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Using sport and physical activity in recovery with military veterans

This is an excerpt from Advances in Sport and Exercise Psychology-4th Edition by Thelma Horn & Alan Smith.

Wounded Warriors

I was instantly drawn to the adrenaline high of the intense focus and flow of the Pilates environment. I was equally horrified at the complete total inability I had to connect my body as a whole unit. I had only experienced working on isolating the training of muscles in order to obtain strength, and to suddenly see my body as one force, stabilizing, supporting, coordinating and connecting, was the most overwhelming and empowering realization. I was blown away by the instructor's ability to read my posture and gait patterns, to constantly alter my training needs and reinvent material adaptable to my personal injury, as well as fine-tune the path forward, and I experienced movement in the most fundamental and functional way possible."

Special forces soldier, Bowman, 2015, p. 169

The preceding quotation obtained from a military veteran with a disability reflects his positive reaction, both in the moment and for the future, to an experience with a nontraditional activity (i.e., Pilates). As we know from the general sport and exercise psychology literature, the psychological benefits of physical activity (PA) and sport include anxiety reduction, increased positive mood states, and enhanced self-regard. Thus, these are reasons to believe that sport and PA can be used to alleviate the depression, anxiety, and chronic pain that war veterans often experience.

PA experiences are often social in nature and therefore can result in social benefits (e.g., increased social support; Caddick & Smith, 2014). Many recovering war veterans had participated in daily fitness programs and were athletes when able bodied. As a result, those who are injured while in service may also be attracted to PA and adventure and sport programs. Sport can restore lost camaraderie and feelings of belongingness when military life is over. For instance, one Paralympic athlete indicated that he was able to substitute his Paralympic team sense of belonging for his military sense of belonging (Day, 2013). War veterans are often seen as possessing desirable qualities for elite-level sport participation such as self-discipline and motivation for hard physical training within a structured environment where team goals have priority over individual goals (Brittain & Green, 2012).

In one of the most extensive investigations in this area, the effects of a 5-day and 5-night residential adapted sport and adventure training camp were examined across a series of three studies (Carless, 2014; Carless, Peacock, McKenna, & Cooke, 2013; Carless, Sparkes, Douglas, & Cooke, 2014). Camp participants engaged in sport (e.g., wheelchair basketball), recreation (e.g., caving, kayaking), and informal (e.g., dinner conversations) and formal (e.g., mental skill discussions) activities. In their first study, Carless et al. (2013) interviewed and observed 11 injured ex-military personnel. The researchers presented the results as life stories and thus documented the participants' experiences over time. Two distinct psychosocial-themed benefits emerged. First, participants framed their camp experiences as helping them reengage in the everyday activities of life and giving them a sense of purpose. For example, the ability to talk with other ex-military participants who understood the military culture helped them reengage in life socially. The time away at camp was also seen as renewing some participants' sense of purpose by strengthening marital relationships through a greater appreciation of their spouses.

The second theme was tied to exploration. It was about the opportunity to try something new (e.g., archery), to feel respected and cared about by staff and other participants, and to enjoy quality facilities (e.g., a single room with TV and Wi-Fi). Participants' recognition of these benefits was likely a result of the contrasting military experiences they had (e.g., sleeping on the ground) and where strict conformity to orders was the norm. A final part of this theme included a feeling of being inspired by fellow participants, both through interactions with fellow participants who had a different disability and those who had the same disability. Some of the feelings of inspiration appeared from observing a similar other (i.e., role model) accomplishing a challenging physical task (e.g., kayaking). Carless et al. (2013) asserted that the dynamics went deeper than a simple "If he can do it I can do it," and were the result of respect and admiration of the commitment and hard work necessary for the role model's success.

Carless and colleagues also reported in-depth on two participants from the same 5-day training camp (Carless et al., 2014). One participant, Stuart, reaffirmed the value of engaging in the various sport and adventure activities as part of a group and the social support derived from shared experiences with teammates (i.e., military background and adjusting to a disability). Sam, who had to manage chronic pain, noted that adventure and sport training reestablished his confidence in his physical abilities. Sam was also able to refute his perception that a person couldn't be fit and strong while in a wheelchair. This change in perspective enabled him to develop a sense of assurance that in the future, when he would regularly use a wheelchair, he would have a positive attitude toward being in a wheelchair.

In the final study, Carless (2014) sought similarities across the life stories of six soldiers attending the 5-day camp. The trauma that produced the participants' injuries also caused them to struggle with adjusting to their disability and the related life changes (e.g., altered career aspirations). Personal interactions during the sport adventure camp were a catalyst for less self-focused rumination and more social engagement. One participant reported,

I don't know but maybe one of the benefits is giving guys a chance to meet other guys who've been through something like they have. That's why I'm talking about this to you today I suppose, so someone else might hear something in my story that fits their life, that makes them feel like they're not going through stuff alone.

Carless, 2014, p. 1447

Carless (2014) concluded that most participants experienced positive psychosocial growth from the camp activities. Specifically, opportunities to be engaged with other injured veterans in meaningful activities (e.g., mountain climbing) that were enjoyable and affirming in a supportive atmosphere, and that were opposite the autocratic military ethos, were cited as factors responsible for their growth.

Many of the preceding observations were reported by Burke and Utley (2013), who interviewed injured veterans about training for and climbing Mt. Kilimanjaro. Participants were interviewed before the climb, as well as during and after the descent. In addition, participant observations were conducted. Three themes were identified. First, despite the physical difficulty of the climb (e.g., prolonged exposure to high altitude) and impairment effects (e.g., pain from prosthetics), all participants demonstrated commitment and determination that appeared to be largely a function of the challenge of climbing. In turn, their adaptive responses were seen as promoting their recovery (Burke & Utley, 2013). Second, the climbers also provided extensive functional (e.g., helped each other with physical tasks) and emotional (e.g., humor) social support to each other. Finally, the climbers engaged in active behavioral coping before (e.g., extensive physical training) and during (e.g., frequent rest breaks) the climb as well as cognitive coping during the climb (e.g., positive self-talk). The researchers concluded that the climb aided in developing a deeper understanding of their capabilities and the value of having meaningful life goals that gave their lives purpose (Burke & Utley, 2013).

Other researchers have examined sport and the natural environment. For instance, the benefits of surfing (Caddick, Smith, & Phoenix, 2014; Fleischmann et al., 2011), whitewater rafting (Dustin, Bricker, Arave, Wall, & Wendt, 2011), mountain climbing (Burke & Utley, 2013), and Outward Bound (Hyer, Boyd, Scurfield, Smith, & Burke, 1996) have all been documented.Caddick et al. examined the influence of surfing (i.e., the blue gym) on the well-being of 15 male veterans diagnosed with post-traumatic stress disorder (PTSD). A life history research approach was used across a period of 1-1/2 years, and results indicated that surfing served as a respite from the difficulty associated with PTSD. The positive effects did not last beyond the time spent in the water surfing. However, the participants' subjective well-being was positively influenced by pushing PTSD into the background and promoting a focus on the present. These results are consistent with a case study conducted by Fleishman et al. (2011) with a polytrauma patient that demonstrated the positive effects of surfing. Another water-based activity, scuba diving, has also been effective in promoting both the physical and mental health of wounded warriors (Buckley & Raulerson, 2013). In addition to nontraditional outdoor sports like surfing and scuba diving, Pilates has been used by Royal Danish Ballet dancers to help Danish wounded warriors recover (Bowman, 2015). Finally, besides surfing, scuba diving, and ballet, horseback riding has shown promise. Also known as equine assisted psychotherapy, the use of horses for mental health treatment has a long history (Kruger & Serpell, 2006), and a recent review suggests that animal-assisted therapies can be effective (Maujean, Pepping, & Kendall, 2015).

Lundberg, Bennet, and Smith (2011) examined the effect of sport and PA in the natural environment on quality of life (QOL), mood, and competence. Study participants, all with an acquired disability or PTSD diagnosis, engaged in 5 days of therapeutic adaptive sport (e.g., Nordic skiing, water skiing) or physically active recreation (e.g., fly fishing, canoeing). Participation in both adaptive sports and recreation activities resulted in reduced negative mood states (i.e., tension, depression, and anger) and increased perceived sport competence from pre- to postintervention.

In summary, as the research reviewed in the previous paragraphs indicate, sport and PA can certainly have positive therapeutic effects on wounded veterans' physical and psychosocial health. More specifically, participating in sport after acquiring a disability can reaffirm veterans' exercise or athletic identity that was dormant during the initial trauma of their accident. Second, mastery experiences can strengthen specific self-efficacy cognitions (e.g., being able to balance on a surfboard) all the way to global self-esteem perceptions. Third, social support, especially from similar others, can promote momentary feelings of group cohesion all the way to deeper bonding that is a result of prolonged engagement in multiday experiences. Fourth, sport and PA in the natural environment (i.e., green exercise) may have additional mental health-related benefits beyond PA alone (Barton & Pretty, 2010; Pretty, Peacock, Sellens, & Griffin, 2005).

Learn more about Advances in Sport and Exercise Psychology, Fourth Edition.

More Excerpts From Advances in Sport and Exercise Psychology 4th Edition

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