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Outdoor Behavioral Healthcare (OBH) evolved from wilderness therapy and offers an integrative outdoor therapy experience with therapeutic techniques and interventions that are delivered by not just clinical staff, but also by direct care staff who are trained to support clients on a daily basis.

The main components of Outdoor Behavioral Healthcare include:

  • Extended backcountry travel and wilderness living experiences
  • Active and direct use of clients’ participation and responsibility
  • Continual group living and regular formal group therapy sessions to foster teamwork and social interactions
  • Individual therapy sessions, supported by the inclusion of family therapy
  • Adventure experiences utilized to enhance treatment by fostering the development of eustress (ie, the positive use of stress) as a beneficial element in the therapeutic experience
  • The use of nature in reality as a metaphor within the therapeutic process and
  • A strong ethic of care and support throughout the therapeutic experience

Outdoor Behavioral Healthcare has been shown to be a more successful mental health intervention than “treatment as usual”, such as outpatient services. One study comparing OBH with treatment as usual found treatment gains at one-year post treatment were three times larger in the OBH group.

In their article, The value of outdoor behavioral healthcare for adolescent substance users with comorbid conditions, Gass et al. define outdoor behavioral healthcare (OBH) as “a 24-hour intermediate outdoor group living environment that includes group, individual, and family therapy. These therapies are designed to address behavioral and emotional issues by utilizing treatment modalities centered on nature, challenging experiences combined with reflection/mindfulness, interpersonal development, and intrapersonal growth” (Gass, et. al., 2019).

Roberts et al. explains that OBH is a “unique specialty treatment modality” and it often refers to wilderness or adventure therapy and “utilized the inherent value of contact with nature to promote health combined with therapeutic programming, group living and trained staff” (Roberts et al., 2016). These definitions show the growth the field has had in the past few decades as research scientists in the early 2000s acknowledged a lack of consistency in defining this modality (Russell, 2000).


  • Gass, M., Wilson, T., Talbot, B., Tucker, A., Ugianskis, M., & Brennan, N. (2019). The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions. Substance Abuse: Research and Treatment, 1-8.
  • Gass, M. (Ed.). (2014). Manual of Accreditation Standards for Outdoor Behavioral Healthcare Programs. AEE.
  • DeMille, S., Tucker, A. R., Gass, M. A., Javorski, S., VanKanegan, C., Talbot, B., & Karoff, M. (2018). The effectiveness of outdoor behavioral healthcare with struggling adolescents: A comparison group study a contribution for the special issue: Social innovation in child and youth services. Children and Youth Services Review, 88, 241–248. https://doi.org/10.1016/j.childyouth.2018.03.015
  • Bowen, Daniel & Neill, James. (2013). A Meta-Analysis of Adventure Therapy Outcomes and Moderators. The Open Psychology Journal. 6. 10.2174/1874350120130802001.
  • Neill, J. T. (2003). Reviewing and benchmarking adventure therapy outcomes: Applications of meta-analysis. J Exp Educ 2003; 25(3): 316-21.
  • Roberts, S. D., Stroud, D., Hoag, M. J., & Combs, K. M. (2016). Outdoor Behavioral Health Care: Client and Treatment Characteristics Effects on Young Adult Outcomes. Journal of Experiential Education, 288-302.
  • Russell, K. C. (2001). What is Wilderness Therapy? The Journal of Experiential Education, 70-79.

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