Bowen PhD Final Seminar 2016

Daniel Bowen
Doctor of Philosophy in Clinical Psychology
University of Canberra
(2012 – 2016)
Adventure Therapy:
Treatment Effectiveness and
Applications with Australian Youth
Primary Supervisor:
Assistant Professor James Neill
Secondary Supervisor:
Professor Anita Mak
PhD including Publication
Final Seminar
29th July 2016
www.danielbowen.com.au/research/PhD

Presentation Overview
Context of Project
Definition of Adventure Therapy
Aims and objectives of Thesis
Contribution of the Thesis
Overview of Studies 1-4
Implications
Strengths and Limitations
Conclusion

Context of Project
• Ensuring that young people get the best possible start in life is central
to the health, social inclusion, and productivity agendas of the
Australian Government
• At the forefront of a broad range of intellectual and professional
agendas is the issue of what to do with ‘youth-at-risk’, and the need to
protect, monitor, and sustain young people on the path to responsible
adulthood
• Current evidence suggests that youth health, education and crime is
an important problem within Australia
• Developing and using innovative preventative and intervention
strategies which can effectively improve the health and well-being of
young Australians is imperative.

Definition of Adventure Therapy
(Bowen, 2016; Adapted from Pryor, 2009)
Adventure Therapy (AT) involves:
“use of small groups, nature-contact, adventure
activities, and therapeutic processes to create
opportunities for psychological change in
participants, usually with the purpose of supporting
an individual (or family) to move towards greater
health and well-being.”

Aims of the Thesis
Broadly, this project aimed to:
• Consolidate and advance understanding of the therapeutic uses and
treatment effectiveness of adventure therapy
• Provide insight into the utility and therapeutic outcomes of Australian
AT programs for youth
Objectives:
 Study 1: Examine the efficacy of adventure therapy programs
 Study 2: Provide an up-to-date description of outdoor adventure
intervention (OAI) programs and practices in Australia
 Study 3: Examine the efficacy of the Wilderness Adventure Therapy
model of clinical treatment
 Study 4: Examine the efficacy of the PCYC Bornhoffen Catalyst
program

Contribution of the Thesis
• A comprehensive meta-analysis of the efficacy of adventure therapy
programs around the world (Study 1)
• A descriptive analysis of Australian outdoor adventure interventions
(OAI) for youth based on a national survey of program managers
and leaders (Study 2)
• A research evaluation of the efficacy of the Wilderness Adventure
Therapy® model of clinical treatment for Australian youth (Study 3)
• A mixed methods evaluation of the efficacy of the PCYC Bornhoffen
Catalyst program for Australian youth-at-risk (Study 4)
Note - Each study has an associated peer-reviewed publication which is freely
and openly available

Study 1
Meta-Analysis of AT
Program Outcomes and
Moderators
Publication Status: Published
Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of
adventure therapy outcomes and moderators. The Open
Psychology Journal, 6, 28-53. doi:
10.2174/1874350120130802001

Broadly, this study aimed to:
 Examine the efficacy of adventure therapy programs
internationally through a meta-analysis of outcomes and
moderators
– There are currently no published meta-analyses directly
concerned with adventure therapy across the life span.
 Provide valuable insight regarding the utility and
therapeutic outcomes of AT programs
– In the 21st century, it is necessary for rigorous research to
document the effect of adventure therapy programs, and analyse
the contributing factors.
• For: Boards, treatment facilities, funding bodies, policy makers and consumers.
Study 1: Introduction
Meta-Analysis of AT Program Outcomes and Moderators

 Established selection criteria
– AT program; reported pre/post outcomes, 1960 or later; English
 Completed a comprehensive search
– Identified and obtained studies were included or excluded based
on the selection criteria.
 Data was extracted from included studies via a Coding
Manual (Adapted from George (2011) and Wilson & Lipsey (2000))
 Analysis (calculation of effect sizes) was completed
using Comprehensive Meta-Analysis - Version 2
 Additional comparisons were conducted to explore the
existence of potential moderators
Study 1: Method

Based On:
 2,908 effect sizes
 From 206 unique samples located within 197 studies
 Published between 1967 and 2012
Effect Sizes Pertain To:
Treatment Group No. & %
Adventure Therapy 2,275; 78.2%
Alternative Therapy 335; 11.5%
No Therapy 298; 10.3%
Time Comparison No. & %
Base-Pre 55; 1.9%
Pre-Post 2,274; 78.2%
Post-Follow-Up 579; 19.9%
Study 1: Results

Based On:
 Participants: ~ 17,728 (M = 86.1; SD = 148.3 per study)
 Gender: male (62.5%) and female (37.5%)
 Age: between 9 and 64 years (M = 16.9; SD = 7.0)
 Program location: USA (78%), Australia (13%), Canada (3%),
Asia (3%), NZ (2%), & Europe (1%)
 Program Model: Ropes/Challenge/Adventure-Based (42%),
Expedition (27%), Mixed (21%), Base Camp (5%), Residential
(4%), & Outpatient (1%).
 Program length: 1-534 days (M = 63.5 days; SD = 148.0)
 Mean time b/w Base-Pre: 20.8 days (SD = 15.3)
 Mean time b/w Post-Follow-up: 181.4 days (SD = 276.0)
Study 1: Results

Overall Effect Sizes for Treatment Group by Time Comparison
Interpreting Effect Size: 0.20 (small), 0.50 (medium), 0.80 (large)
Study 1: Results

Comparison of Different Types of Therapy
Note: 1) As there are several noteworthy differences between adventure therapy and more traditional forms of psychotherapy, comparison of meta-analytic
findings is problematic and should be interpreted with caution, and 2) as confidence intervals overlap, there are no significant differences between treatment types.

 Most substantial and robust meta-analysis of adventure
therapy program outcomes to date.
 Confirms that overall adventure therapy is moderately
effective in facilitating positive short-term change.
 On average appears to be maintained in the long-term.
 Heterogeneity of outcomes indicates considerable
variability, although little of variance appears to be
explained by the measured moderators.
Study 1: Discussion/Conclusion

Study 2
Profile of OAIs
For Youth in Australia
Bowen, D. J., Neill, J. T., Williams, I. R., Mak, A. S., Allen, N. B.,
& Olsson, C. A. (2016). A profile of outdoor adventure
interventions for young people in Australia. Journal of
Outdoor Recreation, Education and Leadership.

Justification:
 There is a lack of knowledge and understanding about
current OAI programs in Australia (Pryor, 2009)
Research Questions:
1. What are the characteristics of Australian outdoor
adventure interventions for youth?
2. What are the perceived outcomes and benefits from
participating in Australian outdoor adventure interventions
for youth?
Profile of OAIs for Youth in Australia

Methodology:
 National data set collected by Outdoor Youth Programs
Research Alliance’s (OYPRA, 2011)
– Survey collected information from program leaders (Part 1; N =
211) and managers (Part 2; N = 177) about the characteristics
and qualities of outdoor programs offered to young people
 Subset was selected on the basis of the main purpose or goals
of the program
– Programs which aimed to address problem behaviours (e.g., poor
school attendance, drug use, depression)
 Subset included 98 leaders and 24 managers
Study 2: Method

Organisational Characteristics:
 Programs were most often provided by:
– Not-for-profit organisations (43%), followed by school/education (17%), community (13%),
government organisations (7%), business/corporate (11%), religious (6%), and health (3%)
 Respondents represented organisations from all states and territories
– Program managers worked for organisations in Victoria (34%), South Australia (24%), New
South Wales (12%), Queensland (12%), Tasmania (6%), Northern Territory (6%), Western
Australia (3%), and the Australian Capital Territory (3%)
Staff Characteristics:
 Approximately two thirds of program leaders were male (63%)
 Approximately half of the leaders were 18 to 40 years of age (54%), about a
quarter (26%) were between 41 and 50 years, and 20% were aged 50+
 Most or all field staff held relevant qualifications, including:
– Outdoor education (26%), other education/teaching (26%), outdoor recreation/instruction (24%),
mental health (21%), youth work (17%), community work (7%), physical education (5%), and
other (40%)
Study 2: Results

Program Design Characteristics:
 The duration of Most or All programs was:
– Less than 1 day (19%), 1 day (6%), 2 to 4 days (42%), 5 to 7 days (24%), 1 to 2 weeks (18%),
and 2 weeks (29%)
 Most programs were overnight journey based (57%), followed by:
– Overnight hard-top programs (24%), day programs (18%), and overnight base-camp programs
(13%)
 The main mode of travel for journey-based programs was hiking (50%),
followed by:
– Canoeing (15%), cycle touring (13%), kayaking (9%), other (9%), and rafting (4%)
 The most popular activity was hiking (50%), followed by:
– Continuous ropes challenge courses (37%), canoeing (30%), initiative exercises (30%),
environmental activities (28%), rappelling (23%), pioneer/bush/camp skills (23%), and giant
swing/zip line (22%)
 The most common theoretical frameworks featured in the program were:
– Experiential learning (73%), challenge by choice (54%), facilitated reflection (52%), natural
consequence (51%), and social learning (30%)
Study 2: Results

Participant Characteristics:
 Ranged in age from 8 - 22 years old (Mdn = 14, M = 14.0)
 Programs ranged in size from 6 - 360 participants (Mdn = 27, M = 51.3, Mode = 8)
– With similar numbers of males (Mdn = 11, M = 28.5) and females (Mdn = 11, M = 21.9).
 Between 1 - 46 leaders were involved in each program (Mdn = 5, M = 6.5, Mode = 2)
– Including male leaders (Mdn = 3, M = 3.94) and female leaders (Mdn = 2, M = 3.24).
 Programs were most often conducted with mixed-gender groups (56%)
– Boys-only groups were less common (18%), and no program managers indicated that most of
their programs were for girls only
 Participants were referred from:
– School/education organisations (36%), community organisations (26%), government
organisations (14%), not-for-profit organisations (10%), health organisations (10%), religious
organisations (2%), and businesses/corporations (2%)
Study 2: Results

Results:
 Prototypical group:
– Lead by a male who had worked in the sector for 10 or more years and
who held a tertiary qualification
– Approximately 10 participants, co-educational, with a staff to student ratio
of 1:4
 Most common type of program:
– Takes place over two to four days in the outdoors
– Involves adventure activities (hiking, continuous ropes challenge courses,
and canoeing),
– Involves group activities requiring team work, cooperation, mutual support
and communication
– Involves the intentional involvement of program leaders as a basis of
learning.
Study 2: Results

Results:
 Surveyed staff perceived:
Program leaders believed that:
 The benefits lasted long-term (years) or lifelong (lasted forever).
Study 2: Results
Main Program Goals Main Program Outcomes
Addressing problem behaviours Fun/enjoyment/recreation
Personal development Personal development
Social development Social development
Fun/enjoyment/recreation Addressing problems behaviours

Study 3
The Effectiveness
of Wilderness
Adventure Therapy (WAT)
Bowen, D. J., Neill, J. T., & Crisp, S. J. R. (2016). Wilderness
adventure therapy effects on the mental health of youth
participants. Evaluation and Program Planning.

The Effectiveness of Wilderness Adventure Therapy (WAT)
 WAT®, pioneered by Dr Simon Crisp, is a theoretically
designed approach using evidence-based practice
 However, to date, research evaluation findings have not
been formally published
Research questions:
1. What is the efficacy of WAT?
2. How do the effects of WAT compare to other forms of
adventure therapy?
3. How do the effects of WAT compare to other forms of
therapy?

Program:
 Established in 1992 as a component of Australia's first clinical
adolescent day-program at the Austin Health, Child and
Adolescent Mental Health Service (Vic, Australia)
 Manualised, 10-week, part-time program
 Includes 7 day-based adventure activities (e.g., bushwalking,
abseiling, cross country skiing, & white water rafting)
 Includes 2 & 5 day outdoor expeditions
 Parents, teachers and support workers participate in 8 AT-
based sessions
 Follow-up includes liaison with other agencies, group re-union,
and school or placement outreach follow-up

Participants:
 Completed 1 of 8 WAT interventions in 2000 and 2001
 36 adolescents:
– 21 females & 15 males
– Aged between 12-18 years (M = 14.6)
 Self-report data collected:
– pre-program, post-program and at three-month follow-up
Measures Included:
Study 3: Method
 Resilience Questionnaire
 Beck Depression Inventory
 Youth Self Report
 Coopersmith Self Esteem Inventory
 C.O.R.E Family Functioning Questionnaire
 Life Attitudes Schedule

Study 3: Results
Short- & Longer-Term Effect Sizes for All Participants (n = 36)
* indicates ES is statistically significant. An increase signifies improvement
Note. All Short-term ES are within aged-based AT meta-analytic benchmarks,
except Suicidal-Proneness which is lower than expected
Outcome ES % Change ES % Change
Resilience 0.49*  24 -0.30  15
Depression 0.46*  22 0.00 0
Behavioural & Emotional Functioning 0.36  18 0.03  2
Self-Esteem 0.26  13 0.06  3
Overall 0.26*  13 -0.06  3
Family Functioning 0.12  6 -0.58*  28
Suicidal-Proneness -0.06  3 0.43*  21

Study 3: Results
Statistically Significant Short-Term Effect Sizes & AT
Meta-Analytic Benchmarks for all Participants (n = 36)

Study 3: Results
Statistically
Significant Short-
Term Effect Sizes
& AT
Meta-Analytic
Benchmarks for
Clinical Range
Participants

Study 3: Results
Depressive Symptoms for Participants in the Clinical (n = 23)
and Non-Clinical (n = 13) Range Before Treatment

Study 3: Results
YSR Means for Most Severe Mental Health Symptom for
Participants Before Treatment (n = 36)

Discussion/Conclusion:
 The overall short-term effect size was small, positive, and statistically
significant (0.26)
 For the most part, short-term changes were retained at a three-month
follow-up
 Most of the short-term effects were within the age-based meta-analytic
adventure therapy benchmarks
 Participants in clinical symptom range pre-program reported large to very
large, statistically significant improvements
 Findings suggest some promise that WAT interventions may offer a
viable alternative treatment modality to more traditional
psychotherapeutic approaches for youth at-risk
 More in-depth investigation would help to better understand what works
and what could be improved

Study 4
The Effectiveness of the
PCYC Catalyst Program
Bowen, D. J., & Neill, J. T. (2015). Effects of the PCYC Catalyst
outdoor adventure intervention program on youths’ life
skills, mental health, and delinquent behaviour.
International Journal of Adolescence and Youth, 1-22. doi:
10.1080/02673843.2015.102771

The Effectiveness of the PCYC Catalyst Program
(PCYC Bornhoffen Adventure Development, 2011)
PCYC Bornhoffen Catalyst Program:
 An AT program operated by PCYC in QLD between 2012 and 2013,
funded via state-based Blue Light and Proceeds of Crime Funds
– Targeting: Personal and social development, within the context of reducing crime
 For young people (aged 11 to 14 years) ‘at risk’ of adverse outcomes
in their educational, vocational and life-course pathways
 Involves a 3 day lead-in, a 9 day expedition, and a 3 day follow-up
(with gaps in-between each section)
Research questions:
 What is the efficacy of the Catalyst program?
 How do the effects of the Catalyst program compare to other forms of
adventure therapy?
 How do the effects of the Catalyst compare to other forms of therapy?

Participants:
• 6 Catalyst programs completed by 53 youth
Methodology & Analysis:
• Quantitative: Self-Report Measures
o Collected pre- and post-program (N = 36), 6-12 month follow-up (N = 29)
o Youth at Risk Program Evaluation Tool; General Well-Being; Adolescent
Behavioural Conduct
o Short- (T1 to T2) and longer-term (T2 to T3) changes were investigated using
descriptive statistics, and mean effect sizes with 95% confidence intervals.
o Results were compared to meta-analytic benchmarks from Bowen & Neill (2013)
• Qualitative: Semi-Structured Interviews
o Semi-structured interviews were completed with 14 youth participants
o Analysed using inductive thematic analysis (Braun & Clarke, 2006)
Study 4: Method

Longer-term ES for Life Effectiveness (n = 29)
Study 4: Quantitative Results

Longer-term ES for Mental Health (n = 28)

Longer-term ES for Behavioural Conduct (n = 27)

Six major themes were identified:
Study 4: Qualitative Results
Pattern Codes Descriptive Codes
Overcoming
challenging backgrounds
Extreme circumstances; Multiple risk factors
Contending with adversity Distress, Crisis, Difficulty, Challenge, Conflict
Personal development Resilience, Self-belief, Self-confidence, Self-
control, Self-esteem
Social development Social skills, Communication, Cooperative
Teamwork, Relationships
Motivation to work for change Try harder, have a go, Make an effort
More optimistic outlook
on the future
New beginnings, Goal setting, Hope

 Participants reported:
– Small positive changes in life effectiveness,
– A large long-term improvement in psychological well-being,
– Some improvements in particular aspects of delinquent behaviour (e.g., Harming,
Fighting, Stealing, and Vandalism),
– No positive longer-term impact on psychological distress and some aspects of
behaviour
 Six major themes emerged from interviews with youth participants:
– Overcoming challenging backgrounds, contending with adversity, personal
development, social development, motivation to work for change, and optimistic
future outlook
 Quantitative and qualitative results support the conclusion that this program
may offer a viable alternative or adjunct treatment approach to more
traditional psychotherapeutic approaches for youth at-risk
 More in-depth investigation would help to better understand what works and
what could be improved

Thesis: Practice Implications
• AT meta-analytic findings can be used in benchmarking and monitoring program
effectiveness (Study 1)
• Participant age was the only significant moderator of adventure therapy
programs, with stronger outcomes for older participants (Study 1)
• Despite diversity in approach, the OAI profile depicts an approach for working
with youth that provides an environment of change through use of small groups,
contact with nature, adventure activities, and therapeutic processes (Study 2)
• The use of AT to address psychological, behavioural, emotional, and
interpersonal problems for youth in Australia could be improved (effects were
below the international benchmark) (Study 1, 3, and 4)
• WAT is as effective as traditional psychotherapy techniques for clinically
symptomatic youth (Study 3)
• The PCYC Bornhoffen Catalyst program offers a potentially viable alternative
treatment modality to more traditional psychotherapeutic approaches for youth
at-risk (Study 4)

Thesis: Research Implications
• A more targeted survey is required to develop a comprehensive
profile of adventure therapy programming in Australia
• More in-depth and methodologically rigorous program evaluation with
larger samples sizes is required to understand the effectiveness of
adventure-based interventions and increase generalisability
• Multiple imputation and maximum likelihood are recommended to
handle missing data in future adventure therapy research
• Future adventure therapy research should consider focusing on the
clinical application of findings (rather than statistical significance)
• There is a need for future mixed method research to extend
understanding of adventure therapy processes and outcomes
• There is a need for future research to consider the cost-effectiveness
of AT as compared to alternative treatments

Thesis: Strengths
• Addressed several major limitations of prior related meta-analyses,
compared outcomes with alternative and no treatment groups, and
employed additional meta-analytic analysis techniques (publication
bias, meta-regression, moderator analyses) (Study 1)
• Provided an up-to-date profile of Australian outdoor adventure
intervention programs for youth (Study 2)
• Used multiple imputation, a ‘state of the art’ technique, to deal with
missing data (Study 3)
• In addition to considering statistical significance, client change was
also reported in terms of clinical significance (Study 3)
• Completed a mixed method investigation of an Australian outdoor
adventure intervention (Study 4)

Thesis: Limitations
• Exclusively relied on participant self-report data (Studies 1-4)
• Study 2 was based on a subset of data which was collected to
establish a profile of Australian outdoor youth programs
• Lack of random assignment to treatment conditions and the absence
of a comparison group (Studies 3 & 4)
• Generalisability due to adventure therapy programs differing
significantly (finding from Study 1 and 2)
• Generalisability due to small sample size (Studies 3 & 4)
• Study 3 utilised two non-validated questionnaires

Conclusion
• While adventure therapy is not a panacea, findings from this thesis
confirm that adventure therapy has broad application for adolescents
and adults for a wide range of presenting issues
• This thesis provides good evidence that adventure therapy programs
provide social, behavioural and psychological benefits for
participants which are comparable to the majority of efficacious
treatments for patients across the age span reported in the literature
• Findings from this thesis strongly support the inclusion of adventure
therapy as part of the suite of therapeutic interventions that operate
in diverse service settings across Australia

Thanks for your time!
Questions / Feedback?
Daniel Bowen
www.danielbowen.com.au/research/PhD
u3079209@uni.canberra.edu.au
daniel@danielbowen.com.au

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