Veterans with mental conditions, substance abuse disorder help researchers find answers
July 9, 2021
By Mike Richman
VA Research Communications
Veteran with PTSD, depression finds relief through mindfulness training
Dr. William Marchand is an avid recreational sailor. To him, the scenery, wind, and water are calming and compatible with mindfulness.
Mindfulness involves focusing on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. Walking, hiking, meditation, and yoga can help someone achieve a state of mindfulness—as can any other type of sport or recreational activity—if one is focused on the present.
So an idea dawned on Marchand, a psychiatrist at the VA Salt Lake City Health Care System. Understanding that many Veterans with mental conditions and substance use disorders do not experience full remission from conventional treatments or engage in such therapies at all, he and VA colleagues embarked on testing a recreational program that would encourage participation by offering an enjoyable experience, while imparting a therapeutic benefit.
His choice: mindfulness-based therapeutic sailing (MBTS). “There isn’t a rule that says treatment can’t be fun,” he reasons.`
Bringing one back to the present moment
Marchand has led three pilot studies thus far, including one with nature exposure through recreational sailing and another with nature exposure through sailing combined with mindfulness training. The latter teaches one to have a non-judgmental awareness of the present and to differentiate that from autopilot thinking, or thinking instinctively, about the past and the future, according to Marchand.
“The practice involves being aware of that autopilot thinking and bringing one back to the present moment,” he says. “That’s primarily what we wanted as the take home message about mindfulness, something that people could grasp in a short period of time and could start using.”
Marchand’s most recent research was based on what he and his colleagues learned from the first two pilot studies: The concept appeared to be feasible and warranted further evaluation, and the sessions should include only sailing and not classroom-only sessions. The study included mindfulness training and was aimed at establishing a version of MBTS that would be ready for a rigorous controlled study with a large number of participants. The findings appeared in the journal Military Medicine in February 2021.
The study included 25 Veterans, all but two of whom were men (see sidebar). Each participant had at least one mental health condition or substance use disorder, and more than 90% had two or more conditions. With help from the Park City Sailing Association in Utah, the Veterans engaged in three sailing sessions of at least an hour each at the Jordanelle Reservoir State Park in Utah.
The researchers used a physical activity enjoyment scale to determine how much the participants liked the program. Scores indicated that most of the participants enjoyed the sailing, and that it was potentially linked to a decline in substance use treatment services. But the latter finding, Marchand cautions, is a correlation and not a cause and effect. He says it’s unclear how MBTS is related to less need for substance abuse treatment.
“The sailing possibly helped participants decrease substance use, and thus less treatment was needed,” Marchand says. “But more rigorous studies will be needed to further explore this finding.” Findings support results from prior studyThe results must be considered preliminary, according to Marchand and his team. “However, these findings corroborate results from a previous pilot study and indicate that MBTS holds promise as a complementary [program] that could result in enhanced treatment engagement and-or outcomes for the population studied,” the researchers write. “A randomized controlled trial of MBTS is warranted. Further, the model of a three-session [program] combining mindfulness training with nature exposure could be adapted for other types of nature exposure, such as hiking, snowshoeing, or other complementary [therapies], including equine-assisted activities and therapies.”
Marchand is confident that MBTS can improve treatment engagement or response among Veterans in conventional programs, similar to the potential of other complementary therapies, such as yoga, tai chi, or meditation. However, he would not recommend MBTS as a stand-alone treatment for a mental health condition because of its limited evidence base. A conventional treatment, such as medication or one of the trauma-focused psychotherapies VA uses to treat patients with PTSD—cognitive processing therapy or prolonged exposure—must be used first or in parallel with a complementary therapy, such as MBTS, he notes. “Over time and with lots of research, many things once considered complementary develop as stand-along treatments,” he says. “But recreational sailing would most likely remain a complementary intervention long-term.”
Based on the post-sailing questionnaire, researchers in Marchand’s most recent study also concluded that MBTS is linked to increases in psychological flexibility and mindfulness. Psychological flexibility, he says, is the ability to respond to situations in a manner that helps the person and is also consistent with his or her personal values.
“One way of thinking about it is the level of rigidity in one’s thinking versus the ability to be adaptive and perhaps most importantly to be able to engage in flexible behaviors,” he says. “A good example is that when we are upset, we tend to respond in an emotional way. So a Veteran has an argument with his or her spouse and feels upset and angry and tends to respond the way they’ve always responded in habitual behavior patterns that often aren’t very helpful. With psychological flexibility, one can better take stock and say, `Hmmm, this is what I always do, but it doesn’t work very well. Maybe I need to try something different.’”
The researchers didn’t measure PTSD-specific outcomes, for example, by using a PTSD symptom scale. “Increases in mindfulness and psychological flexibility would be expected to be beneficial for PTSD, but that must be explored in future studies,” he says.Nearly 100% of participants attended all of the sessionsOne goal of developing the MBTS program was to increase treatment participation. Marchand was surprised by the level of engagement, with 96% of the participants attending all of the sessions. That was an “excellent result” that strongly supports the use of MBTS from an engagement in treatment standpoint, he says. “This was primarily a proof of concept study, and our ability to assess outcomes was limited due to the small sample size. That said, outcome data were promising, but clearly more rigorous studies are needed with much larger sample sizes,” he says.
Participation was up, he says, mainly because all of the sessions in the study included sailing. All of this begs the following questions: How practical is MBTS as a long-term therapy for Veterans experiencing mental and substance abuse disorders? And how many Veterans can VA help with this type of therapy?
“That is difficult to answer until we do more rigorous studies that can assess cost benefit data to determine if [MBTS] would be cost-effective to implement at other VA facilities,” Marchand says. “Also, the motivation and ability to implement a program like this will vary from one VA site to another. So even if MBTS is shown to be beneficial and cost-effective in larger studies, it is impossible to know how widely it will be disseminated.
“However, that said, MBTS is a model that could be implemented with community partners–like we did with the Park City Sailing Association in Utah– in many parts of the country at least during the summer months,” he adds. “Using this model at our site, we could likely serve around 100 Veterans per summer season.”
But not all VA medical centers are close to a body of water.
“That’s one of the major limitations,” Marchand says. “Part of our work has been to develop the general concept of a therapy involving recreation and nature exposure and not necessarily tie it to sailing. For example, hiking is much more accessible and also is a nature exposure. So it might be that this model could be adapted to other more accessible forms of nature exposure.”
Control groups a challenge in studies on recreational therapyMarchand says there are various ways he could carry out a randomized controlled trial on the effectiveness of a recreational therapy. One approach would be to focus on a specific population, such as Veterans with PTSD, and randomize the participants into a treatment group that includes a recreational therapy and mindfulness training, and a control group with standard treatment. He explains that controls are challenging for studies like this because it’s impossible to blind participants and the study team. The number of Veterans would likely be around 120, with 60 in each group.
“The concept is really combining a mindfulness program with something else that is healing like nature exposure and using it to engage Veterans,” he says, “because one of the real problems we have is engaging Veterans in treatment. So combining treatment with something that is often perceived as pleasurable tends to be more engaging than inviting someone to sit in a therapy office for six to eight sessions.”
Currently, Marchand’s main research focus is on equine services, or interaction with horses, and equine-assisted psychotherapy. In one of his upcoming studies, the treatment group will include equine services with no mindfulness training, and the control group will include standard treatment.
“We’ve become interested in taking this general concept and applying it to other activities, such as hiking, which is probably just as accessible and might be just as effective, and equine services,” he says. “We want to use the outcome measures from our pilot studies, as well as diagnosis specific measures, such as PTSD symptom scales. I’m not sure that we’ll necessarily continue to explore the sailing piece. Everything is speculative at this point.”
Statement of ConditionPlanking
Plank seams overall were tight with Portland cement adhering well. There were no overly wet seams except for the upper edge of the ballast seam being damp. Seven plugs were pulled during survey to reveal the original bronze fastenings. The putty was removed and the area re-faired with epoxy. During the haulout in 2019 she was re-caulked at and below the waterline.
Overall the planking tapped hard (a quick hammer bounce back and minimal vibration of planks). In March 2016 five planks were replaced; two planks below the waterline at the port bow,
Propeller and Cutlass BearinGThe Propeller is two bladed and showed without damage from impact. The blade tips were found true when tested, and the propeller is held in place with a single thick nut with a safety cotter key aft of it.
The engine shaft cutlass bearing showed a minor amount of wear; set screws are provided to contain the bearing in its housing. The cutlass bearing was replaced in 2019 as a prudent measure. The engine shaft was found centered in the bearing and easily turned by hand. In 2019 the shaft was pulled and cleaned; a graphite sleeve for the shaft log installed, and the shaft reinstalled.
Stem Tap-testing the stem found all surfaces to be hard; the upper forwardmost section at the bow may be a replacement due its length, and was found with ferrous staining from through bolts and deep cracks at the top and aft surface. There was deterioration on its aft face which penetrated 2”. These areas were treated and fiberglassed in early 2021.
The Samson posts had deep cracks on its aft face with rot at deck level and penetration about 2”. Its top was checked and dried out, and copper covering plate was loose. This was addressed after laying the new deck, where the checks were paid with System3 epoxy and micro-filler; and wrapped in fiberglass.
Decks and Deck Beams The decks are teak planked with 3” wide x ~ 1 5/8” think planks of Burmese teak. The outer covering boards are 6 ½” wide. The deck planking was dado’ed to accept the hatches which give the planks ends when viewed inside the appearance of being thinner. Deck beams are white oak 3 ½” wide x 3” thick on 16” centers or 12” between the beams. The deck planking appears to be fastened by bronze spikes. The main deck house carlin is 4” wide and ~3 ½” thick. The shear plank is pitch pine ~ 7 1/8” x 3 ¼” thick. The shear clamp is notched to accept the deck beams which are through-bolted with single ½” diameter bronze bolts.
On survey, evidence of deck and cabin leakage was found in the full length of the vessel at many areas. Deck planking had loosened from the deck beams with many areas showing a gap of at 1/8” or more. There were a moderate amount of deck beams that tapped with a distinct hollow sound as is typical of beams that are degrading from the top surface downward into the beam’s core. This condition minimizes the holding power of fastenings, hence the vibration discovered during tap-testing.
Many of the deck beam to carlin joints showed gaps from prior movement and are dry and checked and show water staining. Carlins under the starboard side of the pilothouse were fully deterioration and leakage had deteriorated portions of the framework below the pilothouse cockpit and caused excessive corrosion deposits on the steel knees.
Overall, the deck was in such a weakened condition that in order to be viable as a sailing vessel, dramatic repair and re-structuring would be necessary. WBFV had a steep mountain to climb, if it was to move beyond this essential part of the project.
During the early phase of the restoration all that could be done was to stop further damage by covering the existing deck with a mixture of fiberglass cloth and aerobol, to provide a protective barrier from rainwater. This was not put on the cabintop however, which continued to leak if not ocvered over with a tarp. In October 2020 work began to reef our the seams and caulking of the cabintop, sand the deck planking smooth and caulk the seams with cotton and pay with teak sealant.
Still the decision on addressing the main deck loomed. As the project progressed, there was much discussion over the practical approaches to addressing the surveyor’s ominous pronouncement. The first was an outright replacement, which would involve removing the cabins and hatches, and remove the deck planking carefully to reuse, and finally replace all of the deck framing structure underneath. This was judged beyond WBFV’s capabilities to raise the necessary funding to make this happen. WBFV consulted with many experts on an alternate approach to build a new deck and attach it to the existing structure; this was the path adopted.
Finally, in January 2021 WBFV pitched a tent across the entire vessel and
The protective fiberglass covering was ground off and the original deck prepared, with all deck fittings – light prisms, bronze padeyes, the two wooden hatches up forward as well as the steel bitts, and the Bomar hatch on the fantail – removed and restored. Two layers of 3/8” okoume marine plywood were cut to shape using patterns and successively glued down and screwed into the existing deck framework. System3 with epoxy and micro-filler was used to fill all of the voids between the original and new deck material.
On top two layers of fiber multidirectional reinforced cloth were laid, adding significant strength to the overall structure. At the edges fiberglass cloth was brought up two inches around every cabin and hatch, and up the first strake of the bulwarks (and around their top timbers). The bulwarks were stripped, repaired and restored as well.
The result is a new main deck on top of the existing deck that altogether doubles the thickness of the deck and restores the structural integrity of the boat.
Hatches and CabinsDuring and after the deck was repaired, many problems with the hatches and cabins were attended to.
The forward hatch with a 21” x 20” opening was removed from the boat and the glue joints epoxied; it was then faired and remounted atop the new deck and secured with drift screws.
The hatch forward of the mast has a 36” x 53” footprint and three hinged lids, fitted with glass tops and bronze rod deflectors. There was widespread glue failure which was repaired, and it was also adjusted to sit flush on the new deck, and glassed and screwed into place.
The hatch aft of the mast has a 40” x 41” footprint and two hinged lids, similarly fitted with glass panels and bronze rod deflectors. There are further repairs needed that are described further on in the report.
The companionway hatch and its adjacent storage lockers on the cabin top have a 72” x 50” footprint. The port side is a sliding bronze plate hatch, teak framed which slides on stainless steel flat bar attached to teak cleats.
The aft bridge deck hatch has a 39” x 37” footprint and four hinged lids with glass tops with rod deflectors. The hinges for all four hatches were refastened and the lids tightened, and the glue joints were renewed.
The pilothouse cabin is a large structure measuring about 7’ x 7 ½’. It is a solid teak framed construction with a fixed bronze framed window forward and two downward-sliding plate grass windows on each side. There is a central sliding companionway hatch on top. The glue seams have been renewed with epoxy. The pilot house was removed and reinstalled in 2019 and glued onto the original deck. In 2021 when the additional deck material went on, the pilothouse was not disturbed but rather the marine plywood was fitted around it and glassed in. The carlin underneath the port and starboard side of the pilot house, and the adjacent deck framing was removed, new framing scarfed in, and the new structures sistered with white oak. There is much remaining to strengthen the structure, described later in this report.
Aft of the helm is a deck mounted “Freeman” or “Bomar” hatch. The hatch ring was removed sand-blasted and hot-dipped. The deck framework under the hatch was repaired by removing the deteriorated sections, and the new sections scarfed in and sistered.
Steel Floors Luke Brothers used steel strap floors through the hull, except for three wooden floors in way of the bilge section immediately forward of the engine compartment. Some floors in the waist of the vessel were provided with a transverse beam at the upper level which joins at the opposite sides. The floors are bolted through the keep and extend upwards about five plank widths and are through-bolted to a single frame with bronze bolts.
The surveyor warned that many floors needed to be removed and replaced so that their contribution to the vessel’s structural framing system would be realized.
After the haulout of 2016, the floors under the main saloon the were chipped free of rust and repainted. It wasn’t until the haulout of 2019 that we were able to go to serious work on the floors. Removing the aft cabin, the engine, and fuel tank, we could finally see how bad the deterioration extended. Six floors under the engine and fuel tank were removed and replaced with steel plate that was painted and installed. Three wooden frames forward of the engine compartment were replaced.
Hull FramesThe white oak frames are double sawn with staggered joints. Most of the frames tap hard with no vibration or cracks noted. Many of the bulwark frames (aka top timbers) fitted loosely to the inside plank surface of the bulwarks and tapped with vibration; these were addressed during the deck repair phase in 2021.
Keel BoltsThe keel bolts are 1 ¼” bronze securing the cast lead external ballast. The keel bolt nuts viewed in the forward section of the main salon bilges showed without significant deterioration. Washer plates are small in size and show a slight amount of compression in the wood keelson.
Main SalonThe frame structure underneath the cabin sole was supplemented with new beams sometime before WBFV received the vessel. The aft most cabin sole beam beneath the doorway was significantly deteriorated from water damage. In 2016 it was replaced with a new beam. The paneling and upholstery were fully restored.
Steering and Rudder Steering is via a varnished woo spoke wheel attached to a traditional worm drive atop a bronze rudder shaft. The wheel was repaired in 2016. Steering is generally smooth and tight without sloppiness. Components of the worm drive move easily, and pivot points show without significant wear. The rudder was found without deterioration. Gudgeon and straps are secure without evidence of movement or significant wear.
Sea Connections The following table lists the initial condition of all through-hull valves; each has been replaced.
Engine ShaftThe engine shaft is a flanged base type lag bolted to the keel. Above it long term leakage caused corrosion of steel floor timbers and the resultant ferrous deposits drained forward, coating the timber and the stern gland. The entire area was cleaned by Carlos and re-examined by Jeff.
Engine Compartment The engine’s statement of condition will be provided in a separate report, as at the time of this writing we are waiting for the outcome of the decision on the Carl Moyer Grant WBFV is pursuing from the May Area air Quality Management District. The engine bed logs and rails were removed, and new material fabricated and installed in 2019.
Spars and Rigging CLOVER was converted from a gaff topsail cutter to a Marconi rig sometime in the 1960’s in the Caribbean, with an extension scarfed onto her original mast. In 2021 her spars were moved to Rutherford’s Boat Shop where work began in earnest to repair deterioration, remove all fittings, and cut the mast back to her original dimensions.
This was a painted wooden mast stepped on the keel, masthead rigged and equipped with double inner forestays and a baby stay. The mast was removed in 2018 and stored. It’s components were removed and given a thorough inspection. In 2021 fittings to be reused were sand-blasted, hot-dipped, neutralized, primed and repainted. The new bowsprit was installed during the 2019 haulout. The boom and staysail boom are original and were likewise stripped of old paint, and varnished bright. The mast showed evidence of having been extended and changed to a Marconi rig. The standing and running rigging was badly corroded and except for the bronze turnbuckles were unusable.
A primary goal of this restoration project was to return the vessel to her original gaff topsail cutter configuration. Using photos provided by a former shipmate of the original owner, Mr. Michael Thomas of Devon, we have cut back to scale the existing mast and completed repairs on the mast and boom; many areas needed graving pieces and splines to repair previous damage. The spreader fittings for the intermediate spreader were re-installed in their previous location to become the single set of spreaders. These sketches provide an idea of the new scheme for the running and standing rigging. A detailed sail planning is next to provide the rigger with the necessary dimensions to make up the rigging.
The 2018 Crane Lift
In February 2018, CLOVER’s mast and rig were removed, as well as her aft cabin and engine. The full extent of the deterioration in the aft section was then realized; all her floors underneath the engine, and the engine bed rails and logs needed replacement before any further restoration work on the deck or machinery could commence. The rig was stored, the engine sent for repainting, and the focus turned to raising funds to haul the boat – asap!
The 2019 Haulout
Up to this point work progressed slowly as WBFV got up and running and recruited volunteers. By 2018 CLOVER’s pilothouse, mast and rig, her engine, and tankage had been removed for repair. Her stem and knightheads repaired, and down below her cabin sole beam structure replaced. All of her gear and fittings were removed, carefully catalogued, and stored.
But now it was time to tackle the more serious elements of the restoration. CLOVER was hauled again in 2019, with these objectives: replace 7 floors and install new engine bed rails in the aft section of the vessel; re-caulk her planking below the waterline; reinstall the engine, pilothouse, and tankage. In addition the propeller shaft was removed and refurbished; her shaft log and cutlass bearing were removed and replaced.
In March 2020 moved from Pt. Richmond to her new home in Glen Cove Marina. Later in the year, work began in earnest to repair the deck, hatches, and samson post, forward and aft mooring bitts. Work continued into the early part of 2021 with a completely new deck laid on top of the original laid deck, and all hatches and fittings strengthened and made watertight.
What follows is the story of CLOVER herself and detailed account of the work completed; there is also a description of the remaining phases in the project to return her to sailing condition.
The SurveyPrior to deciding whether to accept CLOVER, WBFV commissioned a marine surveyor to ascertain her condition. She was in an advanced state of decay with bilge pumps running around the clock. She was taken from Alameda to Richmond and hauled at Bay Marine Boatyard to be hauled out for the first time in a decade. We weren’t sure what we’d find.
In June 2015, CLOVER was surveyed by renowned marine surveyor Kent Parker. Kent spent three days tap-testing, probing, and visually inspecting all the accessible structural areas from the keel to the deck, from the stems to the horn timbers of the stern; all deck beams and carlins, hull frames and steel floors; the cabins hatches and internal partitions; and the mast and spars on deck, rigging end fittings, turnbuckles and chain plates. It was a thorough examination of the vessel’s condition and guides the restoration project.
The 2016 Haulout
In March 2016 CLOVER returned to Bay Marine Boatyard, and begin the first phase of her restoration, focusing on making her hull and deck watertight and addressing the immediate structural issues. In all portions of 5 planks were removed and replaced; a fiberglass covering put on the deck; 7 through-hull fittings and valves were replaced, and the hull topsides and bottom painted. It was a start.
After the haulout, CLOVER was moved across from Bay Marine to Sugar Dock, where her deck was covered, and work continued below decks to treat the corrosion in the bilges, repaint the floors, remove all electrical wiring and plumbing, remove and catalog all the equipment, and prepare the engine and rig for removal. Still leaking, she was sealed up while preparations and funding were raised.
CLOVER was designed by Albert Luke in 1938 in Hamble, Southampton, England for Eric Thompson, a Royal Navy Reserve officer. She was built in Hamble, Southampton, England by the Luke Brothers Boat Yard. A renowned yard for decades, sadly she was targeted for destruction by the German Luftwaffe for building seaplanes and landing craft, and bombed out of existence in 1940.
Principle dimensions are 68’ overall, 50’ on the waterline, 14’3” beam and 9’ draft. Her displacement is approximately 100,000 lb. CLOVER is traditionally carvel planked using Long Pine planking and double sawn oak frames with staggered joints. She was fastened with what appear to be bronze spikes and is externally ballasted with a cast lead keel estimated to weigh 11,000 lb., fastened with 1 ¼” bronze bolts. The topsides have been refastened with stainless steel screws. Floors are steel straps bolted through the keel and extended upwards five plank widths and through-bolted to a single frame with bronze bolts.
We understand from the Royal Cruising Club that she and Thompson were members, and that Clover was sold circa 1960 to a British couple that took her to Jamaica and lived aboard with their young family. From there she passed into several charter owners and transited the Panama Canal in the 1970's, arriving in the Bay Area. She was donated to us in 2016 after laying dormant and uncared for for ten or more years; sinking, damaged and close to being destroyed.
CLOVER’s ASDIC Gear from World War II
Note in the picture of her on the hard the presence of oval metal plates measuring about 27” x 18” at the port and starboard hull sides just forward of the forward edge of the ballast keel. These plates are associated with 12” diameter internally mounted vertical cylinders with seal tops. There are junction boxes on the tops of the cylinders. This is believed to be CLOVER’s wartime gear – her “ASDIC”, developed by the British Admiralty’s Anti-Submarine Division between the World Wars.
Another interesting coincidence is the presence of what appears to be a compass binnacle mounted on top of the main cabin, a curious spot to place a ship’s compass, but in fact is located very close to the ASDIC equipment below decks.
The equipment that remains today is watertight and sound; it presents dramatic evidence that she served her country during its darkest hour, presumably in the English Channel and off the coast of Western France, to detect metal objects in the water such as mines and U-boats. When the equipment was installed is an open question and raises the possibility that her owner, being involved in the Royal Navy’s diving department, may have had this equipment installed during construction to perform some manner of testing.
Terry founded WBFV in 2014 to build a community of veterans and their families around wooden boats.
Service, Sailing, & Community