Wilderness & Adventure Experiential Learning Inclusion & Exclusion Criteria

Summary of Key Findings

Clinical Scenario
Implication to Occupational Therapy
Level of Evidence Table
Wilderness Therapy (WT) emerged in the 1920s as a
rehabilitation program for young people at risk.
It typically involves expedition-based interventions in outdoor
wilderness settings away from home, and through experiential
learning, the focus is to change maladaptive behaviors
(Margalit & Ben-Ari, 2014).
Historically, there has been some blurring between WT and
wilderness and adventure experiences.
Wilderness & Adventure Experiences:
Implications on the Behavioral & Self-Efficacy Skills of Adolescents & Young Adults with Mental Health
Problems
Kamrie Fryer, OTS & Sotheavy Moeung, OTS
Touro University Nevada

Experiencing a mental illness may have devastating effects
on young people in society, as adolescence and young
adulthood are in pivotal stages of life. Mental illnesses can
cause a decrease in self-esteem and self-confidence and often
cause withdrawals from social interactions and isolation from
peers (Schell, Cotton, & Luxmoore, 2012).
Epidemiological findings worldwide have shown that 23% of
adolescents meet the diagnostic criteria for mental health
disorder, suicide is the third leading cause of death in
adolescents, and approximately 50% of psychiatric disorders
in adults have an adolescent onset (Kessler, 2007).
Exploration of wilderness or adventure experiences and its
potential to improve behavioral or self-efficacy skills of
adolescents and young adults with mental health problems is
beneficial to the clients affected, the families involved, and the
security of the community.
Inclusion Criteria:
Any wilderness or adventure experiences with adolescents
and young adults with mental health and behavioral
problems
Key terms include wilderness, adventure, outdoor,
adolescents, behavior, and mental health
Research written in English
Evidence published after 2003
Exclusion Criteria:
Adults over age 25 and children under age 12
Any wilderness or adventure experiences that were
residential or community-based
Articles published prior to 2003
Dissertations
Level of
Evidence
Study Design/Methodology of Selected Articles # of Articles
Selected
I Systematic reviews, meta-analysis, randomized control trials 1
II Two groups, non-randomized studies (e.g., cohort, case-control) 3
III One Group, nonrandomized (e.g., before and after, pretest, and
posttest)
5
IV Descriptive studies that include analysis of outcomes (single
subject design, case studies)
1
V Case reports and expert opinion, which include narrative
literature reviews and consensus statements
0
Other Qualitative Studies 0
TOTAL: 10
Despite the blurring, the intervention
strategies that both programs use
have displayed positive outcomes for
individuals with a wide array of
behavioral and mental health issues
(Clark, Marmol, Cooley, & Gathercoal,
2004).

The articles showed positive results associated with the
following related themes:
Improvements with substance-use
Increase in self-concept
Progression in school performance
Escalation of happiness and satisfaction
Reduction in depression
Wilderness experiences ranged from 4 days to 10 weeks.
Since the short experiences showed such a positive impact on
adolescents with behavioral problems, it was inferred that
longer periods would show even more effective outcomes.
The authors noted the importance of appropriate follow-up
and transition services for youth leaving the wilderness
programs in order to maintain progress on a clinical and
community level.
Further research should be conducted with family therapy
and/or family involvement utilized in conjunction with
wilderness and adventure programs in helping adolescents
and young adults with mental and behavioral problems.
A decrease in maladaptive scores, immature defense
responses, disruptive actions, and risky behaviors will enable
adolescents to effectively reintegrate into the community and be
more valuable members of society.
Healthcare should consider coverage for transition planning
since this need was noted as critical to the success of wilderness
and outdoor interventions. OTs can play a prominent role with the
adolescents and young adults as they transition from the
wilderness program to their life at home and community.
OT students are educated in helping those with behavioral and
mental problems engage in occupation-based interventions.
Using a holistic approach, OT students can enter into this
emerging area of wilderness and outdoor therapy to help clients
become independent and gain important life skills. OT students
can assist with program implementation, assessments of the
participants, and with continued transition planning back to the
home and community.

References (Partial List)
Clark, J., Marmol L., Cooley, R., & Gathercoal K. (2004). The effects of wilderness therapy on the clinical concerns (on Axes
I, II, and
IV) of troubled adolescents. Journal of Experiential Education, 27(2), 213-232. doi: 10.1177/105382590402700207
Kessler, R. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20, 359-364.
doi:10.1097/YCO.0b013e32816ebc8c
Margalit, D. & Ben-Ari, A. (2014). The effect of wilderness therapy on adolescents' cognitive autonomy and self-efficacy:
Results of a
non randomized trial. Child & Youth Care Forum, 43(2), 181-194. doi: 10.1007/s10566-013-9234-x
Schell, L., Cotton, S., & Luxmoore, M. (2012). Outdoor adventure for young people with a mental illness. Early Intervention in
Psychiatry, 6, 407-414. doi: 10.1111/j.1751-7893.2011.00326.x.
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