A Natural Road to Recovery for Injured Warriors

four older men in suits cut a green ribbon with large scissors while a crowd watches

Research aims to uncover treatments for PTSD

On September 26, 2016, the Institute for Integrative Health welcomed 200 guests for the dedication of the Green Road, an outdoor healing environment for injured military service members and their families at Naval Support Activity Bethesda, home of Walter Reed National Military Medical Center.

Created as a model for similar projects at military and civilian health care institutions, the two-acre woodland garden is the first to use wild nature to support the health of injured service members.

The next step in the project is a research study to measure the Green Road’s healing impact on service members’ recovery from post-traumatic stress disorder (PTSD) and other serious conditions.

“We’re hopeful that findings of the Green Road research will lead to more effective, holistic treatments for service members and veterans suffering with traumatic injuries,” said retired U.S. Navy neurologist Frederick Foote, MD, who conceived the vision for the Green Road and managed its development.

PTSD and traumatic brain injury contribute to the despair that can lead to suicide. Anecdotal evidence suggests that spending time in nature has a positive impact on these conditions; however, very few scientific studies have examined these effects. The Institute for Integrative Health and scientists from four institutions will work to fill that gap with the support of many donors, including the TKF Foundation.

“I think the research that’s going to come from this is going to be very far-reaching.”

– Senator Barbara A. Mikulski

The Institute is now in its final stage of raising funds for the Green Road to support a two-year research program and veteran projects.

“What we learn can lead to healthier communities for all of us,” said Brian Berman, MD, president of the Institute for Integrative Health. “Innovative research can open doors to greater understanding of nature’s role in our health. It can shape policy decisions and influence funding for more natural spaces in our communities and health care centers.”

The Green Road’s research team aims to shed light on the array of positive changes that occur throughout the body when a sick or injured person encounters nature. An initial study will measure four biomarkers of the stress response and mathematically combine them to produce the first single, whole-body stress metric in clinical use. Researchers will also assess the expression of genes related to PTSD and analyze stories and journals through qualitative language analysis and natural language processing.

The project’s researchers are from Arizona Center for Integrative Medicine, College of Medicine, University of Arizona at Tucson; Benson-Henry Institute of the Massachusetts General Hospital; Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences; and National Institutes of Health Clinical Center, Pain and Palliative Care Service.

Located between two main patient residence areas on the naval base, the Green Road features a natural stream, mature trees, a commemorative pavilion for honoring fallen warriors, a communal pavilion, and a streamside wheelchair/walking path. Seating areas include a circle of large stones, called a council ring.

The Green Road was created by a team of military service members, architects, engineers, landscape architects, and healthcare professionals. Design-build firm CDM Smith performed the engineering and construction. Collaborators on the Green Road’s design were CDM Smith, Alt Architecture, and the University of Maryland Landscape Architecture program under the direction of Jack Sullivan, FASLA.

VIDEONBC Washington/News4 reports on the Green Road’s dedication.

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.