Outward bound, diabetes and motivation: experiential education in a wilderness setting

Effective diabetes management requires the commitment to take charge of one's life, and the strength to face the daily challenges the illness presents on a long-term basis. Outward Bound Programmes utilize challenging experiences in a wilderness setting to foster personal growth and responsibility, and to encourage the participants to reach beyond their limitations. Six Outward Bound courses were taught, to a total of 56 students with Type 1 diabetes, 14 to 42 years old. With appropriate precautions, the fairly strenuous programme was conducted safely. A battery of psychosocial measures, administered to the initial pilot group of eight students before the course, and again 7 to 11 months after returning home, indicated a statistically significant improvement in problem scores on the Achenbach Youth Self-Report Profile, and suggested modest improvements in diabetes adjustment, locus of control, and self-esteem. Other course participants report having had an exhilarating experience, which helped to increase their self-confidence and determination to take charge. A few have begun to break previous patterns of dysfunction. Many have acquired new insights into the causes of fluctuating blood sugars, and into the options at their disposal to optimize self-care.