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Brittany Johnson Research Methods Final Literature Review October 30,2014 Outcomes of Adaptive Sports and Recreation Participation among Veterans Returning from Combat with Acquired Disability Regarding the military men and women returning home from combat war, more than 31% of veterans from the Iraqi and Afghanistan war meet criteria for a mental illness. These illnesses consist of traumatic brain injuries, depression, anxiety, and the most prevalent; PTSD. As Friedman expressed in the 2013 article, Finalizing PTSD in DSM-5: Getting Here From There and Where to Go Next, Post-Traumatic Stress Disorder is developed after one is exposed to a traumatic event such as sexual assaults, warfare, serious injury, or threats of imminent death; physically or psychologically. The diagnosis is given when the following symptoms occur for more than a month after the event: re-experiencing flashbacks, having negative cognitions or mood states, numbing of memories of the event, hyper arousal, and being reckless or having selfdestructive behavior (American Psychiatric Association, 2013). There are various interventions to help prevent and treat the mental illnesses for those returning home from war but many are unsuccessful due to misunderstanding PTSD. A recent trend in interventions for military personnel is adaptive sports programs. In the first article, Stebbins (2012) analyzed the effectiveness of a winter sports clinic used as medicine or rehabilitation on a retired Army Veteran. His findings of the particular individual were established to be constructive to the veteran. The adaptive sports the participant took part in was skiing but the sports clinic offered rock climbing, scuba diving, trapshooting, snowmobiling, curling, and sled hockey. The Army Veteran had previously been diagnosed with PTSD and was a double amputee (Stebbins, 2012). The sports program was aimed to imply aspects of trust, social interaction, community reintegration, and self-esteem boosting activities. The study elaborated only on what measures the individual had to contest to participate but proves the Outcomes of Adaptive Sports 2 benefits of adaptive sports on military personnel due to the increase of competence and quality of life. Hawkins and Crowe (2011) also examined how participation in a sports clinic such as a Paralympic Military sports camp would affect the quality of life for injured service members. Hawkins and Crowe analyzed 50 service members participating in sports such as rowing, cycling, archery, volleyball, swimming, and track and field. The object of the Paralympics is to gain independence and confidence while promoting self-empowerment. The sports at hand alter the perceptions of the disabled and increases social reintegration. Some limitations to this particular study is that the service members are from the same general area and willingly participate in the program yearly compared to having a complete randomized study. Stebbins study along with Crowe and Hawkins illustrate the gain of self-autonomy for the service members returning home with little data or set goals for the studies. Building on the importance of adaptive sports programs for military veterans with PostTraumatic Stress Disorder; Lawrence, De Silva, and Henley (2008) actively observed the effect of sports/games in alleviating or reducing the symptoms of PTSD compared to other care interventions. They discovered when an individual has PTSD, their emotional reactions to things become uncontrollable so the utilization of sports and recreation helps take the emphasis off of the negative aspects of PTSD by focusing on the positive through recreation. Through recreation the veterans could enhance their self-discipline, communication skills, teamwork and being more aware of the body versus just living in the body. The research concluded the participants had increased self-awareness, less distress of situations, and reduced the hypervigilance by 42% (2008). Weaning away from the impact of PTSD specifically, adaptive sports can benefit those with combat injuries such as traumatic brain injuries, spinal cord injuries, amputees, etc. A prime Outcomes of Adaptive Sports 3 example of being beneficial to combat related injuries is Surf Therapy. French (2011) conducted an evidence based article on the health benefits surfing can have on those injuries. Surf Therapy programs assist individuals cope with mental and physical illness by increasing self-efficacy through the engagement of physical activities. It becomes therapeutic due to the experience the ocean offers but also rehabilitative due to the extraneous impact it has on the body. French (2011) illustrated surfing can help alleviate back pain in those who have spinal cord injuries because the individuals are forced to use every muscle in the body. Besides the physical benefits of surfing, it can also be emotionally and socially benefiting. It helps boost self-esteem and improve quality of life which can enhance all aspects of one who has a physical or psychological disability (French, 2011). For military members, it gives them a sense of adrenaline like the previous studies. Adrenaline seeking activities are significant to Veterans because that is what they are used to and they tend to miss in civilian life. One of the biggest theories in this article was that military members can become easily hooked on medications to numb the pain inside and out. But with surfing they do not take the medicine and have no side effects unlike medications. Veterans not only face coping with mental illnesses as well as physical disabilities due to combat in Iraqi and Afghanistan but have to cope with keeping or forming relationships, especially family life. One of the first articles that tied in social support for Veterans as well as adaptive sports was Addressing Posttraumatic Stress Among Iraq and Afghanistan Veterans and Significant Others: An Intervention Utilizing Sport and Recreation by Bennet, Lundberg, Zabriske, and Egget in 2014. This study was conducted to assess how effective an adaptive sports program called Higher Ground can decrease symptoms of Post-Traumatic Stress Disorder, personal growth after combat, and strengthen marital satisfaction in veterans who have served in Outcomes of Adaptive Sports 4 Operation Iraqi Freedom and Operation Enduring Freedom: Iraq and Afghanistan. The study is developed by the Sun Valley Adaptive Sports Program. This program consisted of skiing, snowboarding, and evening activities. The study had two groups and one control group: one experimental group had five participants and their significant other, another had six couples, and the control consisted of six couples. Each participant was giving a pretest and a posttest to track the findings of the study. The Sun Valley Program is geared to helping the veterans successfully reintegrate into civilian life and reestablish healthy relationships. Those with PTSD have decreased family functioning, poor communication skills, isolate themselves, and have conflict in relationships so the program added in activities to enhance the problem areas (2014). Families, particularly spouses were involved with the participation of majority of the activities to not only support the veterans through the process but to get a better understanding of one another. Research indicated that when veterans have been diagnosed with PTSD their significant other would report less satisfaction with their life which leads to relationship distress, intimacy difficulties, and psychiatric symptoms (2013). Considering the debilitating effects of PTSD, it is not surprising that veterans and their significant others have elevated marital distress. Having strong social support is one of the prime factors in being successful in any therapy intervention those with combat related injuries undergo. In further expansion of social support on the adaptive sports programs, the following two articles elaborate on the significance of the program as well as participating in the programs with loved ones. Bennet, Puymbroeck, Piat, Rydell (2014), analyzed how veterans’ perceptions of life change during the participation in the fly-fishing program. The study’s intent was to reduce the symptoms of PTSD, depression, anxiety, negative moods, and increase life satisfaction, leisure satisfaction, and sleep quality. Six focus groups of four to seven individuals; 28 participants, Outcomes of Adaptive Sports 5 were conducted and compared the perceived benefits and program components. Each participant had a spouse or significant other along with them in the study. The groups lasted four days fishing in Utah, Idaho, or Wyoming rivers. The men got to fish 8 hours out of the day and had no evening activities planned. The object of the study was to learn a new activity while enhancing problem areas through recreation (2014). While the Veterans participated in the recreational activities such as fly-fishing, their spouse was participating in the activities as well. Half of the couples would spend the whole day together, and then go to dinner together. At each dinner session, the couples were asked series of questions pertaining to the day to enhance affection, communication, intimacy, etc. amongst the couple. The comparing groups, half of the couples participated in the activity together but went their separate ways for dinner and were asked individually questions about the day and the relationship shared amongst the couples. The results were higher with the couples who spent the day together but went their separate ways for the night due to needing a healthy moderation of time for the Veteran to focus and become a civilian. The researchers found that when the couples spent time apart, the aspects of their relationship were increased (2014). Like the article above, Lundberg and Smith (2011), conducted a study on the outcomes of adaptive sports and recreation programs among veterans with acquired disabilities. The intent of conducting this study was to see if changes in quality of life, relationships, mood state, and competence were increased in a therapeutic adaptive sports and recreation program. The thesis of the study was participation in such programs would increase physical, social, psychological, and environmental quality of life. 18 veterans and their significant other participated in a three week long study in Sun Valley Idaho. In the study the veterans took a pretest and posttest to analyze the results of the program at the end. Results of the study showed a significant increase in overall Outcomes of Adaptive Sports 6 health and those high impact adaptive sports programs for veterans can help improve quality of life. There was a drastic increase in relationships at the end of the study due to the participation and support from loved ones. As stated by Carroll, Orthner, Behnke, Smith, Day, and, Raburn (2013), “Military families face daunting challenges as they attempt to build and sustain relationship strengths while experiencing ever increasing demands and pressures” (pp. 559). In conclusion, Post-Traumatic Stress Disorder is a debilitating illness that affects every aspect of an individual’s life including the families. Many interventions are utilized to help the individual cope with civilian life however many are unsuccessful. What the therapists do not understand is the Veterans are reluctant to discuss traumatic events during combat due to the stereotype; therapists will not be able to understand. The adaptive sports programs are operated to be individualized and allow the Veterans to participate in adrenaline induced activities, which offer opportunities to challenge them, improve their quality of life, self-awareness, competence, and feel like a person again, not someone who is just living in their body. The researchers touch base on the prominence of the success rate for the veterans when they have social support, especially from their loved ones. Having a joint participation makes the Veterans feel as if they are not alone and they spouse is putting forth the effort to comprehend. The articles and research I have found specifically on adaptive sports programs are not aimed around talking about the problems; it is about feeling as if they can contribute to civilian life through partaking in everyday activities. Through recreation, the individuals feel supported and comfortable which ultimately allows them to open up about their illness or injury. Adaptive sports programs concede on the importance of investigating how the physical self is tied into emotional or psychological self, as well as state of mind. Adaptive sports can be a good alternative intervention compared to treatments such as pharmacotherapy or cognitive behavioral therapy. Outcomes of Adaptive Sports 7 Regardless of the lack of actual implementation in many of the articles, the final result of adaptive sports is that there are no side effects to adaptive sports programs and recreation. Outcomes of Adaptive Sports 8 References Bennet, J., Lundberg, N., Zabriskie, R., & Egget, D. (2014). Addressing Posttraumatic Stress Among Iraq and Afghanistan Veterans and Significant Others An Intervention Utilizing Sport and Recreation. Therapeutic Recreation Journal, Vol. XLVIII,(No 1.), 74-93. Retrieved October 22, 2014, from file:///C:/Users/Brittany/Downloads/3723-15677-1PB.pdf Bennet, J., Puymbroeck, M., Piat, J., & J. Rydell, R. (2014). Veterans’ Perceptions of Benefits and Important Program Components of a Therapeutic Fly-Fishing Program. Therapeutic Recreation Journal, Vol. XLVIII(No. 2). Carroll, E. B., Orthner, D. K., Behnke, A., Smith, C. M., Day, S., & Raburn, M. (2013). Integrating Life Skills into Relationship and Marriage Education: The Essential Life Skills for Military Families Program. Family Relations, 62(4), 559-570. French, A. (2011). Surf therapy. Surfer, 52(4), 96-102. Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting Here From There and Where to Go Next. Journal Of Traumatic Stress, 26(5), 548-556. Hawkins, B., Cory, A., & Crowe, B. (2011). Effects of Participation in a Paralympic Military Sports Camp on Injured Service Member. Therapeutic Recreation Journal, Vol. XLV(No. 4), 309-325. Lawrence, S., De Silva, M., & Henley, R. (2008, June 15). Sports and Games for Post Traumatic Stress Disorder (PTSD). Retrieved October 22, 2014. Lester, P., & Flake, E. (2013). How Wartime Military Service Affects Children and Families. Future Of Children, 23(2), 121-141 Outcomes of Adaptive Sports 9 Lundberg, N., & Smith, S. (2011). Outcomes of Adaptive Sports and Recreation Participation Among Veterans Returning from Combat with Acquired Disability. Therapeutic Recreation Journal, Vol. XLV, No. 2, 105-120. Stebbins, J. (2012, June 1). Finding Their Footing. Retrieved October 23, 2014.