A growing number of programs try to treat PTSD by getting veterans into nature, even deep under the sea.
On a recent morning, Shawn Campbell, 38, led a scuba diving trip off the coast of Clearwater. Joining him were Air Force veteran Bob Herris and his son Justin, an active duty pilot who serves in San Antonio, Tex.
Campbell briefed them on their dive site, an underwater military memorial called the Circle of Heroes.
"This is very important for me not just as a local diver, but I am also a combat veteran of three tours; I'm a disabled veteran,” he explained.
The retired Army medic said transitioning back to civilian life after he was wounded in Iraq was tough for him.
“Diving was an outlet that let me do something that I found a lot of solitude and peace in but also kept me very active and healthy, so it was great for my mind and my body,” he said.
Being underwater relieves Campbell from the joint pain he feels on land. And he said the medtiative experience of drifting beneath the surface has helped with his mental wounds.
He turned the hobby into a career and is now a dive master at Narcosis Scuba in Tarpon Springs. The shop has a lot of military ties and its crews take service members out whenever they can.
Justin Herris, 35, got back from his fourth deployment a couple weeks before the trip. He said he doesn't have PTSD, but said scuba diving gives him a much-needed break from the stress of military life.
"We're either flying all the time or deploying and away from our families, so this opportunity to get away from that lifestyle, go down there and kind of forget about all the things going on in your life, focus on the fish, the wildlife, being under the water – it’s extremely relieving," he said.
Narcosis is a family-owned dive shop and doesn’t claim to be a formal therapy group. But Campbell said it's not surprising other organizations are exploring the use of scuba to treat PTSD.
"This is an opportunity to get out again, and maybe they're (veterans) not out around a ton of people but they're still out, and they become a part of a community that is a healthy community instead of just going to the bar or drinking themselves into a coma at home or self-medicating in any way,” he said. “They can do something healthy and meet like-minded people and start living life again."
Nonprofit groups that introduce veterans to diving span the country, from more obvious scuba locations like Florida to places far from the coasts. They organize trips to diving hotspots such as the Bahamas or Mexico, typically for week-long retreats.
Some groups like Lifewaters in St. Louis have doctors and nurses as volunteer staff to help veterans who use wheelchairs or are missing limbs go on dives. Others, like Deep Sea Valkyries in Phoenix, have licensed counselors and military chaplains who focus on trauma.
Barriers to scuba therapy
Retired Army Col. Kathy Platoni, a clinical psychologist in Dayton, Ohio and author on military trauma, said that is the ideal situation.
She said there is limited research on the benefits of nature-based therapies like scuba, but there is merit to them. She sometimes incorporates them into her own treatment plans for patients.
But she said it’s important to involve health professionals, and added that even then, the experience is not for everyone.
"It's very hard to put people in a challenging situation who do have PTSD or have been severely traumatized into something that may further traumatize them,” she explained. “For instance, getting in the water with a scuba tank may be terrifying for some people."
And there are other barriers. The VA and health insurance companies don't cover scuba therapy. And not everyone can pay for the expensive equipment and frequent dive trips out of pocket.
Some support groups cover costs for their trips but that's one experience, and Platoni said it can be really hard to maintain the benefits once the exotic adventure is over.
"So you have to have something that follows the scuba therapy which would be individual psychotherapy or group therapy, or just having some kind of contact with the other members of the group that have gone through this experience, because so much of the benefit comes from the belongingness and the comradery that counters the despair that so many veterans experience," she said.
Platoni said there is no gold standard of PTSD treatment. She said people need to be creative and cater care to the individual.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.