Medical Research Study Summary
ROR’s Philosophy:
Rivers of Recovery (ROR) is dedicated to the welfare and future of our nation’s veterans. ROR provides a biological, social and psychological environment designed to improve self image and social skills while reinforcing optimism, resiliency and self-determination.
A review of our “Testimonials” page reveals the incredible successes our participants have achieved. However, as a popular phrase states: “The proof is in the pudding.” In the case of recreational rehabilitation, the proof lies in scientific results. This research study was conducted in 2009 by researchers at the University of Southern Maine, the University of Utah and the Salt Lake City VA.
Results:
Demographics Summary
Sample Size: 28 Veterans (25 men, 3 women; M = 45 yrs, SD = 12.76yrs)
Inclusionary/Exclusionary Criteria: All veterans served in a foreign country at some point during their military careers and demonstrated a confirmed diagnosis of Post-Traumatic Stress Disorder (PTSD; n = 27) or exhibited a clinically relevant score on the PTSD check list (Military Version; n = 1). Dual diagnosis of PTSD/traumatic brain injury (n = 5) or PTSD/major depressive disorder (n = 18) was permitted due to the high co-morbidity rates of these psychopathologies; however, veterans were excluded on the basis of substance abuse disorders or any other Axis II diagnosis from the Diagnostic and Statistical Manual (IV).
Of the 28 veterans, 21 (75%) identified themselves as Caucasian, and 23 (78.6%) reported education beyond a high school diploma or equivalent. Most of the veterans served in the U.S. Army (n = 19; 70%), with the remaining veterans having served in the U.S. Army National Guard (n = 4), Marines (n = 3) or Navy (n = 2).
Procedures
The current study represents a within subjects longitudinal investigation on the efficacy of the Rivers of Recovery Program, a non-profit organization dedicated to stress reduction for combat veterans with PTSD through participation in a 2 day, 3 night residential fly fishing retreat off the Green River in Northern Utah. Program participants underwent repeated psychosocial assessments of mood, depression, anxiety, and somatic symptoms of stress across three time periods, corresponding to 2 weeks prior to the fly fishing excursion (baseline), the last day of the fly fishing retreat, and a 6 week follow up assessment. Additional psychosocial assessments of perceptual stress, PTSD symptoms, and sleep quality were administered during the baseline and follow up periods. Participants also underwent repeated physiological assessments of stress responding during the fly fishing retreat via sampling of salivary cortisol, urinary catecholamines (e.g., epinephrine and norepinephrine) and immune function (salivary immunoglobulins). We hypothesized that participation in the fly fishing retreat would be linked to significant and sustained improvement in psychosocial well being, as evidenced in improved mood states and sleep quality, and reduced depression, anxiety, and PTSD symptoms. Further, it was hypothesized that retreat participants would display significant reductions in stress hormone responding (e.g., lower cortisol responses throughout the day) and improved immune function (e.g., increases in salivary immunoglobulins).
Psychosocial Results
Analytic Strategy
Multivariate repeated measures analyses of variance (MANOVA’s) with Bonferroni post hoc analyses evaluated significant changes in mood states, depression, anxiety, and somatic stress across the three time periods of assessment. Mood was measured using the Positive Affect and Negative Affect Schedule, a commonly used inventory that assesses mood states experienced in the past week. The Brief Symptom Inventory was used to assess depression, anxiety, and somatic stress in the past week.
The inventories corresponding to perceptual stress (Perceptual Stress Scale), PTSD symptoms (PTSD Checklist, Military Version), and sleep quality (Pittsburgh Sleep Quality Inventory) pertain to self reported experiences from the past month, and so were administered at the baseline and follow up assessment periods. For all three inventories, lower scores reflect improvement: less stress, fewer PTSD symptoms, and enhanced sleep quality, respectively. Paired sample T-tests were used to assess significant reductions on these measures between the baseline and follow up periods.
Question: Is the fly fishing retreat linked to significant improvement in perceptual stress, PTSD symptoms, and sleep quality?
Answer: Yes.
Perceptual Stress: t(21) = 2.73, p = .013; PSS scores displayed a significant reduction from Baseline (M = 24.18, SD = 6.87) to Follow Up (M = 21.05, SD = 7.09), representing a 13% reduction from the baseline score.
PTSD Symptoms: t(18) = 2.08, p = .052; PTSD scores displayed a marginally significant reduction from Baseline (M = 59.16, SD = 13.79) to Follow Up (M = 52.37, SD = 16.97), representing a 11% reduction in PTSD symptoms.
Sleep Quality: t(17) = 3.5, p = .003; PSQI scores showed a significant reduction from Baseline (M = 14.61, SD = 3.99) to Follow Up (M = 12.11, SD = 4.04), representing a 17% reduction from the baseline sleep quality score.
Although these initial findings may appear relatively modest in magnitude, it is quite encouraging to observe significant improvements on these inventories based upon such a brief intervention in a small sample size. Moreover, these scales are predictive of health outcome over time, so the significant findings may be regarded as having meaningful implications that merit replication in a larger sample.
Question: Is the fly fishing retreat linked to significant reductions in Anxiety, Depression, and Somatic Symptoms of Stress as measured through the Brief Symptom Inventory (BSI)?
Answer: Yes.
MANOVA on Brief Symptom Inventory (Somatic Stress, Depression, Anxiety, and Total Score) was significant, F(6, 72) = 5.32, p < .001
Univariate Analyses:
Overall Score, F(2, 38) = 19.51, p < .001
Somatic Stress, F(2, 38) = 12.82, p < .001
Depression, F(2, 38) =16.03, p < .001
Anxiety, F(2, 38) = 14.5, p < .001
Figure 1.0. This figure illustrates signficant and sustained reductions in overall BSI score: Baseline (M = 27.52, SD = 12.42); Day 3 (M = 10.85, SD = 8.39; 61% reduction from baseline); and Follow Up (M = 19.25, SD = 12.9; 30% reduction from baseline).
Figure 2.0. This figure depicts the BSI Subscale results. First, the fly fishing trip was linked to signficant and sustained reductions in somatic stress (e.g., faintness, chest pains, nausea) from baseline (M = 7.1, SD = 4.7) to Day 3 (M = 3.15, SD = 3.12; 56% reduction from baseline) and the follow up assessment (M = 4.75, SD = 3.99; 33% reduction from baseline). Significant reductions were also observed for both depression (e.g., feelings of worthlessness, hopelessness, suicidal ideation) and anxiety (e.g., nervous, tense, panic) from baseline to Day 3 (Depression scores displayed a 68% reduction: Baseline M = 9.95, SD = 5.44 to Day 3 M = 3.15, SD = 3.10; Anxiety scores showed a 57% reduction: Baseline M = 10.48, SD = 5.36 to Day 3 M = 4.55, SD = 3.79).
These findings suggest that this brief fly fishing excursion amid peers is linked to significant reductions in depression, anxiety and somatic stress. Further, the effect on somatic stress endures to a 6 week follow up assessment.
Question: Is the fly fishing retreat predictive of significant reductions in negative mood states?
Answer: Yes.
MANOVA on Negative Moods (Guilt, Hostility, Fear, Sadness, and Overall Negative Affect) was significant, F(10, 64) = 3.32, p = .002
Univariate Analyses:
Guilt, F(2, 36) = 14.46, p < .001
Hostility, F(2, 36) = 13.07, p < .001
Fear, F(2, 36) = 8.4, p = .001
Sadness, F(2, 36) = 12.16, p < .001
Negative Affect, F(2, 36) = 15.93, p < .001
Figure 3.0. Encouraging results reveal significant and sustained reductions in feelings of guilt (e.g., ashamed, blameworthy, angry at self) from baseline (M = 17.1, SD = 6.4) to Day 3 (M = 9.4, SD = 3.02; 45% reduction from baseline) and the follow up assessment (M = 12.53, SD = 6.6; 27% reduction from baseline).
Figure 4.0. Results indicated fly fishing trip linked to an acute significant reduction in reports of hostility (e.g., scornful, irritable, loathing) from baseline (M = 15.95, SD = 5.92) to Day 3 (M = 8.63, SD = 2.61), representing a 49% reduction from baseline.
Figure 5.0. Results indicated fly fishing trip linked to an acute significant reduction in reports of fear (e.g., afraid, shaky, scared) from baseline (M = 15.95, SD = 5.62) to Day 3 (M = 10, SD = 3.29), representing a 37% reduction from baseline.
Figure 6.0. Results revealed the fly fishing trip to be linked to significant reductions in feelings of sadness (e.g., alone, blue, downhearted) from baseline (M = 14.21, SD = 4.55) to Day 3 (M = 8.16, SD = 2.46), representing a 43% reduction from baseline.
Figure 7.0. Results indicated significant reductions in negative affect (e.g., upset, nervous, jittery) from baseline (M = 27.74, SD = 8.94) to Day 3 (M = 16.05, SD = 4.66), representing a 42% reduction from baseline.
Question: Is the fly fishing retreat predictive of significant increases in positive mood states?
Answer: Yes.
MANOVA on positive moods (serenity, self assuredness, joviality, and general positive affect), F(8, 66) = 5.10, p < .001.
Univariate Analyses:
Serenity, F(2, 36) = 8.93, p = .001
Self Assured, F(2, 36) = 7.31, p = .002
Joviality, F(2, 36) = 21.14, p < .001
Overall Positive Affect, F(2, 36) = 9.27, p = .001
Figure 8.0. These findings suggest that participation in the fly fishing retreat was linked to acute increases in sensations of serenity (e.g., calm, relaxed, at ease). This figure displays significant increases in serenity from the baseline period (M = 7.21, SD = 2.46) to the Day 3 assessment (M = 10.05, SD = 3.25), representing a 39% increase from baseline.
Figure 9.0. Similar to the effects for the PANAS Serenity subscale, these findings suggest that the fly fishing retreat was also linked to significant increases in feelings of self assuredness (e.g., bold, confident, daring) from baseline (M = 13.84, SD = 5.4) to Day 3 (M = 17.32, SD = 5.81), representing a 25% increase from baseline. 
Figure 10.0. Significant increases in Joviality (e.g., happy, enthusiastic, cheerful) between baseline (M = 18.53, SD = 7.36) and Day 3 (M = 26.68, SD = 8.59), representing a 44% increase from baseline. 
Figure 11.0. Significant increase in PA from baseline (M = 25.84, SD = 8.97) to Day 3 (M = 32.95, SD = 9.16), representing a 27% increase from baseline.
These findings suggest that the fly fishing intervention is effective at improving mood states at an acute level.
Physiological Results
Cortisol
My analyses are based upon an assessment in the literature known as 'area under the curve' (AUC) which basically takes into consideration individual diurnal rhythms in cortisol levels (e.g., Pruessner et al., 2003). People normally display their highest cortisol levels upon waking in order to mobilize resources to deal with events of the day. So, this assessment evaluates averaged levels of cortisol measured throughout the day while simultaneously accounting for amount of variation in these measurements. For the intent of our analyses, we hypothesize that the fly fishing experience will predict lower AUC levels from one day to the next, reflecting reduced cortisol responses. For example, recent research on cortisol levels as a function of trait leisurely activities suggests that individuals who typically engage in restorative activities, such outdoor recreation, display lower AUC cortisol levels than those who do not typically engage in such behaviors (Pressman & Matthews, 2009). So, this publication focused on such activity from the trait level, whereas our findings will be in reference to acute effects of restorative activities. Here is a summary of our descriptive stats of cortisol and AUC variables in the form of means and standard deviations:
Friday am Cort (ng/mL): M = 19.14, SD = 14.07
Friday noon Cort (ng/mL): M = 9.35, SD = 8.24
Friday pm Cort (ng/mL): M = 7.26, SD = 5.07
Sat am Cort (ng/mL): M = 17.63, SD = 8.56
Sat noon Cort (ng/mL): M = 5.87, SD = 3.3
Sat pm Cort (ng/mL): M = 6.63, SD = 3.37
Fri AUC: M = 96.87, SD = 34.25
Sat AUC: M = 79.12, SD = 24.97 (18% reduction in Cort AUC assessment)
When reviewing the Cort values for Friday and Saturday, take notice how the overall values decrease from one day to the next, as well as the amount of variation (i.e., standard deviation). These descriptive stats reveal that the Cort levels decrease consistently from the first day on the green to the next, which support the notion of a calming effect.
Significant Paired Sample t test comparing Fri AUC to Sat AUC:
t(22) = 2.54, p = .019
Catecholamine Analyses
Urinary catecholamine assays were assessed in order to evaluate daily values of circulating sympathetic nervous system hormones of epinephrine and epinephrine. Participants underwent urinary sampling on the afternoons of their arrival at the Rivers of Recovery residential facility and the afternoon of their second day fly fishing. Although we had hypothesized significant reductions in sympathetic nervous system activity, we should have assayed urine samples on Friday and Saturday, in order to approximate a time period similar to the sampling of salivary cortisol. Consequently, our data comparing Thursday (day of arrival) to Saturday (second day fly fishing) indicate significant increases in norepinephrine levels, ostensibly in accordance with increased sympathetic activity corresponding to the act of fly fishing itself:
Thursday NorEp (ug/gCR): M = 36.85, SD = 22.46
Saturday NorEp (ug/gCR): M = 53.00, SD = 25.60
Significant Paired Samples t test: t(19) = -2.99, p = .007
Immunoglobulin A Analyses
Salivary immunoglobulin A analyses were largely nonsignificant, although going in the direction of expectation. For example, the descriptive statistics for the first and second days of the fly fishing excursion do indicate an increase in salivary immunoglobulin A levels, but a paired samples t-test suggests that this difference was not strong enough to reach the threshold of significance. Nonetheless, these findings are in accordance with the direction of association for acute improvements in immune function and as such are encouraging.
Thursday immunoglobulin (mg/dL): M = 9.26, SD = 7.47
Friday immunoglobulin (mg/dL): M = 12.69, SD = 10.11
Nonsignificant Paired Samples t test going in direction of expectation:
t(18) = -1.42, p = .174