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Surf Therapy Practice, Research, and Coalition Building: Future Directions Guest Editors

Surf Therapy Practice, Research, and Coalition Building: Future Directions
Guest Editors
Kristen H. Walter
,Gregor V. Sarkisian
, Giovanni Martínez
, and Philip B. Ward
Author Biographies:
Kristen H. Walter,
is a Clinical Research Psychologist at the
Naval Health Research Center in San Diego, California, where she investigates the
treatment of posttraumatic stress disorder (PTSD) and conditions that commonly
co-occur with PTSD, such as major depressive disorder (MDD), and traumatic brain
injury. Dr. Walter explores both evidence-based treatments for PTSD and co-
occurring conditions, as well as complementary and alternative approaches. She is
an Investigator on several Department of Defense-funded trials, including
randomized controlled trials comparing evidence-based psychotherapies for co-
occurring PTSD/MDD and another comparing two activity-based interventions (surf
and hike therapy) for MDD. She is also a privileged clinical provider at Naval
Medical Center San Diego and a licensed psychologist in the states of California and
Gregor V. Sarkisian,
Professor, has taught in the Applied Community
Psychology specialization within the M.A. clinical psychology program at Antioch
University Los Angeles since 2005. Dr. Sarkisian began working with the Jimmy
Miller Memorial Foundation (JMMF) in 2015 where he has served as a volunteer surf
instructor and more recently as the Director of Research and Evaluation for JMMF to
better understand the benefits of surf therapy for youth at-promise and U.S.
veterans. Since 2018, Dr. Sarkisian has been a member of the International Surf
Naval Health Research Center, San Diego, CA, USA
Antioch University, Los Angeles, CA, USA
Founder, Surf4Dem, Aguadilla, PR
University of New South Wales, Sydney, AU
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Global Journal of Community Psychology Practice, Page 2
Therapy Organization (ISTO) and he is actively engaged in coalition building, the
dissemination of research on surf therapy and serves as a technical consultant to
programs interested in developing surf therapy program evaluations.
is a licensed Clinical Psychologist in Puerto Rico, the Founder/Executive
Director of the 501(c)3 non-profit organization, Surf4Dem, Inc., and Advisor to the
Board of Directors of the International Surf Therapy Organization (ISTO). Surf4DEM
offers children and families affected by Autism Spectrum Disorder an environment
of support to connect and share by creating opportunities and enjoying the
therapeutic benefits of surf therapy. As a Clinician Dr. Martinez has vast experience
working with Neurodevelopmental Disorders in particular ASD, in relation to the
clinical evaluation, training and program development. His background on research
comes as an Adjunct Professor at the Medical Sciences Campus University of
Puerto Rico, his research focus on aspects of Public Health and Development of
Alternatives Methods of Intervention for children with ASD.
Philip B. Ward,
is a
clinical neuroscientist and UNSW Sydney professor of psychiatry who has always
loved body surfing. Phil is a passionate advocate for building the evidence base for
surf therapy and is inspired by the positive vibe that surrounds surf therapy and the
people who support it. He is a founding partner of the International Surf Therapy
Organization, and a board director of the Waves of Wellness Foundation.
Recommended Citation: Walter, K. H., Sarkisian, G. V., Martínez, G., & Ward, P. B.
(2020). Surf Therapy Practice, Research, and Coalition Building: Future Directions.
Global Journal of Community Psychology Practice, 11
(2), 1 11. Retrieved
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Global Journal of Community Psychology Practice
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Global Journal of Community Psychology Practice, Page 3
Surf Therapy Practice, Research, and Coalition Building: Future Directions
Articles in this Special Issue of the Global Journal of Community Psychology Practice on
Surf Therapy Around the Globe have focused on theory development, practice
considerations, empirical research, and coalition building in order to advance the field of
surf therapy. In this concluding article, the Guest Editors highlight the ways in which the
collective work in this Special Issue expands on the current literature in terms of theory,
as well as processes and outcomes for different programs across a variety of populations
across the globe. Suggestions for conducting future studies on surf therapy are provided
in order to build an even stronger knowledge base in this area. Finally, initiatives set
forth by the International Surf Therapy Organization are presented in order to foster
coalition building, participant inclusion, social justice, research and evaluation, and
public advocacy. Collectively, this article aims to summarize the work highlighted in this
Special Issue and pave a path for surf therapy practice and research going forward.
This Special Issue of the Global Journal of
Community Psychology Practice on Surf
Therapy Around the Globe explored the
current state of theory development, coalition
building, program development, evaluation
and empirical research on surf therapy. The
collection of research in this Special Issue
adds to the literature and science of surf
therapy and represents the most
comprehensive collection of research on surf
therapy to date. While the practice of surf
therapy varies greatly between programs,
benefits have been observed for a variety of
populations, and research using grounded
theory has identified common characteristics
across programs with differing interventions
and populations. There is a growing body of
research on the benefits of surf therapy and a
need to engage in more rigorous approaches,
from observational designs to studies
utilizing comparison groups and randomized
controlled trials. The global coalition efforts
auspiced by the International Surf Therapy
Organization have enhanced the growth of
surf therapy practice and research over the
three years since its foundation.
Research highlighting components of surf
therapy that might play an important role in
its effects include processes such as
empowerment and respite. Psychological
empowerment, while only explicitly
mentioned in one evaluation study (Gomes et
al., 2020), is a central process at play in most
surf therapy programs. Through engaging in
the physical activity of surfing in an
unpredictable but fun ocean environment,
participants must focus attention on each
moment while learning to ride a wave. The
focus of mind and body required by the ocean
environment simultaneously brings respite, a
break from trauma symptoms, or from being
stigmatized due to being part of a
disenfranchised group. Respite could be a
catalyst to changing one’s perspective on
where they stand in their sociopolitical
environment. Additionally, through
accomplishing the challenge of riding a wave
in a socially supportive group, one could view
this experience as a small win that could be
applied to different challenges (Weick, 1986).
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Surf Therapy Practice and Implications of
Grounded Theory Research
Marshall et al. (2020) developed a grounded
theory based on the experience of U.S.
veterans that articulates empowering
processes of surf therapy and reflects the
programming and evaluation findings
presented in this special issue. At their core,
most surf therapy programs provide
participants with the opportunity to take on
the challenge of learning to surf at one’s own
pace and to experience surfing in a non-
judgmental and socially supportive group. As
a result, many participants experience respite
through the focus required by the activity of
surfing, social connectedness to fellow-
surfers, and a sense of accomplishment that is
transferrable to other activities. Outcomes
include improved psycho-social wellbeing,
decreased isolation and symptom reduction
(Marshall et al., 2020). In previous research,
Marshall et al. (2019) developed a similar
grounded theory based on the experiences of
vulnerable youth in the U.K. While both
studies involved different programs serving
different populations, the processes and
outcomes experienced by participants were
very similar (Marshall et al. 2019; Marshall et
al., 2020). How can surfing bring similar
benefits to people experiencing different
challenges vulnerable youth and veterans
with combat-related PTSD?
The complexity of the above question
increases when one explores the variation in
surf therapy program delivery on at least five
dimensions: (1) Population(s) served, (2) surf
instructor preparation and methodology of
instruction, (3) dosage (i.e., session
frequency, duration and program length) of
surf therapy, (4) additional program activities
apart from surfing and (5) outcomes
measured. Despite this, Marshall et al.’s
(2019; 2020) grounded theory research
provides a starting point to conceptualize the
common elements of surf therapy programs
along these dimensions.
In addition to advances in understanding the
theoretical foundations of surf therapy
practice, this Special Issue included two
articles that have broadened opportunities to
promote better modes of direct
communication among youth with
disabilities, who may be more comfortable
communicating through the integration of
visual techniques (Britton et al., 2020; Van
der Merwe & Yarrow, 2020). Britton et al.
(2020) used body mapping, integrating visual
representations of the body-mind
environment, to facilitate increased
communication about complex emotions. Van
der Merwe and Yarrow (2020) utilized
Makaton symbols, six visual symbols
representing emotions, to better
communicate with participants during surf
therapy sessions. Van der Merwe and Yarrow
(2020) identified four areas in which
program adaptations were made from
meeting the needs of a neuro-typical to a
neuro-diverse population which were
consistent with the structure of the more
established Surf Project program described
by Van Ewijk et al. (2020) integrating visual
communication, incorporating routine and
structure into regular operations,
maintaining a low surfer-surf-instructor ratio,
and, training for surf therapy program staff
on positively interacting with youth with
For programs serving vulnerable youth, there
is variation in how vulnerable youth are
defined as a population, program dosage
ranges from one day to three years, and there
are a wide variety of program activities
outside of surfing (Sarkisian et al., 2020;
Devine-Wright & Godfrey, 2020; Gomes et al.,
2020). Yet, the common threads of surf
therapy programming which emerged in
Marshall et al.’s (2020) grounded theory
findings (emergent categories of surf therapy
intervention) are embedded in the practice of
all six programs serving youth with
disabilities and vulnerable youth tackling a
challenge at one’s own pace and being part of
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a social environment that provides a familial,
non-judgmental safe space for participants.
Surf Therapy Program Evaluation and
Empirical Research
Over the past ten years, there has been a
growing body of program evaluation on the
benefits of surf therapy. In a scoping review
of the research evidence on surf therapy,
Benninger and colleagues (2020) conducted a
search of peer-review journals,
books/chapters, theses and dissertations
which yielded 29 studies. Table 1 presents
the characteristics of the 8 additional studies
on surf therapy included in this special issue,
bringing the total number of studies to 37.
With the exception of one study (Snelling,
2015), all programs that have published
results reported benefits to participants.
These benefits have been measured primarily
through observational pretest-posttest
designs on outcomes such as wellbeing and
health although there have been two studies
that utilized a randomized controlled trial
design (Snelling, 2015; Walter, et al., 2019a).
While the observational pretest-posttest
design is an accepted practice among
community-based organizations, and serves
as a means of reporting to funders - critical to
program sustainability - it does not offer
sufficient rigor to clearly provide causal
inference for changes in outcomes. A
roadblock to conducting more rigorous
research such as quasi-experimental or
experimental designs is the research capacity
of surf therapy programs which is often
limited by funding, research expertise, or
both of these elements.
Recommendations for Future Program
Evaluation and Research
Due to a dearth of surf therapy studies that
use experimental designs in the current
literature, it is difficult to fully evaluate the
impact of surf therapy. Although several
studies in this Special Issue promote the
science of surf therapy with more stringent
study methodology, there are ways that
future research could further advance the
field. Specifically, including comparison
groups, establishing common metrics and
assessment tools, identifying the optimal
dosage and duration of effects, determining
how surf therapy is best used (e.g., as a stand-
alone or adjunctive intervention), and
distinguishing the components of surf
therapy that provide the greatest benefit are
ways to improve our understanding of the
impact of surf therapy.
Few studies to date in the surf therapy
literature (Otis et al., 2020; Rosenberg, 2014;
Snelling, 2015 for exceptions) included a
comparison group, let alone use more
rigorous methods, such as randomized
controlled trial (RCT) designs. RCTs a
design where each participant is equally
likely to be assigned to an intervention/group
within a study provide rigorous evidence
for intervention efficacy. Although RCTs have
been used in the field of surf therapy (e.g.,
Snelling, 2015; Walter et al., 2019a), these
trials may not be feasible in some surf
therapy programs due to practical, ethical, or
resource limitations. To date, the majority of
surf therapy research has focused on
program evaluation that measures changes in
participants over the course of a surf therapy
program. Program evaluation can serve as an
initial step, but does not shed light on
whether reported changes are due to surf
therapy, time, concurrent interventions, or
other factors. If more stringent program
designs are not feasible and program
evaluation offers limited utility, surf therapy
should at least incorporate a comparison
group. For example, studies could compare
one surf therapy program to another or
include different samples in the same
program (e.g., children with primary physical
or psychological concerns; veterans
compared to civilians). A comparison group
allows examination of differences in effects
due to different factors for each group (e.g.,
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sample, program, duration, etc.) and thus
whether the outcomes are more generalized
or circumscribed. Future research should use
the most rigorous methodology that is
feasible in a given setting to advance surf
therapy research.
Table 1
Characteristics of Studies on Surf Therapy Included in the 2020 Special Issue on Surf Therapy
Around the Globe
Focus of
Britton et
al., 2020
Youth with ASD
skills &
Body Mapping,
Wright &
Health & Well-
Posttest, Mixed
Stirling Children’s
Wellbeing Scale,
Edinburgh Mental
Wellbeing Scale,
Rosenberg Self-
Esteem Scale,
Interviews, focus
Gomes et
al., 2020
skills &
Strength and
Marshall et
al., 2020
Veterans with
& Mental
Otis et al.,
Active duty
members with
& Mental
PTSD Checklist for
DSM-5, Patient
Anxiety Disorder
Scale, Positive and
Negative Affect
Schedule, Positive
Affect Schedule
et al., 2020
Mental Health
& Wellbeing
Posttest, Mixed
Children’s Hope
Scale, Participant
drawings and
related text
Van der
Merwe &
Youth with ASD
Case Study
Focus Groups,
Makaton symbols
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skills and
Van Ewijk
et al., 2020
Youth with
skills and
Another avenue for the field of surf therapy is
to establish a common set of metrics and
assessment tools to be used among
populations and outcomes. Among published
surf therapy studies, there is a wide array of
assessment instruments used to measure
outcomes, including many measuring similar
constructs (see Benninger et al., 2020 for a
thorough review). It is critically important to
identify well-established assessment tools
that are validated for the subpopulations in
which they are used and that can be used
across programs. For constructs in which
established and validated measures do not
exist, care should be exercised in developing
and empirically evaluating new measures.
Furthermore, standardized measures and
approaches should be established for both
qualitative and quantitative research, which
address different research questions, but
when jointly deployed greatly enhance our
knowledge about surf therapy. Establishing
common assessment instruments is crucial as
it allows for comparison between studies,
populations, and outcomes, which ultimately
serves to build a global research base for surf
An important goal for future surf therapy
research is to identify the optimal dose of surf
therapy programs in terms of session
frequency, duration, and program length.
Similar to other medical or psychological
treatments, determining the length of each
surf therapy session and how many sessions
are needed to yield a given physical,
psychological, or functional outcome is vitally
important. Not only does distinguishing the
sufficient dose allow for greater benefit for
participants, it also assists with efficient
utilization of resources. Furthermore,
identifying the duration and sufficient
number of surf therapy sessions will improve
the accuracy of surf therapy research in that
outcomes can be better evaluated in the
context of whether or not the person received
an adequate dose of surf therapy to produce a
given benefit. In addition, it is essential that
future surf therapy studies include repeated
and follow-up assessment time points to
determine not only the immediate outcomes
of surf therapy, but also how long any
benefits are maintained. This will provide
important knowledge about the benefits and
limitations of surf therapy programs and how
they can best be utilized for the benefit of
participants. Future research studies should
analyze outcome data by sessions attended
and the duration of sessions so that optimal
dosage can be ascertained, as well as
frequently assess outcomes during surf
therapy programs and after programs have
been completed so that the duration of effects
can be established.
A critical consideration in surf therapy
research is whether surf therapy provides the
greatest benefit as an adjunctive or stand-
alone intervention, and for which populations
or conditions. Very few surf therapy studies
acknowledge the use of other interventions
by participants or report these data (see
Walter et al., 2019b for an exception), which
is necessary for understanding the
independent effects of surf therapy. Surf
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therapy may enhance benefits from other
interventions and be most appropriate as an
adjunctive intervention, which is the most
suitable recommendation based on the
current data available. It is also possible that
surf therapy could serve as a stand-alone
intervention producing significant benefits to
participants, but there is limited data to
suggest that surf therapy alone can yield
sufficient benefits to participants for a given
condition. Adequately assessing and
reporting on the use of other interventions by
surf therapy participants and determining
outcomes for those receiving surf therapy as
an adjunctive intervention versus surf
therapy alone will help to address this in
future research.
Finally, research has begun to explore an
array of outcomes associated with surf
therapy many highlighted in this special
issue. Even though more outcome research is
needed in the field of surf therapy, future
research efforts should start to determine
which components of surf therapy programs
account for the greatest amount of change in
outcomes (i.e., dismantling designs). For
example, a study could compare a surf
therapy program delivered with only the
surfing component to the surfing component
combined with a psychosocial intervention.
This research would elucidate whether the
psychosocial component accounts for change
in outcomes and if so, how much.
Additionally, Marshall and colleagues (2019)
present elements of surf therapy programs
such as surfing activity, ocean environment,
participants, surf instructors, peer mentors,
and equipment that can ultimately affect
program outcomes, whether directly or
indirectly. Furthermore, exploring how surf
therapy facilitates changes in symptoms and
functioning, such as providing a respite from
concerns, creating a safe physical and
emotional space, offering opportunities for
social connection, and fostering experiences
that are challenging, but approached through
self-selected pacing (Marshall et al., 2019;
Caddick et al., 2015) can provide insight as to
the unique aspects of surf therapy that affect
change. Identifying the ‘active ingredients’ of
surf therapy and the processes by which they
work is fundamental for the future
development and implementation of surf
therapy programs.
Taken together, surf therapy research has
largely focused on program evaluation, which
has provided initial support for its effects on
various health and psychosocial outcomes.
However, the current state of surf therapy
research should be enhanced in order to
expand our understanding of its use and
application. Future research should
incorporate more rigorous research design
elements, standardized assessment measures,
and identify the optimal frequency and
duration of programs.
The Role of the International Surf Therapy
Organization (ISTO) in Coalition Building
The International Surf Therapy Organization
(ISTO) is a collective of surf therapy
programs, researchers and influencers
working to collaborate on research, share
best practices and advocate the benefits of
surf therapy
( ISTO held
its third conference in November, 2019 and
has grown from eight to more than sixty
contributing member surf therapy
organizations in three years. Utilizing the
collective impact model as coalition building
framework (Kania & Kramer, 2011), some
elements of the collective impact model were
helpful (i.e., shared leadership, common
agenda, reinforcing activities, and continuous
communication) and others more challenging
(i.e., the approach feeling top-down, difficulty
agreeing on a common agenda, shared
measurement, and uneven contribution and
follow-through from programs) in moving
coalition efforts forward (Mattila, 2020).
Participant Inclusion and Social Justice
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Moving forward, ISTO has an opportunity to
address some of the inherent challenges of
the collective impact model (Wolff, 2016)
through broadening its efforts at participant
inclusion and social justice. For instance,
many of the program directors of surf therapy
programs have direct relationships to
participants as family members, such as a
veteran with PTSD running a program for
veterans with PTSD or a psychologist with a
family member with ASD who runs a program
for youth and families with ASD. With
coalition members who already have a
connection and personal investment in the
wellbeing of populations being served by surf
therapy programs, it is likely there will be
widespread support for more participant-
inclusive and social justice-oriented coalition
practices. ISTO plans to develop additional
opportunities for participants to be included
in the coalition as well as to develop a social
justice working group within the coalition
that would include participants from surf
therapy programs (Mattila, 2020). Through
greater inclusion of participants in program
development and coalition building activities,
the greater the likelihood that the diverse
experiences and skills of participants will
allow for collaborations that address gaps in
the field and expand opportunities for
participant-driven, social justice focused
ISTO has an important role in fostering
research by facilitating collaborative
relationships, advocating for empirical
evaluation and supporting research
initiatives that will push the knowledge on
benefits to surf therapy forward. One area in
which this has already begun is through
collaborations that developed from ISTO
conferences. ISTO could support more formal
research mentoring initiatives to develop a
network that matches surf therapy programs
with a researcher’s skillset, by region,
language, and population served. For
example, the third author of this article has
provided mentorship to surf therapy
programs in Latin America (where Spanish is
the primary language) and the target
population is children with ASD or other
neurodevelopmental disorders. These
relationships were initiated and fostered at
the ISTO conferences and via related social
networks (e.g., the ISTO web page, Through
experienced researchers mentoring other
surf therapy programs where those
delivering the program had less research
experience, programs can enhance their
empirical research capacity in an efficient and
informed manner.
ISTO has also developed a shared research
tool kit that includes the measures used by
contributing organizations. Future goals
include establishing core sets of
recommended assessments for different
populations, and developing population-
specific research groups among contributing
organizations to support multi-site research
using common measures.
Policy Advocacy
One of ISTOs stated goals is to develop an
evidence base to support health funding
agencies to include surf therapy as a standard
form of healthcare. The more rigorous forms
of research and evaluation methods that were
outlined previously will be crucial in
providing a compelling evidence base to
support funding proposals for surf therapy. If
surf therapy research expands to utilize such
research designs, funding of programs could
potentially occur on par with other evidence-
based therapeutic approaches. As editors, we
are confident this special issue will provide
the impetus for further development of surf
therapy programs, and more rigorous
research to elucidate the many benefits of
surf therapy that improve the well-being of
program participants.
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Benninger, E., Curtis, C., Sarkisian, G.V.,
Rogers, C., Bender, K., & Comer, M.
(2020). Surf therapy: A scoping
review of the qualitative and
quantitative research evidence.
Special Issue of Global Journal of
Community Psychology Practice on
Surf Therapy.
Britton, E., Kindermann, G., Carlin, C. (2020).
Surfing and the senses. Using body
mapping to understand the embodied
and therapeutic experiences of young
surfers with Autism. Special Issue of
Global Journal of Community
Psychology Practice on Surf Therapy.
Caddick, N., Smith, B., & Phoenix, C. (2015).
The effects of surfing and the natural
environment on the well-being of
combat veterans. Qualitative Health
Research, 25, 7686.
Devine-Wright, H. & Godfrey, C. (2020). The
Wave Project: Evidencing surf therapy
for young people in the UK. Special
Issue of Global Journal of Community
Psychology Practice on Surf Therapy.
Gomes, P., Fazenda, N., Gomez-Baya, D.,
Rauktis, M.E., & Provost, G. (2020).
SURF.ART in Portugal: Daring,
accomplishing and transforming
Portuguese youth and their
communities. Special Issue of Global
Journal of Community Psychology
Practice on Surf Therapy.
Kania, J. & Kramer, M. (2011). Collective
Impact. Stanford Social Innovation
Review, Retrieved from
Marshall, J., Ferrier, B., Ward, P., & Martindale,
R. (2020). “When I was surfing with
those guys I was surfing with family.”
A grounded exploration of program
theory within the Jimmy Miller
Memorial Foundation surf therapy
intervention. Special Issue of Global
Journal of Community Psychology
Practice on Surf Therapy.
Marshall, J., Kelly, P., & Niven, A. (2019).
“When I Go There, I Feel Like I Can Be
Myself.” Exploring Programme
Theory within the Wave Project Surf
Therapy Intervention. International
Journal of Environmental Research and
Public Health, 16(12), 2159.
Mattila, M. (2020). Coalition building in surf
therapy: A case study on collective
impact. Special Issue of Global Journal
of Community Psychology Practice on
Surf Therapy.
Olive, L., Parker, R., Dober, M., Drake, C., Keith,
M., & Telford, R. (2020). Intervention
mapping: Using theory and evidence
to inform the Ocean Mind surf therapy
program for improving youth mental
health. Special Issue of Global Journal
of Community Psychology Practice on
Surf Therapy.
Otis, N. P., Walter, K. H., Glassman, L. H., Ray,
T. N., Michalewicz-Kragh, B., &
Thomsen, C. J. (2020). Effects of PTSD
and MDD comorbidity on
psychological changes during surf
therapy sessions for active duty
service members. Special Issue of
Global Journal of Community
Psychology Practice on Surf Therapy.
Rosenberg, R. S., Lange, W., Zebrack, B.,
Moulton, S., & Kosslyn, S. M. (2014).
An Outdoor Adventure Program for
Young Adults with Cancer: Positive
Effects on Body Image and
Global Journal of Community Psychology Practice
Volume 11, Issue 2 April 2020
Global Journal of Community Psychology Practice, Page 11
Psychosocial Functioning. Journal of
Psychosocial Oncology, 32(5), 622
Sarkisian, G.V., Curtis, C., & Rogers, C.M.
(2020). Emerging hope: Outcomes of
a one-day surf therapy program with
at-promise youth. Special Issue of
Global Journal of Community
Psychology Practice on Surf Therapy.
Snelling, M. (2015). Breaking cycles of
violence, one wave at a time: A
formative evaluation of the waves for
change surf therapy programme
(master's thesis). University of Cape
Town, Cape Town South Africa.
Van der Merwe, N. & Yarrow, P. (2020). More
than surfing: Inclusive surf therapy
informed by the voices of South
African children with Autism
Spectrum Disorder. Special Issue of
Global Journal of Community
Psychology Practice on Surf Therapy.
Van Ewijk, H., Wansink-Lokerman, M.,
Lamerz, A., & Van den Broek, S.
(2020). Positive effects of surfing on
psychological wellbeing for children
with developmental difficulties.
Special Issue of Global Journal of
Community Psychology Practice on
Surf Therapy.
Walter, K. H., Otis, N. P., Glassman, L. H., Ray,
T. N., Michalewicz-Kragh, B., Elliott, K.
T., & Thomsen, C. J. (2019a).
Comparison of surf and hike therapy
for active duty service members with
major depressive disorder: Study
protocol for a randomized controlled
trial of novel interventions in a
naturalistic setting. Contemporary
Clinical Trials Communications.
Walter, K. H., Otis, N. P., Ray, T. N., Powell, A.
L., Glassman, L. H., Michalewicz-
Kragh, B., & Thomsen, C. J. (2019b).
Breaking the Surface: Psychological
outcomes among U.S. active duty
service members following a surf
therapy program. Psychology of Sport
and Exercise.
Weick. K. (1986). Small wins: Redefining the
scale of social issues. In E. Seidman &
J. Rappaport (Eds.), Redefining social
problems (pp. 29-48). New York:
Plenum Press.
Wolff, T. (2016). Ten Places Where Collective
Impact Gets It Wrong. Global Journal
of Community Psychology Practice,
7(1), 1-11. Retrieved from
KHW is an employee of the U.S. Government.
This work was prepared as part of her official
duties. Title 17, U.S.C. §105 provides that
copyright protection under this title is not
available for any work of the U.S.
Government. Title 17, U.S.C. §101 defines a
U.S. Government work as work prepared by a
military service member or employee of the
U.S. Government as part of that person’s
official duties. The views expressed in this
article are those of the authors and do not
necessarily reflect the official policy or
position of the Department of the Navy,
Department of Defense, nor the U.S.
... The use of surfing as a therapeutic intervention to address psychological symptoms has increased significantly over the past several years [1,2]. Surf therapy programs operate around the world and are often offered as an adjunctive intervention to standard treatments to support psychological health and well-being. ...
... Service members also reported high levels of satisfaction with the surf therapy program [6]. Collectively, these findings provide initial support for the use of surf therapy as an adjunctive intervention resulting in psychological benefits and high satisfaction ratings among active duty service members and veterans [2,6]. However, surf therapy has yet to be directly compared to either traditional or alternative therapies; as such, more research is needed to establish the efficacy of surf therapy as well as the nuances of surf outcomes across diverse populations [2]. ...
... Collectively, these findings provide initial support for the use of surf therapy as an adjunctive intervention resulting in psychological benefits and high satisfaction ratings among active duty service members and veterans [2,6]. However, surf therapy has yet to be directly compared to either traditional or alternative therapies; as such, more research is needed to establish the efficacy of surf therapy as well as the nuances of surf outcomes across diverse populations [2]. ...
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Surf therapy is increasingly being used as an intervention to address various health problems, including psychological symptoms. Although recent research supports the positive impact of surf therapy on psychological outcomes, it is unclear whether these outcomes differ between men and women. This study compared changes in depression/anxiety (Patient Health Questionnaire-4), positive affect (Positive and Negative Affect Schedule), and pain (Numerical Pain Rating Scale) between U.S. service men and women (N = 74) during six weekly surf therapy sessions. Overall, participants reported decreased depression/anxiety (p < 0.001) and increased positive affect (p < 0.001), but no change in pain rating following each session (p = 0.141). Significant gender differences were found in the magnitude of changes in depression/anxiety (B = −1.01, p = 0.008) and positive affect (B = 4.53, p < 0.001) during surf sessions, despite no differences in pre-session scores on either outcome. Women showed greater improvements in depression/anxiety and positive affect compared with men—an important finding, given that surfing and military environments are often socially dominated by men. Future research is needed to replicate these findings in other samples, extend this research to other underrepresented populations, and identify barriers and facilitators of the sustainable implementation of surf therapy across populations.
... Almost all participants who engaged in the Surfability intervention reported experiencing psychological distress, anxiety and/or depression prior to participating in the group. Increasing evidence suggests that surfing in an ocean environment can facilitate feelings of respite and enhance wellbeing in individuals with lasting psycho-social difficulties [55,69] by necessitating a focus on body and mind in the present moment [70]. In line with these findings, participants who attended the Surfability intervention reported feelings of stress reduction, indicating that surfing had interrupted bouts of rumination arising from relationship breakdown and challenging personal events. ...
... Surfability provided an opportunity for brain injury survivors who had previously reported feeling isolated to experience greater social connections and form meaningful social ties with individuals from diverse backgrounds, reinforcing the role of social connectedness in surfrelated positive health and wellbeing outcomes [55,69]. Being in a group with similar others facilitated a sense of belonging and identity through shared life experiences [82], with one person describing their peers as a 'family' connected by a mutual understanding of experience (Participant One). ...
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Nature has long demonstrated the capacity to facilitate wellbeing. Interventions involving the natural environment such as surf therapy, are increasingly being used to facilitate aspects of wellbeing in clinical populations. However, explorations of how nature-based interventions such as surf therapy may be used to promote wellbeing in the context of neu-rorehabilitation are missing from the peer-reviewed literature. Here we characterize the experience of a five-week surfing intervention involving fifteen adults living with the psycho-social and cognitive sequelae of acquired brain injury. Insights were analysed using reflexive thematic analysis, which highlighted the importance of seven overarching themes, including: 1) Connection to Nature, 2) Facilitating Trust and Safety, 3) Managing and Accepting Difficult Emotions, 4) Facilitating Positive Emotion, Meaning and Purpose, 5) Building Community through Social Connection, and 6) Positive Change. Barriers and opportunities (theme 7) were also identified as components on which clinical services may be improved. We present a theoretical model for the benefits of surf therapy in people living with acquired brain injury (ABI) based on these themes and reflections on findings from the wider literature. Findings emphasise the importance of leveraging community partnerships to augment the holistic model of neurorehabilitation and potential implications for service redesign are discussed , focusing on recent developments in wellbeing science.
... Although the evidence reviewed above suggests that surfing may have the potential in some circumstances to improve mental health and assist in reducing the burden of some psychological disorders (e.g., depression, anxiety), the underlying physiological and psychological mechanisms involved remain unclear. To our knowledge, this has yet to be systematically investigated and there has been a recent call for future work to investigate the "active ingredients" of surf-based therapies that may contribute to their salutary effects (Walter, Sarkisian, Martínez, & Ward, 2020). The present article provides a review of potential causal mechanisms through which the therapeutic effects of surfing may emerge, with the aim to provide direction and impetus to further research into surfing-based therapies. ...
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There is growing interest in surfing as a recreational activity that may facilitate skill development and improved mental health. However, there remains uncertainty regarding the causal processes through which surfing may improve psychological well-being. With the aim to guide future research, we review potential mechanisms that may underpin the psychotherapeutic effects of surfing. A range of plausible factors are identified, including exercise, water immersion, exposure to sunlight, transcendent experiences, reductions in rumination and the satisfaction of basic psychological needs. Further research is needed to clarify the effectiveness of surfing-based therapies and to establish the relative contributions of the causal mechanisms at play.
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The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8–18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children’s Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.
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There is a growing body of evidence for the benefits of the use of water-based activities and environments as an alternative or complimentary therapeutic intervention to mainstream, medicalised approaches. Surfing is one such activity with the health benefits of surf therapy linked to the fluid and dynamic nature of surfing and the sea, while learning to surf in a group context can help enhance a sense of belonging and identity through shared experiences in the surf. This paper introduces the ways in which embodied and creative work in nature can empower young people with mental health difficulties, in particular Autism. The study explores embodied experiences and the use of a creative, participatory approach to evaluating a surf therapy intervention. As such, we investigate the usability of a novel participatory evaluation method, body mapping, to evaluate the feelings and emotional wellbeing of young participants in a surf therapy programme. Findings show how body mapping can be used to help create a richer picture of the potential health and wellbeing outcomes from engaging with the sea and highlights surfing as psychosomatic experience. The paper highlights the potential of in-situ embodiment practices and creative methodologies like body mapping to support therapeutic processes, in particular those related to the imagination and emotional body, in a playful and engaging way.
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Since 2013, Hannah Devine-Wright and Cath Godfrey have developed and implemented an iterative evaluation programme for The Wave Project, a charity delivering surf therapy for young people across the UK. Hannah and Cath are currently investigating how surfing can be made available on prescription for young people within the UK's National Health Service, and how young people living outside coastal areas can benefit from surf therapy.
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This article explores the experience of the surf therapy sector developing a coalition using the collective impact framework. Several dozen surf therapy programs and sector supporters now meet annually to discuss progress and collaborate on shared sector goals after years of programs working independently and even viewing one another as competitors. Key participants found collective impact worked in encouraging shared leadership, common agenda, reinforcing activities, and continuous communication. However, participants found challenges with collective impact in the approach feeling top-down, difficultly agreeing on a common agenda and shared measures, and uneven contribution and follow-through from programs. Additional challenges included limited opportunities for program participants to contribute to the coalition building, lack of a social justice orientation, and lack of backbone organization funding. Recommendations for sectors using coalition building include considering funding and previous experience building coalitions, finding humble and bold leaders, getting the timing right, being focused and realistic with targets, and streamlining decision making.
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Together, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are debilitating and commonly comorbid; however, the effects of this comorbidity on psychological outcomes during exercise programs, such as surf therapy, have not been examined. This study compared changes in depression/anxiety and positive affect during surf therapy sessions between active duty service members with comorbid PTSD and MDD and those with either disorder alone. The study applied DSM-5 criteria to baseline self-report measures to assign probable disorder status, and used a longitudinal design involving repeated measurements to assess outcomes within 6 weekly sessions. Service members completed validated self-report questionnaires using the Patient Health Questionnaire-4 and the Positive Affect Schedule before and after each session. Within surf therapy sessions, both the comorbid and single disorder groups reported significant improvements in symptoms of depression/anxiety and positive affect. However, those with comorbid PTSD and MDD experienced significantly greater reductions in depression/anxiety (β = −1.22, p = .028) and significantly greater improvements in positive affect (β = 3.94, p = .046) compared with the single disorder group. Surf therapy appears to have global effects on psychological symptom reduction and may be a useful adjunctive intervention for the treatment of comorbid PTSD and MDD in both clinical and community health settings.
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Surf therapy is an intervention increasingly being utilized to tackle a range of health inequalities for military veterans. While increasing evidence demonstrates the effectiveness of surf therapy, there has been limited exploration of program theoretical explanations as to how it achieves positive outcomes. Theoretical understanding is important as it allows for service optimization, monitoring and further development. The current study utilized a pragmatic qualitative approach to explore theoretical mediators of the outcomes of Jimmy Miller Memorial Foundation (JMMF) surf therapy intervention. JMMF is a California (USA)-based program supporting military veterans facing mental and physical health challenges. Eighteen people who had participated in JMMF interventions (12 males and 6 females; mean age = 42 years; standard deviation = 11 years; range 28-71) were interviewed in depth about their experiences of the surf therapy intervention. Data were analyzed through constant comparative analysis and memo writing in line with pragmatic grounded theory. Two core intervention categories (relating to service delivery) were identified: “Constant challenge tackled at own pace” and “A non-judgmental familial safe space.” A further three individual categories (relating to participants) were identified: “Accomplishment,” “Respite,” and “Social Connections.” One contextualized category was identified; “Physical Therapeutic Elements.” Furthermore, a culture of “Reframing Failure” pervaded every element of the intervention. The findings demonstrated strong links to self-determination and flow theories which suggest potential theoretical frameworks for better understanding of the constructs that underpin surf therapy. The findings provide empirical evidence as to how best to optimize and expand JMMF service delivery in the US and potentially for surf therapy in wider veteran populations.
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Many active duty service members suffer from major depressive disorder (MDD). Although traditional treatments exist, alternative approaches may also be effective in treating depressive symptoms. Previous research has shown that physical activity has significant positive effects on depression symptoms in individuals with MDD, and that these benefits may be enhanced when physical activity occurs in a natural environment. Even though physical activity (i.e., hiking, walking) in natural environments has been shown to reduce depressive symptoms, water-based activity occurring in a natural environment (e.g., surfing) may produce even greater improvements in depressive symptoms. We detail an ongoing randomized controlled trial (RCT) comparing the efficacy of surf therapy and hike therapy with respect to immediate and longer-term psychological, physical, and functional outcomes in active duty service members with MDD. We describe the methodological development of this RCT evaluating novel treatment approaches and discuss considerations for evaluating physical activity interventions in a naturalistic setting.
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Mental health issues in young people are a priority for health and social care. Surf therapy is an innovative intervention that may help address this health burden globally. While increasing evidence demonstrates the effectiveness of surf therapy, there has been limited exploration as to how it achieves its outcomes. Such theoretical exploration is important for service optimisation, monitoring and proliferation. This research aimed to adopt, for the first time, a rigorous grounded theory approach to explore underlying programme theory within the Wave Project surf therapy intervention. Participants (n = 22, 14 males and 8 females; mean age = 14 years, SD = 3.5, range 8–23) were interviewed about their intervention experiences. Data were analysed through constant comparative analysis and memo writing. Two core categories reflected mediators by which surf therapy may achieve its outcomes: “Self-Selected Pacing and Progression While Surfing” and “Creation of Emotional and Physical Safe Space at Beach”. Three antecedent (linking known inputs to core categories) and three consequent categories (linking core categories to associated outputs) were also identified. These demonstrate theorised pathways from known inputs to associated outcomes within the intervention. These important findings provide plausible evidence on how to optimise the Wave Project’s delivery in tackling mental health burden.
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Although researchers have identified the benefits of physical activity on well-being, there is little evidence concerning the effects of nature-based physical activity. We investigated the effect of one nature-based activity-surfing-on the well-being of combat veterans experiencing posttraumatic stress disorder (PTSD). We conducted interviews and participant observations with a group of combat veterans belonging to a United Kingdom-based veterans' surfing charity. Our primary analytical approach was dialogical narrative analysis. Based on our rigorous analysis and findings, we suggest that surfing facilitated a sense of respite from PTSD. Respite was a fully embodied feeling of release from suffering that was cultivated through surfing and shaped by the stories veterans told of their experiences. We significantly extend previous knowledge on physical activity, combat veterans, and PTSD by highlighting how nature-based physical activity, encapsulated in the conceptual notion of the "blue gym," can promote well-being among combat veterans.
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Argues that the massive scale on which social problems are conceived precludes innovative action because bounded rationality is exceeded and dysfunctional levels of arousal are induced. Reformulation of social issues as mere problems allows for a strategy of small wins wherein a series of concrete, complete outcomes of moderate importance build a pattern that attracts allies and deters opponents. The psychology of small wins is discussed with respect to cognitive limitations, affective limitations, stress, and enactment of environments. It is concluded that the strategy of small wins incorporates sound psychology and is sensitive to the pragmatics of policymaking. (62 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Surf therapy: A scoping review of the qualitative and quantitative research evidence
  • E Benninger
  • C Curtis
  • G V Sarkisian
  • C Rogers
  • K Bender
  • M Comer
Benninger, E., Curtis, C., Sarkisian, G.V., Rogers, C., Bender, K., & Comer, M. (2020). Surf therapy: A scoping review of the qualitative and quantitative research evidence. Special Issue of Global Journal of Community Psychology Practice on Surf Therapy.