Comparison of surf and hike therapy for active duty service members with major depressive disorder: Study protocol for a randomized controlled trial of novel interventions in a naturalistic setting

Kristen H Walter, Nicholas P Otis, Lisa H Glassman, Travis N Ray, Betty Michalewicz-Kragh, Kim T Kobayashi Elliott, Cynthia J Thomsen, Kristen H Walter, Nicholas P Otis, Lisa H Glassman, Travis N Ray, Betty Michalewicz-Kragh, Kim T Kobayashi Elliott, Cynthia J Thomsen

Abstract

Many active duty service members suffer from major depressive disorder (MDD). Although traditional treatments exist, alternative approaches may also be effective in treating depressive symptoms. Previous research has shown that physical activity has significant positive effects on depression symptoms in individuals with MDD, and that these benefits may be enhanced when physical activity occurs in a natural environment. Even though physical activity (i.e., hiking, walking) in natural environments has been shown to reduce depressive symptoms, water-based activity occurring in a natural environment (e.g., surfing) may produce even greater improvements in depressive symptoms. We detail an ongoing randomized controlled trial (RCT) comparing the efficacy of surf therapy and hike therapy with respect to immediate and longer-term psychological, physical, and functional outcomes in active duty service members with MDD. We describe the methodological development of this RCT evaluating novel treatment approaches and discuss considerations for evaluating physical activity interventions in a naturalistic setting.

Keywords: Hike therapy; Major depressive disorder; Military; Physical activity; Surf therapy.

Figures

Fig. 1
Fig. 1
Time course of data collection and measures used. Both surf and hike therapy programs are 6 weeks in duration. aAssessor-administered. AIMS = Athletic Identity Measurement Scale; Borg RPE Scale = Borg Rating of Perceived Exertion Scale; CSQ-8 = Client Satisfaction Questionnaire-8; GAD-7 = Generalized Anxiety Disorder 7-item scale; IPAQ-SF = International Physical Activity Questionnaire – Short Form; ISI = Insomnia Severity Index; MADRS = Montgomery–Åsberg Depression Rating Scale; MINI-7 = Mini International Neuropsychiatric Interview 7.0; NPRS = Numerical Pain Rating Scale; OSU TBI-ID-SF = The Ohio State University Traumatic Brain Injury Identification – Short Form; PANAS = Positive and Negative Affect Schedule; PAS = Positive Affect Schedule; PCL-5 = PTSD Checklist for DSM-5; PHQ-4 = Patient Health Questionnaire-4; PHQ-9 = Patient Health Questionnaire-9; RSES-4 = Response to Stressful Events Scale-4; SF-36v2® = Short Form Health Survey – 36-Item, Version 2.

References

    1. Blakeley K., Jansen D.J. 2013. Post-traumatic Stress Disorder and Other Mental Health Problems in the Military: Oversight Issues for Congress. Retrieved from.
    1. Tanielian T., Jaycox L.H., editors. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation; Santa Monica, CA: 2008.
    1. Gadermann A.M., Engel C.C.C., Naifeh J.A., Nock M.K., Petukhova M., Santiago L.P.N., Kessler R.C. Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil. Med. 2012;177(Suppl. 8):47–59.
    1. Kessler R.C., Petukhova M., Sampson N.A., Zaslavsky A.M., Wittchen H. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int. J. Methods Psychiatr. Res. 2012;21(3):169–184. doi: 10.1002/mpr.1359.
    1. Brown G.K., Beck A.T., Steer R.A., Grisham J.R. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J. Consult. Clin. Psychol. 2000;68(3):371–377.
    1. Cuijpers P., Smit F. Excess mortality in depression: a meta-analysis of community studies. J. Affect. Disord. 2002;72(3):227–236.
    1. Butler A.C., Chapman J.E., Forman E.M., Beck A.T. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin. Psychol. Rev. 2006;26(1):17–31.
    1. Cuijpers P., Berking M., Andersson G., Quigley L., Kleiboer A., Dobson K.S. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can. J. Psychiatr. 2013;58(7):376–385.
    1. Hofmann S.G., Asnaani A., Vonk I.J., Sawyer A.T., Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn. Ther. Res. 2012;36(5):427–440.
    1. Hollon S.D., Beck A.T. Cognitive and cognitive behavioral therapies. In: Lambert M.J., editor. Bergin and Garfield's Handbook of Psychotherapy and Behavior Change. sixth ed. John Wiley & Sons; Hoboken, NJ: 2013. pp. 393–443.
    1. Fournier Jc C., DeRubeis R.J., Hollon S.D., Dimidjian S., Amsterdam J.D., Shelton R.C., Fawcett J. Antidepressant drug effects and depression severity: a patient-level meta-analysis. J. Am. Med. Assoc. 2010;303(1):47–53.
    1. Khan A., Leventhal R.M., Khan S.R., Brown W.A. Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. J. Clin. Psychopharmacol. 2002;22(1):40–45.
    1. Cuijpers P., van Straten A., Bohlmeijer E., Hollon S.D., Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol. Med. 2010;40(2):211–223.
    1. Bulloch A.G., Patten S.B. Non-adherence with psychotropic medications in the general population. Soc. Psychiatry Psychiatr. Epidemiol. 2010;45(1):47–56.
    1. Papakostas G.I. Tolerability of modern antidepressants. J. Clin. Psychiatry. 2008;69(Suppl. E1):8–13.
    1. Geddes J.R., Carney S.M., Davies C., Furukawa T.A., Kupfer D.J., Frank E., Goodwin G.M. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. The Lancet. 2003;361(9358):653–661.
    1. Fava M., Rush A.J., Trivedi M.H., Nierenberg A.A., Thase M.E., Sackeim H.A., Kupfer D.J. Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr. Clin. N. Am. 2003;26(2):457–494.
    1. Kessler R., Berglund P., Demler O., Jin R., Koretz D., Merikangas K., Wang P. The epidemiology of major depressive disorder: results from the national comorbidity Survey replication (NCS-r) J. Am. Med. Assoc. 2003;289(23):3095–3105.
    1. aan het Rot M., Collins K.A., Fitterling H.L. Physical exercise and depression. MSJM (Mt. Sinai J. Med.) 2009;76(2):204–214.
    1. Rosenbaum S., Tiedemann A., Sherrington C., Curtis J., Ward P.B. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J. Clin. Psychiatry. 2014;75(9):964–974.
    1. Babyak M., Blumenthal J.A., Herman S., Khatri P., Doraiswamy M., Moore K., Krishnan K.R. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom. Med. 2000;62(5):633–638.
    1. Craft L.L., Landers D.M. The effect of exercise on clinical depression and depression resulting from mental illness: a meta-analysis. J. Sport Exerc. Psychol. 1998;20(4):339–357.
    1. Mota-Pereira J., Silverio J., Carvalho S., Ribeiro J.C., Fonte D., Ramos J. Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. J. Psychiatr. Res. 2011;45(8):1005–1011.
    1. Schuch F.B., Vancampfort D., Richards J., Rosenbaum S., Ward P.B., Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J. Psychiatr. Res. 2016;77:42–51.
    1. Silveira H., Moraes H., Oliveira N., Coutinho E.S.F., Laks J., Deslandes A. Physical exercise and clinically depressed patients: a systematic review and meta-analysis. Neuropsychobiology. 2013;67(2):61–68.
    1. Gourgouvelis J., Yielder P., Clarke S.T., Behbahani H., Murphy B.A. Exercise leads to better clinical outcomes in those receiving medication plus cognitive behavioral therapy for major depressive disorder. Front. Psychiatry. 2018;9:37.
    1. Knapen J., Vancampfort D., Moriën Y., Marchal Y. Exercise therapy improves both mental and physical health in patients with major depression. Disabil. Rehabil. 2015;37(16):1490–1495.
    1. Thompson Coon J., Boddy K., Stein K., Whear R., Barton J., Depledge M.H. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ. Sci. Technol. 2011;45(5):1761–1772.
    1. Barton J., Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ. Sci. Technol. 2010;44(10):3947–3955.
    1. Britton E., Kindermann G., Domegan C., Carlin C. Blue care: a systematic review of blue space interventions for health and wellbeing. Health Promot. Int. 2018:1–20.
    1. Haeffner M., Jackson-Smith D., Buchert M., Risley J. Accessing blue spaces: social and geographic factors structuring familiarity with, use of, and appreciation of urban waterways. Landsc. Urban Plan. 2017;167:136–146.
    1. American Psychiatric Association . fifth ed. American Psychiatric Association; Washington, DC: 2013. Diagnostic and Statistical Manual of Mental Disorders.
    1. Sheehan D.V. Medical Outcomes Systems; Jacksonville, FL: 2015. Mini International Neuropsychiatric Interview 7.0.
    1. Caddick N., Phoenix C., Smith B. Collective stories and well-being: using a dialogical narrative approach to understand peer relationships among combat veterans experiencing post-traumatic stress disorder. J. Health Psychol. 2015;20:286–299.
    1. Caddick N., Smith B., Phoenix C. The effects of surfing and the natural environment on the well-being of combat veterans. Qual. Health Res. 2015;25(1):76–86.
    1. Hawkins B., Townsend J., Garst B. Nature-based recreational therapy for military service members. Ther. Recreat. J. 2016;50:55–74.
    1. Marshall J., Kelly P., Niven A. “When I go there, I feel like I can be myself.” Exploring programme theory within the Wave Project surf therapy intervention. Int. J. Environ. Res. Public Health. 2019;16:2159.
    1. Montgomery S.A., Åsberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry. 1979;134:382–389.
    1. Kroenke K., Spitzer R., Williams J. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16(9):606–613.
    1. Kroenke K., Spitzer R.L., Williams J.B., Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–621.
    1. Spitzer R.L., Kroenke K., Williams J.B., Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 2006;166(10):1092–1097.
    1. Weathers F.W., Litz B.T., Keane T.M., Palmieri P., Marx B., Schnurr P. The PTSD checklist for DSM-5 (PCL-5) [measurement instrument] 2013. Retrieved from.
    1. Weathers F.W., Blake D., Schnurr P., Kaloupek D., Marx B., Keane T. The Life events checklist for DSM-5 (LEC-5) [measurement instrument] 2013. Retrieved from.
    1. Blevins C.A., Weathers F.W., Davis M.T., Witte T.K., Domino J.L. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J. Trauma. Stress. 2015;28:489–498.
    1. Corrigan J.D., Bogner J. Initial reliability and validity of the Ohio state university TBI identification method. J. Head Trauma Rehabil. 2007;22(6):318–329.
    1. Bogner J., Corrigan J.D. Reliability and predictive validity of the Ohio State University TBI Identification method with prisoners. J. Head Trauma Rehabil. 2009;24(4):279–291.
    1. Morin C.M., Barlow D.H. vol 104. Guilford Press; New York, NY: 1993. (Insomnia: Psychological Assessment and Management).
    1. Morin C.M., Belleville G., Bélanger L., Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601–608.
    1. McCaffery M., Beebe A. C.V. Mosby Company; St. Louis, MO: 1989. Pain: Clinical Manual for Nursing Practice.
    1. Watson D., Clark L.A., Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Personal. Soc. Psychol. 1988;54(6):1063–1070.
    1. De La Rosa G.M., Webb-Murphy J.A., Johnston S.L. Development and validation of a brief measure of psychological resilience: an adaptation of the Response to Stressful Experiences Scale. Mil. Med. 2016;181(3):202–208.
    1. Johnson D.C., Polusny M.A., Erbes C.R., King D., King L., Litz B.T., Southwick S.M. Development and initial validation of the response to stressful experiences scale. Mil. Med. 2011;176(2):161–169.
    1. McDowell I. third ed. Oxford University Press; New York, NY: 2006. Measuring Health: A Guide to Rating Scales and Questionnaires.
    1. Ware J.E., Jr. SF-36 health Survey update. Spine. 2000;25(24):3130–3139.
    1. Borg G.A. Psychophysical bases of perceived exertion. Med. Sci. Sport. Exerc. 1982;14(5):377–381.
    1. Day M.L., McGuigan M.R., Brice G., Foster C. Monitoring exercise intensity during resistance training using the session RPE scale. J. Strength Cond. Res. 2004;18(2):353–358.
    1. Kendrick K.R., Baxi S.C., Smith R.M. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J. Emerg. Nurs. 2000;26(3):216–222.
    1. Wilson R.C., Jones P.W. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin. Sci. 1989;76(3):277–282.
    1. Wilson R.C., Jones P.W. Long-term reproducibility of Borg scale estimates of breathlessness during exercise. Clin. Sci. 1991;80(4):309–312.
    1. Chen M.J., Fan X., Moe S.T. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: a meta-analysis. J. Sport. Sci. 2010;20(11):873–899.
    1. Brewer B., Van Raalte J., Linder D. Athletic identity: hercules' muscles or Achilles heel? Int. J. Sport Psychol. 1993;24:237–254.
    1. Craig C.L., Marshall A.L., Sjöström M., Bauman A.E., Booth M.L., Ainsworth B.E., Oja P. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sport. Exerc. 2003;195(9131/03) 3508–1381.
    1. Dinger M.K., Behrens T.K., Han J.L. Validity and reliability of the international physical activity questionnaire in college students. Am. J. Health Educ. 2006;37(6):337–343.
    1. Lee P.H., Macfarlane D.J., Lam T., Stewart S.M. Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review. Int. J. Behav. Nutr. Phys. Act. 2011;8(1):115.
    1. Bauman A., Ainsworth B.E., Bull F., Craig C.L., Hagströmer M., Sallis J.F., Sjöström M. Progress and pitfalls in the use of the International Physical Activity Questionnaire (IPAQ) for adult physical activity surveillance. J. Phys. Act. Health. 2009;6(Suppl. 1):S5–S8.
    1. de Zambotti M., Goldstone A., Claudatos S., Colrain I.M., Baker F.C. A validation study of Fitbit Charge 2™ compared with polysomnography in adults. Chronobiol. Int. 2018;35(4):465–476.
    1. Benedetto S., Caldato C., Bazzan E., Greenwood D.C., Pensabene V., Actis P. Assessment of the Fitbit Charge 2 for monitoring heart rate. PLoS One. 2018;13(2)
    1. Salazar V.E., Lucio N.D., Funk M.D. Accuracy of Fitbit Charge 2 worn at different wrist locations during exercise. Proc. Int. J. Exerc. Sci.: Conf. Proc. 2017;2(9)
    1. Thomson E. Validity of heart rate measurements for the apple watch and Fitbit Charge HR 2. Med. Sci. Sport. Exerc. 2018;50(5S):666.
    1. Figueroa I.A., Lucio N.D., Gamez J.L., Jr., Salazar V.E., Funk M.D. Validity of daily physical activity measurements of Fitbit Charge 2. Int. J. Exerc. Sci.: Conf. Proc. 2018;2(10)
    1. Li K., Nuss K., Thomson E.A., Comstock A., Blake S., Reinwald S., Tracy B. Validation of overall energy expenditure measurements in the Fitbit Charge HR 2 and apple watch. Med. Sci. Sport. Exerc. 2018;50(5S):661.
    1. Lucio N.D., Salazar E.V., Figueroa I.A., Gamez J.L., Russell R.D., Funk M.D. Accuracy of Fitbit Charge 2 at estimating VO2max, calories, and steps on a treadmill. Int. J. Exerc. Sci.: Conf. Proc. 2018;2(10)
    1. Larsen D.L., Attkisson C.C., Hargreaves W.A., Nguyen T.D. Assessment of client/patient satisfaction: development of a general scale. Eval. Program Plann. 1979;2:197–207.
    1. Attkisson C.C., Zwick R.J. The Client Satisfaction Questionnaire: psychometric properties and correlation with service utilization and psychotherapy outcome. Eval. Program Plann. 1982;5:233–237.
    1. Walter K.H., Otis N.P., Ray T.N., Powell A.L., Glassman L.H., Michalewicz-Kragh B., Thomsen C.J. Psychol. Sport Exerc. 2019
    1. Ainsworth B.E., Haskell W.L., Herrmann S.D., Meckes N., Bassett D.R., Jr., Tudor-Locke C., Leon A.S. Compendium of Physical Activities Tracking Guide. (n.d), Retrieved from.
    1. Ainsworth B.E., Haskell W.L., Herrmann S.D., Meckes N., Bassett D.R., Jr., Tudor-Locke C., Leon A.S. 2011 Compendium of physical activities: a second update of codes and MET values. Med. Sci. Sport. Exerc. 2011;43(8):1575–1581.
    1. Hartig T., Mang M., Evans G.W. Restorative effects of natural environment experiences. Environ. Behav. 1991;23(1):3–26.
    1. Li Q., Morimoto K., Kobayashi M., Inagaki H., Katsumata M., Hirata Y., Kawada T. Visiting a forest, but not a city, increases human natural killer activity and expression of anti-cancer proteins. Int. J. Immunopathol. Pharmacol. 2008;21(1):117–127.
    1. Marselle M.R., Irvine K.N., Warber S.L. Examining group walks in nature and multiple aspects of well-being: a large-scale study. Ecopsychology. 2014;6(3):134–147.
    1. Crawford R.T. ProQuest; 2016. The Impact of Ocean Therapy on Veterans with Posttraumatic Stress Disorder. (Doctoral dissertation). Retrieved f rom. (10252268)
    1. Rogers C.M., Mallinson T., Peppers D. High-intensity sports for posttraumatic stress disorder and depression: feasibility study of ocean therapy with veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Am. J. Occup. Ther. 2014;68(4):395–404.
    1. Morita E., Fukuda S., Nagano J., Hamajima N., Yamamoto H., Iwai Y.…Shirakawa T. Psychological effects of forest environments on healthy adults: shinrin-yoku (forest-air bathing, walking) as a possible method of stress reduction. Public Health. 2007;121(1):54–63.
    1. Li Q., Otsuka T., Kobayashi M., Wakayama Y., Inagaki H., Katsumata M., Suzuki H. Acute effects of walking in forest environments on cardiovascular and metabolic parameters. Eur. J. Appl. Physiol. 2011;111(11):2845–2853.
    1. Mao G.X., Lan X.G., Cao Y.B., Chen Z.M., He Z.H., Lv Y.D., Jing Y.A.N. Effects of short-term forest bathing on human health in a broad-leaved evergreen forest in Zhejiang Province, China. Biomed. Environ. Sci. 2012;25(3):317–324.
    1. Park B.J., Tsunetsugu Y., Kasetani T., Morikawa T., Kagawa T., Miyazaki Y. Physiological effects of forest recreation in a young conifer forest in Hinokage Town, Japan. Silva Fenn. 2009;43(2):291–301.
    1. Moussavi S., Chatterji S., Verdes E., Tandon A., Patel V., Ustun B. Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet. 2007;370:851–858.
    1. Rosenbaum S., Stubbs B., Ward P.B., Steel Z., Lederman O., Vancampfort D. The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis. Metabolism. 2015;64(8):926–933.
    1. Chief of Naval Operations . 2011. Physical Readiness Program Policy Changes (OPNAVINST 6110.1) Retrieved from.
    1. Cooney G., Dwan K., Greig C., Lawlor D., Rimer J., Waugh F., Mead G. Exercise for depression. Cochrane Database Syst. Rev. 2013;(9):1–157. 2013.
    1. Blumenthal J.A., Babyak M.A., Moore K.A., Craighead W.E., Herman S., Khatri P., Doraiswamy P.M. Effects of exercise training on older patients with major depression. Arch. Intern. Med. 1999;159(19):2349–2356.
    1. Blumenthal J.A., Babyak M.A., Doraiswamy P.M., Watkins L., Hoffman B.M., Barbour K.A., Hinderliter A. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom. Med. 2007;69(7):587–596.
    1. Ekkekakis P. Honey, I shrunk the pooled SMD! Guide to critical appraisal of systematic reviews and meta-analyses using the Cochrane review on exercise for depression as example. Ment. Health Phys. Act. 2015;8:21–36.
    1. QualityMetric Inc. SF-36v2: Short Form Health Survey Instrument - 36 Item Version (Version 2). Lincoln, RI.

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