Nothing could stop Sandi Braunstein from carving her way down a ski run at Snowmass Resort in Colorado. She glided over the snow alongside her two coaches, Jeff and Erik, who were there to instruct and support her as she made turns down the mountain.

Braunstein uses a bi-sit ski, which consists of a molded seat mounted on a frame with two skis underneath. This adaptive equipment is designed for people who ski in a seated position and might have difficulty balancing on traditional skis.

“When you go down the hill, it is both thrilling and terrifying,” she said. “I’m like, don’t fall, don’t fall, don’t fall.”

Braunstein is a full-time mom, student and hobby farmer in Grand Rapids, Minn. She is also a military veteran who served for nearly a decade in the Minnesota Army National Guard.

During a training exercise in the Guard, she broke her leg and three vertebrae in her back. After seven unsuccessful surgeries over the span of nine years, Braunstein elected to have her left leg amputated below the knee. Now she is an avid member of the group Disabled American Veterans. That is why she was downhill skiing in Colorado.

“I love sports, and this is the winter sports clinic that they do every year. I skipped last year, so I am happy to be back on the slopes,” Braunstein said.

Returning to civilian life after military service can be a welcome change, but the abrupt transition can also be stressful and overwhelming. The reintegration process can feel isolating, and especially difficult for veterans who come back from long or dangerous deployments, or who found a deep sense of community in the military. Reentry can provoke anxiety, depression and post-traumatic stress.

Braunstein has been exposed to multiple traumas over the course of her life and lives with post-traumatic stress disorder, or PTSD, a mental health condition that can develop after experiencing or witnessing a traumatic event.

She said nature has a positive influence on her mental health.

“Even if you go to a park, just touch the grass,” Braunstein said. “I know it sounds mundane, but it helps. It has helped.”

Spending time engaging in outdoor recreation is known to improve general health and well-being. And research shows that veterans, in particular, benefit from outdoor activities as part of a complementary approach to treating mental health.

Studies indicate that outdoor recreation and multi-day wilderness trips can reduce symptoms of PTSD, anxiety and depression. Outdoor excursions also build on veterans’ strengths and can echo positive aspects of military service, like being physically challenged, having a defined purpose and building camaraderie.

“To me, it’s more healing and fulfilling than anything else I’ve experienced,” Braunstein said. “I’ve met so many incredible people, and I’ve done so many incredible things that I don’t think I would have had the spirit to do otherwise.”

The U.S. Department of Veterans Affairs says about 13% of female veterans and 6% of male veterans have been diagnosed with PTSD. The percentage is higher for Iraq and Afghanistan war veterans.

Symptoms like flashbacks, nightmares, difficulty sleeping, hypervigilance and detachment manifest differently from person to person. They can persist for an extended period of time and impact a person’s relationships, ability to work and daily activities.

The Veterans Administration’s health care system sets clinical practice guidelines to identify first-line treatments for PTSD. Psychiatric medication may be included in the treatment plan, but psychotherapy is generally the first line of treatment.

Engaging in beneficial activities, such as wilderness adventures, can complement both medication and therapy.

Getting outside is something Matthew Kaler, a psychologist with the Veterans Administration in Minneapolis, encourages wholeheartedly. He said it is a way for people to introduce rewards into their day-to-day life that may have been taken from them by their symptoms.

“Getting to a place where you feel like you have meaning in your life again is critically important, and so we want to encourage people to find those things that fit for them,” Kaler said.

Veteran advocacy groups around the U.S. successfully backed federal legislation in 2020 that launched programs and policies to help veterans with reintegration, mental health and treatment. The legislation also requires a Veterans Administration task force to research the benefits of outdoor recreation therapy.

Trent Dilks is the Minnesota legislative director for Disabled American Veterans. He advocates for veterans at the state and federal levels and said the VA task force study is overdue. Dilks also served 10 years with the Minnesota National Guard and did two combat tours in Iraq.

“Being in Iraq and seeing all of that, and then the culture shock of coming back to all of the excess and all of the things and all of the noise here, it was difficult,” he said. “I was restless. I was not comfortable where I was. I was dealing with a lot of anxiety. Later, I would realize it was post-traumatic stress.”

Dilks coped with his PTSD in destructive ways by partying and trying to numb his feelings. He tried therapy and medication but did not like how the drugs made him feel. Dilks recognized that he needed to find his own path to healing. A significant part of that journey involved spending time outdoors.

With a burst of excitement, Dilks grabbed his phone and tapped open a video from a trip to Colorado. In the clip, he and his former roommate from Iraq are summiting a peak. Snow is blowing in every direction.

“It was him and I hiking up there, and the wind gusts were just absolutely crazy,” he said.

Watching the video, Dilks burst into laughter, and a smile spread across his face as he noticed the icicle hanging from his beard. He said that whenever life feels difficult, he returns to the outdoors, because nothing beats fresh air and the space to breathe.