By Diane Ryan
In this article, Diane Ryan, Mirasol's Executive Director and former Clinical Director, explores the goals and effectiveness of wilderness therapy in eating disorder treatment.
The first time I took Mirasol clients camping, there was widespread anxiety about the trip. One client in particular was worried about the tents, the sleeping bags, the wild animals, the bathroom situation ... every question answered triggered another a new concern! She was very quiet on the ride to the camping site, and I wondered whether she would be able to relax and enjoy the experience. After we set up camp and began exploring the area, she found me collecting wood for the fire. I anticipated another round of questions, but instead she just grinned and said, "You know, it's weird, but this is the most like myself that I've ever felt!"
That incredibly gratifying experience has reoccurred many times, as clients encounter themselves in unfamiliar environments and experience a fresh perspective that might only be achieved after months or years of traditional therapeutic interventions. Almost by definition, eating disorders arise from an individual's inability to connect with the self and with others. The limitless ability of the natural world to both challenge and soothe presents opportunities to grow new relationships, and make wilderness interventions a natural fit for both adolescents and adults in treatment (Caulkins, White and Russell, "The Role of Physical Exercise in Wilderness Therapy for Troubled Adolescent Women", Journal of Experiential Education, March, 2006).
The goal of experiential interventions is to create opportunities for engagement in the healing process. Wilderness therapy with its remote location and intentionally primitive conditions, promotes therapeutic interactions, social connection and leadership development and fosters interdependence, awareness, openness, personal responsibility and self-reflection. Within this context, therapists encourage, reinforce and assist the client in processing these changes both individually and in groups.
This theoretical approach is based on the assumption that behavior change occurs when direct experiences are applied in a challenging environment. Wilderness is used as an instrument to quickly and effectively impact individual decision-making. It provides the opportunity for physical and emotional shifts while uncovering maladaptive behaviors that may interfere with recovery (Kessell, M. J., "Women's adventure group: Experiential therapy in an HMO setting", Women and Therapy, 15(3-4)).
Your Brain On Wilderness
Challenge courses, hiking and other outdoor activities have always been part of Mirasol's eating disorder treatment program. But in 2006, Ryan began adding wilderness experiences including camping and even caving. The response from clients and staff was overwhelmingly positive. More importantly, EEG brain maps and standard psychological tests demonstrated significant decreases in symptoms of anxiety and depression.
"There was a significant improvement in brain functioning for most participants, especially in the beta waves that are generally associated with anxiety," says Ryan. Most clients also reported a decrease in symptoms of depression and an increase in their ability to cope with stress, as measured by a Children's Depression Inventory (CDI) and Coping Skills Inventory (CSI) administered before and after the camping trips.
The visible transformation that occurs during Mirasol's adventure therapy program is a huge source of inspiration to clients and their families as well as Mirasol staff. Ryan recalls another experience with a severely depressed adolescent client:
"She had only been with us a few weeks, and she wasn't doing well. She refused to eat, and we considered transitioning her to another program where she could receive a higher level of care. We were all surprised when she agreed to participate in a weekend camping trip that we had planned for her last weekend at Mirasol. And then almost hour by hour, she began to lighten up, talk to other clients and participate in group activities. By Sunday, she came to me and said she wanted to stay at Mirasol, and, for the first time, she told us she wanted to get better. She began following her meal plan, and although she continued to struggle, she never returned to that dark place where she had been before the camping trip."
The limitless ability of the natural world to both challenge and soothe presents opportunities to grow new relationships, and make wilderness interventions a natural fit for both adolescents and adults in treatment.
In the coming months, Mirasol will be expanding its adolescent eating disorder treatment program to include backpacking. So far as we know, no other eating disorder treatment program offers backpacking, despite the proven efficacy of wilderness therapy for troubled adolescents. We're aiming to offer bimonthly two- and three-day trips, taking advantage of Arizona's wealth of impossibly lovely wild public lands. Each trip will include a 50-50 split of medically- and emotionally-appropriate clients and the clinical staff required to ensure their safety and support them in their journey. Staff are gathering the equipment and training for an initial foray in the Catalina Mountains in February, followed by a three-day exploration of Aravaipa Canyon in April. The results of the program will be closely monitored by administering brain maps, depression inventories and similar tools before and after each trip.
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