Combining acceptance and commitment therapy with adventure therapy to face vulnerability: Examples and insights from a sailing experience

Experiential exposure is considered one of the most powerful strategies in several therapeutic approaches, such as Acceptance and Commitment Therapy (ACT) and Adventure Therapy (AT). The paper aims to provide: (i) the conceptual framework of the ESPRIMO "Demons on the boat" program, which combines elements of ACT and AT to maximize the effects of experiential exposure; (ii) exemplification of its adoption with a group of young adults with a chronic disease (i.e., multiple sclerosis) aimed to foster their adaptation to illness, chronicity and disability; (iii) description of insights, perspectives, benefits from the voice of participants. The program offers experiential exposure to painful intrapersonal events and external challenging experiences, associated with a psychological individual and group re-elaboration under the light of ACT processes in a natural, immersive, and stimulating AT context. The use of a leading ACT metaphor linked psychological flexibility processes and the navigation experience in the Mediterranean Sea, guiding the therapeutic experience of 11 participants (i.e., young adults with MS with a low level of disability; mean age 35 years). An inductive thematic analysis approach was used to analyze the qualitative data collected, obtained through the daily use of a logbook by the participants. ACT and AT elements have been successfully integrated and implemented in the ESPRIMO "Demons on the boat" innovative program. From the perspectives of all participants, positive benefits - on a bio-psycho-social level emerged. Overall, the experience represents an opportunity to give new meanings to the MS experience and to foster a better illness adaptation. The main therapeutic elements (individual and group elaboration, the metaphor, the logbook, the natural environment, the challenging experiences, the group/relational dimension) have been discussed to guide the future implementation of similar experience in other possible clinical contexts and scenarios. ESPRIMO "Demons on the Boat" program serves as a model of how to integrate the ACT and AT approaches, where the central point of synergy is the relevance given to experiential exposure. The innovative and promising model is highly adaptable, allowing it to be used for a wide range of applications and vulnerable groups.