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The influence of the Outward Bound Veterans Program on sense of coherence

Marieke Van Puymbroeck, PhD, CTRS, Alan W. Ewert, PhD, Yuan Luo, PhD


Veterans returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn may experience threats to their mental health and well-being as a result of their military service. The sense of coherence is a concept that is health promoting, and when high, can be protective against negative health consequences of stress. There are few studies that have determined interventions that may enhance the sense of coherence. Therefore, the purpose of this study was to determine the influence of the Outward Bound Veterans Program (OBVP) on the sense of coherence for US veterans. This study examined 246 veterans who attended the OBVP. The OBVP is a program that uses problem-solving tasks and challenges in a land or water-based outdoor setting that become increasingly difficult. The OBVP relies on teamwork and a series of physical and cognitive challenges. After attending the OBVP, there was a significant increase in the sense of coherence for veterans, and this change persisted 1 year following the completion of the program.
To our knowledge, this is the first intervention that has demonstrated increased sense of coherence following an intervention and 1 year later. Recreational therapists should consider the sense of coherence as an important variable when working with veterans.


adventure, health promotion, physical activity, recreational therapy, salutogenesis, sense of coherence, veterans

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Seal KH, Bertenthal D, Maguen S, et al.: Getting beyond “Don’t ask; don’t tell”: An evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. Am J Public Health. 2008; 98(4): 714-720.

Sanders JW, Putnam SD, Frankart C, et al.: Impact of illness and non-combat injury during Operations Iraqi Freedom and Enduring Freedom (Afghanistan). Am J Trop Med Hyg. 2005; 73(4): 713-719.

Antonovsky A: The “sense of coherence” concept. In Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass Publishers, 1987: 14-32.

Eriksson M, Lindstrom B: Validity of Antonovsky’s sense of coherence scale: A systematic review. J Epidemiol Community Health. 2005; 59(6): 460-466.

Eriksson M, Lindstrom B: Antonovsky’s sense of coherence scale and the relation with health: A systematic review. J Epidemiol Community Health. 2006; 60(5): 376-381.

Lindstrom B, Eriksson M: Contextualizing salutogenesis and Antonovsky in public health development. Health Promot Int. 2006; 21(3): 238-244.

Van Puymbroeck M, Rittman MR: Quality-of-life predictors for caregivers at 1 and 6 months poststroke: Results of path analyses. J Rehabil Res Dev. 2005; 42(6): 747-760.

Van Puymbroeck M, Sberna-Hinojisa M, Rittman M: Influence of sense of coherence on caregiver burden and depression at 12 months post-stroke. Top Stroke Rehabil. 2008; 15(3): 272-282.

Lutgendorf SK, Vitaliano PP, Tripp-Reimer T, et al.: Sense of coherence moderates the relationship between life stress and natural killer cell activity in healthy older adults. Psychol Aging. 1999; 14(4): 552-563.

Walsh V, Golins G: The Exploration of the Outward Bound Process. Denver, CO: Outward Bound Publications, 1976.

Bruner J: Toward a Theory of Instruction. Cambridge, MA: Belknap Pr, 1966.

Sibthorp J: An empirical look at Walsh and Golins’ Adventure Education Process Model: Relationships between antecedent factors, perceptions of characteristics of an adventure education experience, and changes in self-efficacy. J Leisure Res. 2003; 35(1): 80-107.

Ewert AW, Van Puymbroeck M, Frankel J, et al.: Adventure education and the redeploying military veteran: What do we know? Paper presented at Leisure Research Institute, Minneapolis, MN, 2010.

Gass M: Adventure Therapy: Therapeutic Applications of Adventure Programming. Dubuque, IA: Kendall-Hunt, 1993.

Wheeler DP, Bragin M: Bringing it all back home: Social work and the challenge of returning veterans. Health Soc Work. 2007; 32(4): 297-300.

Ewert A, Van Puymbroeck M, Luo Y, et al.: Coming home: Integrating the returning veteran through Outward Bound. Paper presented at 2010 NRPA Leisure Research Symposium, Minneapolis, MN, October 26-29, 2010.

Antonovsky A: The structure and properties of the sense of coherence scale. Soc Sci Med. 1993; 36(6): 725-733.

Gallagher TJ, Wagenfeld MO, Baro F, et al.: Sense of coherence, coping and caregiver role overload. Soc Sci Med. 1994; 39(12): 1615-1622.

Antonovsky H, Sagy S: The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol. 1986; 126(2): 213-225.

Berg A, Hallberg IR: Effects of systematic clinical supervision on psychiatric nurses’ sense of coherence, creativity, work-related strain, job satisfaction and view of the effects from clinical supervision: A pre-post test design. J Psychiatr Ment Health Nurs. 1999; 6(5): 371-381.

Forsgarde M, Westman B, Nygren L: Ethical discussion groups as an intervention to improve the climate in interprofessional work with the elderly and disabled. J Interprof Care. 2000; 14(4): 351-361.

Hillert L, Savlin P, Levy Berg A, et al.: Environmental illness-effectiveness of a salutogenic group-intervention programme. Scand J Public Health. 2002; 30(3): 166-175.

Delbar V, Benor DE: Impact of a nursing intervention on cancer patients’ ability to cope. J Psychosoc Oncol. 2001; 19(2): 57-75.

Antonovsky A: The structural sources of salutogenic strengths. In: Cooper CL, Payne R (eds.): Personality and Stress: Individual Differences on the Stress Process. Chichester: John Wiley & Sons, 1991: 67-104.

Antonovsky A, Sagy S, Adler I, et al.: Attitudes toward retirement in an Israeli cohort. Int J Aging Hum Dev. 1990; 31(1): 57-77.

Feldt T, Leskinen E, Kinnunen U, et al.: The stability of sense of coherence: Comparing two age groups in a 5-year follow-up study. Pers Individ Dif. 2003; 35(5): 1151-1165.

Sagy S, Antonovsky A, Adler I: Explaining life satisfaction in later life: The sense of coherence model and activity theory. Behav Health Aging. 1990; 1: 11-25.

Lindstrom B, Eriksson M: Salutogenesis. J Epidemiol Community Health. 2005; 59(6): 440-442.

Batten SV, Pollack SJ: Integrative outpatient treatment for returning service members. J Clin Psychol. 2008; 64(8): 928-939.

Dedert EA, Green KT, Calhoun PS, et al.: Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001. J Psychiatr Res. 2009; 43(9): 830-836.

Smith B, Ryan MA, Wingard DL, et al.: Cigarette smoking and military deployment: A prospective evaluation. Am J Prev Med. 2008; 35(6): 539-546.

McKenzie M: How are adventure education program outcomes achieved?: A review of the literature. Aust J Outdoor Educ. 2000; 5(1): 19-29.

Ewert A, Voight A, Compton D, et al.: Changing the academic course: Moving from parks as a place to parks as an experience. Paper presented at Healthy Parks/Healthy People Congress, Melbourne, Australia, 2010.

Bullock JG, Green DP, Ha SE: Yes, but what’s the mechanism? (don’t expect an easy answer). J Pers Soc Psychol. 2010; 98(4): 550-558.

MacKinnon DP: Introduction to Statistical Mediation Analysis. New York: Erlbaum, 2008.



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