Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members.

Introduction: Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors. Methods: The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention. Results: Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition. Conclusion: Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain. Clinical trial registration: ClinicalTrials.gov, NCT03302611.

A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment. METHODS: This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session. RESULTS: Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015). LIMITATIONS: The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context. CONCLUSIONS: Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions. TRIAL REGISTRATION: Clinical trials registration number NCT03302611; First registered on 05/10/2017.

Components of Hostile Masculinity and Their Associations With Male-Perpetrated Sexual Aggression Toward Women: A Systematic Review.

Hostile masculinity and its components (i.e., sexual dominance, hostility toward women, adversarial sexual beliefs, rape myth acceptance, and acceptance of interpersonal violence) have received considerable research attention as predictors of male-perpetrated sexual aggression toward women. The current systematic review sought to synthesize and organize the extant literature. Studies were included in the systematic review if they were published in a peer-reviewed journal between the years 1990 and 2020, contained a male sample within the United States, analyzed quantitative data, and examined at least one component of hostile masculinity and its association with sexual aggression. Literature searches were conducted in three academic databases, and additional records were identified through references sections from known hostile masculinity research. A total of 95 articles met inclusion criteria and were integrated into the overview of results. The reviewed literature provided broad support for the association between hostile masculinity and sexual aggression, including evidence for the theoretical framework posited by the confluence model of sexual aggression. Prevention efforts are likely to find success by modifying hostile masculine characteristics among men, particularly within problematic environmental contexts. However, the review also highlighted the need for a uniform conceptualization and operational definition of hostile masculinity. Additionally, empirical work with diverse samples is necessary to determine the scope of generalizability and potential subcultural distinctions. Future research that addresses these limitations will contribute to the understanding and prevention of sexual aggression beyond what is provided by the extant literature.

Profiles of Childhood Victimization as Predictors of Sexual Aggression and Intimate Partner Violence Perpetration.

The study utilized a latent profile analysis to evaluate distinct combinations of men's childhood victimization experiences and their communal predictive ability for sexual aggression (SA) and intimate partner violence (IPV) perpetration. Men living in the United States (N = 399) completed assessments of emotional, physical, and sexual childhood victimization, as well as SA and IPV toward women. The results indicated that members of profiles characterized by moderate to high frequencies of childhood victimization-especially sexual victimization-were at increased risk of SA and IPV perpetration. Contrary to expectations, adult- versus peer-perpetrated victimization did not appear to substantially alter risk of perpetration.

Heteronormativity, Disgust Sensitivity, and Hostile Attitudes toward Gay Men: Potential Mechanisms to Maintain Social Hierarchies.

Within a social hierarchy based on sexual orientation, heteronormative ideology serves as a social force that maintains dominant group members' status (e.g., heterosexual men). Disgust may be an emotional reaction to gay men's violation of heteronormativity (i.e., same-sex sexual behavior) and motivate hostile attitudes toward gay men to promote interpersonal and intergroup boundaries. Based on this theoretical framework, we hypothesized that sexual disgust-compared to pathogen or moral disgust-would be most strongly associated with antigay hostility and would statistically mediate its relationship with heteronormativity. Heterosexual men in the United States (n = 409) completed an online questionnaire assessing heteronormative ideology, disgust sensitivity, and hostile attitudes toward gay men. Results support the hypotheses and suggest that gay men's sexual behavior is the most likely elicitor of disgust and antigay hostility, as opposed to a perceived pathogen threat or moral transgression. The findings indicate that heteronormative attitudes and sexual disgust are likely contributors to antigay hostility. Thus, intervention efforts should seek to improve tolerance of same-sex sexual behavior among heterosexual men, which may mitigate emotional reactions and hostile attitudes toward gay men.

Potentially morally injurious events and depression symptoms among a trauma-exposed sample: Examining the roles of interpersonal needs and emotion dysregulation.

The current study examined a conceptual model of the association between potentially morally injurious events (PMIEs) and depression symptoms. It was hypothesized that interpersonal needs (i.e., perceived burdensomeness and thwarted belongingness) would independently mediate the relationship between PMIEs and depression symptoms, while emotion dysregulation would moderate the associations. Individuals who experienced a traumatic event and were residing in the United States (N = 147) completed a cross-sectional questionnaire containing measures of PMIEs, interpersonal needs, emotion dysregulation and depression symptoms. Results indicated that the indirect effect through perceived burdensomeness was significant at high levels of emotion dysregulation, whereas the indirect effect through thwarted belongingness was non-significant. Additionally, emotion dysregulation moderated each pathway, with the exception of the direct effects from PMIEs to depression symptoms. The proposed model may be informative for researchers and clinicians interested in the association between PMIEs and depression symptoms. The results may encourage the use of emotion regulation strategies to assist patients suffering from depression symptoms, especially when exposure to a PMIE has occurred.

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.

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.