Systematic literature review: Nature-based interventions for Veterans

Abstract: Many veterans are not seeking treatment for their mental health needs. Traditional evidence-based practice approaches, (e.g., cognitive processing therapy, cognitive behavioral therapy, and eye movement desensitization movement and reprocessing (EMDR), are often assigned to those experiencing symptoms of post-traumatic stress. While these approaches are typically understood as best practice treatments, there continues to be concerns such as stigma, lack of interest, and challenges related to retention for post-traumatic stress disorder (PTSD) treatment, particularly for veterans. Looking toward novel approaches to treatment may address this concern. Ecotherapy and its accompanying nature-based interventions may be considered to fit this role. These approaches engage people in different ways that are more attractive, fun, cost-effective, and reduce stigma, as they focus on one’s relationship with nature as the mechanism of change by connecting to the self through nature. A systematic literature review of the existing literature on nature-based studies for the veteran population was conducted and synthesized to better understand the current state of such programs. The systematic literature review showed that this is a burgeoning field with a significant positive impact on veteran’s mental health and well-being. While all the literature examined showed efficacious results, there were notable limitations. Predominantly, the studies reviewed lacked diversity amongst the veteran population and, on average, had a small sample size, limiting the breadth of experience to be extrapolated. Most of the identified programs were peer-led or supported without direct clinical interventions, thus making most such programs therapeutic, not therapy. Incorporating therapists into such programs may improve treatment outcomes for those who participate. Additionally, doing so may assist in moving the field of ecotherapy and nature-based approaches to be indoctrinated as an evidence-based approach toward treatment for mental health needs. Therefore, opening the door for such approaches to be adapted into more traditional approaches to treatment. Overall, in its current state, nature-based programs for veterans are not well studied and lack diversity, clinical guidance, and a scientific basis. It maintains inconsistency in design to promote more evidence-based practice, which is needed for the field to evolve from therapeutic to therapy.