A Nature-Based Intervention to Improve Mental Health: Efficacy of An Angling Intervention for Military Veterans and Emergency Service Personnel with Post-Traumatic Stress Disorder (PTSD)

Research question This study investigates the impact of nature-based interventions (NBIs), specifically angling in a natural and social setting, on the mental health of individuals with post-traumatic stress disorder (PTSD).

The research question seeks to determine whether angling in a tranquil, rural environment improves the mental health and well-being of individuals with PTSD.

The study aligns with the priorities set by the DHSC Policy Research Programme (PRP) to build an evidence-base for NBIs using rigorous experimental methods.

Background Military veterans and members of the emergency services are particularly prone to PTSD whilst also often reluctant to engage or remain in traditional therapies. PTSD is often comorbid with depression, anxiety and substance abuse and this complicates treatment further. Novel, more user-friendly, approaches to dealing with PTSD are therefore required.

Our previous work and the development phase of this project suggest that angling NBIs are one such promising methodology.

Aims and Objectives Conduct a full-scale randomised controlled study powered to provide definitive evidence of the NBI for veterans with PTSD. Extend the study to include emergency service personnel. Collect long-term measures of the effects of the interaction. Develop, implement and evaluate an exit plan for participants.

Develop an iCARP PTSD-specific training programme for angling coaches.

Develop process measures into publishable instruments, evaluate mediation of the primary outcomes and incorporate psychophysiological measures of stress and vigilance as objective process measures. Evaluate cost effectiveness of the intervention. Develop a brief information pamphlet. Finalise manual.

Assess feasibility of running interventions across the UK. Methods A waitlist-controlled, stratified randomised trial (RCT) of an angling NBI for PTSD.

Mental health and wellbeing will be measured online using established, validated measures at 2-weeks pre-intervention and 2-weeks and 4-weeks post-intervention. Measures of mood, vigilance, blood pressure and reflections on the intervention will be collected lakeside.

We will recruit sufficient numbers to ensure complete data collection for a minimum of 196 participants randomised to either active or waitlist control groups. Those in the waitlist group will be offered the intervention after completion of the RCT. Long-term follow-up measures will be taken 6-and 12-months after the intervention for the active fishing group.

Timelines for delivery Project start date is January 2024 with recruitment starting March. RCT data collection begins May 2024 with the first intervention running in June and continues until November 2026. Final long-term follow-up will cease in July 2027. Anticipated Impact and Dissemination NBIs have the potential to promote wellbeing and reduce social cost.

This work contributes to an evidentiary basis for NBIs, a method for their delivery to the community and provides the potential to inform and transform guidance to the primary, secondary and community care sectors on the ways in which this NBI might be incorporated into policy and practice.

In order to affect this impact, the findings will be disseminated via: a workshop on NBIs for policy makers organised by the DHSC; academic conferences; health and environmental forums; peer-reviewed scientific journals; dissemination events for service users and providers and the general public[CNR1] . [CNR1]500 words