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Healing through Self-Awareness: Treating Complex Clinical Issues in Wilderness

Maura Nolan, LPC, LCMHC, NCC | Clinical Therapist

As a clinical therapist at Open Sky, I frequently work with students and families struggling to navigate complex mental health issues. Depression, anxiety, mania, trauma, psychosis, addictionthey all leave a wake of destruction in their midst if left untreated, one that affects not just the individual, but the entire family unit. My role is to help students and families build self-awareness and provide them with the tools, education, compassion, and support they need to move from surviving to thriving. 

The Nervous System Connection

At the heart of recovery is self-awareness, which is why it is essential to bring attention to the connection between our emotions and our bodies. We live in a world of hyperactivity, filled with distractions in the form of cell phones, the internet, drugs and alcohol, video games, pornography, eating, exercising, and the list goes on. It can be easy to ignore our internal sensations, the ones that are trying to tell us valuable information about our mind and body. There is power in simply noticing what is occurring within us, be that anger or sadness or tension in our left hip, as it enhances our ability to better understand our internal landscape, get in touch with what we’re feeling, and begin to challenge our perceptions. 

Throughout my career, I’ve encountered many clients who don’t want to feel their bodies. This is often the result of experiencing complex trauma; the experience of trauma can get stored in our bodies and manifest in ways that cause extreme emotional discomfort, tension, and somatic pain. When an individual experiences stress, the body’s sympathetic nervous system activates the acute stress response. The body’s parasympathetic nervous system does the opposite, working to calm the body through hormone release once a threat has passed. Trauma interferes with the rhythmic balance of the nervous system. During a traumatic experience, the nervous system loses the ability to self-regulate, resulting in individuals feeling stuck in the fight, flight, or freeze response. Some people always remain in these states, resulting in symptoms that range from hyperactivity, panic, and fear to depression, hopelessness, fatigue, and numbness. 

A person sits quietly and gazes at the sky in the Utah desert.Self-awareness is at the heart of recovery.

How Mindfulness Supports Slowing Down the Nervous System

It makes sense why someone who constantly feels hyperaware, numb, or depressed would not want to be in touch with their body. But Bessel Van Der Kolk says it best: “Avoiding feeling the sensations in our bodies increases our vulnerability to being overwhelmed by them.” If we can begin to notice and label the sensations and emotions in our bodies without judgment, we are likely to notice that these feelings ebb and flow. Emotions are not constant. They shift and change just like we can shift our perceptions toward them. Through cultivating awareness, we can understand where emotions are stored in our bodies and learn to better tolerate and regulate these feelings.   

What I’ve described above is a form of mindfulness, a practice that I am consistently applying in the field with my students. Numerous studies show the immense benefits of mindfulness practice. Mindfulness can help decrease psychosomatic and stress related symptoms, such as depression, anxiety, and chronic pain; train brain regions involved in emotion regulation; and decrease the activity of the amygdala, which is in charge of the brain’s response. Within this practice, I’ll also have students observe the intersection between their thoughts and physical sensations. For example, I’ll have an individual observe how thoughts like “I will never get sober” or “I’m not deserving of love” manifest as physical sensations in their body. Becoming aware of how our bodies organize particular emotions and memories opens up the possibility of releasing sensations and impulses we once blocked, in order to survive (Van Der Kolk, 2014). The practice of mindfulness allows us to become masters of our inner worlds and is just one of the many mind-body therapies I apply in the field. Somatic therapies, such as grounding, resourcing, movement, progressive muscle relaxation, and breath work, are other tools I use to help students bring focus to their bodies and tolerate uncomfortable sensations. 

An Open Sky Wilderness Therapy student in a yellow shirt sits and meditates on a sunny day in the Utah desert. Mindfulness helps us build self-awareness and become masters of our inner worlds.

Emotion Regulation

Affect—or emotion—regulation refers to an individual’s ability to control their emotional state. Developing self-awareness, emotion regulation, and distress tolerance is a 24/7 component of wilderness therapy. If a student leaves gear behind on a hike, only to realize three miles later that it is missing, the entire team has to back hike together to retrieve the item. That is bound to bring up some anxiety, frustration, and stress. The student may feel the urge to lash out at the team instead of hold themself accountable. Or, if a student gets into conflict with a team member, they may feel shame, sadness, and the urge to self-harm.  

In these situations, my goal is to give students the tools to “hit the pause button” to create space between what they are feeling and how they choose to respond. One of my go-to treatment approaches is dialectical behavior therapy, an evidence-based approach introduced in the 1980s by Dr. Marsha Linehan. The main goals of DBT are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others (Behavioral Tech, 2021). DBT includes four modules that strive to create a balance between self-acceptance and change. They are: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.  

Engaging in dialectical behavior therapy calls for action. As does the wilderness. The combination of the two can foster great change. Take the example of the student who was feeling the urge to self-harm. In this moment, they may be feeling sad, angry, confused, frustrated, or disappointed. Prior to Open Sky, the student may have self-harmed as a way to manage distress. It may not have felt like there were alternative ways to deal with these feelings. Through the systematic practice of DBT skills, this student can build self-awareness and choose alternative ways to regulate their emotions. They can learn to soothe or distract themselves (distress tolerance), try to express their needs through assertive communication skills (interpersonal effectiveness), stop to observe emotional and physical sensations in the body (mindfulness), or try to do the opposite of what the urge is telling them (emotion regulation). When a student moves toward action, specifically when they choose to cope differently, it further reinforces that they are capable of changing their behavior and dealing with things in a healthy way. 

Identifying and shifting negative core beliefs is another way students tap into self-awareness and break harmful patterns and ideas related to the self. One of the most unique aspects of wilderness therapy is that it helps student challenge the negative ways in which they think about themselves over and over. Again, it calls them to action. I’ve encountered many young adults who believe they are a failure or incapable. These beliefs have been continuously reinforced as the individual tried to manage their uncomfortable emotions through unhealthy behaviors, such as drinking or using drugs, engaging in self-harm, staying in bed all day, or not following through on social obligations. In wilderness therapy, this individual will face challenges that give them the power to step into capability and success, whether it be persevering through bow drilling or choosing to ask for help on a difficult hike instead of withdrawing. These challenges are empowering, allowing students to build a stronger sense of self and enabling them to change their inner monologues. 

Healing through Human Connection

Sometimes, the most healing thing for humans is connection. Study after study shows that having a good support network serves as the most powerful protection against trauma (Van Der Kolk, 2014). Establishing and engaging in social connection has also been proven to lower anxiety and depression, produce higher levels of self-esteem, and increase empathy and connection. In wilderness therapy, students receive a built-in support network. They have the guidance of field guides and clinical therapists, as well as the connection between peers in their team. 

Building trusting relationships with my clients is paramount. I pay dedicated attention to the group culture of my team, ensuring it is a space of physical and emotional safety, laughter, play, and creativity. I emphasize the importance of creating an environment where students can share authentically and vulnerably without fear of being judged. My students are encouraged to engage their social nervous systems, as they play a large role in increasing our capacity to respond effectively when we feel on edge with anxiety or withdrawn with depression. Some of the ways in which the social nervous system can be engaged by increasing awareness of the present moment, breathing fully and deeply, and connecting lovingly with other people, animals, or ourselves via self-compassion (Schwartz, 2016). In my team, students connect with each other through intentional one-on-one and small group conversations; participating in wilder-art projects, yoga, and group meditation projects; and hiking and exploring the beautiful landscape of the Southwest.

When working with students, I call them into a space of self-awareness and action. Empowering students through psychoeducation, mindfulness, emotion regulation techniques, and social connection are effective ways to target and decrease symptoms of various mental health issues. What an incredible reward it is to watch my clients persevere through difficult tasks in the wilderness, challenge their perceptions, and manage their mental health and emotions in new ways.  

February 24th, 2022

Maura Nolan, LPC, LCMHC, NCC | Clinical Therapist