Rivers of Recovery: Research on Fly-fishing and Therapeutic Outcomes for Veterans
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Talk given at the Center for Health and Nature Virtual Symposium, hosted by Houston methodist and Texan By Nature.
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Rivers of Recovery: Research on Fly-fishing and Therapeutic Outcomes for Veterans
- 1. Rivers of Recovery: Research on Fly-fishing and Therapeutic Outcomes for Veterans Keith G. Tidball, PhD Center for Health & Nature Virtual Symposium October 7, 2020 Hosted by Houston Methodist and Texan by Nature
- 3. “What’s happening now is different. It’s widespread, systematic, and, at least in aspiration, evidence based. Though boutique wilderness treatments for trauma and some behavioral disorders have existed for years, the idea that your primary-care physician, psychiatric nurse practitioner, or cardiologist might prescribe a park before a pill is quite new.” ~ Aaron Reuben, Outside Magazine, 2019.
- 4. “Since the publication of Dame Juliana Berner’s Treatise of Fishing with an Angle (1496) and Izaac Walton’s The Compleat Angler (1653), the public has been in the process of being convinced that fly-fishing is good for you.” Tidball, K. G. (2020). Rivers of Recovery: Fly-Fishing and Therapeutic Outcomes. In Dustin, D., Bricker, K., Tysor, D., & Brownlee, M. [Eds.]. Outdoor Recreation and Our Military Family: Pathways to Recovery. Urbana, IL: Sagamore-Venture Publishing.
- 5. Fly-Fishing and Health • Dr. Herbert Benson says humankind has learned over millennia how to turn off stress by “breaking the train of everyday thinking” by invoking the relaxation response. • Two things are necessary to create the relaxation response––a passive setting and the repetition of a sound, word, phrase, prayer, or movement. • “What better example of this than fly-fishing,” says Benson, “with the repetitive back-and-forth motion of the rod and line and fly? You’re focusing on where that fly is going to land on the water and that breaks the train of everyday thought.”
- 6. • Rivers of Recovery is dedicated to providing rehabilitation to physically and psychologically injured combat veterans through innovative, outdoor-based therapies and pioneering research. • Strive to provide participants with therapeutic programs which result in measurable and sustainable improvement. • Programs are designed to re-enable and re-energize participants and provide the support and self- confidence necessary to maximize long-term recovery. • http://riversofrecovery.com/
- 7. Research & RoR • Rivers of Recovery has prided itself on placing a high priority on demonstratable and repeatable results. • Produce peer-reviewed studies that support their therapeutic objectives. • RoR works with Dr. Gary Wynn of the Uniformed Services University • Dr Wynn co-authored Complimentary and Alternative Medicine for PTSD, published by Oxford University Press
- 8. RoR Recent Studies Craig, P. J., J. D. Alger, J. Bennett, and T. Martin. 2020. The Transformative Nature of Fly-Fishing for Veterans and Military Personnel with Posttraumatic Stress Disorder. Therapeutic Recreation Journal, LIV, No 2. • Phenomenological study - utilized a focus group methodology • Explores ways in which fly-fishing may serve as a coping resource in transcending negative life events, such as PTSD • Describes how fly-fishing may help move veterans and military personnel toward personal transformation and posttraumatic growth.
- 9. RoR Recent Studies Bennett, J. L., J. A. Piatt, and M. Van Puymbroeck. 2017. Outcomes of a Therapeutic Fly-Fishing Program for Veterans with Combat- Related Disabilities: A Community-Based Rehabilitation Initiative. Community Mental Health Journal 53:756-765. • Examines the outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities. • A total of 40 veterans participated in the 4-day therapeutic fly-fishing program and this study. • The outcomes examined included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional impairment (i.e., work, relationships, physical, and everyday life), increasing self-determination, and leisure satisfaction. • Each research participant completed pretest, posttest, and 3-month follow- up questionnaires. • The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up. • These results highlight the use of fly fishing in therapeutic recreation programming for veterans with disabilities as a holistic approach to treatment and recovery.
- 10. RoR Recent Studies Bennett, J. L., Van Puymbroeck, M., Piatt, J. A., & Rydell, R. J. (2014). Veterans' perceptions of benefits and important program components of a therapeutic fly-fishing program. Therapeutic Recreation Journal, 48(2), 169-187. • Examines the perceptions of veterans with combat-related disabilities following participation in a therapeutic fly-fishing program. • Six focus group discussions were conducted and the constant comparison method of analysis was used to discover the two primary themes of Perceived Benefits and Important Program Components. • Subthemes emerged for Primary themes • Perceived Benefits subthemes were: • Successful Experience • Reconnection • Important Program Components subthemes were: • Physical Setting • Atmosphere • Staff
- 11. RoR Recent Studies Vella, E. J., B. Milligan, and J. L. Bennett. 2013. Participation in outdoor recreation program predicts improved psychosocial well- being among veterans with post-traumatic stress disorder: a pilot study. Mil Med 178:254-260. • PURPOSE: • Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post- traumatic stress disorder (PTSD). • METHODS: • Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods. • RESULTS: • Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms. • CONCLUSIONS: • The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.
- 12. RoR Recent Studies MOWATT, Rasul A.; BENNETT, Jessie. War Narratives: Veteran Stories, PTSD Effects, and Therapeutic Fly-Fishing. Therapeutic Recreation Journal, [S.l.], v. 45, n. 4, Dec. 2011. • The necessity of camaraderie while undergoing treatment. • The ongoing presence of regret. • The process of reflection in reconciling memory. • The benefits from outdoor recreational activity participation.
- 14. RoR Future Work… What, if anything, distinguishes fly fishing and cold-water fisheries/trout experiences from other outdoor recreation therapeutic modalities? But why Fly Fishing?
- 15. Does fly fishing encourage independent thinking and behavior in a low-risk environment? Does it create an opportunity to take a break from daily stress? Does it give veterans a chance to learn a new skill or improve on their skills, which can build confidence? Does catching fish (even if only to release them) create a sense of accomplishment? Do regular fishing opportunities give veterans a chance to look forward to something pleasurable? Does satisfaction can come from catching a beautiful fish to bring home and prepare to eat for loved ones? Is fly fishing meditative, allowing veterans the opportunity to practice quietude, the art of “being in the moment,” making fishing a mindful, holistic activity? Does fly fishing function as a form of mild fitness that can only take place outside? Do fly fishing and fly tying have relationships with creativity and innovation, indicating brain recovery and health? Some questions I have…
- 16. Thank you – to be continued kgtidball@cornell.edu
Editor's Notes
- Good Morning, its great to be with you this morning to continue these discussions on how Nature can be prescribed for positive results in prevention, treatment, and recovery. My name is Keith Tidball, and I hail from Cornell University in upstate New York. My talk today is titled Rivers of Recovery: Research on Fly-fishing and Therapeutic Outcomes for Veterans.
- The subject of my talk today is the central focus of my academic life at this point. My lab, WWRx, engages a suite of related initiatives, all dealing with the therapeutic attributes of time spent outdoors, especially for those who have experienced trauma such as combat-wounded veterans. (Note website and Facebook)
- This Rx thing in tandem with Nature or Outside, or Parks is interesting, isn’t? and exciting! According to Aaron Reuben, a writer for Outside Magazine, “What’s happening now is different. It’s widespread, systematic, and, at least in aspiration, evidence based. Though boutique wilderness treatments for trauma and some behavioral disorders have existed for years, the idea that your primary-care physician, psychiatric nurse practitioner, or cardiologist might prescribe a park before a pill is quite new.” Or is it?
- So this presentation is about fly-fishing in the Nature Rx context, and in a book chapter I wrote that will be out soon, I wrote – “The notion that fly-fishing can be therapeutic is not new. According to John Gierach "They say you forget your troubles on a trout stream, but that's not quite it. What happens is that you begin to see where your troubles fit into the grand scheme of things, and suddenly they're just not such a big deal anymore." I wrote “Since the publication of Dame Juliana Berner’s Treatise of Fishing with an Angle (1496) and Izaac Walton’s The Compleat Angler (1653), which “marked the birth of recreational fishing and defined many of its core traits including the retreat to nature, fair chase, and rugged individualism” (Pritchett 2018), the public has been in the process of being convinced that fly-fishing is good for you.” That’s probably because it is good for you…
- Dr. Herbert Benson, the Mind Body Medicine Professor of Medicine at Harvard Medical School and director emeritus of the Benson-Henry Institute at Massachusetts General Hospital, says humankind has learned over millennia how to turn off stress by “breaking the train of everyday thinking” by invoking the relaxation response. Two things are necessary to create the relaxation response––a passive setting and the repetition of a sound, word, phrase, prayer, or movement. “What better example of this than fly-fishing,” says Benson, “with the repetitive back-and-forth motion of the rod and line and fly? You’re focusing on where that fly is going to land on the water and that breaks the train of everyday thought.” In other ways, fly-fishing has been compared to meditation, in that fly-fishers perform a simple, repeated task, often for hours on end. “The motion of fly-fishing is part and parcel of the activity itself and may contribute to its calming effect,” says Benson. “Besides, it’s achieving something—you might catch a fish!”
- One of my main partner organizations in this work is the not-for-profit group Rivers of Recovery. Rivers of Recovery is dedicated to providing rehabilitation to physically and psychologically injured combat veterans through innovative, outdoor-based therapies and pioneering research. RoR strives to provide participants with therapeutic programs which result in measurable and sustainable improvement. RoR programs are designed to re-enable and re-energize participants and provide the support and self-confidence necessary to maximize long-term recovery.
- Rivers of Recovery has prided itself on placing a high priority on demonstratable and repeatable results. They have a record and a reputation for producing peer-reviewed studies that support their therapeutic objectives. I gratefully serve as their research advisor. RoR works with Dr. Gary Wynn who serves in the US Army at the rank of LTC, currently at the Uniformed Services University as well as several other research institutions such as University of Southern Maine and of course Cornell University. Dr Wynn co-authored Complimentary and Alternative Medicine for PTSD, published by Oxford University Press
- In the time I have left, I am going to take you on a whirlwind tour of some of the research results from studies of Rivers of Recovery programs and participants, starting with the most recent. Most recently, a paper focused mostly on the Project Healing Waters program appeared in the Therapeutic Recreation Journal. Authors of this study have worked with Rivers of Recovery in the past and it is clear that observations and findings in this study build upon previous work. This study utilized a focus group method to explore the meaning of fly-fishing for veterans and military personnel with PTSD while also delving into ways in which fly-fishing 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 posttraumatic growth.
- Dr. Jessie Bennett, one of the authors on the article described above, is the researcher who has conducted the most data collection and analysis with Rivers of Recovery on therapeutic fly-fishing. She worked with RoR in both her master’s studies and in pursuit of her PhD. A few years before the 2020 article described above, Jessie and colleagues (2017) published “Outcomes of a Therapeutic Fly-fishing Program for Veterans with Combat-related disabilities: A Community-based Rehabilitation Initiative” in the Community Mental Health Journal. This study focused on 40 veterans that participated in 4-day therapeutic fly-fishing programs. The outcomes explored included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional, increasing self-determination, and leisure satisfaction. Each research participant completed pretest, posttest, and 3-month follow-up questionnaires. The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up.
- In 2014, Jessie and another group of colleagues published earlier research with Rivers of Recovery in an article titled “Veterans' perceptions of benefits and important program components of a therapeutic fly-fishing program” in the Therapeutic Recreation. This work examined the perceptions of veterans with combat-related disabilities following participation in a Rivers of Recovery therapeutic fly-fishing program. The study utilized six focus group discussions and the constant comparison method of analysis was used to discover the two primary emergent themes of Perceived Benefits and Important Program Components. Subthemes emerged for Primary themes.
- In 2013, in consort with her academic advisor and mentor, Jessie and colleagues published initial data and analysis gathered from Rivers of Recovery participants in the article titled “Participation in Outdoor Recreation Program Predicts Improved Psychosocial Well-being Among Veterans with Post-Traumatic Stress Disorder: A Pilot Study” This study evaluated the effectiveness of a 2-day, 3-night outdoor recreation intervention conducted by Rivers of Recovery involving fly-fishing in reducing stress among 74 veterans with PTSD. In this study, participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. According to the study’s results, comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms. These findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation such as fly-fishing to improve psychosocial well-being.
- In 2011, Jessie and a colleague published “War Narratives: Veteran Stories, PTSD Effects, and Therapeutic Fly-Fishing”, a study in which 67 letters of veterans as they concluded their participation in a Rivers of Recovery therapeutic fly-fishing program in Dutch John, Utah along the Green River were analyzed. The collected narratives were analyzed based on a three-part process of reading: explication, explanation, and exploration. The authors systematically analyzed the stories to present a narrative and set of themes that would inform and guide future empirical studies on the realities of veterans, program experiences, and perspective on outdoor recreation therapy treatments.
- Finally, to conclude this review of Rivers of Recovery therapeutic fly-fishing literature, most of which has been generated in partnership with Rivers of Recovery, Dr. Elizabeth Vella (2010) conducted groundbreaking work on how outdoor recreation therapy improves psychosocial wellness and reduces daily cortisol production among veterans with PTSD. Vella found that the RoR therapeutic fly-fishing program suggested improved psychosocial well-being while reducing daily cortisol production. Further, significant improvements were observed with respect to sleep quality and reductions in somatic and perceptual stress, with a marginal reduction in PTSD symptoms.
- So given all of this , you might ask, why fly-fishing? What, if anything, distinguishes fly fishing and cold-water fisheries/trout experiences from other outdoor recreation therapeutic modalities?
- To answer those questions, I will continue in my role as research advisor for Rivers of Recovery by pursuing the following questions: Does it create an opportunity to take a break from daily stress? Does it give veterans a chance to learn a new skill or improve on their skills, which can build confidence? Does catching fish (even if only to release them) create a sense of accomplishment? Do regular fishing opportunities give veterans a chance to look forward to something pleasurable? Does satisfaction can come from catching a beautiful fish to bring home and prepare to eat for loved ones? Is fly fishing meditative, allowing veterans the opportunity to practice quietude, the art of “being in the moment,” making fishing a mindful, holistic activity? Does fly fishing function as a form of mild fitness that can only take place outside? Do fly fishing and fly tying have relationships with creativity and innovation, indicating brain recovery and health? Does fly fishing encourage independent thinking and behavior in a low-risk environment?
- So, in conclusion, I hope you see that Rivers of Recovery and their approaches to therapeutic fly-fishing are engaging those affected by trauma in ways that are being empirically documented and analyzed, and that the preliminary results look promising indeed. There is more work to be done- I hope in partnership with many of you. Thank you.