NAAEE

A scoping review was conducted to clarify how adventure therapy practice might be used as an intervention for complex trauma among adolescents. Authors defined complex trauma (CT) as “the harm done to a person’s mind, brain, and body by a duration of events ranging from neglectful, to hostile, to horrific, in a person’s childhood.” Increasingly, adventure therapy (AT) is being used with people with CT. AT is an adventurous activity, requiring some risk, with therapeutic intent taking place in a natural environment.

Inclusion criteria for the review included research conducted on youth aged 12–18 years with a diagnosis of CT, developmental trauma disorder, or complex post-traumatic disorder who had also engaged in an AT intervention. Research that did not include the term CT, was not in English, or was published prior to 2014 was excluded from the review. Six databases were searched, and a gray literature review was also conducted, yielding a total of seven texts for review.

The review identified seven themes for effective AT practice in regard to CT: practice, change, experience, adventure, trauma, youth, and therapy. The practice theme, examining theory-derived professional behavior, was most prominent. Central components within this theme were AT program aspects that supported youth empowerment, skill development, reflection, and the microsystem—"the dynamic of interconnectedness within the adventure experience.” Changes in participants’ behavior “were rapid and enduring,” and included improvements to emotional function, mood, or anxiety. Experiences gained through AT that were attributed to healing were described as “new or novel experiences, with opportunities for challenge and short periods of strenuous activity, in places of natural beauty.” Connection to Indigenous world views, reflection, cooperative group work, and an individual’s strengths being recognized by the group were also healing experiences. Conversely, in some instances, negative  experiences were described by youth who were under the direction of harsh or unsupportive program leaders. Components of adventure were described as risk, natural con- sequences, challenge, success, and cooperation with others in new environments free of distractions. Such learning from direct experiences was felt to be superior to "talk therapy."  In the context of the trauma theme, the authors reported benefits of AT as including “reframing power, psychoeducation, experiencing self-regulation leading to improved interactions, recognizing strengths in self and others, and experiencing safety involving relationships.” Adventure was felt to be particularly suitable for the adolescent stage of development due to youths' rapid acquisition of skills, social orientation, and interest in meaning-making. Each of the studies reviewed described enduring therapeutic benefits as a result of AT generally felt to be related both to the adventure experience and to things like the process of reflection and safe relationships with staff that are embedded within it.

The review contributes to a practice framework for CT-informed AT. Researchers contend that through such a framework, “AT should, given its orientation to shared experience, participant empowerment, and nature immersion, be humane and human rights focused.” The review also sheds light on instances where power was not evenly distributed within AT programs, which raises concern over potentially re-traumatizing experiences for youth with CT. Understanding the AT practitioner as central to restorative experiences and supporting their professional development is critical. The authors noted that variations in defining CT, lack of a coherent socio-ecological approach in AT and insufficient attention to the nature-based elements involved in AT are current limitations in the field. Overall, however, the review supports the view that AT provides adolescents with CT an opportunity for healing through “humane, empowering, and dignified experiences.”