Glassman, Lisa HOtis, Nicholas PKobayashi Elliott, Kim TMichalewicz-Kragh, BettyWalter, Kristen H2024-03-212024-03-212024-02-1938397730https://hdl.handle.net/10673/2452Surf and hike therapies have demonstrated effectiveness as adjunct interventions for service members with major depressive disorder (MDD). This study explores gender differences in intervention outcomes following a pragmatic, randomized controlled trial of Surf and Hike Therapy for service members with MDD ( = 96; men, = 46; women, = 50). Clinician-administered and self-report measures (depression, anxiety, positive affect, negative affect, resilience, and pain) were completed at preprogram, postprogram, and 3-month follow-up; brief measures (depression/anxiety and positive affect) were completed before and after each session. Multilevel modeling results showed that anxiety decreased from pre- to postprogram and significantly differed by gender (B = -2.26, = 0.029), with women reporting greater reductions. The remaining outcomes from pre- to postprogram demonstrated significant improvements that did not differ by gender (s = 0.218-0.733). There were no gender differences through follow-up (s = 0.119-0.780). However, within sessions, women reported greater improvements in depression/anxiety (B = -0.93, = 0.005) and positive affect (B = 3.73, = 0.001). The change in positive affect scores within sessions was greater for women in Hike Therapy compared to men ( = 0.016). Overall, results demonstrate that both genders benefit from adjunctive Surf and Hike Therapies, but women exhibit a better response in terms of longer-term anxiety and immediate psychological outcomes.endepressionexercisemilitarynature exposureoutdoor activityoutdoor recreation programsphysical activityWork unit; N1600Article