A car accident, an assault, a combat injury -- trauma can arrive in many forms, and its trail can leave behind newfound social anxieties. New people, situations and experiences can simply add up to too many unknowns and uncertainties for those adjusting to life after severe distress.

Introducing safe ways to reintegrate is the specialty of Madigan Army Medical Center's Warrior Transition Battalion's occupational therapy community outing group, which takes 12 to 15 soldiers each month on new adventures such as a hike in the Nisqually Valley, a trip to the governor's mansion or a visit to a pumpkin patch. In addition to working with soldiers who experienced trauma, the group helps soldiers who are injured to find leisure activities they can still enjoy, and it introduces career soldiers to activities they can continue to participate in once they leave the military.

"The OT outings really give soldiers the opportunity to explore that camaraderie, that feeling of being well-connected and being around other people. It really brings the best sense of themselves, and it allows them to express themselves freely and also not close themselves off but open themselves up, because when they go back to duty or when they go back to the civilian sector, they're going to need to learn how to interact with other people," said 1st Lt. Brian Park, the WTB's Alpha Company executive officer.

At times the group partners with nonprofits such as Outdoors for All to offer activities like sailing, teaching soldiers to navigate the waters in three-person crews.

"They had to work as a team; they had to communicate and cooperate to be able to sail this boat," said Phyllis Tharp, a certified occupational therapy assistant at the WTB and co-leader of the community outings group.

She recalled one soldier in particular who loved sailing before his injuries and his post-traumatic stress.

"He probably wouldn't have been able to do this unless we had that to show him that he could do it. Just a little bit of adapting and grading it, and he could do it," said Tharp. "Now he had confidence enough to say, ‘I'm going to bring my child and my wife,' and the three of them went back up to do it again on their own time."

As a field, occupational therapy focuses on improving life skills spanning the physical, emotional, cognitive, leisure and social realms. The OT community outing group strives to incorporate many of these into each activity to make them as therapeutic as possible for soldiers. Hikes like the one in Nisqually offered a physical activity that scaled to people's abilities -- some used canes and others rested in chairs as needed. A paired scavenger hunt to find birds and plants in season brought a cognitive focus and a social one as well.

Tharp said that joining in new activities can also increase self-confidence as soldiers recover from injuries, and can help those with more severe traumatic brain injuries, for instance, build the skills to participate in activities independently.

"I had a soldier who was really fearful of getting out. He's been in the active-duty Army a long time; he got injured. He had some high anxiety of getting out into public places," said Tharp. After his first outing with the group, though, "he actually came up to me and said, ‘Thank you; this really helped me, and now I know I can do it.'"

The program lets soldiers de-stress and decompress while also joining in new experiences.

"It really gives soldiers the opportunity to maybe be in uncomfortable settings just because they're not used to it, but at the end of the day they benefit so much from it and they keep signing up," said Park.