A growing number of programs try to treat PTSD by getting veterans into nature, even deep under the sea. But there's little scientific evidence that treatments like "scuba therapy" work.
On a recent morning, Shawn Campbell, 38, led a scuba diving trip off the coast of Clearwater, Fla. Joining him were Air Force veteran Bob Herris and his son Justin, an active duty pilot who serves in San Antonio, Tex.
Campbell briefed them on their dive site, an underwater military memorial called the Circle of Heroes.
"This is very important for me not just as a local diver, but I am also a combat veteran of three tours; I'm a disabled veteran," Campbell said.
The retired Army medic said transitioning back to civilian life after he was wounded in Iraq was tough for him.
"Diving was an outlet that let me do something that I found a lot of solitude and peace in but also kept me very active and healthy, so it was great for my mind and my body," he said.
Being underwater allows Campbell to meditate and relieves him from the joint pain he feels on land. He turned the hobby into a career and is now a dive master at Narcosis Scuba.
The shop has a lot of military ties, and its crews take service members out whenever they can.
Justin Herris, 35, got back from his fourth deployment a couple weeks before the trip and said it was a much-needed break from the stress of military life.
"We're either flying all the time or deploying and away from our families, so this opportunity to get away from that lifestyle, go down there and kind of forget about all the things going on in your life, focus on the fish, the wildlife, being under the water - it's extremely relieving," he said.
Narcosis is a family-owned dive shop and doesn't claim to be a formal therapy group. But Campbell said it's not surprising other organizations are exploring the use of scuba to treat veterans' PTSD.
"This is an opportunity to get out again," Campbell said, "and they become a part of a community that is a healthy community instead of just going to the bar or drinking themselves into a coma at home or self-medicating."
Nonprofit groups that introduce veterans to diving span the country, from more obvious scuba locations like Florida to places far from the coasts like Phoenix and St. Louis. They organize trips to diving hotspots like the Bahamas and Mexico, typically for week-long retreats.
Some of the groups have licensed counselors and military chaplains who volunteer to focus on trauma.
Retired Army Col. Kathy Platoni, a clinical psychologist in Dayton, Ohio and author on military trauma, said that is the ideal situation.
She said there is limited research on the benefits of nature-based therapies like scuba, but there is merit to them. She sometimes incorporates them into her own treatment plans for patients.
But she said it's important to involve health professionals, and even then, the classes are not for everyone.
"It's very hard to put people in a challenging situation who do have PTSD or have been severely traumatized into something that may further traumatize them," she said. "For instance, getting in the water with a scuba tank may be terrifying for some people."
And there are other barriers. The VA and health insurance companies don't cover scuba therapy. And not everyone can pay for the expensive equipment and frequent dive trips out of pocket.
Some support groups cover costs for an initial scuba trip, but Platoni said it can be hard to maintain the health benefits once the exotic adventure is over.
"So you have to have something that follows the scuba therapy, which would be individual psychotherapy or group therapy, or just having some kind of contact with the other members of the group that have gone through this experience," Platoni said.
"So much of the benefit comes from the belongingness and the comradery that counters the despair that so many veterans experience."
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.