Unpacking Relational Dignity: In Pursuit of an Ethic of Care for Outdoor Therapies.

Dignity is a universal principle that requires us to treat every person as having worth beyond who a particular person is or what they do. Dignity is a complex and sometimes contested idea, that at times can be compromised in health care and allegedly also within the practice of outdoor therapy. Outdoor therapies comprise a range of therapeutic approaches including nature-based therapy, adventure therapy, animal-assisted therapy, forest therapy, wilderness therapy, surf therapy, and more. Within the literature of outdoor therapies there has been limited research on ethics related to common understandings of care concepts such as relational dignity and human rights. The aim of this paper is therefore to unravel briefly whether dignity in general, and relational qualities of dignified care more particularly, might be a useful concept to apply in order to support an ethical practice in outdoor therapies.

Nature's Role in Outdoor Therapies: An Umbrella Review.

Objective: To report on the role of nature in outdoor therapies through review and summary of existing systematic and meta-analytic reviews in an effort to articulate a theoretical framework for practice. Materials and methods: An umbrella review was conducted following systematic protocols PRISMA guidelines. Results: Fourteen studies met the inclusion criteria and represented five self-identified approaches: nature-based therapies, forest therapy, horticultural therapy, wilderness therapy, and adventure therapy. Clear and comprehensive descriptions of theory, program structure, and activity details with causal links to outcomes were mostly absent. Conclusions: A rigorous and determined program of research is required in order to explicit in-depth theories of change in outdoor therapies. Conversely, or maybe concurrently, a holistic theory of integrated relatedness may be developed as a parallel expression of support for nature in therapy while the explanatory science catches up.

What are constructive anxiety levels in wilderness therapy? An exploratory pilot study.

BACKGROUND AND PURPOSE: Participant state anxiety in outdoor therapeutic practices continues to raise many questions. To help inform this important topic we present and discuss the results of an exploratory pilot study on participant day-to-day state anxiety throughout a Norwegian wilderness therapy intervention. MATERIALS AND METHODS: Thirty-three adolescents from six groups completed a total of 251 state sections of the State-Trait Anxiety Inventory. RESULTS: On average, there was a slight decrease in state anxiety as the program progressed and a significant reduction in anxiety between the first and final days. The between-subject range was large, and boys reported significantly lower anxiety than did girls. CONCLUSION: In light of the results, we discuss general understandings of day-to-day state anxiety, gender differences, group differences, the perception of risk, and the relationship between perceived autonomy and state anxiety. The paper concludes with implications for the outdoor therapy field at large.

Of Dodo birds and common factors: A scoping review of direct comparison trials in adventure therapy.

BACKGROUND: Adventure therapy (AT) is a term that includes therapies such as wilderness therapy and adventure-based counseling. With growing empirical support for AT, the diversity of studies make it difficult to attribute outcomes to specific treatment factors. OBJECTIVES: Researchers explored whether AT, often perceived as an alternative therapy, works because of AT's unique components, or whether factors shared by all therapies were responsible. METHODS: A scoping review was undertaken utilizing a search of major databases, unpublished dissertations, and a hand search for direct comparison trials matching AT with another therapeutic intervention. RESULTS: 881 publications were identified. 105 quantitative studies were included following a title and abstract review. Only 13 met the full inclusion criteria. Little to no differences were found to isolate specific therapeutic factors. CONCLUSIONS: We discuss the implications of these results considering the movement toward evidence-based practice and recommend future research to eclipse our current understanding of AT.

Nature Elements and Fundamental Motor Skill Development Opportunities at Five Elementary School Districts in British Columbia.

The majority of Canadian children are not physically active enough for healthy development. School playgrounds are a primary location to promote physical activity and motor skill practice. The benefits of children's play in nature have also been highlighted, but few studies have evaluated children's access and exposure to nature for play on school grounds. This study examined children's access to nature on school grounds and the opportunities afforded by those natural elements for motor skill practice. RESULTS: Extensive naturescapes (multiple nature elements in one setting) were not common, and natural elements were limited, ranging from 1.97 to 5.71 elements/school. The most common element was a forested area (26.5% of all natural elements identified). In comparison to built structures, the number of natural elements was low. Some elements differed between school districts and appeared to be related to local geography and terrain (hilly, rocky terrain, tidal flats, etc.). Our assessment showed that naturescape elements afforded opportunities for the development of some key fundamental motor skills (FMS), specifically, locomotor and stability skills, but opportunities to develop manipulative skills were limited. To maximize potential FMS development, physical literacy, and psycho-social benefits, additional elements or more comprehensive multi-element naturescapes and facilitation (social or environmental) are recommended.