Exploring Mental Health Outcome Variables in Outdoor Adventure Education

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Exploring Mental Health Outcome Variables in Outdoor Adventure Education

https://doi.org/10.21203/rs.3.rs-2118060/v1

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Background: The COVID-19 Pandemic has changed many facets of outdoor recreation. These changes have significantly impacted various outdoor adventure and experiential education (OAEE) programs.

Purpose: Using past literature, four variables were thought to represent future and important student outcome variables for which OAEE programs should consider striving to impact. Accordingly, the purpose of this pilot study was to examine the effects of participation in an OAEE program and the impacts of coping with anxiety and uncertainty, depression, hopelessness, and enhancing resilience.

Approach: This study used an online data collection software with a 30-item inventory to measure selected variables. Using a retrospective-pre design, data were collected and analyzed using repeated measure t-tests.

Results: This study showed significant differences on anxiety, hopelessness, and resilience.

Implications: Results suggest that OAEE programs can effectively enhance an individual's ability to cope with anxiety and hopelessness while enhancing their levels of resilience.

Outdoor Adventure Education

Mental Health

COVID-19 Pandemic

Experiential Education

Outcome Variables

In a previous paper, Ewert and Davidson (2021) posited that the emergence of COVID-19 (SARS-CoV-2) has impacted students participating in Outdoor Adventure and Experiential Education (OAEE) programs on several variables, including levels of resilience, stress, dealing with uncertainty and anxiety, feelings of hopelessness and helplessness, and depression. This paper describes a recent pilot study that examined whether participation in an OAEE program resulted in changes to the above variables. This pilot study seeks to establish a framework for examining mental health outcome variables and OAEE programs and establish a methodology for a larger-scale investigation into this vital topic. This paper seeks to answer the call established by Cohen et., al (2022) for measuring mental health outcome variables in outdoor programs.

Given the uncertainty caused by the pandemic and other factors facing young people, viable interventions that improve mental health and wellness should be established. Given the nature of OAEE programs, one might posit that these programs are well-positioned to make a positive contribution to this topic. For example, since many OAEE programs occur in the natural environment, the stress reduction that naturally occurs in this setting might enhance OAEE outcomes (Yao, Zhang, & Gong, 2021). Mental wellness variables, such as loneliness and body composition, have recently begun to gain traction in the field, as is evident in the literature (Sachs et al., 2022; Widmer et al., 2022).

Perhaps not surprisingly, many studies support the conclusion that COVID-19 has dramatically impacted people's mental health and subsequent behaviors (Browning et al., 2021). These impacts are critical to broad areas of society, including OAEE programs and offerings. Moreover, Leonard and his colleagues (2021) report substantial negative impacts to organizations providing OAEE experiences, including a reduction in staffing, either permanently or temporarily closed programs, a reduced number of students, and significant modifications to program designs. With the COVID-19 pandemic, there are many economic, social, and psychological issues that society will experience. In turn, OAEE students will bring a variety of these concerns and issues to their courses and programs. We posit that OAEE can play an important role in helping OAEE participants manage various issues, including the ones listed above. This pilot study seeks to establish some of those variables, including coping with feelings of anxiety, depression, hopelessness, and enhancing resilience.

Literature Review

COVID-19 has impacted society on all levels. Many institutions, including education, have attempted to deal with the global public health crisis (Daniel, 2020). In the case of higher education, a recent review highlights some of the documented psychological impacts of COVID-19 on college students (Browning et al., 2021). Common changes in how students now feel compared with how they felt before the pandemic included an increased lack of motivation and increased levels of anxiety, depression, stress, worry, fear, and feelings of isolation. Interestingly, students in the Browning et al. study who reported spending two or more hours outdoors reported lower levels of negative psychological impacts when compared to students spending less time outdoors.

A growing corpus of the literature suggests that both outdoor recreation and nature exposure can improve psychosocial and eudaimonic wellbeing (Holland et al., 2018). Moreover, recent studies of people worldwide show protective psychological effects of park and green space access during the pandemic and lower rates of infection and mortality (Klompmaker et al., 2021). For example, in comparing the effects of nature hiking with hiking in urban settings and using 415 military veterans, Bratman and others (2021) found that hiking in nature was more effective at reducing levels of PTSD than those achieved with urban hiking. The authors concluded that this pilot study essentially confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD.

Several outcome variables are commonly associated with OAEE programs, including self-awareness, personal efficacy, skill mastery, and self-concept. Relative to the intersection of OAEE programs and the pandemic, Ewert & Davidson (2021) argue that outcome variables that should be of particular interest in a post-pandemic world would include: resilience, dealing with anxiety, stress, feelings of hopelessness, and depression. OAEE programs most often occur in the natural environment and may uniquely position programs to have inherent mental-health benefits related to stress and anxiety reduction.

Resilience

Goodman et al. (2020) defined resilience as an interactive and dynamic process of adapting, managing, and negotiating adversity. Resilience can also be thought of as an individual's ability to "bounce back" or recover quickly from the effects of a stressor, thus allowing individuals to maintain a more stable and homeostatic psychological equilibrium over time (Bonanno, 2004; Liu, Reed, & Girard, 2017). Richardson (2002) suggests there are three timeframes when considering resilience: (a) an increase in functional coping during challenges or adversity, (b) a quicker recovery time after the exposure to the adversity, and (c) an increased adaptive capacity to deal with future adversity. Psychological resilience can be vital for coping effectively with hardship, uncertainty, and change.

Using the CD-RISC scale originally developed by Connor and Davidson, (2003), Killgore, et al., (2020) found that during the first weeks of the pandemic, levels of psychological resilience among those sampled were significantly lower when compared to published normative data for the CD-RISC scale. They also found that while average resilience was lower than published norms, it was greater among those who tended to get outside more often, exercise more, perceive more social support from family, friends, and significant others, and sleep better. They also posited that the level of self-perceived psychological resilience among the U.S. populace had been adversely affected by the ongoing crisis, perhaps through acute changes in emotional outlook or perceived support.

During the COVID-19 pandemic and afterward, many OAEE students may experience the need to develop greater levels of resilience as a mediating factor for their personal lives or their perception of hardships to their family, community, or country. How an individual performs on an OAEE course can be similar to how individuals will "bounce back" after the pandemic or other life hardships. Group discussions that focus on how students have recovered from adversity in their lives can be assistive in helping them see how they can do so following the pandemic. In this way, OAEE programs can provide individuals with opportunities to practice these skills related to coping and resilience.

Anxiety

Relative to anxiety and COVID-19, a report by Mental Health America (2020) indicated a 634% increase in reported anxiety disorders in 2020. Anxiety disorders often start with adolescence and early adulthood, the very age group many OAEE students, and can present in a variety of physical, psychological, and behavioral issues. Moreover, Mallett, Coyl, Kuang, and Gillanders (2021) report that the pandemic can have significant and deleterious effects on an individual's sense of wellbeing because of the effects of anxiety and feelings of uncertainty. Carleton et al. (2012) introduce the concept of "intolerance of uncertainty." Intolerance of uncertainty can increase psychosocial comorbidity with factors such as anxiety and depression, and reducing uncertainty is a necessary condition for reducing anxiety and depressive symptoms with a pandemic (Mertens et al., 2020).

Supporting this perspective, Glowacz and Schmits (2020) studied 2,871 from three age groups: 18–30; 30–50; and > 50 years and levels of psychological distress. Their findings indicated that much of the population suffers from anxiety and depression, with younger adults expressing higher levels of anxiety, depression, and uncertainty than older participants.

Stress

One important source of anxiety is stress and can be defined as a dichotomy between individual resources and specific demands that can develop several undesirable physiological, psychological, behavioral, or social outcomes (Ewert & Chang, 2018). Emerging evidence suggests rates of posttraumatic and psychological stress in the general population are elevated due to COVID-19 (Paü, et al., 2021). Cooke, Eirich, Racine, and Madigan (2020) report that nearly one in four adults has experienced significant stress due to the COVID-19 pandemic. In a study conducted using college students, Lindsey et al. (2020) found that most students were suffering from perceived stress and anxiety, with women reporting higher stress levels than male students. Likewise, in a study investigating the effect of COVID-19 on levels of stress on users of public spaces, Agustí et al. (2021) used heart-rate variability (HRV) measures and found significant increases in stress during the pandemic. This suggests that beyond the stress associated with the illness itself, factors such as stay-at-home orders, quarantine, economic uncertainty, and vaccine requirements can elevate stress levels, both individually and collectively. Thus, it seems reasonable to expect that students attending a post-pandemic OAEE program will often arrive with heightened stress levels due to their lived experience during the pandemic, the threat of potential infection, and the future holds for them.

Depression

Defined as a mental disorder that can last for varying amounts of time ranging from two weeks to a lifetime, depression can affect a person's ability to work, carry out activities of daily living (ADLs), or engage in fulfilling personal relationships. Symptoms of depression often include loss of enjoyment and interest, difficulty in focus and making decisions, lack of energy, and sleeping difficulties (Mental Health First Aid, 2020). Salari et al. (2020) report that anxiety, depression, and stress are significantly higher in the age group of 21–40 years. They suggest that this age group may be more concerned about the future and economic challenges caused by the pandemic. Varma et al., (2020) investigated the presence of depression in 1653 individuals representing 63 countries. They report significant symptoms of depression in most of the respondents of their study. In addition, they found that younger adults reported higher levels of vulnerability to stress and anxiety during the pandemic, in addition to faring worse with respect to depression when compared to older populations.

Hopelessness

Shea and Hurley (1964) defined hopelessness as "the feeling that any effort aimed at constructive change … is doomed before it is even attempted" They also defined hopelessness as "the conviction that everything that can be done has been done, which results in an inability to mobilize energy and effort …" Similarly, Peterson and Seligman (1983) define learned hopelessness as "the emotional numbing and maladaptive passivity sometimes following victimization." Scioli and Biller (2009) list nine types of hopelessness, three of which have implications to OAEE programs. These include (1) a feeling that the student cannot live safely in their environment, (2) a sense of failed or only partial mastery of skills needed in their lives, and (3) a feeling that one is incapable of achieving an individual's desired goals. Varma's et al., (2021) study of psychological protective factors in COVID-19 finds that social support can be a critical factor in ameliorating the effects of hopelessness. Given the characteristics often associated with OAEE programs, such as providing a supportive small group environment, it is reasonable to expect some positive change in feelings of hopelessness from participation in OAEE programs.

The goal of this study was to ascertain the effects of participation in an OAEE program on an individual's ability to manage and mitigate feelings of anxiety, hopelessness, and depression while having an inverse, positive impact on resilience (that is, enhancing resilience). This project was approved by the host institution’s institutional review board. Subjects provided consent before participating in the study via Qualtrics. The following research questions guided this research:

RQ1: Do OAEE programs significantly impact an individual's ability to manage feelings of anxiety after their course?

RQ2: Do OAEE programs significantly impact an individual's ability to manage feelings of hopelessness after their course?

RQ3: Do OAEE programs significantly impact an individual's ability to manage feelings of depression following their course?

RQ4: Do OAEE programs significantly impact an individual's sense of resilience after their course?

RQ5: Do OAEE programs significantly impact an individual's sense of mental wellness after their course (an aggregate of the variables above)?

Sample

This pilot study utilized data collected in the summer and fall of 2021. The project encompassed 22 individuals who had participated in an OAEE program that year (n = 22). The instrument consisted of four preexisting instruments and was administered online via Qualtrics. In its entirety, the instrument consisted of 30 items, with seven to eight items per variable. Subjects were entered into a drawing for a $50 gift certificate to a major outdoor retail store for their participation.

Instruments

The instrument for this project was a compilation of four preexisting inventories which focus on a variable of interest in this study. The first instrument, the Generalized Anxiety Disorder Seven developed by Spitzer et al. (2006), was designed to assess generalized anxiety disorder with various populations (α = .92). The second instrument, the Beck Depression Inventory developed by Beck et al. (1961) was designed to measure feelings of depression in many settings and populations. This instrument is widely used and found to have acceptable levels of reliability α = .94 (Blackmon et al., 2017; de Sá Junior et al., 2018; Elovanio et al., 2020). The third instrument was developed by Beck et al. (1974) to record changes in feeling hopelessness before and after the OAEE experience (α = .93). The fourth quantitative instrument was designed to capture levels of resilience and was adapted from Resiliency Scale for Children and Adolescence (Prince-Embury, 2008), which is an instrument with three sub-scales designed to measure resiliency through a sense of master, relatedness, and emotional reactivity (α = .85 to .91).

Because the variables associated with mental wellness in this study are prone to response-shift bias, that is, a shifting of meaning or interpretation over time, a retrospective pretest format was utilized in the data collection process (Pratt et al., 2000). The following is an example of the question format:

Before this course, I looked to the future with hope and enthusiasm

Now, I look to the future with hope and enthusiasm.

Each item was measured on a one to five Likert scale using the retrospective pre-design with "1" indicating the subject strongly disagreed and "5" indicating they strongly agreed.

The quantitative instrument was e-mailed out periodically throughout the summer, with respondents completing the survey when it was convenient. Subjects self-reported how much time had passed since their OAEE course, with a mean of 37.6 days.

Quantitative Results

Five paired-samples t-tests were used to identify any statistically significant mean differences between each of the four constructs before and after participants' OAEE course. Additionally, an aggregated score of all the variables was calculated, which was deemed "mental wellness." Differences in pre/post measurements were calculated for anxiety, depression, hopelessness, and resilience. There were no outliers in the data, as assessed by inspection of a boxplot for values greater than 1.5 box lengths from the edge of the box. As assessed by Shapiro-Wilk's test, the mean scores for each dependent were normally distributed (p > .05).

There was a significant difference in the scores for anxiety for students before and after their OAEE course with anxiety pre (M = 3.0063, SD = 0.77849) and anxiety post (M = 3.631250, SD = 0.568463) scores; t(19) = 6.116, p = 0.000007. There was no significant difference in the scores for depression for students before and after their OAEE course. depression pre (M = 3.00, SD = 0.357946) and depression post (M = 3.071429, SD = 0.322518) conditions; t(20) = .959, p = 0.349. There was a significant difference in the scores for hopelessness for students before and after their OAEE course. hopelessness pre (M = 3.363636, SD = 0.668211) and hopelessness post (M = 4.051948, SD = 0.484042) conditions; t(21) = 6.098, p = 0.000005. Finally, there was a significant difference in the scores for resilience for students before and after their OAEE course with resilience pre (M = 3.8, SD = 0.573794) and resilience post (M = 4.366667, SD = 0.348766) conditions; t(19) = 4.957, p = 0.000088.

Finally, we wanted to combine the variables into an overarching theoretical variable that combined this study's four variables of interest. We dubbed this variable "mental wellness." This was done to explore the possibility of an overarching aggregate variable and to allow for future analysis of interaction among these variables. For the aggregated “mental wellness” variable there was a significant difference in mean scores found in these data (M = 0.3386, SD = 0.2906) conditions: t(18) = 5.078, p = 0.000078. In addition, the researchers utilized Cohen's small, medium and large delineations for effect size (Wilcox & Tian, 2011), with the results shown in Table 1.

Effect size scores

Variable	Cohen’s d	Interpretation
Anxiety	.45	Medium
Hopelessness	.53	Medium
Resilience	.51	Medium
Mental Wellness	.29	Small

The results from this study suggest that participation in OAEE courses can increase an individual's ability to manage and mitigate feelings of hopelessness and anxiety while also increasing their levels of resilience. These data are encouraging but making further inferences from these data should be done with caution (more on this in the limitations section). However, in an age where mental health and wellness are of growing importance, researchers and practitioners should consider documenting what types of mental health outcomes OAEE experiences can facilitate and how those outcomes are achieved. OAEE programs can likely contribute to an individual's mental wellness in a post-pandemic society, although questions of efficacy and durability remain.

First, the sense of escape and contact with the natural environment likely contribute to the positive results of enhancing mental well-being, as suggested in these data. Nature-based stress reduction is a popular theme and becoming well documented in the literature (Choe et al., 2020; Ewert & Chang, 2018; Lackey et al., 2019). In addition, the small group and supportive structure of typical OAEE courses likely result in enhanced social support, which has been shown to have a positive impact on mental well-being (Davidson & Ewert, 2012). It is possible that these factors all contribute to a positive experience for students and thus lead to positive increases in selected mental health outcome variables.

No significant differences were found with feelings of depression which may be due to individuals' level of depression prior to enrolling in their OAEE experience (e.g., they do not feel a sense of depression). Additionally, the treatment may not impact levels of depression given the level of training held by instructional staff or a lack of programmatic emphasis on certain types of mental health concerns. Moreover, depression has often been shown to require long treatment times given the oftentimes complex nature of the affliction. As a result of this pilot project, future work may want to consider depression as a more serious mental health concern for individuals, thus reframing the impact an OAEE experience may have on these types of conditions.

Levels of hopelessness and anxiety were significantly reduced following participation in the OAEE experience. This result was not unexpected as OAEE programs are well documented to help students with empowerment and resilience, which are often linked to the constructs of anxiety and uncertainty. Further, this also speaks to an individual's ability to manage and mitigate stress. Again, these can be linked to nature-based stress reduction research in various fields. In the age of civil unrest and a global pandemic, these are certainly important skill sets that individuals would benefit from developing.

What is clear from these data is that the potential for OAEE programs to impact the people who participate in these programs is full of potential. In a post-pandemic society, programs and staff should consider the role OAEE programs can and should play in contributing to these areas. Striving to impact these variables surrounding mental health would lend itself to positioning the industry to play an essential role in the future of making a positive impact on peoples' lives. Enhancing staff training in these areas, shifting course policies, and rethinking the design of these experiences may help enhance OAEE programs' abilities further to significantly contribute to the mental wellbeing of those students whom these programs serve.

Future Research

Much additional research is needed on this topic. To begin, this study should be replicated to include a larger, more inclusive sample. Additionally, repeating a similar study at a variety of OAEE programs would also enhance the reliability of these findings. A larger sample size could also highlight nuances of how OAEE programs might affect different individuals based on a mix of demographic variables (e.g., age, gender, ethnicity, etc.). It would be potentially misleading to assume that all programs have similar benefits or effects for all different types of populations. Controlling for variables like demographics, course length, and types of activities the students participated in would be important in measuring the potential impacts of OAEE programs on variables surrounding mental wellness.

Future work should also include the mental health skills of facilitators of these programs. It stands to reason that if there is an increased need for mental healthcare in schools, the same would be true for OAEE programs (Mojtabai & Olfson, 2020). Yet, there is still limited training and emphasis on this skill set among instructors, councilors, and field staff. Increasing programmatic capacity to manage and mitigate behavioral healthcare needs will likely increase the overall efficacy of OAEE programming and increase the ability to serve a greater variety of students.

Limitations

Several factors limited this study. First, the small sample size in this pilot study limited the generalizability of the data and presented the possibility of a non-representative sample. Broader generalizability and validity of the findings would be enhanced with a larger sample. Additionally, data were collected at only one location. Future projects should seek to repeat this study at multiple organizations and geographic locations. By collecting data at one location, this study was also limited in the variety of activities and course length. Additionally, a lack of a control group limits the internal validity of this project. Further, this study utilized the same instrumentation for all course types, lengths, and demographics. It is possible that more targeted studies focusing on specific sub-populations of OAEE participants may find different results. Future studies will want to focus on cohorts and how benefits impact different samples differently.

The findings from this study suggest that OAEE programs can positively impact an individual's ability to reduce feelings of hopelessness and anxiety while increasing their resilience. These findings are significant as OAEE programs consider their place in a post-pandemic world and the contributions these programs can make in helping students develop healthy coping mechanisms where they are resilient to the uncertainty of a changing world. While these findings should be interpreted and adopted with caution due to the limitations of this pilot study, the results are nevertheless promising that OAEE programs can provide an important and meaningful service for helping with mental health and wellness in the lives of those who participate. More research into outcomes and best practices to promote mental wellness through OAEE should be a high priority for researchers and practitioners' consideration the role OAEE programs play in a post-pandemic society.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest concerning this article's research, authorship, and publication.

Funding: The authors received no financial support for this article's research authorship and publication.

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Exploring Mental Health Outcome Variables in Outdoor Adventure Education

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Abstract

Introduction

Resilience

Anxiety

Stress

Depression

Hopelessness

Methods

Instruments

Results

Quantitative Results

Discussion

Future Research

Limitations

Conclusions

Declarations

References

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