military
personnel (National Academies of Sciences, Engineering, & Medicine, 2018).
PTSD is the emotional disorder most frequently associated with combat and other
potentially traumatic experiences that may occur during military service, such as mili-
tary sexual assault (Strauss et al., 2011). PTSD is an extreme response to a traumatic
event that is characterized by a combination of mental health symptoms that are pres-
ent for at least one month and impair functioning across multiple domains (American
Psychological Association [APA], 2017). Diagnostic criteria include: (a) intrusion or
re-experiencing of a traumatic event, (b) avoidance of trauma-associated stimuli, (c)
alterations in cognition and mood, and (d) alterations in arousal and reactivity (APA).
PTSD is associated with signicant adverse consequences for veterans and mili-
tary personnel, including high rates of depression and other psychiatric comorbidities,
substance abuse, suicidality, impaired social, occupational, and family functioning, de-
creased quality of life, and increased rates of medical morbidity, health risk behaviors,
and health service use (Giordano et al., 2018). Le untreated, veterans and military
personnel with PTSD are at risk for a lifetime progression of increasing functional dis-
ability, psychological distress, and poor quality of life (Fulton et al., 2015).
e VA and DoD (2017) provide a spectrum of treatment approaches including
individualized, trauma-focused and non-trauma-focused psychotherapies, as well as
pharmacologic agents. Although shown to be viable options during the initial stages
of treatment, these approaches have not demonstrated consistent long-term clinical
eects (Poulsny et al., 2015), as many patients still have diagnosable PTSD following
treatment (Steenkamp et al., 2015). Further, because many trauma-focused psychother-
apies require engagement in repeated conversations and imagery related to traumatic
events, many patients prefer to try other strategies (Markowitz et al., 2016). us, an
exploration of ways to supplement existing treatments, reduce barriers to engagement
in treatment, and provide alternative treatment options for individuals with PTSD is
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needed. Complementary integrative health (CIH) approaches, such as nature-based
recreation, can be viable supplemental treatment options, as they leverage individual
interests and motivations for sustained and engaged participation (National Center for
Complementary & Integrative Health [NCCIH], 2015).
As nature-based approaches have gained popularity across a variety of disciplines,
therapeutic recreation (TR) practitioners have used nature-based interventions and
activities to address functional outcomes and provide recreation opportunities for vet-
eran and military populations with PTSD (Hawkins, Towsend, & Garst, 2016). Mul-
tiple types of nature-based approaches, such as outdoor adventure therapy, wilderness
therapy, outdoor experiential therapy, and eco-therapy utilize the natural environment
for specic therapeutic outcomes (Poulsen, Stigsdotter, & Refshage, 2015). Although
this line of research is in its infancy, preliminary evidence suggests that nature-based
recreation approaches merit continued investigation to evaluate ecacy and imple-
mentation within the VA, DoD, and community-based TR and recreation settings
serving veterans and military personnel (Townsend et al., 2018). e purpose of this
phenomenological study was to explore the meaning of y-shing for veterans and
military personnel with PTSD, and to understand how y-shing may serve as a cop-
ing resource for this population.
Literature Review
Conventional PTSD Treatment Approaches
Within the VA and DoD (2017), preferred rst-line treatments for PTSD are in-
dividual, trauma- and non-trauma-focused psychotherapies, and pharmacological
approaches. Trauma-focused psychotherapy uses cognitive, emotional, or behavioral
restructuring techniques to facilitate the processing of a traumatic experience (e.g.,
prolonged exposure therapy, cognitive processing therapy, eye movement desensitiza-
tion and reprocessing, brief eclectic therapy). Non-trauma-focused psychotherapies
include stress inoculation therapy, present-centered therapy, and interpersonal psy-
chotherapy (VA & DoD). In pharmacotherapy, medications referred to as “cognitive
enhancers” are used in conjunction with trauma-focused therapies to enhance psy-
chological interventions (National Center for PTSD, 2019, p. 1). Although ecacy of
these conventional approaches is widely reported in the literature (Foa et al., 2009; VA
& DoD), between 30%-50% of participating veterans fail to show long-term clinically
signicant improvements (Poulsny et al., 2015). Further, participant dropout is high,
ranging from 30%-38% in randomized trials and 32%-44% in clinic-based studies,
likely due to diculty tolerating trauma-focused material that are hallmarks of these
approaches (Poulsny et al., 2015).
Complementary and Integrative Health Approaches
Given the challenges associated with conventional PTSD treatment methods, an
exploration of CIH approaches that can interrupt undesirable symptoms of PTSD is
warranted and, thus, has emerged as a top priority for the VA and DoD (NCCIH, 2015).
Complementary health approaches are a group of diverse medical and health systems,
practices, and products that are not considered to be part of conventional medicine,
but rather are used in conjunction with conventional therapies (NCCIH, 2015). Inte-
grative approaches are a style of practice that places a strong emphasis on a holistic ap-
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Fly-fishing for Veterans and Military Personnel
proach to patient care while focusing on reduced use of technology (NCCIH). CIH ap-
proaches are typically noninvasive or minimally invasive, considered unlikely to result
in negative side eects, and may be more aligned with individual treatment preferences
and interests than conventional treatment options (Strauss et al., 2011).
Emerging CIH approaches for veteran and military populations include modali-
ties such as mind-body medicine (e.g., meditation, mindfulness-based stress reduc-
tion, yoga, acupuncture), the use of natural products (e.g., dietary supplements, herbal
remedies, probiotics), manipulative and body-based practices (e.g., massage therapy,
spinal manipulation), whole medical systems (e.g., traditional Chinese or Ayurvedic
medicines), technological-based treatments (e.g., internet and computer-based treat-
ments, virtual reality) and other practices (e.g., light or magnet therapy, movement
therapies) (Cukor et al., 2009; NCCIH, 2015). Although the VA and DoD are invested
in developing better ways to assess, manage, and treat PTSD through CIH approaches,
evidence of their eectiveness is limited (Strauss et al., 2011).
Complementary approaches such as nature-based recreation have long been rec-
ognized for their therapeutic benets and potential for instilling personal agency, and
facilitating healing among a variety of populations (Berman, Jonides, & Kaplan, 2008;
Gelkopf et al., 2013; Kaplan & Kaplan, 1989; Walsh, 2011). Further, there is a growing
evidence base in TR for the ecacy of nature-based recreation in facilitating functional
outcomes and symptom reduction for veteran and military populations with PTSD
and comorbid conditions (Bennett, Piatt, & Van Puymbroeck, 2017; Duvall & Kaplan,
2013; Hawkins et al., 2016; Price et al., 2015; Rogers, Loy, Brown-Bochicchio, 2016).
However, none of this literature explores the processes through which nature-based
recreation can help veterans and military personnel cope with PTSD. is study at-
tempts to ll this gap.
Stress and Coping
e inuence of Lazarus and Folkman’s (1984) transactional theory of stress and
coping is the cornerstone of psychological stress and coping research across multiple
elds and disciplines, including leisure studies (Iwasaki & Schneider, 2003). According
to Lazarus and Folkman, stress is dened as exposure to stimuli appraised as harmful,
threatening, or challenging, that exceeds an individual’s capacity to cope. e primary
features of the theory are cognitive appraisal and coping, which are said to co-occur.
e individual is constantly appraising stimuli within their environment. is cogni-
tive appraisal process generates emotions, and when stimuli are appraised as threat-
ening, challenging, or harmful (i.e., stressors), the resulting distress initiates coping
strategies to manage emotions or attempt to directly address the stressor itself. us,
coping is viewed as process-oriented and dynamic, and involves conscious, purposeful
actions employed when an individual appraises a situation as stressful.
Emotion-focused coping regulates emotions associated with stress without at-
tempting to change the situation itself and is largely a matter of nding ways to survive
the pain and/or avoid thinking about the threat of the stressor (Lazarus & Folkman,
1984). In the context of this study, veterans and military personnel who have PTSD
may utilize a diverse range of emotion-focused strategies such as denial, avoidance,
minimizing, distancing, and/or regulating one’s emotions by “pulling up one’s boot
straps” or discharging emotions through outbursts, venting, or crying (Benedek &
Wynn, 2016). Problem-focused coping is when the individual tries to dene the prob-
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Craig, Alger, Bennett, and Martin
lem, nd solutions, and consider alternative courses of action (Lazarus & Folkman,
1984). Changes can be made to the environment or through a cognitive reappraisal of
an individual’s goals and behaviors. In the context of this study, veterans and military
personnel with PTSD may use problem-focused coping when re-evaluating their life
goals or avoiding environments that trigger thoughts or feelings of the negative event
(Benedek & Wynn, 2016).
Role of Leisure in Coping
Research on the role of leisure in the stress-coping process has received renewed
attention in the last three decades (Chang & Yu, 2012; Denovan & Macaskill, 2017;
Iwasaki, 2006; Iwasaki, Mactavish, & MacKay, 2005; Iwasaki & Mannell, 2000; Iwasaki
& Schneider, 2003; Kleiber, Hutchinson, & Williams, 2002; Kleiber, Reel, & Hutchin-
son, 2008). In contrast to necessary daily tasks, routines, and work obligations, leisure
is dened as free time individuals have at their disposal, and they can utilize this time at
their own discretion and in their own characteristic style (Russell, 2017). Experiences
and activities people choose to engage in during leisure time for enjoyment, excite-
ment, and pleasure are referred to as recreation.
Among various types of coping resources and strategies, leisure researchers pro-
pose that leisure can be a means through which people cope with stress and main-
tain or improve their health (Iwasaki & Schneider, 2003). However, the mechanisms
through which leisure activates the stress-coping process are understood in dierent
ways. According to Iwasaki (2006), stress-coping research has historically focused on
the eectiveness of coping sources that regulate distress but have largely underrepre-
sented the ways in which pleasurable aect can impact the stress-coping response
. is study draws upon one such conceptualization that suggests leisure may be
a mechanism through which long-term adjustment to major negative life events can
occur, rather than just simply as a vehicle for coping with immediate or daily stress-
ors. Building upon Lazarus and Folkman’s theory, Kleiber and colleagues (Kleiber et
al., 2002, 2008) propose four major functions of leisure in transcending negative life
events. Two of these functions deal with leisure as ways of coping for self-protective
devices (breathers, sustainers), while the other two functions (restorers, personal
transformation) consider leisure as a means of adjustment to negative life events. e
restorer and personal transformation functions emphasize the role of leisure in restor-
ing one’s valued self that is continuous with the past, as well as in transforming oneself
to grow by nding new opportunities and perspectives (Kleiber et al., 2008). In these
ways, leisure can be an eective coping resource as it can create stability and control for
those who have experienced a negative life event by reducing, deecting, and manag-
ing emotional distress, and infusing positive emotions into the situation.
In the wake of combat trauma, leisure may help veterans and military personnel
with PTSD nd new meanings and directions in life. e role of leisure as a vehicle for
positive transformation of self while experiencing stressors is crucial for this popula-
tion as they attempt to adjust to their lives aer injury. is is known as posttraumatic
growth (PTG), which is dened as “a self-regulatory mechanism connected to one’s
innate biological tendency toward protection from the distress caused by stress, ad-
versity, and crisis” (Mikal-Flynn, Anders, & Homan, 2018, p. 271). PTG can serve as
a protective resource against the harmful health eects of combat exposure or symp-
toms of PTSD (Jankowski & Bell Vargas, 2019). For example, the trauma of war may
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Fly-fishing for Veterans and Military Personnel
negatively impact social identity among veterans and military personnel, resulting in
confusion about their understanding of the world around them, and their place within
that world. For PTG to occur, trauma survivors must rebuild their assumptions about
the world around them, which starts with a re-evaluation of the self (Calhoun & Tede-
schi, 2001). e restorative qualities of leisure in this process, specically activities that
utilize the outdoor environment, are well supported in the literature (Tidball & Krasny,
2007; Walsh, 2011).
Nature-Based Recreation as a Resource in Coping
Recreation activities are the conduit through which individuals experience lei-
sure. Nature-based recreation can be a unique form of meaningful leisure that can
assist with both emotion-focused and problem-focused coping by using the natural en-
vironment to help individuals overcome sources of anxiety, reduce stress, and reinstate
feelings of reward and pleasure (Tidball & Krasny, 2007). Among non-military popu-
lations, interventions in natural settings have shown enhanced physical, social, and
mental health outcomes, including “greater cognitive, attentional, emotional, spiritual,
and subjective well-being” (Walsh, 2011, p. 584). Several studies examining the ecacy
of veteran-specic nature-based modalities such as y-shing (Alexander, 2017; Ben-
nett et al., 2017; Mowatt & Bennett, 2011), river running (Dustin et al., 2011), outdoor
recreation/adventure therapy (Vella, Milligan, & Bennett, 2013), and equine-assisted
activities (Lanning & Kreneck, 2013) have shown promise in improving mood, psy-
chosocial health, and quality of life, and reducing PTSD symptoms among individuals
with service-connected disabilities.
Fly-shing is a growing nature-based recreation approach being used across the
U.S. to help veterans and military personnel cope with symptoms of PTSD. Within the
last decade, community-based organizations such as Project Healing Waters Fly-Fish-
ing (PHWFF), Rivers of Recovery, Fly’n Heroes, Fly Fishing for Vets, Veteran’s First Fly
Fishing Club, and others have recognized the therapeutic benets of y-shing for this
population, and have established local and national programs that provide pleasurable
recreation experiences. ese recreation programs are typically run by administrative
and/or professional sta and are supported by volunteers who are oen former partici-
pants and/or those with y-shing expertise. TR professionals oen partner with these
community-based y-shing programs as they refer clients from the VA and DoD with
whom they are working on individual rehabilitation plans (Rogers et al., 2016). Given
the prevalence of PTSD among veterans and military personnel, the VA and DoD’s in-
terest in CIH approaches, and the growth of nature-based recreation programs, a study
exploring the meaning of y-shing and its role in coping with PTSD is warranted.
Methods
A phenomenological method was used to elucidate a range of perspectives about
y-shing among veterans and military personnel with PTSD who participate in the
Project Healing Waters Fly-Fishing program (PHWFF). ese perspectives provide
depth and context to our understanding of the y-shing experience for this popula-
tion, allowing underlying commonalities in meanings to be understood through the
development of themes (Moustakas, 1994). Although participants share their own
personal meaning of experience through language, to understand the commonality of
meaning behind those experiences requires interpretation on the part of the research-
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Craig, Alger, Bennett, and Martin
ers (van Manen, 1997). Using phenomenology as an empirical lens in this study al-
lowed the researchers to access the complexity of participants’ y-shing experiences
and explore their perceptions of its role in coping with PTSD.
A common phenomenological data collection method is the individualized in-
depth interview, which is designed to explore essential essence of phenomena (Webb
& Kevern, 2001). While a focus group strategy is less common, and some would say
“incompatible” with the underlying philosophy of phenomenology (Webb & Kevern, p.
800), Bradbury-Jones, Sambrook, and Irvine (2009) suggest focus groups are a relevant
format through which “an individual lived experience can be preserved within a group
context” (p. 667). ey argue that focus groups within a phenomenological framework
may actually be more benecial than individual interviews because they stimulate dis-
cussion, open up new perspectives among group members, and are useful for clarica-
tion and cross-checking participants’ responses in real time. Further, data are said to
be enriched in focus groups as a result of hearing each other’s stories to which group
members can add their own perspectives and insights. Focus group discussions explore
specic topics and participant opinions in a non-threatening environment, revealing
not only what participants think, but also the reasons behind their attitudes and be-
haviors (Krueger, 1994). e group setting provides time for reection while others are
speaking, which can serve to validate the points as being shared experiences (Cote-
Arsenault & Morrison-Beedy, 2001).
In this study, a focus group method within a phenomenological framework was
used to collect data during the course of two naturally occurring PHWFF events in-
volving veterans and active duty military personnel with PTSD in the northeast region
of the U.S. Mini focus groups (Krueger, 1994) were used to accommodate a small-
er number of participants, so that each participant had opportunities to contribute
unique perspectives about their military experiences, their PTSD symptoms, and the
meaning of y-shing in their lives.
Setting
e Project Healing Waters Fly-Fishing program (PHWFF) is a year-round, vol-
unteer-led, nonprot corporation dedicated to the physical and psychological reha-
bilitation of wounded active duty military personnel and veterans through y-shing,
y-tying education, y-shing trips that range from one to ve days, and outdoor ex-
cursions (PHWFF, n.d.).e organization comprises 230 programs across the U.S. and
relies on experienced volunteer y shers and guides from Fly Fishers International,
Trout Unlimited, and independent y-shing clubs to conduct the program at VA
Medical Centers, DoD Medical Centers, and Warrior Transition Units. Recreational
therapists from inpatient units and outpatient clinics at VA Medical Centers and/or
from community-based TR programs working with veterans and military personnel
partner with PHWFF by providing patient referrals, supporting weekly sessions and
y-shing expeditions, designing adaptive equipment, and assisting with access issues.
PHWFF provides classes and clinics on y-shing, casting, tying, and rod build-
ing for beginners and those with experience who are adapting their skills to their new
abilities. Fly-shing tackle, y-tying materials and equipment are provided, including
accommodations for those with specic needs. All services are provided at no cost to
eligible participants. Participants include veterans and active guard and reserve mili-
tary personnel with disabilities from all conict eras. PHWFF attempts to create col-
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laborative, cooperative, trusting and caring experiences to enhance community reinte-
gration and quality of life by employing peer mentoring, experiential learning, outdoor
education and group interactions. Nationwide, the program served 8,593 veterans and
wounded military personnel in 2019 (PHWFF, n.d.).
Selection of Sample
is study was approved by the University’s Institutional Review Board. Research-
ers used a criterion sampling procedure to invite veterans and military personnel with
PTSD from PHWFF’s northeast region to participate in focus groups. Participants were
recruited based on four essential criteria: (1) were male and female adults who were
either veterans, or active duty military personnel engaged in the medical separation
process; (2) presented with a service-connected PTSD disability rating as diagnosed by
the VA; (3) were participants in the northeast region of the PHWFF program; and (4)
had previously completed PHWFF classroom and/or water environment sessions as
“repeat” or new participants.
e PHWFF Northeast Regional Coordinator emailed a recruitment yer to par-
ticipants on the regional mailing list. Contact information from interested participants
was forwarded to the second author, who then reached out to interested participants
via email to share details regarding the purpose of the study, informed consent proce-
dures, and logistics for the focus group meetings. Nine participants (two females, seven
males) agreed to participate in the study.
Data Collection
Qualitative data were collected, including transcripts and eld notes, from two
separate focus groups. e second author, who is a veteran who has y-shing expe-
rience and personal knowledge of PTSD, conducted the focus groups and took eld
notes at the conclusion of each group. e focus groups took place during two separate,
naturally occurring PHWFF program events. e focus groups were 90 minutes in du-
ration, were audio taped, and later transcribed verbatim. e transcripts were mailed
to the participants as a member check to verify the accuracy of their responses; none
of the participants requested changes to or clarication in the transcripts. e focus
group facilitator documented observations, impressions, and reections at the conclu-
sion of each focus group: ese eld notes were subsequently used to supplement data
analysis. Pseudonyms were created to protect participant anonymity.
Instrumentation
e semi-structured focus group interview tool was designed to elicit discussion
about the meaning of y-shing, and ways in which y-shing had inuenced partici-
pants’ ability to manage and cope with PTSD symptoms. e interview tool included
25 topical questions with probing follow-up questions as needed. Topics included, but
were not limited to: (a) meaning of y-shing in participants’ lives; (b) ways in which
y-shing impacted function across physical, social, emotional/psychological, cogni-
tive, and spiritual domains; and (c) perspectives about how y-shing inuenced their
coping processes. To address the issue of authenticity, the interview tool was developed
through a literature review on the role of CIH approaches in the treatment of veteran
and military populations with PTSD (Kearney et al., 2012; NCCIH, 2015; Tan et al.,
2010). Further, the PHWFF Northeast Regional Program Coordinator, and a Program
Leader from a regional PHWFF program not included in the study, reviewed the focus
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group tool for relevance and accuracy, and their input was incorporated into the nal
interview tool, which was used across both focus groups.
Data Analysis
Analysis relied on focus group transcripts and supplemental eld notes as dis-
cussed in the previous section. Four researchers independently reviewed each focus
group transcript by reading and re-reading the text to gain an inductive understanding
of “the whole,” or what the data were suggesting. e researchers then independently
coded the transcripts by breaking them down into manageable segments and identify-
ing, labeling, and naming those segments. Researchers individually condensed those
segments into descriptive categories based on valid inference and interpretation, and
then met as a team over the course of six meetings to simultaneously dene and rene
the categories. Utilizing the constant comparative method (Glaser & Strauss, 1967),
researchers compared and contrasted each new segment of data to the existing catego-
ries, and if the new coded data was an appropriate t with an existing category, it was
placed in that category. Conversely, if the new coded data was an inappropriate t with
an existing category, then the researchers either redened a category or created a new
category until all of the data were labeled. e researchers created a master codebook
using Excel and conducted analysis within each focus group, and then between the
two focus groups. ematic ndings represent pooled analyses between the two focus
group cohorts.
Creswell and Creswell’s (2018) primary verication procedures for credibility, re-
liability, and authenticity were employed, as the researchers thoroughly triangulated
their descriptions and interpretations with each other during the analysis stage. is
debrieng process enabled the researchers to utilize multiple perspectives and meth-
ods to corroborate the ndings, which added credibility to the interpretation process.
e salient categories that resulted from the constant comparative method led to the
development of four prominent themes describing participant perspectives about the
meaning of y-shing.
Findings
Participants
Participants included seven males and two females (n = 9) who ranged in age from
28-68 (M =47) and had between <1-5 years of experience (M =3) as a participant in
the PHWFF program (see Table 1). e rst focus group was conducted with ve par-
ticipants during a eld trip to a y-shing vendor show in the northeast region of the
U.S. e ve participants (three males, two females) in this focus group were veterans
from the Army (n = 4) and Marines (n=1) who served in Desert Storm, Post 9/11, and
Vietnam conicts. ese ve participants were familiar with each other through their
involvement in an urban-based PHWFF group in the northeast region of the U.S. e
second focus group was conducted during a y-tying event that took place at a com-
mercial outdoor business with four participants from a Military Transition Unit in
the northeast region of the U.S. e four participants in this group were active duty
military personnel from the Army (Post-9/11 wars) who were in the process of being
medically separated from their units as a result of injury and, thus, they were less fa-
miliar with each other.
Seven of the nine total study participants held “Participant” roles in the PHWFF
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program, and two of the nine held “Program Lead” roles, which means they served as
volunteer leaders in a specic PHWFF group. e process of progressing from a “Par-
ticipant” role to a “Program Lead” role happens over time. If participants are observed
by other Program Leads to have innate leadership skills, strong commitment, dedica-
tion, and y-shing acumen, they are invited to serve as a “Deputy Program Lead” for a
specied amount of time under the guidance of a Program Lead, before being assigned
to lead their own group.
Table 1
Participant Profiles
Pseudonym Gender Age Branch/Era Time in
Program
PHWFF
Program Role
Laura Female 53 Army (Desert
Storm)
3 years Participant
Yvette Female 49 Army (Desert
Storm)
3 years Participant
Owen Male 28 Army (Post 9/11) 1 year Participant
Brent Male 68 Marines (Vietnam) 5 years Participant
Larry Male 68 Army (Vietnam) 4 years Participant
Elliott Male 44 Army (Post 9/11)
Active Duty
3 years Participant
Roger Male 38 Army (Post 9/11)
Active Duty
2 years Program Lead
Mack Male 42 Army (Post 9/11)
Active Duty
4 years Program Lead
Johnny Male 31 Army (Post 9/11)
Active Duty
< 1 year Participant
Thematic Findings
Four themes were constructed from the data, suggesting y-shing: (a) facilitates
positive mood and buers the negative impact of PTSD; (b) sustains coping eort and
commitment by generating motivation and providing challenge; (c) facilitates healing
by restoring control, fostering connections, and creating hope for the future; and (d)
helps move participants toward personal transformation and posttraumatic growth.
Theme I: Fly-fishing Facilitates Positive Mood and Buffers the Negative
Impact of PTSD
Free Self from Stress, Distraction/Diversion.A number of participants acknowl-
edged the calming eects of y-shing on their anxiety symptoms and valued its inu-
ence on their ability to “decompress” from everyday stressors. For Larry, a 68-year-old
Army veteran, y-shing provides a necessary respite from the stress of everyday life:
“It helps you relax, to unwind…it puts you in a better frame of mind…it’s just tranquil.”
Mack, a 42-year-old active duty soldier who was in the process of being medically sepa-
rated from his Army unit, shared similar sentiments about the inuence of the peaceful
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Craig, Alger, Bennett, and Martin
y-shing environment on his mood: “It’s hard to explain to people the tranquility of
just being on a stream. It doesn’t matter if I’m shing, or just trying to see what kind
of bugs are on the water; it’s just that feeling of peace and quiet.” Johnny, a 31-year-
old who had recently medically separated from his Army unit, shared that y-shing
helped distract him from ruminative thoughts, “A lot of people have problems with
dwelling on the past. [Fly-shing] gives me something to do…it keeps me occupied so
I’m not thinking about that stu on a daily basis. It helps relieve stress and its peaceful
to me.”
Positive Mood. is “quieting” characterization was prominent for participants in
dierent ways. Yvette, a 49-year-old Army veteran who has been participating in the
PHWFF program for three years, described the soothing feelings associated with the
casting aspect of y-shing, noting: “It denitely helps me with my anxiety; just cast-
ing, alone in itself. And, just knowing, I’ve got to get better, I’ve got to go further…it’s
a soothing thing, it helps you just calm down within because you don’t have to rush it.”
Owen, a 28-year-old Army veteran, shared his ability to transfer the peaceful feelings
he experienced through y-shing to other life situations in which he felt anxious and
out of control. He noted,
I close my eyes and just remember the tranquility, the sound of the river, the
light shining, and the sh ghting. When I’m in a place where I just want to
smash everything, and I can’t breathe, I just think of that and can hear the
river again, it calms me down. e sounds of nature will calm you down, but I
didn’t know that, because most the time when I saw nature, we were blowing
it up. But now it’s a whole dierent ballgame.
For some, y-shing served as a substitute for medication, or helped reduce reli-
ance on medication for symptom management. Brent, a 68-year-old Vietnam veteran,
viewed casting and y-tying as a substitute for his medication: “e stress immediately
melts when you’re casting. It’s taught me a great deal. If I get uptight, I’ll start tying ies
at home, just like it’s medication. It’s my vice, my medication. I don’t care if I even catch
any sh.” Owen described y-tying as a more eective alternative for anxiety manage-
ment than his prescribed medications,
I take the maximum dose of medications you can take. But nothing calms me
down more than tying something. I get these reactions where I start throwing
up, I get dizzy, I just want to smash things or just want to lay down and sleep
the rest of my life. But instead of popping a pill, I’ll tie a copper john.
Mood Regulation and Expression of Feelings. For some participants, y-shing
fostered an awareness of challenges associated with mood regulation, a common symp-
tom of PTSD (APA, 2017). is was true for Yvette, who shared that y-shing helped
her learn how to recognize and express her feelings, which led to self-reection about
her adjustment:
I remember that black heart, where I couldn’t go this way or that way. My fam-
ily didn’t understand me. Art helped me to express those feelings, but when I
started y-shing, I was like THIS is for that. So with every cast, I am thinking
about why my family is not understanding, and I wish they could see me now.
It helped me to really talk through for myself.
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Fly-fishing for Veterans and Military Personnel
Owen indicated that y-shing helped him recognize signs of emotional numb-
ing, and helped him remember what it meant to feel good again: “It reminds me of
what I’m capable of feeling like. You forget what is was like before, and then you are
shing on the river and you know what’s possible again. It gives me the opportunity to
peek at what I’m capable of feeling like all the time.”
Theme II. Fly-fishing Sustains Coping Effort and Commitment by Generat-
ing Motivation and Providing Challenge
Participants described problem-based outcomes of y-shing in terms of being
better able to manage their PTSD symptoms and being able to cognitively reappraise
and restructure perceptions of stress. ey described ways in which y-shing helped
them sustain coping eort in the face of stress by generating motivation, introducing
challenge, and developing new skills.
Improved Patience and Concentration. Fly-tying emerged as an important task
through which participants were able to develop patience and concentration which
they viewed as critical for stress management. For Elliott, a 44-year-old Army veter-
an, y-tying was instrumental in helping him improve those key skills: “When I rst
got back from Iraq, I didn’t have any patience at all, my concentration wasn’t there…I
couldn’t tie a y. Now, with y-shing, I’m probably more patient than I have been in a
long time.” Mack shared a similar sentiment as he talked about how y-tying and cast-
ing required him to pay attention, which he described as integral in helping him man-
age stress: “Fly tying and casting denitely helps with my patience. I’m not a patient
person, which can cause stress and anger for myself and others. I had to learn to slow
down and really pay attention to that stu. I don’t get anxious now.”
Generating Motivation. Debilitating PTSD symptoms such as depression and
fatigue can strip away one’s motivation and desire to engage in life activities (APA,
2017). Finding new pathways that foster motivation to participate in life activities is
important and, as participant comments illustrate, y-shing appears to be an eective
mechanism through which to achieve this outcome. For example, Johnny commented
on the challenge of his transition from full-time work in the military to retirement, and
viewed his participation in PHWFF program as a constructive way to ll that void: “…
once I retired, I didn’t have anything to do, I didn’t have a job, I moved away and le
all of my military buddies…so it just gives you something to do so that you’re not just
dwelling on bad things; it’s a positive thing for you to do.” Laura, a 53-year-old Army
veteran from Desert Storm, shared a renewed level of motivation across multiple set-
tings as a result of her involvement in the program: “Ever since I’ve been in the PHWFF
program, I’ve been getting up earlier every day, and I’m motivated to do things. I joined
AMVETS [American Veterans National Service Foundation]. I am motivated to do so
many things now - I volunteer at the hospital.” Larry shared a similar sentiment: “Be-
cause of PHWFF, I get out of bed.”
Challenge. e military experience oers numerous situations in which individu-
als face signicant physical, mental, and psychological challenges. Although prolonged
exposure to such stressors has been shown to negatively impact military personnel
(Fulton et al., 2015), these experiences can also be catalysts for growth, as they pres-
ent opportunities for shaping one’s resilience and course of action through adversity.
Once discharged from service, however, veterans may not nd adequate substitutions
that can mirror these types of challenges outside of the military context. Participants
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Craig, Alger, Bennett, and Martin
pointed to y-shing as one potential avenue to again experience that sense of chal-
lenge. Fly-shing requires a diverse skill set, including selection and management of
shing tackle, knot tying and leader construction, insect identication and creative
y-tying, rod building, casting technique, and reading the complex ow of water and
behavior of the sh. For Roger, a 38-year-old who had participated in PHWFF for
two years as he completed the medical separation process from the Army, y-shing
lled that challenge void across many dierent areas of life: “I’m trying to tie a y and
I’m concentrating so much on getting that right that I’m not dwelling on other things.
Every aspect of it is about learning new skills, concentration, and it’s all really coming
together.” Laura’s comment reects the need for commitment in the PHWFF program,
which appears to parallel the type of commitment required for the military context:
“It’s just not like the one-time experience you get in some programs. You have to earn
that rod, you just don’t come and get it. ey have to see that you are really interested
and you have been coming for a while.”
Theme III. Fly-fishing Facilitates Healing by Restoring Control, Fostering
Connections, and Creating Hope for the Future
Participants described y-shing as a bridge toward self-restoration by providing
opportunities to regain control in their lives, helping them feel connected to others and
nature, and creating hope for the future.
Restoring Control. Participants noted that y-shing helped restore a sense of
control in their lives. at was true for Laura, who described a renewed sense of control
as she was able to progress from being a PHWFF participant to a volunteer:
Sometimes, it just feels like you have no control over your life, like this thing
is eating you up from the inside and there’s nothing you can do about it. But
then I volunteered to run a tying class. I went from a participant to a volun-
teer. at makes me look in the mirror and is something I am proud of.
Fostering Connections through Shared Experiences. Participants shared how
nding a group of people that enjoyed doing the same things together gave them a
renewed sense of inclusion and connection to others and provided socialization and
bonding opportunities. Elliott described his connection with other members of the
PHWFF group this way: “…it’s a bunch of guys you normally wouldn’t even know,
and you wind up becoming shing partners.” Roger shared this about what it means
to socialize with others through y-shing: “I didn’t know anybody. I just moved from
a dierent post and met people who had been through similar experiences. You bond
with dierent people and, once on the river, you talk about stu. It serves as an outlet
for that kind of thing.” Owen stated that he doesn’t participate in y-shing to catch
sh, but rather to connect with others: “Fly-shing breaks down a lot of barriers, and
makes you feel like you’re not alone…it’s a big network, and a mentorship. For me, it’s
not about the shing at all. I love to catch sh, but I don’t go to sh at all, I go to see
everybody.”
Notably, many participants identied the greatest benet of these new connections
was being able to share, learn and grow with others while y-shing. Owen stated, “...
we feed o of each other, on the healing aspect because some of us are on dierent
levels of past healing, and so we can give each other shortcuts and stu.” Laura shared
this, “We got friends here…we have a common bond out there.” Elliot summarized
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Fly-fishing for Veterans and Military Personnel
the value of the shared experience in this way, “…you know everybody is in the same
boat...this is my family.” For others, y-shing was integral in helping them reconnect
with the outdoors. is was evident for Brent, who made the observation, “I nd you
become more in contact with the environment…you learn about the environment…it
makes you conscious of the environment.” Yvette also contemplated the natural envi-
ronment in her coping process, “Everything about it is so—I’m not going to say divine
—but it’s just natural, just being around the water and the trees. And it helps you cope
even when you’re stuck. I was so stuck.”
Creating Hope for the Future. Participants described a renewed sense of excite-
ment and optimism about the future as a result of their y-shing experiences. is re-
newal was a welcomed change from the negativity that tended to dominate their daily
thoughts and emotions. Larry shared this, “You are looking forward to the next trip,
and you want one every week.” Owen’s renewed optimism helped him put challenges
into perspective: “I may have a bad week or two, but tell myself Friday is a casting ses-
sion which helps me get through the day. I can deal with a few bad days because there
is going to be one day I can go shing.” For Roger, the anticipatory nature of catching
sh seemed to be an apt metaphor for renewing optimism and hope in his life: “Fly-
shing gives me something to look forward to and with every cast, I have hope that
something’s going to happen…I came from a place where I didn’t think there was hope
for anything.”
Theme IV. Fly-fishing Helps Move Participants Toward Personal Transfor-
mation and Posttraumatic Growth
Participants expressed how y-shing helped them to begin forging a path to-
wards self-restoration and personal transformation. Owen talked about how y-shing
impacted how he viewed himself noting, “I feel like I do love myself. I love shing and
I just feel happy and relaxed and peaceful. I got one thought in my head, not a million.”
Laura suggested that y-shing helped her learn how to take care of herself: “With y-
shing, you have something you take on forever, you can take it with you. ey don’t
come and feed you but teach you how to sh and feed yourself.” She went on to describe
that metaphor in the context of her life goals,
It gives you back life. It did that for me. It’s not that you want to die, it’s just
like “oh, the heck with it”…it’s just what happens; now you tie this [y], now I
can do that. It’s your real life now, you can manage your PTS[D] now that you
have goals, and you can see short-term goals.
Yvette similarly described a sense of pride when she was able to share knowledge
of y-shing with others. Her comment hints at a re-visioning of her “self ” in this
process:
You don’t have a lot of proud moments in your life, so when you can talk
about y-shing, that gives you a lot of pride. And you feel like you can take
this back to somebody and say, hey, I’m making advances here, I’m nding
something positive, I am just a dierent kind of person when I am here. I
suer from frozen shoulder and all the back and legs issues, but none of that
bothers me when I am here. It just takes me to a dierent zone. It is like I am
a whole person.
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Craig, Alger, Bennett, and Martin
Yvette summarized her thoughts by sharing this powerful insight about the
transformative potential of y-shing: “It ain’t about the shing. It’s about where
it takes you and how it can reform you and make you over and help you get out
of a rut, and just try. It’ll transform you. It helped me to be more complete.”
Discussion
Fly-shing appears to be an eective coping resource that can activate the
coping process and facilitate engagement in life rather than self-imposed isola-
tion for veterans and military personnel with PTSD. e meanings that par-
ticipants ascribe to y-shing align with Kleiber et al.’s (2002, 2008) underlying
theoretical propositions explaining how leisure can assist with the stress-coping
process. is alignment supported the development of a new conceptual model
(see Figure 1), which is used to frame this discussion.
Figure 1
Conceptual Model of Fly-Fishing as a Coping Resource for Veterans and Military
with PTSD
Figure 1. Conceptual Model of Fly-Fishing as a Coping Resource for Veterans and Military with PTSD
NEGATIVE LIFE EVENTS
PTSD
Disrupts Life Across Multiple Health Domains
Physical
COPING PROCESS
Emotion-Based Coping Problem-Based Coping
happen
together
Mood, Aect
(positively toned emotions)
Cognitive Appraisal & Reappraisal
(restructure perceptions of stress)
SUSTAINERS RESTORERS
BREATHERS
- free self from stress
- distraction/diversion
- positive mood
- pleasurable events &
activities
- improve
patience &
concentration
- generate
motivation
- challenge
- restore control
- fosters
connections
Move veterans & military personnel
with PTSD
toward personal
transformation
POSTTRAUMATIC GROWTH
LEISURE AS COPING RESOURCE
Fly-Fishing
Social
Emotional
Cognitive
Spiritual
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Fly-fishing for Veterans and Military Personnel
Consistent with the buering role of leisure in the stress-coping process, par-
ticipants articulated positive emotional and cognitive changes as a result of their y-
shing experiences. As reected in Figure 1, these ndings reinforce the notion that
a leisure experience, such as y-shing, can be a critical self-protective resource for
emotion-focused and problem-focused coping with negative life events, such as PTSD,
and that such experiences may serve as the foundation for personal transformation
(Kleiber et al., 2008). As depicted in the top portion of Figure 1, a negative life event
such as PTSD may produce myriad disruptions across multiple functional domains.
Instead of demonstrating avoidant behavior, acting reactively, or disassociating when
encountering challenging situations, veterans and military personnel with PTSD need
to nd new ways to actively cope by tapping emotion-and problem-based processes
(Benedek & Wynn, 2016).
As depicted in the rst circle in the middle section of Figure 1, eme I ndings
support Kleiber et al.’s (2008) proposition that y-shing can be used as a self-protec-
tive resource, or breather (p. 322), for individuals who have experienced a negative life
event by freeing themselves from stress, diverting attention away from the negative
symptoms through distraction, and providing opportunities to experience pleasure
and positive mood states. Participants reported that the calming nature of y-shing
helped buer the negative eects of their symptoms by providing an opportunity to ex-
perience a sense of peace, contentment, and tranquility. Many participants were able to
verbalize and name their distress, suggesting that when engaged in y-shing activities
they were able to reduce the intensity and duration of symptoms. Participants viewed
y-shing as a welcomed respite from their stress symptoms, as it diverted attention
away from intrusive, negative thoughts and feelings. Some even noted a decreased need
for medications to manage PTSD symptoms. is temporary suspension of attention
provided participants with enough distance and space to allow positive emotions and
thoughts to emerge, which subsequently led to greater emotional awareness and ex-
pression.
As depicted in the middle circle in the middle section of Figure 1, eme II nd-
ings suggest y-shing can have a positive impact on problem-based coping, as it helps
generate motivation and commitment while concurrently providing challenge. is
nding aligns with Kleiber et al.’s (2008) proposition that leisure can generate and sus-
tain (p. 323) a sense of optimism, excitement, and hope for the future, thus allowing the
individual to cope with their present situation. Participants appeared to value the in-
herent challenges presented by y-shing, and appreciated the opportunity to develop
skills in casting and y-tying, while simultaneously developing functional skills such
as concentration and patience. While challenge may have been perceived as stress-
ful in the past, y-shing helped participants cognitively reappraise and restructure
these perceptions. As participants moved away from avoidance behaviors in relation
to stress, and towards the consideration of alternative possibilities in their lives, they
began to experience a shi in their understanding of ‘self.’ Fly-shing appeared to help
them sustain positive forward progress as they adapted to their PTSD.
As depicted in the last circle in the middle section of Figure 1, eme III nd-
ings suggest y-shing has the potential to help participants regain control, experience
social connections with others and the outdoors, and experience hope for the future.
is nding aligns with Kleiber et al.’s (2008) proposition that leisure can restore (p.
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Craig, Alger, Bennett, and Martin
323) some aspects of the self by restoring hope, making connections with others, and
reconstructing one’s life story that is connected with the past. e inherent challenges
associated with y-shing oered participants a renewed sense of self-worth and em-
powerment as they viewed themselves as having the tools to face these challenges, and
in some cases, master them. is sense of control is an important feature while coping
with crisis (Hasson-Ohayon et al., 2006), as it enables one to cope as an active agent
rather than as a passive and detached by-stander.
As further depicted in the last circle in the middle section of Figure 1, partici-
pants also acknowledged that the social connections and fellowship they developed
with each other were critical for their sense of coherence. Being together with a group
of people with similar concerns and interests appears to contribute to the solidarity
that arises between them and has the potential to move them out of isolation and back
into society. Learning to y-sh by attending meetings for group instruction in vari-
ous skill development areas including casting, y-tying, insect identication, and over-
night outings rekindled the bonds forged during their time in military service. One
signicant dierence, of course, is that y-shing occurs in environments that tend
to be pristine, beautiful, and safe, where the conict simply involves “ghting a sh”
at the end of the y-line. e expanding repertoire of shared experiences and what is
learned in the process represents the therapeutic outcome of this group participation.
Some participants noted the shared experience extended beyond y-shing sessions to
include helping fellow members move, carpooling to eld trips, volunteering to teach
skills courses to others, visiting each other when sick or in the hospital, and generally
“taking care of each other.”
Findings from eme IV suggest that collectively, the breathers, sustainers, and
restorers show promise in helping veterans and military personnel with PTSD move
toward personal transformation and posttraumatic growth, as depicted in the bottom
section of Figure 1. is nding aligns with Kleiber et al.’s (2008) proposition that lei-
sure can serve as a context for personal transformation (p. 324) as it facilitates positive
emotions and appreciation of life, which helps individuals realize their full potential.
Positive interactions and successes in the PHWFF program allowed participants to
start seeing themselves in a dierent way and gave them an opportunity to start re-
constructing their own story, which is an important step toward posttraumatic growth
(Tedeschi & Calhoun, 1996). A number of participants engaged in self-reection about
who they were becoming and shared the pride they experienced in this growth pro-
cess. Some even oered to “pay it forward” by serving as a volunteer Program Lead for
other members in the PHWFF program who did not yet have the requisite background
and skills to succeed in y-shing. is movement is represented by the green arrows
emerging from the PTG outcome depicted at the bottom of Figure 1. As participants
experienced PTG, they felt empowered to assume a new role in the y-shing program
—that of a leader, mentor, and coach who could instruct, support, and help shape the
next cohort of y-shers. Achieving psychosocial stability appeared to be dependent
on participants’ recognition and appreciation of their existing abilities, which helped
them begin reconstructing a coherent narrative about who they are post-injury. Find-
ings suggest that y-shing has the potential to contribute to this process of personal
transformation and fulllment of one’s potential, thus leading to posttraumatic growth.
is phenomenological study adds to the literature by demonstrating that nature-
based recreation, such as y-shing, can create a healing environment that can pro-
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Fly-fishing for Veterans and Military Personnel
mote a return to healthy activity and personal transformation for veterans and military
personnel with PTSD. Fly-shing provides a dramatic distinction between the trials
of combat and the calming eects of sharing natural environments with like-minded
companions in pursuit of elusive wild sh. Developing skills in casting and y-tying
oers an opportunity to practice skills and adjust to current abilities. ese activities
rekindle and enhance participants’ appreciation and enthusiasm for recreational activi-
ties while also encouraging socialization, a sense of belonging, hope, and the ability to
appreciate and enjoy life.
Limitations
is study has several limitations. Although generalizability is typically not sought
in qualitative research, this study included a small sample of PHWFF participants from
the northeast region of the U.S. and thus, ndings only represent their perspectives.
Selection bias may also be a limitation, as it is possible that only PHWFF members
who already felt they had made gains as a result of their y-shing experience volun-
teered to participate in the study. Most participants were male, and primarily repre-
sented the U.S. Army, which may also inuence the ndings. Further, limited access
to demographic data of the sample, such as years of military service and the number
of deployments, prevented a full understanding of the context in which participants
served. Additionally, the focus groups took place during two dierent types of PHWFF
events, which may have inuenced how comfortable participants felt disclosing sensi-
tive details about their PTSD symptoms. Sharing PTSD concerns in a focus group set-
ting is not easy and may have lead participants to report that they are doing well when
in reality they might be struggling with emotional issues. Choosing a qualitative design
to gain a deeper understanding of these sensitive issues was a logical methodological
decision to address this limitation; however, participant responses may have been un-
duly inuenced by the ‘group think’ dynamic, or by social desirability. Further, because
the PHWFF program is primarily run by volunteers and y-shing experts who donate
their time, program delivery structures and curricula may have varied between the two
dierent focus groups, leading to qualitatively dierent experiences.
Future Research
Although qualitative research designs do not allow us to conclude that y-sh-
ing was responsible for the noted changes in PTSD symptoms among participants,
this nature-based activity does show promise as a viable therapeutic approach for this
population, and continued research on its ecacy is warranted. e next logical step
would be an experimental design of a y-shing program for the treatment of PTSD
among this population. Such an investigation should include a sucient sample size,
consistent structure and delivery of the y-shing intervention/program (delity), and
a standardized measurement tool designed to assess PTSD symptoms, as well as as-
sociated behavioral and emotional symptoms. Future studies should attempt to de-
termine which specic components of the PHWFF program are most inuential in
eecting change. Lastly, while the researchers decided to pool the analyses of the two
focus group datasets for convenience of time, future research may consider examining
the dierence and similarities between participants from Warrior Transition Units and
veteran-only groups.
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Craig, Alger, Bennett, and Martin
Implications for TR Practice
e VA and DoD’s shi toward an aspirational approach to health recognizes
that individual interests and motivations are drivers for behaviors that improve health
among veterans and military personnel (NCCIH, 2015). Although y-shing is not
currently considered a rst-line treatment for PTSD among this population, it does
appear to be a viable CIH approach that can be used in TR and recreation settings
to achieve important client outcomes. RTs use purposeful recreation to facilitate in-
creased access to community resources, and individual strengths and skills that sup-
port well-being across multiple health domains (Anderson & Heyne, 2012). Within
this context, treatment involves participation and engagement in a variety of person-
ally and culturally relevant recreation activities (e.g., tness, sports, outdoor pursuits,
cultural arts, aquatics, animal-based therapies) that support health, social connections,
and reinforce positive aspects of one’s self and values (Iwasaki, Coyle, & Shank, 2010).
Strengths-based, recovery-oriented strategies are identied as the current standard of
care for the treatment of individuals with mental health disorders such as PTSD, de-
pression, and anxiety (National Alliance on Mental Illness, n.d.).
As ndings from this study suggest, nature-based recreation approaches may serve
as a rich training ground for strengthening coping responses and functional changes
among our clients who have experienced trauma. e potential of nature-based ap-
proaches, ranging from gardens to wilderness therapy, is highlighted as a therapeutic
resource in TR as they provide opportunities for reection and personal restoration.
TR professionals should be aware, however, that our clients who have experienced
trauma might need additional supports and opportunities to apply and generalize
newly learned understandings and skills in their daily lives. Lastly, these ndings sup-
port the continued development and expansion of nature-based recreation programs
like PHWFF that provide continuous, ongoing opportunities, rather than programs
and events that provide limited one-time experiences.
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