Combining Acceptance and Commitment Therapy with Adventure Therapy to promote psychological wellbeing of children at-risk

Summary

The natural environment seemed to play a key role in advancing the goals of a therapeutic program for children with challenging emotional and/or behavioral needs

This study represents a preliminary evaluation of a therapeutic program combining two different approaches: Acceptance and Commitment Therapy (ACT) and Adventure Therapy (AT).  ACT uses a cognitive behavioral approach to helping individuals “achieve a valued and meaningful life.” The AT approach is designed to “remedy psychosocial difficulties through one’s engagement with outdoor activities and experiential learning exercises.” The integrated program is referred to as “ACT in the Outdoors.”

Nine children (age 11 -12) from the ACT in the Outdoors program participated in this study. All of the children were identified as having behavioral and emotional difficulties. The program consisted of 8 weekly sessions conducted in outdoor settings, including a beach and a park. The first 7 sessions were one hour in length; the last session was 2 hours in length. Program activities were planned and conducted by a multidisciplinary team of professionals consisting of a registered psychologist with specific ACT training, a specialist in outdoor learning and experiential education, a therapeutic recreation specialist, and a nature pedagogue. The focus of the activities included the six core processes of ACT: acceptance, defusion, contact with the present moment also known as mindfulness, self-as-context, valuing, and committed action. These processes working together are designed to help individuals achieve psychological flexibility, defined as “the ability to be present in the moment, pursue important values and select behavior that is aligned to these values whilst accepting the presence of unpleasant experiences.”

Program evaluation measures included pre and post psychological assessments of participants and post interviews with participants and teachers. Interview responses indicated that changes for participating children from before to after the program included “self-calming through mindfulness, committing to action, enhanced teamwork and ability to trust others, and showing support and respect for others.” Teachers indicated that the children’s ability to calm themselves in situations where they felt angry, frustrated, or anxious was the most prominent impact of the program. Children reported that mindfulness was an important new skill they learned through the program.

The quantitative pre- and post-assessment results showed that five of the nine participants made significant progress in at least one aspect of psychological well-being. All five of these participants attended seven or eight of the program sessions. Children who attended less than seven sessions did not make such changes. Areas of improvement identified through the quantitative assessment included general school self-concept, anxiety and depression, life interference associated with anxiety, mindfulness, and psychological flexibility. In addition to attendance, level of psychological well-being when entering the program also seemed to influence the outcomes for individual children, as the data indicated that children with particularly low levels of psychological well-being at entry tended to experience greater gains from the program than the other children.

The overall results of this study suggest that the integration of Acceptance and Commitment Therapy and Adventure Therapy may positively impact the psychological well-being and skill development of children with challenging emotional and/or behavioral needs. The natural environment in this integrated model seemed to be a key facilitator in promoting some of the desired results.

Citation

Tracey, D., Gray, T., Truong, S., Ward, K., (2018). Combining Acceptance and Commitment Therapy with Adventure Therapy to promote psychological wellbeing of children at-risk. Frontiers in Psychology

DOI

http://dx.doi.org/10.3389/fpsyg.2018.01565

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