Could Wilderness Help Vets With PTSD?

When Sean Gobin left the Marine Corps in 2012, he knew exactly where he wanted to go.

At the time, he was struggling with the cumulative effects of three deployments, experiencing social anxiety, emotional numbness and negative feelings toward people and society. "I was a tank platoon commander during the invasion of Iraq in 2003. I fought in Fallujah, Iraq in 2005. Then I spent a year in Afghanistan in 2011 training the Afghan national security forces," says Gobin, who now resides in Thornton, New Hampshire.

He says hiking the Appalachian Trail was always a bucket list item for him. "So my last day in the Marine Corps, I drove out the back gate at Camp Lejeune, North Carolina, and drove straight to Georgia." That's where he picked up the nation's most popular long trail, completing the nearly 2,200-mile hike to Maine four and a half months later. "The physical exertion of traversing up the trail [is] just a great way to get your body back in sync with your mind, nature and sleep cycles," he says. "It works out a lot of the anxious energy -- anxiety that you've built up."

Though it wasn't until later that year that he was diagnosed at a Veterans Administration clinic with post-traumatic stress disorder, he has no doubt that time on the trail helped him deal with it. And he still returns to the great outdoors as a means to cope with post-traumatic stress today. "It was during that hike that I really started to feel the therapeutic value of doing a long distance hike," Gobin says. "What the hike did for me is it really put me in a good head space to start the next chapter of my life. When I finished the trail, I felt very at peace with myself. I was really good socially, because we had interacted with so many wonderful people along the way that were community supporters, and so it was a great re-socialization effect. I was relaxed [and] in a good state of mind."

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Gobin went on to found the nonprofit Warrior Expeditions, based in Roanoke, Virginia, that provides support for veterans to go on their own long distance hikes, like the AT, as well as three- to four-month-long canoeing trips and bike trips.

Wilderness experience programs -- including what's called wilderness therapy, which commonly incorporates mental health services in some facet into the outdoor program -- are popular with many veterans. That includes those who have PTSD, which affects many people who experience a traumatic or life-threatening event, like combat.

Though PTSD is considered a psychiatric disorder, many experts describe it as a natural result of war for vets who experience it. That's in large part because the same things that served a service member well in combat -- like being hyper-alert and attuned to danger -- are what make it difficult for returning vets to cope in civilian life. "In a way, PTSD is kind of a learning disorder -- because they have learned that the world is dangerous place," says Zachary Dietrich, a clinical psychologist in private practice in Louisville, Kentucky, who is also a Marine Corp veteran. "The brain has actually rewired itself to be hypervigilant, to look for threats in everyday situations."

While traditional treatment like therapy and medication help some cope with PTSD, experts say what's really missing for members of the military who return from combat today is ample time to process and reset before resuming civilian life. After all three of his combat deployments, Gobin says he was home within 72 hours of actually being on the battlefield. What on the surface may seem like a great thing -- particularly for families who've long waited for loved ones to return -- can make it harder for men and women in the military to truly come home. "Obviously there's a lot of trauma being experienced while you're in war, and if you don't take the time and space to reflect and process and decompress from that trauma, what we mostly do is we just pack it away," Gobin says.

While Gobin has found hitting the hiking trail helps him cope, many veterans who aren't able to work through the profound effects of combat turn to drugs and alcohol. Many also struggle with depression, and some -- after successfully dodging fire abroad -- take their own lives at home.

Warrior Expeditions supports veterans not only with things like gear, a monthly stipend to purchase resupply items and a network of vets who host hikers, bikers and paddlers intermittently along their routes; the vets also receive weekly psychoeducational messages via email (which they're still able to check periodically) from Dietrich and Shauna Joye, a clinical psychologist in private practice in Savannah, Georgia. The messages have a cognitive behavioral therapy framework, Joye notes: "The idea is if you can change your thoughts and behaviors then eventually your emotions will follow." The messages provide information on PTSD and related food for thought. Dietrich and Joye also talk by phone with veterans as needed to help them deal with personal issues.

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Along with firsthand experience working with vets, Dietrich and Joye have spent a lot of time trying to get a 10,000-foot view of the effect wilderness experiences have on outcomes for vets and their PTSD. But as they noted in a 2015 study they co-authored with researcher Joseph Amos Garcia, "Although research looking specifically at combat veterans using wilderness settings as a catalyst for therapeutic gains is promising, the small number of studies makes it difficult to make conclusive arguments."

That pilot study, published in the Journal of Experiential Education, focused on the experiences of a handful of veterans who completed the Appalachian Trail with support from Warrior Expeditions. Like Gobin, those vets hiking the AT reported that physical demands helped alleviate nervous energy and promote better sleep. They were able to establish bonds with other veterans. That's a critical therapeutic component of wilderness programs, according to those who run them, along with -- conversely -- the opportunity for solitude to sift through one's thoughts. And the vets benefitted from the gradual resocialization the trail afforded.

Joye and Dietrich, who continue to study the effects of wilderness on vets, say time outdoors and in community with other vets can lead to a reduction in observable PTSD symptoms, like hypervigilance, as well as anxiety and depression. And Dietrich makes note of brain changes, as well. "When somebody has a condition like PTSD, you actually see neurotoxic corticosteroids being released in individuals at a higher level than somebody who doesn't have a PTSD diagnosis," he says. "When somebody does something like a long-term hike ... they actually secrete BDNF, which stands for brain-derived neurotrophic factor," which counteracts the effects of neurotoxic corticosteroids.

Of course, for reasons ranging from logistical challenges to physical limitations, not everyone can hit the trail for months on end to "walk off the war," as the first person to complete the entire AT, Earl Shaffer, famously told a friend he was doing in 1948 after returning from World War II. Fortunately, though there are potential therapeutic advantages to long excursions, short-term wilderness programs have also shown promise for those with PTSD. (In fact, researchers say that more study is needed to determine what "dose" of wilderness might be optimal to maximize benefit while accommodating individuals' time constraints.)

Nick Watson, co-founder and executive director of Veterans Expeditions, based in Salida, Colorado, who served five years as a U.S. Army Ranger, heads the veteran-run and led organization that takes vets snowshoeing, mountain climbing, rock climbing, ice climbing, flyfishing -- you name it. "We're kind of all over the place with what we do," he laughs. "We're outdoor, human-power-based, and we don't say no to much. If someone comes to us with a great opportunity to get vets outside, we jump on it."

Like nonprofit Warrior Expeditions, the organization relies on outside funding and donations. He says the excursions for vets of all skill and ability levels spark positive lifestyle changes, and provide vets with lasting community after they return home. That's paramount, he says, given how many vets with PTSD tend to isolate themselves. The organization doesn't provide mental health services; "the outdoors is the therapy," Watson says. But he notes that veterans who express the need for professional help are referred to therapists who work with vets.

Watson says that about 80 to 90 percent of vets who join Veterans Expeditions trips struggle with post-traumatic stress at some level. He says that where rates of everything from substance abuse to incarceration are much higher in vets than the general population, the chance to get out in the wilderness with fellow vets motivates some to take an alternative path.

[See: 8 Things You Didn't Know About Counseling.]

"We definitely try [to] model positive behavior," he says. "We don't want to see vets going down that dark road, because many are. We often get vets who are experiencing that, who make positive choices and come out the other side with us -- as opposed to being a statistic."

Michael Schroeder is a health editor at U.S. News. He covers a wide array of topics ranging from cancer to depression and prevention to overtreatment. He's been reporting on health since 2005. You can follow him on Twitter or email him at mschroeder@usnews.com.