Therapeutic Recreation Journal Vol. LIV, No. 2 • pp.

150–172 • 2020
https://doi.org/10.18666/TRJ-2020-V54-I2-9965

Qualitative Paper

The Transformative Nature of Fly-Fishing

for Veterans and Military Personnel with
Posttraumatic Stress Disorder
Patti J. Craig Abstract
Dustin M. Alger
Grounded in the leisure-coping framework (Kleiber et
Jessie L. Bennett al., 2002; 2008), this phenomenological study utilized a
Tamar P. Martin focus group method to explore the meaning of fly-fish-
ing for veterans and military personnel with PTSD. This
study also explored ways in which fly-fishing may serve
as a coping resource in transcending negative life events,
such as PTSD, as it helps move veterans and military
personnel toward personal transformation and posttrau-
matic growth (PTG). A total of nine participants from
the Project Healing Waters Fly-Fishing program partici-
pated in two focus groups to understand how fly-fishing
impacts PTSD symptom management and to identify as-
pects of the program that may be responsible for symp-
tom reduction and growth among this population. Four
themes emerged from the data, suggesting fly-fishing: (a)
serves as a breather from the negative impact of PTSD,
(b) sustains coping effort and commitment, (c) restores
control by alleviating PTSD symptoms, and (d) can serve
as a context for personal transformation and posttrau-
matic growth. Implications for practice are provided.

Keywords
Complimentary and integrative health, fly-fishing, nature-
based recreation, posttraumatic stress disorder, posttrau-
matic growth, stress-coping theory, veterans and military
personnel
Patti J. Craig is an associate professor in the Department of Recreation Management and
Policy at the University of New Hampshire.
Dustin M. Alger is in the Residential Substance Abuse/Post-Traumatic Stress Unit at the
Boise Veterans Affairs Medical Center (VAMC) in Boise, Idaho.
Jessie L. Bennett is an assistant professor at the University of New Hampshire.
Tamar P. Martin is a counseling psychologist and certified rehabilitation counselor in pri-
vate practice in New York City, NY. She is also an adjunct instructor at Hunter College, CUNY,
Programs in Counselor Education, and at New York University, Department of Applied Psychol-
ogy, New York City, NY.
Please send correspondence to Patti J. Craig, pjcraig@unh.edu
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Introduction
Since 2001, the United States (U.S.) has been engaged in the Global War on Terror,
with over 2.77 million service members serving overseas (Wenger, O’Connell, & Cot-
trell, 2018). Approximately 1.6 million service members have experienced multiple de-
ployments with shorter rest periods in between, and have been exposed to the extreme
stressors of combat, including roadside bombs, suicide bombers, and human death
and violence which led to increased risk for posttraumatic stress disorder (PTSD) and
major depression (Burnam et al., 2009). Further, over 50,000 troops from the Global
War on Terror have experienced severe combat injuries such as limb loss, spinal injury,
blast injuries, traumatic brain injury (TBI), depression, generalized anxiety disorder,
and PTSD (Defense Casualty Analysis System, 2017). With the extreme forces used
in combat and the resulting physical and psychological trauma, it is logical that PTSD
remains a significant health concern for veterans, military personnel, and their families
(Institute of Medicine [IOM], 2014).
According to the U.S. Department of Veterans Affairs (VA) and the Department of
Defense (DoD) (VA & DoD, 2017), approximately 10.6% of all veterans receiving care
in the Veterans Health Administration have a diagnosis of PTSD. The estimated cost
of PTSD treatment is staggering; for example, in 2012 alone, the VA spent $3 billion,
and the DoD spent $294 billion in the treatment of PTSD (IOM, 2014). These statistics
suggest PTSD is a prevalent, debilitating, and costly condition for veterans and military
personnel (National Academies of Sciences, Engineering, & Medicine, 2018).
PTSD is the emotional disorder most frequently associated with combat and other
potentially traumatic experiences that may occur during military service, such as mili-
tary sexual assault (Strauss et al., 2011). PTSD is an extreme response to a traumatic
event that is characterized by a combination of mental health symptoms that are pres-
ent for at least one month and impair functioning across multiple domains (American
Psychological Association [APA], 2017). Diagnostic criteria include: (a) intrusion or
re-experiencing of a traumatic event, (b) avoidance of trauma-associated stimuli, (c)
alterations in cognition and mood, and (d) alterations in arousal and reactivity (APA).
PTSD is associated with significant adverse consequences for veterans and mili-
tary personnel, including high rates of depression and other psychiatric comorbidities,
substance abuse, suicidality, impaired social, occupational, and family functioning, de-
creased quality of life, and increased rates of medical morbidity, health risk behaviors,
and health service use (Giordano et al., 2018). Left untreated, veterans and military
personnel with PTSD are at risk for a lifetime progression of increasing functional dis-
ability, psychological distress, and poor quality of life (Fulton et al., 2015).
The VA and DoD (2017) provide a spectrum of treatment approaches including
individualized, trauma-focused and non-trauma-focused psychotherapies, as well as
pharmacologic agents. Although shown to be viable options during the initial stages
of treatment, these approaches have not demonstrated consistent long-term clinical
effects (Poulsny et al., 2015), as many patients still have diagnosable PTSD following
treatment (Steenkamp et al., 2015). Further, because many trauma-focused psychother-
apies require engagement in repeated conversations and imagery related to traumatic
events, many patients prefer to try other strategies (Markowitz et al., 2016). Thus, an
exploration of ways to supplement existing treatments, reduce barriers to engagement
in treatment, and provide alternative treatment options for individuals with PTSD is

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needed. Complementary integrative health (CIH) approaches, such as nature-based

recreation, can be viable supplemental treatment options, as they leverage individual
interests and motivations for sustained and engaged participation (National Center for
Complementary & Integrative Health [NCCIH], 2015).
As nature-based approaches have gained popularity across a variety of disciplines,
therapeutic recreation (TR) practitioners have used nature-based interventions and
activities to address functional outcomes and provide recreation opportunities for vet-
eran and military populations with PTSD (Hawkins, Towsend, & Garst, 2016). Mul-
tiple types of nature-based approaches, such as outdoor adventure therapy, wilderness
therapy, outdoor experiential therapy, and eco-therapy utilize the natural environment
for specific therapeutic outcomes (Poulsen, Stigsdotter, & Refshage, 2015). Although
this line of research is in its infancy, preliminary evidence suggests that nature-based
recreation approaches merit continued investigation to evaluate efficacy and imple-
mentation within the VA, DoD, and community-based TR and recreation settings
serving veterans and military personnel (Townsend et al., 2018). The purpose of this
phenomenological study was to explore the meaning of fly-fishing for veterans and
military personnel with PTSD, and to understand how fly-fishing may serve as a cop-
ing resource for this population.

Literature Review
Conventional PTSD Treatment Approaches
Within the VA and DoD (2017), preferred first-line treatments for PTSD are in-
dividual, trauma- and non-trauma-focused psychotherapies, and pharmacological
approaches. Trauma-focused psychotherapy uses cognitive, emotional, or behavioral
restructuring techniques to facilitate the processing of a traumatic experience (e.g.,
prolonged exposure therapy, cognitive processing therapy, eye movement desensitiza-
tion and reprocessing, brief eclectic therapy). Non-trauma-focused psychotherapies
include stress inoculation therapy, present-centered therapy, and interpersonal psy-
chotherapy (VA & DoD). In pharmacotherapy, medications referred to as “cognitive
enhancers” are used in conjunction with trauma-focused therapies to enhance psy-
chological interventions (National Center for PTSD, 2019, p. 1). Although efficacy of
these conventional approaches is widely reported in the literature (Foa et al., 2009; VA
& DoD), between 30%-50% of participating veterans fail to show long-term clinically
significant improvements (Poulsny et al., 2015). Further, participant dropout is high,
ranging from 30%-38% in randomized trials and 32%-44% in clinic-based studies,
likely due to difficulty tolerating trauma-focused material that are hallmarks of these
approaches (Poulsny et al., 2015).

Complementary and Integrative Health Approaches

Given the challenges associated with conventional PTSD treatment methods, an
exploration of CIH approaches that can interrupt undesirable symptoms of PTSD is
warranted and, thus, has emerged as a top priority for the VA and DoD (NCCIH, 2015).
Complementary health approaches are a group of diverse medical and health systems,
practices, and products that are not considered to be part of conventional medicine,
but rather are used in conjunction with conventional therapies (NCCIH, 2015). Inte-
grative approaches are a style of practice that places a strong emphasis on a holistic ap-

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proach to patient care while focusing on reduced use of technology (NCCIH). CIH ap-
proaches are typically noninvasive or minimally invasive, considered unlikely to result
in negative side effects, and may be more aligned with individual treatment preferences
and interests than conventional treatment options (Strauss et al., 2011).
Emerging CIH approaches for veteran and military populations include modali-
ties such as mind-body medicine (e.g., meditation, mindfulness-based stress reduc-
tion, yoga, acupuncture), the use of natural products (e.g., dietary supplements, herbal
remedies, probiotics), manipulative and body-based practices (e.g., massage therapy,
spinal manipulation), whole medical systems (e.g., traditional Chinese or Ayurvedic
medicines), technological-based treatments (e.g., internet and computer-based treat-
ments, virtual reality) and other practices (e.g., light or magnet therapy, movement
therapies) (Cukor et al., 2009; NCCIH, 2015). Although the VA and DoD are invested
in developing better ways to assess, manage, and treat PTSD through CIH approaches,
evidence of their effectiveness is limited (Strauss et al., 2011).
Complementary approaches such as nature-based recreation have long been rec-
ognized for their therapeutic benefits and potential for instilling personal agency, and
facilitating healing among a variety of populations (Berman, Jonides, & Kaplan, 2008;
Gelkopf et al., 2013; Kaplan & Kaplan, 1989; Walsh, 2011). Further, there is a growing
evidence base in TR for the efficacy of nature-based recreation in facilitating functional
outcomes and symptom reduction for veteran and military populations with PTSD
and comorbid conditions (Bennett, Piatt, & Van Puymbroeck, 2017; Duvall & Kaplan,
2013; Hawkins et al., 2016; Price et al., 2015; Rogers, Loy, Brown-Bochicchio, 2016).
However, none of this literature explores the processes through which nature-based
recreation can help veterans and military personnel cope with PTSD. This study at-
tempts to fill this gap.
Stress and Coping
The influence of Lazarus and Folkman’s (1984) transactional theory of stress and
coping is the cornerstone of psychological stress and coping research across multiple
fields and disciplines, including leisure studies (Iwasaki & Schneider, 2003). According
to Lazarus and Folkman, stress is defined as exposure to stimuli appraised as harmful,
threatening, or challenging, that exceeds an individual’s capacity to cope. The primary
features of the theory are cognitive appraisal and coping, which are said to co-occur.
The individual is constantly appraising stimuli within their environment. This cogni-
tive appraisal process generates emotions, and when stimuli are appraised as threat-
ening, challenging, or harmful (i.e., stressors), the resulting distress initiates coping
strategies to manage emotions or attempt to directly address the stressor itself. Thus,
coping is viewed as process-oriented and dynamic, and involves conscious, purposeful
actions employed when an individual appraises a situation as stressful.
Emotion-focused coping regulates emotions associated with stress without at-
tempting to change the situation itself and is largely a matter of finding ways to survive
the pain and/or avoid thinking about the threat of the stressor (Lazarus & Folkman,
1984). In the context of this study, veterans and military personnel who have PTSD
may utilize a diverse range of emotion-focused strategies such as denial, avoidance,
minimizing, distancing, and/or regulating one’s emotions by “pulling up one’s boot
straps” or discharging emotions through outbursts, venting, or crying (Benedek &
Wynn, 2016). Problem-focused coping is when the individual tries to define the prob-

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lem, find solutions, and consider alternative courses of action (Lazarus & Folkman,
1984). Changes can be made to the environment or through a cognitive reappraisal of
an individual’s goals and behaviors. In the context of this study, veterans and military
personnel with PTSD may use problem-focused coping when re-evaluating their life
goals or avoiding environments that trigger thoughts or feelings of the negative event
(Benedek & Wynn, 2016).

Role of Leisure in Coping

Research on the role of leisure in the stress-coping process has received renewed
attention in the last three decades (Chang & Yu, 2012; Denovan & Macaskill, 2017;
Iwasaki, 2006; Iwasaki, Mactavish, & MacKay, 2005; Iwasaki & Mannell, 2000; Iwasaki
& Schneider, 2003; Kleiber, Hutchinson, & Williams, 2002; Kleiber, Reel, & Hutchin-
son, 2008). In contrast to necessary daily tasks, routines, and work obligations, leisure
is defined as free time individuals have at their disposal, and they can utilize this time at
their own discretion and in their own characteristic style (Russell, 2017). Experiences
and activities people choose to engage in during leisure time for enjoyment, excite-
ment, and pleasure are referred to as recreation.
Among various types of coping resources and strategies, leisure researchers pro-
pose that leisure can be a means through which people cope with stress and main-
tain or improve their health (Iwasaki & Schneider, 2003). However, the mechanisms
through which leisure activates the stress-coping process are understood in different
ways. According to Iwasaki (2006), stress-coping research has historically focused on
the effectiveness of coping sources that regulate distress but have largely underrepre-
sented the ways in which pleasurable affect can impact the stress-coping response
. This study draws upon one such conceptualization that suggests leisure may be
a mechanism through which long-term adjustment to major negative life events can
occur, rather than just simply as a vehicle for coping with immediate or daily stress-
ors. Building upon Lazarus and Folkman’s theory, Kleiber and colleagues (Kleiber et
al., 2002, 2008) propose four major functions of leisure in transcending negative life
events. Two of these functions deal with leisure as ways of coping for self-protective
devices (breathers, sustainers), while the other two functions (restorers, personal
transformation) consider leisure as a means of adjustment to negative life events. The
restorer and personal transformation functions emphasize the role of leisure in restor-
ing one’s valued self that is continuous with the past, as well as in transforming oneself
to grow by finding new opportunities and perspectives (Kleiber et al., 2008). In these
ways, leisure can be an effective coping resource as it can create stability and control for
those who have experienced a negative life event by reducing, deflecting, and manag-
ing emotional distress, and infusing positive emotions into the situation.
In the wake of combat trauma, leisure may help veterans and military personnel
with PTSD find new meanings and directions in life. The role of leisure as a vehicle for
positive transformation of self while experiencing stressors is crucial for this popula-
tion as they attempt to adjust to their lives after injury. This is known as posttraumatic
growth (PTG), which is defined as “a self-regulatory mechanism connected to one’s
innate biological tendency toward protection from the distress caused by stress, ad-
versity, and crisis” (Mikal-Flynn, Anders, & Hoffman, 2018, p. 271). PTG can serve as
a protective resource against the harmful health effects of combat exposure or symp-
toms of PTSD (Jankowski & Bell Vargas, 2019). For example, the trauma of war may
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negatively impact social identity among veterans and military personnel, resulting in
confusion about their understanding of the world around them, and their place within
that world. For PTG to occur, trauma survivors must rebuild their assumptions about
the world around them, which starts with a re-evaluation of the self (Calhoun & Tede-
schi, 2001). The restorative qualities of leisure in this process, specifically activities that
utilize the outdoor environment, are well supported in the literature (Tidball & Krasny,
2007; Walsh, 2011).

Nature-Based Recreation as a Resource in Coping

Recreation activities are the conduit through which individuals experience lei-
sure. Nature-based recreation can be a unique form of meaningful leisure that can
assist with both emotion-focused and problem-focused coping by using the natural en-
vironment to help individuals overcome sources of anxiety, reduce stress, and reinstate
feelings of reward and pleasure (Tidball & Krasny, 2007). Among non-military popu-
lations, interventions in natural settings have shown enhanced physical, social, and
mental health outcomes, including “greater cognitive, attentional, emotional, spiritual,
and subjective well-being” (Walsh, 2011, p. 584). Several studies examining the efficacy
of veteran-specific nature-based modalities such as fly-fishing (Alexander, 2017; Ben-
nett et al., 2017; Mowatt & Bennett, 2011), river running (Dustin et al., 2011), outdoor
recreation/adventure therapy (Vella, Milligan, & Bennett, 2013), and equine-assisted
activities (Lanning & Kreneck, 2013) have shown promise in improving mood, psy-
chosocial health, and quality of life, and reducing PTSD symptoms among individuals
with service-connected disabilities.
Fly-fishing is a growing nature-based recreation approach being used across the
U.S. to help veterans and military personnel cope with symptoms of PTSD. Within the
last decade, community-based organizations such as Project Healing Waters Fly-Fish-
ing (PHWFF), Rivers of Recovery, Fly’n Heroes, Fly Fishing for Vets, Veteran’s First Fly
Fishing Club, and others have recognized the therapeutic benefits of fly-fishing for this
population, and have established local and national programs that provide pleasurable
recreation experiences. These recreation programs are typically run by administrative
and/or professional staff and are supported by volunteers who are often former partici-
pants and/or those with fly-fishing expertise. TR professionals often partner with these
community-based fly-fishing programs as they refer clients from the VA and DoD with
whom they are working on individual rehabilitation plans (Rogers et al., 2016). Given
the prevalence of PTSD among veterans and military personnel, the VA and DoD’s in-
terest in CIH approaches, and the growth of nature-based recreation programs, a study
exploring the meaning of fly-fishing and its role in coping with PTSD is warranted.

Methods
A phenomenological method was used to elucidate a range of perspectives about
fly-fishing among veterans and military personnel with PTSD who participate in the
Project Healing Waters Fly-Fishing program (PHWFF). These perspectives provide
depth and context to our understanding of the fly-fishing experience for this popula-
tion, allowing underlying commonalities in meanings to be understood through the
development of themes (Moustakas, 1994). Although participants share their own
personal meaning of experience through language, to understand the commonality of
meaning behind those experiences requires interpretation on the part of the research-
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ers (van Manen, 1997). Using phenomenology as an empirical lens in this study al-
lowed the researchers to access the complexity of participants’ fly-fishing experiences
and explore their perceptions of its role in coping with PTSD.
A common phenomenological data collection method is the individualized in-
depth interview, which is designed to explore essential essence of phenomena (Webb
& Kevern, 2001). While a focus group strategy is less common, and some would say
“incompatible” with the underlying philosophy of phenomenology (Webb & Kevern, p.
800), Bradbury-Jones, Sambrook, and Irvine (2009) suggest focus groups are a relevant
format through which “an individual lived experience can be preserved within a group
context” (p. 667). They argue that focus groups within a phenomenological framework
may actually be more beneficial than individual interviews because they stimulate dis-
cussion, open up new perspectives among group members, and are useful for clarifica-
tion and cross-checking participants’ responses in real time. Further, data are said to
be enriched in focus groups as a result of hearing each other’s stories to which group
members can add their own perspectives and insights. Focus group discussions explore
specific topics and participant opinions in a non-threatening environment, revealing
not only what participants think, but also the reasons behind their attitudes and be-
haviors (Krueger, 1994). The group setting provides time for reflection while others are
speaking, which can serve to validate the points as being shared experiences (Cote-
Arsenault & Morrison-Beedy, 2001).
In this study, a focus group method within a phenomenological framework was
used to collect data during the course of two naturally occurring PHWFF events in-
volving veterans and active duty military personnel with PTSD in the northeast region
of the U.S. Mini focus groups (Krueger, 1994) were used to accommodate a small-
er number of participants, so that each participant had opportunities to contribute
unique perspectives about their military experiences, their PTSD symptoms, and the
meaning of fly-fishing in their lives.
Setting
The Project Healing Waters Fly-Fishing program (PHWFF) is a year-round, vol-
unteer-led, nonprofit corporation dedicated to the physical and psychological reha-
bilitation of wounded active duty military personnel and veterans through fly-fishing,
fly-tying education, fly-fishing trips that range from one to five days, and outdoor ex-
cursions (PHWFF, n.d.). The organization comprises 230 programs across the U.S. and
relies on experienced volunteer fly fishers and guides from Fly Fishers International,
Trout Unlimited, and independent fly-fishing clubs to conduct the program at VA
Medical Centers, DoD Medical Centers, and Warrior Transition Units. Recreational
therapists from inpatient units and outpatient clinics at VA Medical Centers and/or
from community-based TR programs working with veterans and military personnel
partner with PHWFF by providing patient referrals, supporting weekly sessions and
fly-fishing expeditions, designing adaptive equipment, and assisting with access issues.
PHWFF provides classes and clinics on fly-fishing, casting, tying, and rod build-
ing for beginners and those with experience who are adapting their skills to their new
abilities. Fly-fishing tackle, fly-tying materials and equipment are provided, including
accommodations for those with specific needs. All services are provided at no cost to
eligible participants. Participants include veterans and active guard and reserve mili-
tary personnel with disabilities from all conflict eras. PHWFF attempts to create col-

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laborative, cooperative, trusting and caring experiences to enhance community reinte-

gration and quality of life by employing peer mentoring, experiential learning, outdoor
education and group interactions. Nationwide, the program served 8,593 veterans and
wounded military personnel in 2019 (PHWFF, n.d.).
Selection of Sample
This study was approved by the University’s Institutional Review Board. Research-
ers used a criterion sampling procedure to invite veterans and military personnel with
PTSD from PHWFF’s northeast region to participate in focus groups. Participants were
recruited based on four essential criteria: (1) were male and female adults who were
either veterans, or active duty military personnel engaged in the medical separation
process; (2) presented with a service-connected PTSD disability rating as diagnosed by
the VA; (3) were participants in the northeast region of the PHWFF program; and (4)
had previously completed PHWFF classroom and/or water environment sessions as
“repeat” or new participants.
The PHWFF Northeast Regional Coordinator emailed a recruitment flyer to par-
ticipants on the regional mailing list. Contact information from interested participants
was forwarded to the second author, who then reached out to interested participants
via email to share details regarding the purpose of the study, informed consent proce-
dures, and logistics for the focus group meetings. Nine participants (two females, seven
males) agreed to participate in the study.
Data Collection
Qualitative data were collected, including transcripts and field notes, from two
separate focus groups. The second author, who is a veteran who has fly-fishing expe-
rience and personal knowledge of PTSD, conducted the focus groups and took field
notes at the conclusion of each group. The focus groups took place during two separate,
naturally occurring PHWFF program events. The focus groups were 90 minutes in du-
ration, were audio taped, and later transcribed verbatim. The transcripts were mailed
to the participants as a member check to verify the accuracy of their responses; none
of the participants requested changes to or clarification in the transcripts. The focus
group facilitator documented observations, impressions, and reflections at the conclu-
sion of each focus group: These field notes were subsequently used to supplement data
analysis. Pseudonyms were created to protect participant anonymity.

Instrumentation
The semi-structured focus group interview tool was designed to elicit discussion
about the meaning of fly-fishing, and ways in which fly-fishing had influenced partici-
pants’ ability to manage and cope with PTSD symptoms. The interview tool included
25 topical questions with probing follow-up questions as needed. Topics included, but
were not limited to: (a) meaning of fly-fishing in participants’ lives; (b) ways in which
fly-fishing impacted function across physical, social, emotional/psychological, cogni-
tive, and spiritual domains; and (c) perspectives about how fly-fishing influenced their
coping processes. To address the issue of authenticity, the interview tool was developed
through a literature review on the role of CIH approaches in the treatment of veteran
and military populations with PTSD (Kearney et al., 2012; NCCIH, 2015; Tan et al.,
2010). Further, the PHWFF Northeast Regional Program Coordinator, and a Program
Leader from a regional PHWFF program not included in the study, reviewed the focus

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group tool for relevance and accuracy, and their input was incorporated into the final
interview tool, which was used across both focus groups.
Data Analysis
Analysis relied on focus group transcripts and supplemental field notes as dis-
cussed in the previous section. Four researchers independently reviewed each focus
group transcript by reading and re-reading the text to gain an inductive understanding
of “the whole,” or what the data were suggesting. The researchers then independently
coded the transcripts by breaking them down into manageable segments and identify-
ing, labeling, and naming those segments. Researchers individually condensed those
segments into descriptive categories based on valid inference and interpretation, and
then met as a team over the course of six meetings to simultaneously define and refine
the categories. Utilizing the constant comparative method (Glaser & Strauss, 1967),
researchers compared and contrasted each new segment of data to the existing catego-
ries, and if the new coded data was an appropriate fit with an existing category, it was
placed in that category. Conversely, if the new coded data was an inappropriate fit with
an existing category, then the researchers either redefined a category or created a new
category until all of the data were labeled. The researchers created a master codebook
using Excel and conducted analysis within each focus group, and then between the
two focus groups. Thematic findings represent pooled analyses between the two focus
group cohorts.
Creswell and Creswell’s (2018) primary verification procedures for credibility, re-
liability, and authenticity were employed, as the researchers thoroughly triangulated
their descriptions and interpretations with each other during the analysis stage. This
debriefing process enabled the researchers to utilize multiple perspectives and meth-
ods to corroborate the findings, which added credibility to the interpretation process.
The salient categories that resulted from the constant comparative method led to the
development of four prominent themes describing participant perspectives about the
meaning of fly-fishing.

Findings
Participants
Participants included seven males and two females (n = 9) who ranged in age from
28-68 (M =47) and had between <1-5 years of experience (M =3) as a participant in
the PHWFF program (see Table 1). The first focus group was conducted with five par-
ticipants during a field trip to a fly-fishing vendor show in the northeast region of the
U.S. The five participants (three males, two females) in this focus group were veterans
from the Army (n = 4) and Marines (n=1) who served in Desert Storm, Post 9/11, and
Vietnam conflicts. These five participants were familiar with each other through their
involvement in an urban-based PHWFF group in the northeast region of the U.S. The
second focus group was conducted during a fly-tying event that took place at a com-
mercial outdoor business with four participants from a Military Transition Unit in
the northeast region of the U.S. The four participants in this group were active duty
military personnel from the Army (Post-9/11 wars) who were in the process of being
medically separated from their units as a result of injury and, thus, they were less fa-
miliar with each other.
Seven of the nine total study participants held “Participant” roles in the PHWFF
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program, and two of the nine held “Program Lead” roles, which means they served as
volunteer leaders in a specific PHWFF group. The process of progressing from a “Par-
ticipant” role to a “Program Lead” role happens over time. If participants are observed
by other Program Leads to have innate leadership skills, strong commitment, dedica-
tion, and fly-fishing acumen, they are invited to serve as a “Deputy Program Lead” for a
specified amount of time under the guidance of a Program Lead, before being assigned
to lead their own group.

Table 1
Participant Profiles
Pseudonym Gender Age Branch/Era Time in PHWFF
Program Program Role
Laura Female 53 Army (Desert 3 years Participant
Storm)
Yvette Female 49 Army (Desert 3 years Participant
Storm)
Owen Male 28 Army (Post 9/11) 1 year Participant
Brent Male 68 Marines (Vietnam) 5 years Participant
Larry Male 68 Army (Vietnam) 4 years Participant
Elliott Male 44 Army (Post 9/11) 3 years Participant
Active Duty
Roger Male 38 Army (Post 9/11) 2 years Program Lead
Active Duty
Mack Male 42 Army (Post 9/11) 4 years Program Lead
Active Duty
Johnny Male 31 Army (Post 9/11) < 1 year Participant
Active Duty

Thematic Findings
Four themes were constructed from the data, suggesting fly-fishing: (a) facilitates
positive mood and buffers the negative impact of PTSD; (b) sustains coping effort and
commitment by generating motivation and providing challenge; (c) facilitates healing
by restoring control, fostering connections, and creating hope for the future; and (d)
helps move participants toward personal transformation and posttraumatic growth.
Theme I: Fly-fishing Facilitates Positive Mood and Buffers the Negative
Impact of PTSD
Free Self from Stress, Distraction/Diversion.A number of participants acknowl-
edged the calming effects of fly-fishing on their anxiety symptoms and valued its influ-
ence on their ability to “decompress” from everyday stressors. For Larry, a 68-year-old
Army veteran, fly-fishing provides a necessary respite from the stress of everyday life:
“It helps you relax, to unwind…it puts you in a better frame of mind…it’s just tranquil.”
Mack, a 42-year-old active duty soldier who was in the process of being medically sepa-
rated from his Army unit, shared similar sentiments about the influence of the peaceful

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fly-fishing environment on his mood: “It’s hard to explain to people the tranquility of
just being on a stream. It doesn’t matter if I’m fishing, or just trying to see what kind
of bugs are on the water; it’s just that feeling of peace and quiet.” Johnny, a 31-year-
old who had recently medically separated from his Army unit, shared that fly-fishing
helped distract him from ruminative thoughts, “A lot of people have problems with
dwelling on the past. [Fly-fishing] gives me something to do…it keeps me occupied so
I’m not thinking about that stuff on a daily basis. It helps relieve stress and its peaceful
to me.”
Positive Mood. This “quieting” characterization was prominent for participants in
different ways. Yvette, a 49-year-old Army veteran who has been participating in the
PHWFF program for three years, described the soothing feelings associated with the
casting aspect of fly-fishing, noting: “It definitely helps me with my anxiety; just cast-
ing, alone in itself. And, just knowing, I’ve got to get better, I’ve got to go further…it’s
a soothing thing, it helps you just calm down within because you don’t have to rush it.”
Owen, a 28-year-old Army veteran, shared his ability to transfer the peaceful feelings
he experienced through fly-fishing to other life situations in which he felt anxious and
out of control. He noted,

I close my eyes and just remember the tranquility, the sound of the river, the
light shining, and the fish fighting. When I’m in a place where I just want to
smash everything, and I can’t breathe, I just think of that and can hear the
river again, it calms me down. The sounds of nature will calm you down, but I
didn’t know that, because most the time when I saw nature, we were blowing
it up. But now it’s a whole different ballgame.

For some, fly-fishing served as a substitute for medication, or helped reduce reli-
ance on medication for symptom management. Brent, a 68-year-old Vietnam veteran,
viewed casting and fly-tying as a substitute for his medication: “The stress immediately
melts when you’re casting. It’s taught me a great deal. If I get uptight, I’ll start tying flies
at home, just like it’s medication. It’s my vice, my medication. I don’t care if I even catch
any fish.” Owen described fly-tying as a more effective alternative for anxiety manage-
ment than his prescribed medications,

I take the maximum dose of medications you can take. But nothing calms me
down more than tying something. I get these reactions where I start throwing
up, I get dizzy, I just want to smash things or just want to lay down and sleep
the rest of my life. But instead of popping a pill, I’ll tie a copper john.

Mood Regulation and Expression of Feelings. For some participants, fly-fishing

fostered an awareness of challenges associated with mood regulation, a common symp-
tom of PTSD (APA, 2017). This was true for Yvette, who shared that fly-fishing helped
her learn how to recognize and express her feelings, which led to self-reflection about
her adjustment:

I remember that black heart, where I couldn’t go this way or that way. My fam-
ily didn’t understand me. Art helped me to express those feelings, but when I
started fly-fishing, I was like THIS is for that. So with every cast, I am thinking
about why my family is not understanding, and I wish they could see me now.
It helped me to really talk through for myself.
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Owen indicated that fly-fishing helped him recognize signs of emotional numb-
ing, and helped him remember what it meant to feel good again: “It reminds me of
what I’m capable of feeling like. You forget what is was like before, and then you are
fishing on the river and you know what’s possible again. It gives me the opportunity to
peek at what I’m capable of feeling like all the time.”
Theme II. Fly-fishing Sustains Coping Effort and Commitment by Generat-
ing Motivation and Providing Challenge
Participants described problem-based outcomes of fly-fishing in terms of being
better able to manage their PTSD symptoms and being able to cognitively reappraise
and restructure perceptions of stress. They described ways in which fly-fishing helped
them sustain coping effort in the face of stress by generating motivation, introducing
challenge, and developing new skills.
Improved Patience and Concentration. Fly-tying emerged as an important task
through which participants were able to develop patience and concentration which
they viewed as critical for stress management. For Elliott, a 44-year-old Army veter-
an, fly-tying was instrumental in helping him improve those key skills: “When I first
got back from Iraq, I didn’t have any patience at all, my concentration wasn’t there…I
couldn’t tie a fly. Now, with fly-fishing, I’m probably more patient than I have been in a
long time.” Mack shared a similar sentiment as he talked about how fly-tying and cast-
ing required him to pay attention, which he described as integral in helping him man-
age stress: “Fly tying and casting definitely helps with my patience. I’m not a patient
person, which can cause stress and anger for myself and others. I had to learn to slow
down and really pay attention to that stuff. I don’t get anxious now.”
Generating Motivation. Debilitating PTSD symptoms such as depression and
fatigue can strip away one’s motivation and desire to engage in life activities (APA,
2017). Finding new pathways that foster motivation to participate in life activities is
important and, as participant comments illustrate, fly-fishing appears to be an effective
mechanism through which to achieve this outcome. For example, Johnny commented
on the challenge of his transition from full-time work in the military to retirement, and
viewed his participation in PHWFF program as a constructive way to fill that void: “…
once I retired, I didn’t have anything to do, I didn’t have a job, I moved away and left
all of my military buddies…so it just gives you something to do so that you’re not just
dwelling on bad things; it’s a positive thing for you to do.” Laura, a 53-year-old Army
veteran from Desert Storm, shared a renewed level of motivation across multiple set-
tings as a result of her involvement in the program: “Ever since I’ve been in the PHWFF
program, I’ve been getting up earlier every day, and I’m motivated to do things. I joined
AMVETS [American Veterans National Service Foundation]. I am motivated to do so
many things now - I volunteer at the hospital.” Larry shared a similar sentiment: “Be-
cause of PHWFF, I get out of bed.”
Challenge. The military experience offers numerous situations in which individu-
als face significant physical, mental, and psychological challenges. Although prolonged
exposure to such stressors has been shown to negatively impact military personnel
(Fulton et al., 2015), these experiences can also be catalysts for growth, as they pres-
ent opportunities for shaping one’s resilience and course of action through adversity.
Once discharged from service, however, veterans may not find adequate substitutions
that can mirror these types of challenges outside of the military context. Participants

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pointed to fly-fishing as one potential avenue to again experience that sense of chal-
lenge. Fly-fishing requires a diverse skill set, including selection and management of
fishing tackle, knot tying and leader construction, insect identification and creative
fly-tying, rod building, casting technique, and reading the complex flow of water and
behavior of the fish. For Roger, a 38-year-old who had participated in PHWFF for
two years as he completed the medical separation process from the Army, fly-fishing
filled that challenge void across many different areas of life: “I’m trying to tie a fly and
I’m concentrating so much on getting that right that I’m not dwelling on other things.
Every aspect of it is about learning new skills, concentration, and it’s all really coming
together.” Laura’s comment reflects the need for commitment in the PHWFF program,
which appears to parallel the type of commitment required for the military context:
“It’s just not like the one-time experience you get in some programs. You have to earn
that rod, you just don’t come and get it. They have to see that you are really interested
and you have been coming for a while.”
Theme III. Fly-fishing Facilitates Healing by Restoring Control, Fostering
Connections, and Creating Hope for the Future
Participants described fly-fishing as a bridge toward self-restoration by providing
opportunities to regain control in their lives, helping them feel connected to others and
nature, and creating hope for the future.
Restoring Control. Participants noted that fly-fishing helped restore a sense of
control in their lives. That was true for Laura, who described a renewed sense of control
as she was able to progress from being a PHWFF participant to a volunteer:

Sometimes, it just feels like you have no control over your life, like this thing
is eating you up from the inside and there’s nothing you can do about it. But
then I volunteered to run a tying class. I went from a participant to a volun-
teer. That makes me look in the mirror and is something I am proud of.

Fostering Connections through Shared Experiences. Participants shared how

finding a group of people that enjoyed doing the same things together gave them a
renewed sense of inclusion and connection to others and provided socialization and
bonding opportunities. Elliott described his connection with other members of the
PHWFF group this way: “…it’s a bunch of guys you normally wouldn’t even know,
and you wind up becoming fishing partners.” Roger shared this about what it means
to socialize with others through fly-fishing: “I didn’t know anybody. I just moved from
a different post and met people who had been through similar experiences. You bond
with different people and, once on the river, you talk about stuff. It serves as an outlet
for that kind of thing.” Owen stated that he doesn’t participate in fly-fishing to catch
fish, but rather to connect with others: “Fly-fishing breaks down a lot of barriers, and
makes you feel like you’re not alone…it’s a big network, and a mentorship. For me, it’s
not about the fishing at all. I love to catch fish, but I don’t go to fish at all, I go to see
everybody.”
Notably, many participants identified the greatest benefit of these new connections
was being able to share, learn and grow with others while fly-fishing. Owen stated, “...
we feed off of each other, on the healing aspect because some of us are on different
levels of past healing, and so we can give each other shortcuts and stuff.” Laura shared
this, “We got friends here…we have a common bond out there.” Elliot summarized
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the value of the shared experience in this way, “…you know everybody is in the same
boat...this is my family.” For others, fly-fishing was integral in helping them reconnect
with the outdoors. This was evident for Brent, who made the observation, “I find you
become more in contact with the environment…you learn about the environment…it
makes you conscious of the environment.” Yvette also contemplated the natural envi-
ronment in her coping process, “Everything about it is so—I’m not going to say divine
—but it’s just natural, just being around the water and the trees. And it helps you cope
even when you’re stuck. I was so stuck.”
Creating Hope for the Future. Participants described a renewed sense of excite-
ment and optimism about the future as a result of their fly-fishing experiences. This re-
newal was a welcomed change from the negativity that tended to dominate their daily
thoughts and emotions. Larry shared this, “You are looking forward to the next trip,
and you want one every week.” Owen’s renewed optimism helped him put challenges
into perspective: “I may have a bad week or two, but tell myself Friday is a casting ses-
sion which helps me get through the day. I can deal with a few bad days because there
is going to be one day I can go fishing.” For Roger, the anticipatory nature of catching
fish seemed to be an apt metaphor for renewing optimism and hope in his life: “Fly-
fishing gives me something to look forward to and with every cast, I have hope that
something’s going to happen…I came from a place where I didn’t think there was hope
for anything.”
Theme IV. Fly-fishing Helps Move Participants Toward Personal Transfor-
mation and Posttraumatic Growth
Participants expressed how fly-fishing helped them to begin forging a path to-
wards self-restoration and personal transformation. Owen talked about how fly-fishing
impacted how he viewed himself noting, “I feel like I do love myself. I love fishing and
I just feel happy and relaxed and peaceful. I got one thought in my head, not a million.”
Laura suggested that fly-fishing helped her learn how to take care of herself: “With fly-
fishing, you have something you take on forever, you can take it with you. They don’t
come and feed you but teach you how to fish and feed yourself.” She went on to describe
that metaphor in the context of her life goals,

It gives you back life. It did that for me. It’s not that you want to die, it’s just
like “oh, the heck with it”…it’s just what happens; now you tie this [fly], now I
can do that. It’s your real life now, you can manage your PTS[D] now that you
have goals, and you can see short-term goals.

Yvette similarly described a sense of pride when she was able to share knowledge
of fly-fishing with others. Her comment hints at a re-visioning of her “self ” in this
process:

You don’t have a lot of proud moments in your life, so when you can talk
about fly-fishing, that gives you a lot of pride. And you feel like you can take
this back to somebody and say, hey, I’m making advances here, I’m finding
something positive, I am just a different kind of person when I am here. I
suffer from frozen shoulder and all the back and legs issues, but none of that
bothers me when I am here. It just takes me to a different zone. It is like I am
a whole person.

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 Craig, Alger, Bennett, and Martin

Yvette summarized her thoughts by sharing this powerful insight about the
transformative potential of fly-fishing: “It ain’t about the fishing. It’s about where
it takes you and how it can reform you and make you over and help you get out
of a rut, and just try. It’ll transform you. It helped me to be more complete.”

Discussion
Fly-fishing appears to be an effective coping resource that can activate the
coping process and facilitate engagement in life rather than self-imposed isola-
tion for veterans and military personnel with PTSD. The meanings that par-
ticipants ascribe to fly-fishing align with Kleiber et al.’s (2002, 2008) underlying
theoretical propositions explaining how leisure can assist with the stress-coping
process. This alignment supported the development of a new conceptual model
(see Figure 1), which is used to frame this discussion.

Figure 1
Conceptual Model of Fly-Fishing as a Coping Resource for Veterans and Military
with PTSD

NEGATIVE LIFE EVENTS

PTSD
Disrupts Life Across Multiple Health Domains
Physical Spiritual

Social Cognitive
Emotional

COPING PROCESS

Emotion-Based Coping Problem-Based Coping

happen
Mood, Affect Cognitive Appraisal & Reappraisal
together
(positively toned emotions) (restructure perceptions of stress)

LEISURE AS COPING RESOURCE

Fly-Fishing

BREATHERS SUSTAINERS RESTORERS

- free self from stress - improve - restore control
- distraction/diversion patience & - fosters
- positive mood concentration connections
- pleasurable events & - generate - hope for future
activities motivation
- challenge

Move veterans & military personnel

with PTSD
toward personal
transformation

POSTTRAUMATIC GROWTH
164

Figure 1. Conceptual Model of Fly-Fishing as a Coping Resource for Veterans and Military with PTSD
 Fly-fishing for Veterans and Military Personnel

Consistent with the buffering role of leisure in the stress-coping process, par-
ticipants articulated positive emotional and cognitive changes as a result of their fly-
fishing experiences. As reflected in Figure 1, these findings reinforce the notion that
a leisure experience, such as fly-fishing, can be a critical self-protective resource for
emotion-focused and problem-focused coping with negative life events, such as PTSD,
and that such experiences may serve as the foundation for personal transformation
(Kleiber et al., 2008). As depicted in the top portion of Figure 1, a negative life event
such as PTSD may produce myriad disruptions across multiple functional domains.
Instead of demonstrating avoidant behavior, acting reactively, or disassociating when
encountering challenging situations, veterans and military personnel with PTSD need
to find new ways to actively cope by tapping emotion-and problem-based processes
(Benedek & Wynn, 2016).
As depicted in the first circle in the middle section of Figure 1, Theme I findings
support Kleiber et al.’s (2008) proposition that fly-fishing can be used as a self-protec-
tive resource, or breather (p. 322), for individuals who have experienced a negative life
event by freeing themselves from stress, diverting attention away from the negative
symptoms through distraction, and providing opportunities to experience pleasure
and positive mood states. Participants reported that the calming nature of fly-fishing
helped buffer the negative effects of their symptoms by providing an opportunity to ex-
perience a sense of peace, contentment, and tranquility. Many participants were able to
verbalize and name their distress, suggesting that when engaged in fly-fishing activities
they were able to reduce the intensity and duration of symptoms. Participants viewed
fly-fishing as a welcomed respite from their stress symptoms, as it diverted attention
away from intrusive, negative thoughts and feelings. Some even noted a decreased need
for medications to manage PTSD symptoms. This temporary suspension of attention
provided participants with enough distance and space to allow positive emotions and
thoughts to emerge, which subsequently led to greater emotional awareness and ex-
pression.
As depicted in the middle circle in the middle section of Figure 1, Theme II find-
ings suggest fly-fishing can have a positive impact on problem-based coping, as it helps
generate motivation and commitment while concurrently providing challenge. This
finding aligns with Kleiber et al.’s (2008) proposition that leisure can generate and sus-
tain (p. 323) a sense of optimism, excitement, and hope for the future, thus allowing the
individual to cope with their present situation. Participants appeared to value the in-
herent challenges presented by fly-fishing, and appreciated the opportunity to develop
skills in casting and fly-tying, while simultaneously developing functional skills such
as concentration and patience. While challenge may have been perceived as stress-
ful in the past, fly-fishing helped participants cognitively reappraise and restructure
these perceptions. As participants moved away from avoidance behaviors in relation
to stress, and towards the consideration of alternative possibilities in their lives, they
began to experience a shift in their understanding of ‘self.’ Fly-fishing appeared to help
them sustain positive forward progress as they adapted to their PTSD.
As depicted in the last circle in the middle section of Figure 1, Theme III find-
ings suggest fly-fishing has the potential to help participants regain control, experience
social connections with others and the outdoors, and experience hope for the future.
This finding aligns with Kleiber et al.’s (2008) proposition that leisure can restore (p.
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 Craig, Alger, Bennett, and Martin

323) some aspects of the self by restoring hope, making connections with others, and
reconstructing one’s life story that is connected with the past. The inherent challenges
associated with fly-fishing offered participants a renewed sense of self-worth and em-
powerment as they viewed themselves as having the tools to face these challenges, and
in some cases, master them. This sense of control is an important feature while coping
with crisis (Hasson-Ohayon et al., 2006), as it enables one to cope as an active agent
rather than as a passive and detached by-stander.
As further depicted in the last circle in the middle section of Figure 1, partici-
pants also acknowledged that the social connections and fellowship they developed
with each other were critical for their sense of coherence. Being together with a group
of people with similar concerns and interests appears to contribute to the solidarity
that arises between them and has the potential to move them out of isolation and back
into society. Learning to fly-fish by attending meetings for group instruction in vari-
ous skill development areas including casting, fly-tying, insect identification, and over-
night outings rekindled the bonds forged during their time in military service. One
significant difference, of course, is that fly-fishing occurs in environments that tend
to be pristine, beautiful, and safe, where the conflict simply involves “fighting a fish”
at the end of the fly-line. The expanding repertoire of shared experiences and what is
learned in the process represents the therapeutic outcome of this group participation.
Some participants noted the shared experience extended beyond fly-fishing sessions to
include helping fellow members move, carpooling to field trips, volunteering to teach
skills courses to others, visiting each other when sick or in the hospital, and generally
“taking care of each other.”
Findings from Theme IV suggest that collectively, the breathers, sustainers, and
restorers show promise in helping veterans and military personnel with PTSD move
toward personal transformation and posttraumatic growth, as depicted in the bottom
section of Figure 1. This finding aligns with Kleiber et al.’s (2008) proposition that lei-
sure can serve as a context for personal transformation (p. 324) as it facilitates positive
emotions and appreciation of life, which helps individuals realize their full potential.
Positive interactions and successes in the PHWFF program allowed participants to
start seeing themselves in a different way and gave them an opportunity to start re-
constructing their own story, which is an important step toward posttraumatic growth
(Tedeschi & Calhoun, 1996). A number of participants engaged in self-reflection about
who they were becoming and shared the pride they experienced in this growth pro-
cess. Some even offered to “pay it forward” by serving as a volunteer Program Lead for
other members in the PHWFF program who did not yet have the requisite background
and skills to succeed in fly-fishing. This movement is represented by the green arrows
emerging from the PTG outcome depicted at the bottom of Figure 1. As participants
experienced PTG, they felt empowered to assume a new role in the fly-fishing program
—that of a leader, mentor, and coach who could instruct, support, and help shape the
next cohort of fly-fishers. Achieving psychosocial stability appeared to be dependent
on participants’ recognition and appreciation of their existing abilities, which helped
them begin reconstructing a coherent narrative about who they are post-injury. Find-
ings suggest that fly-fishing has the potential to contribute to this process of personal
transformation and fulfillment of one’s potential, thus leading to posttraumatic growth.
This phenomenological study adds to the literature by demonstrating that nature-
based recreation, such as fly-fishing, can create a healing environment that can pro-
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 Fly-fishing for Veterans and Military Personnel

mote a return to healthy activity and personal transformation for veterans and military
personnel with PTSD. Fly-fishing provides a dramatic distinction between the trials
of combat and the calming effects of sharing natural environments with like-minded
companions in pursuit of elusive wild fish. Developing skills in casting and fly-tying
offers an opportunity to practice skills and adjust to current abilities. These activities
rekindle and enhance participants’ appreciation and enthusiasm for recreational activi-
ties while also encouraging socialization, a sense of belonging, hope, and the ability to
appreciate and enjoy life.
Limitations
This study has several limitations. Although generalizability is typically not sought
in qualitative research, this study included a small sample of PHWFF participants from
the northeast region of the U.S. and thus, findings only represent their perspectives.
Selection bias may also be a limitation, as it is possible that only PHWFF members
who already felt they had made gains as a result of their fly-fishing experience volun-
teered to participate in the study. Most participants were male, and primarily repre-
sented the U.S. Army, which may also influence the findings. Further, limited access
to demographic data of the sample, such as years of military service and the number
of deployments, prevented a full understanding of the context in which participants
served. Additionally, the focus groups took place during two different types of PHWFF
events, which may have influenced how comfortable participants felt disclosing sensi-
tive details about their PTSD symptoms. Sharing PTSD concerns in a focus group set-
ting is not easy and may have lead participants to report that they are doing well when
in reality they might be struggling with emotional issues. Choosing a qualitative design
to gain a deeper understanding of these sensitive issues was a logical methodological
decision to address this limitation; however, participant responses may have been un-
duly influenced by the ‘group think’ dynamic, or by social desirability. Further, because
the PHWFF program is primarily run by volunteers and fly-fishing experts who donate
their time, program delivery structures and curricula may have varied between the two
different focus groups, leading to qualitatively different experiences.
Future Research
Although qualitative research designs do not allow us to conclude that fly-fish-
ing was responsible for the noted changes in PTSD symptoms among participants,
this nature-based activity does show promise as a viable therapeutic approach for this
population, and continued research on its efficacy is warranted. The next logical step
would be an experimental design of a fly-fishing program for the treatment of PTSD
among this population. Such an investigation should include a sufficient sample size,
consistent structure and delivery of the fly-fishing intervention/program (fidelity), and
a standardized measurement tool designed to assess PTSD symptoms, as well as as-
sociated behavioral and emotional symptoms. Future studies should attempt to de-
termine which specific components of the PHWFF program are most influential in
effecting change. Lastly, while the researchers decided to pool the analyses of the two
focus group datasets for convenience of time, future research may consider examining
the difference and similarities between participants from Warrior Transition Units and
veteran-only groups.

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 Craig, Alger, Bennett, and Martin

Implications for TR Practice

The VA and DoD’s shift toward an aspirational approach to health recognizes
that individual interests and motivations are drivers for behaviors that improve health
among veterans and military personnel (NCCIH, 2015). Although fly-fishing is not
currently considered a first-line treatment for PTSD among this population, it does
appear to be a viable CIH approach that can be used in TR and recreation settings
to achieve important client outcomes. RTs use purposeful recreation to facilitate in-
creased access to community resources, and individual strengths and skills that sup-
port well-being across multiple health domains (Anderson & Heyne, 2012). Within
this context, treatment involves participation and engagement in a variety of person-
ally and culturally relevant recreation activities (e.g., fitness, sports, outdoor pursuits,
cultural arts, aquatics, animal-based therapies) that support health, social connections,
and reinforce positive aspects of one’s self and values (Iwasaki, Coyle, & Shank, 2010).
Strengths-based, recovery-oriented strategies are identified as the current standard of
care for the treatment of individuals with mental health disorders such as PTSD, de-
pression, and anxiety (National Alliance on Mental Illness, n.d.).
As findings from this study suggest, nature-based recreation approaches may serve
as a rich training ground for strengthening coping responses and functional changes
among our clients who have experienced trauma. The potential of nature-based ap-
proaches, ranging from gardens to wilderness therapy, is highlighted as a therapeutic
resource in TR as they provide opportunities for reflection and personal restoration.
TR professionals should be aware, however, that our clients who have experienced
trauma might need additional supports and opportunities to apply and generalize
newly learned understandings and skills in their daily lives. Lastly, these findings sup-
port the continued development and expansion of nature-based recreation programs
like PHWFF that provide continuous, ongoing opportunities, rather than programs
and events that provide limited one-time experiences.

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