A holistic approach is essential for the best possible outcome to addiction treatment, according to the Substance Abuse and Mental Health Services Administration.1 A holistic approach is one that promotes the healing of the whole person, addressing issues of body, mind and spirit.
High-quality treatment programs typically combine traditional therapies, such as cognitive behavioral therapy and motivational enhancement therapy, with complementary therapies like acupuncture, yoga and meditation. This approach provides comprehensive treatment that addresses physical and mental health as well as spiritual health, which is concerned in part with finding purpose and meaning in life. By treating the whole person and addressing all of the issues that underlie the addiction—as opposed to treating just the addiction itself—individuals come away with a higher self-esteem and higher self-efficacy as well as better physical, mental and social health.
Experiential therapies are a class of alternative treatments that enjoy a great deal of success in treating substance use disorders. Experiential treatments, which involve hands-on activities like working with horses or creating art or music, are becoming increasingly mainstream as a growing body of research reveals the benefits of these hands-on types of therapy.
Adventure-based counseling is one field of experiential therapy that has been shown through research to be highly effective for treating addiction. A number of studies provide evidence of its efficacy, including a meta-analysis of adventure programs that found this type of therapy positively impacted self-esteem, leadership, personality and interpersonal relations.2
What is Adventure Therapy?
Adventure therapy is based on the therapeutic value of first challenging participants in nature and then leading them through discussions that evaluate their reactions and bring about changes in behavior.
Adventure therapy is an active approach to psychotherapy, or “talk” therapy, that utilizes hands-on outdoor activities like camping, hiking and horseback riding to bring about meaningful internal change through real and perceived risks. Participants create meaning through insights gained during the introduction of the activity, then from experiencing it and finally discussing the experience afterward. The experience and the subsequent discussions help individuals transfer the lessons learned during the activity into changed behavior.
Adventure therapy programs are generally solution-focused and humanistic, emphasizing the whole person and drawing on the idea of innate goodness.
How Adventure Therapy Works
A variety of processes lead to positive behavioral changes and psychological healing in adventure therapy. For example, mastering certain experiences leads to self-efficacy in the adventure, and this self-efficacy can be transferred across life domains. This occurs by:
- Mastering an experience and examining the skills used and learned
- Identifying similar sub-skills
- Developing these sub-skills
- Re-evaluating beliefs concerning self-efficacy
- Generalizing sub-skills and applying them to all areas of life
The discussions that follow an activity provide the context for helping participants to internalize an experience and relate it—and the skills gained in the process—to their specific individual recovery goals.
Kolb’s Experiential Learning Cycle
David Kolb, the celebrated educational theorist whose large body of work focuses on experiential education, states that new experiences are the impetus for developing new concepts and skills. “Learning,” he writes, “is the process whereby knowledge is created through the transformation of experience.”3
Kolb’s theory on experiential learning is represented by a four-stage cycle:
- Concrete experience (do it) is stage one and is the act of engaging in a new experience or situation.
- Reflective observation (what happened?) is stage two and involves actively observing and reflecting on the experience.
- Abstract conceptualization (so what?) is stage three and is marked by the reflection of the experience giving way to a new idea or a reworking of an old idea.
- Active experimentation (now what?) is stage four and involves learners applying their new or reworked idea to their own life and the world around them.
In order for adventure therapy to work for an individual, all four stages need to be executed. The experience alone won’t precipitate change unless it’s reflected upon, conceptualized and applied. According to the University of Kentucky, in order for experiential learning to be effective, participants must be able to:4
- Involve themselves openly and without bias in a new experience
- Reflect upon and observe the new experience from a range of perspectives
- Create concepts based on their observations
- Use these concepts to make decisions and solve problems
The Foundational Concepts of Adventure Therapy
According to the Association for Experiential Education, the foundational concepts of adventure therapy are based in the principles of experiential education, the value of action and a hands-on engagement in the therapy. These include:5
The Involvement of Stress and Risk
In the natural environment, risk and stress are inherent. When risk and stress are effectively managed by the therapist and participant, participants are able to work through challenges, build resilience and develop and apply coping strategies. The therapist is responsible for monitoring participants’ appraisal of the risk and their stress level to ensure a safe therapeutic environment, as well as supporting them in applying what they’ve learned to their life on a broader scale.
Natural and Logical Consequences
Engaging in adventure activities that carry a risk gives participants the opportunity to experience the positive and negative consequences of their decisions and improve their self-awareness. A natural consequence is the outcome of a behavior without any enforcement on the part of the therapist, such as experiencing discomfort as the result of not putting on a rain coat during a downpour. A logical consequence is a therapist-enforced outcome of a behavior such as not being able to water ski if you refuse to wear a life jacket.
The Healing Power of Nature
A large body of research has documented the benefits of engaging with nature, which include reduced anxiety and depression, better cognitive function and increased creativity, according to the University of California at Berkeley.6 Taking therapy into nature is a unique way of providing immediate, non-judgmental feedback to participants and reaping the combined benefits of nature exploration and therapy.
The Shared Experience of the Practitioner
The role of the therapist in adventure therapy is somewhat different than that of traditional therapists. Because the practitioner and clients are sharing the experience, the relationship develops more quickly, and the therapist is in the unique position to be present during the activities that precipitate change. Other benefits of shared experience include:
- The ability of the practitioner to foster reflection at multiple points in the activity
- The ability of the practitioner to determine whether lessons learned have been integrated into other life domains
- A leveling of the power dynamics between client and therapist
- An increased likelihood for transference of lessons learned
The Actively Engaged Client
The opportunities for reflection and change in adventure therapy are many when the client is engaged physically, emotionally and cognitively. Active participation in therapeutic activities allows clients to reveal their true nature in an authentic way as they participate in various experiences. This serves to make the relationship between the participant and the practitioner more productive by allowing the therapist to see how a client might approach solving certain problems in other areas of life.
Client Empowerment, Freedom and Responsibility
The actively engaged client is responsible for choosing the type of change they want, and they’re given the freedom to make choices. The responsibility for the lessons learned and the changes made are their own. This enables participants in adventure therapy to engage in positive and self-directed risk-taking, which in turn enhances the client’s accountability for the outcome of treatment.
Activity as the Vehicle of Change
In adventure therapy, the treatment goals of the participant are addressed through activities that are specifically chosen by the therapist to explore particular issues. Because the activities are fun and engaging and offer a break from negative and inhibitive thinking, the client’s resistance to change and fear of taking risks are diminished.
The “parallel process” inherent in adventure therapy refers to how the processes unfolding in each session mirrors the client’s functioning in “real” life. The activity becomes the catalyst for evaluating behavioral patterns, thought processes and psychological and physiological reactions and opens the door to changes that are real and meaningful.
Types of Adventure Therapy and Common Activities
While these are all very similar, there are some differences. For example, adventure therapy generally involves “risky” outdoor activities like rock climbing that are physically and emotionally challenging and promote desired behavioral changes. Wilderness therapy involves primitive outdoor experiences like backpacking that specifically promote adaptation and coping skills. Outdoor experiential therapy involves structured outdoor activities like obstacle courses that promote rehabilitation, growth and development and enhance participants’ physical, psychological and social well-being.
Adventure therapy in general, regardless of the type, typically involves cooperative games, problem-solving and trust-building activities, high adventures like rock climbing, low adventure activities like mountain biking and wilderness expeditions such as canoeing, backpacking or sailing expeditions. Each type of activity has its own benefits.
Cooperative activities like games and ice breakers require participants in adventure therapy to engage with others for mutual benefit toward each individual’s treatment goals. These activities create positive interaction and a sense of fun, and they’re chosen specifically with a clear intent in mind, such as to introduce group members, reduce stress, deepen the relationship between client and practitioner and promote a fun and relaxed treatment environment.
Other benefits of cooperative activities include:
- Offering important insight for the therapist, enabling the accurate assessment of a client’s comfort level, level of functioning and willingness to engage
- Supporting clients in developing their willingness to work together effectively
- Helping clients build positive interactions with others and modeling healthy relationships
- Building trust within a group
- Helping clients acquire social skills by increasing their self-awareness and challenging preconceived notions about themselves and others
Initiative activities work to initiate the action a client needs to take toward achieving a particular therapeutic goal. For example, clients may be asked to move a marble from one point to another through tubes without touching the marble or letting it touch the ground. These activities typically encourage a group to work together to reach a specific outcome and require participants to take the initiative to communicate with each other, solve problems and make decisions.
Other benefits of initiative activities include:
- Helping clients build cooperation and communication skills
- Building trust among group members
- Promoting problem-solving skills
- Promoting healthy social skills
- Helping clients develop strategies for managing emotions
- Helping clients develop coping skills
- Increased self-awareness
Trust and Support Activities
Trust and support activities create a situation in which the participant isn’t in total control and must rely on others to accomplish a particular task, such as wearing a blindfold while being led by another along an obstacle course. These activities give clients the opportunity to be in a position in which they provide support to others and have some control over others’ physical and emotional well-being. The expected outcome of these activities is a higher level of trust in oneself and in others, and the activity itself is an excellent assessment tool for the practitioner to determine a client’s comfort level and how he or she copes with situations in which personal control is limited. They also clue the therapist in to whether a client is willing to take risks, trust others and maintain healthy boundaries.
Other benefits of trust and support activities include:
- A stronger therapeutic alliance between the client and therapist and the client and other group members
- Allowing clients to explore different levels of trust in a range of different relationships
- Enabling clients to experience the positive effects of a trusting relationship
- Promoting setting healthy boundaries
- Enabling clients to develop confidence in their ability to positively support others
High Constructed Elements
High constructed elements involve activities that take place at some height. Participants are attached to a harness as they ascend a climbing wall or navigate a zip line, for example. These activities involve an increased perception of personal risk and stimulate emotional, cognitive and behavioral responses that are used therapeutically to propel a client toward personal treatment goals.
Other benefits of high constructed elements include:
- Promoting realistic goal-setting
- Leading clients to offer support to one another
- Fostering group cohesion
- Promoting building healthy relationships
- Promoting the development of emotional management and coping skills
- The ability to see one’s own progress toward reaching goals
- Managing impulsive behaviors
- Developing self-confidence and increasing self-efficacy
- Reinforcing trust in others
High-Adventure and Low-Adventure Activities
High adventure activities include rock climbing, rappelling, canyoneering, caving and other outdoor adventure activities. These may be daylong excursions, or they may take place as an overnight expedition or as an extended trip.
High adventure activities carry a higher risk than other types of activities. Neglecting safety requirements can have dire consequences, and as such, these activities typically involve a high level of skills development and foster the mastery of these skills.
Low-adventure activities have fewer risks than high-adventure activities and include hiking, kayaking, creeking and fishing. While these activities are fairly low intensity in terms of physical exertion, they are typically high-intensity experiences for participants.
Benefits of high adventure and low adventure activities include:
- Promoting the development of personal responsibility and self-awareness
- Helping clients see the impact of their behavior on themselves and others
- Promoting helping others and accepting help from others
- Enhanced coping skills
- Enhanced management of emotions
- Promoting healthy relationship-building and cooperation
- Fostering a deep, meaningful connection to the natural world
Expeditionary activities are extended adventure trips that last anywhere from seven to 90 days. Expeditions provide intensive treatment that can produce a high level of change in a short amount of time. Important aspects of expeditions are the removal of a client from mainstream society for a substantial period of time and the vast opportunities expeditions afford for reflection and contemplation.
Benefits of expeditions include:
- The interdependent nature of the expedition, which promotes personal and group responsibility
- Building healthy relationships and fostering trust in oneself and in others
- Promoting self-awareness surrounding personal choices
- An enhanced connection to nature
- The opportunity to develop a high level of self-efficacy
- The development of effective coping skills
- Recovery from mental fatigue
- The restoration of concentration and other cognitive functions
- Improved physical and mental health and healing
- An enhanced positive outlook on life
- An increased ability to cope with stress and illness
How to Choose an Adventure Therapy Program
Not all adventure therapy programs are created equal. A highly trained and experienced facilitator is essential for ensuring personal safety as well as for leading individuals to make the essential connections that precipitate meaningful change. An adventure therapy program should utilize evidence-based activities and follow best-practices industry guidelines. When looking for an adventure program, look for one that’s licensed by the state and employs licensed therapists trained in this type of therapy.
In 2013, the Outdoor Behavioral Healthcare Council at the University of New Hampshire and the Association for Experiential Education expanded existing adventure therapy standards to reflect the field’s current best practices. A detailed set of risk management, ethical and treatment standards was developed to guide these types of programs. Outdoor Behavioral Healthcare offers accreditation to adventure therapy programs that meet or exceed these standards and, according to the Association for Experiential Education, provides solid evidence that a program is committed to quality and to the continuing improvement of the program based on emerging research and up-to-date best practices.8
Accreditation by or association with other professional organizations can also help to ensure an adventure therapy program is of high quality. These organizations include:
- The Association for Experiential Education connects the global community of adventure-based counseling programs and defines and identifies professional standards and best practices.9
- The Association for Challenge Course Technology sets standards for challenge and aerial course installation, operation and inspection to ensure the highest level of safety.10
- Recovery and Recovery Support. (2015, October 5). Retrieved from http://www.samhsa.gov/recovery
- Elliott, R., & Pieper, L. (n.d.). Adventure Therapy. Retrieved from https://www.bradwoods.org/wp-content/uploads/2012/03/Bradford-Woods-Adventure-Therapy-Overview.pdf
- Kolb, D. A. (1984). Experiential learning: Experience as The Source of Learning and Development. Retrieved from https://pdfs.semanticscholar.org/f6ec/20a7a3150822140be7466353d0de572cc4bb.pdf
- Jensen, J., Reynolds, M., Davenport, C., & Nestmann, M.A. (2015, September). Engaging 21st Century Learners and Rounding the Learning Cycle. Retrieved from http://www.uky.edu/UGE/sites/www.uky.edu.UGE/files/pres-u/21st%20Century%20Learner%20and%20Learning%20Cycle%20for%20FF%20kickoff%202015.pptx
- Foundational Concepts. (n.d.). Retrieved from http://www.aee.org/tapg-best-p-foundational-concepts
- Suttie, J. (2016, March 2). How Nature Can Make You Kinder, Happier, and More Creative. Retrieved from http://greatergood.berkeley.edu/article/item/how_nature_makes_you_kinder_happier_more_creative
- Richards, K., Carpenter, C., & Harper, N. (2011). Outdoor and Adventure Therapy: What, Why and Where Next? Retrieved from http://www.outdoor-learning.org/Portals/0/IOL%20Documents/Horizons%20Documents/Horizons%20pdf%20archive/H56.OutdoorAndAdventureTherapy.pdf
- Resource: http://www.obhcenter.org/
- Resource: http://www.aee.org/
- Resource: http://www.acctinfo.org/