Author(s): Gregor V. Sarkisian, Kristien H. Walter, Giovanni Martinez, & Philip B. Ward

Abstract:

This Special Issue on Surf Therapy Around the Globe in the Global Journal of Community Psychology Practice is devoted to advancing the science and practice of surf therapy for diverse populations around the world. This introductory article provides a framework for this Special Issue. Surf therapy’s beginnings as a small group intervention that served a variety of marginalized populations over the past fifteen years is outlined. Next, a description of how surf therapy programs utilize four community psychology practice competencies – empowerment, mentorship, community inclusion and partnership, and health promotion – in the delivery of surf therapy is detailed. A brief overview of each article in this Special Issue is provided, linked to three practice competency categories – collaboration and coalition development, participatory research, and program evaluation. Finally, videos ancillary to three of the articles are introduced and a fourth video without an accompanying article is also outlined.

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Article:

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This Special Issue of the Global Journal of Community Psychology Practice (GJCPP) on Surf Therapy Around the Globe features articles on emerging theory, program evaluation and empirical research on eight surf therapy programs delivered in six countries - Ireland, the Netherlands, Portugal, South Africa, the United Kingdom and the United States of America – serving diverse populations, including youth with disabilities, vulnerable youth, active duty military service members and military veterans. Surf therapy is a small group intervention that has been growing in popularity over the past fifteen years. Given that many surf therapy programs developed organically, operate on small budgets, and serve marginalized groups, program evaluation and empirical research efforts began ten years ago but have increased considerably over the past five years. Surf therapy programs vary greatly in dosage (i.e., session frequency, duration and program length) and programming. Typically, surf therapy programming includes both surf instruction and additional activities (e.g., talking circles or psychoeducation) to promote mental health and wellbeing among participants.

 

Community Psychology Practice Competencies at Play in Surf Therapy Programs

 

As the reader will see in the feature articles of this Special Issue, surf therapy programs utilize four community psychology practice competencies in the delivery of surf therapy (Dalton & Wolfe, 2012). Empowerment is grounded in the physical activity of surfing and enhanced through additional program activities. While some programs focus on surfing as a form of respite, other programs seek to provide participants with opportunities for surf skill development. Surf therapy program participants, who are typically drawn from marginalized groups, often report a shift in their perspective as to where they stand in relation to their socio-political environment. Mentoring occurs through the relationship between the surf instructor or therapist and program participant. A key role of the surf instructor or therapist is encouraging participants to identify strengths, undertake self-reflection, and build social engagement – both while surfing and in everyday life. Mentoring relationships between surf instructors and participants quickly establish trust from the outset as surf instructors provide participants who may have limited experience of the ocean with a sense of physical safety. Community Inclusion and Partnership are central to most surf therapy programs through the ongoing maintenance of a participant-driven experience. From stretching on the beach to learning to surf, progress occurs at the participant’s self-selected pace. The provision of a social environment free of marginalization through positive role modeling and program processes that promote inclusivity outside of surfing, allows participants to express themselves in a socially supportive environment. Finally, Health Promotion is the general goal of surf therapy programs. While symptom reduction has been observed and measured, most surf therapy programs focus on the promotion of wellbeing and involve the measurement of hope, wellbeing, or positive affect.

 

Below, three community psychology practice competency categories are used to structure nine of the twelve articles in this Special Issue. One article focuses on Collaboration and Coalition Development, two articles center on Participatory Research, and six articles encompass Program Evaluation. A Community Tool for planning to replicate programs in new environmental and social contexts is described. And, in a concluding article, the coeditors discuss the implications for future surf therapy practice, research and coalition building based on a synthesis of the work presented in this Special Issue.

 

To set the scene, we start with a scoping review by Benninger and colleagues on research on surf therapy around the globe.

 

Surf Therapy: A Scoping Review of the Qualitative and Quantitative Research Evidence

Elizabeth Benninger, Chloe Curtis, Gregor V. Sarkisian, Carly Rogers, Kailey Bender, and Megan Comer

 

Benninger and colleagues conducted a scoping review on surf therapy over a ten-year time-period that covers peer-reviewed research papers, dissertations, theses, and outreach to experts. Their search yielded 29 studies that met inclusion criteria. They describe the geographic regions in which the programs took place, the populations served, the focus of the surf therapy program, the research design and measures employed, and the reported outcomes. Therapeutic benefits were reported for a variety of populations including vulnerable youth, youth with disabilities, active duty military service members, military veterans, young adult cancer survivors, and adults in recovery from addiction. Gaps in research, such as a lack of generalizability due to an overreliance on observational designs, and practice, such as the difficulty of identifying specific elements of surf therapy programs that lead to observed outcomes, are identified and recommendations for future research and practice are provided.

 

Collaboration and Coalition Development

 

Coalition Building in Surf Therapy: A Case Study on Collective Impact

Mathew Mattila

 

Mattila described his experience using the collective impact model as a framework for coalition building in the development of the International Surf Therapy Organization (ISTO). ISTO was founded in 2017 when representatives from eight leading surf therapy organizations met for the first ISTO conference in South Africa to bring collaboration to the sector. Mattila outlines benefits and challenges of using the collective impact model during the first three years of the development of ISTO as well as how ISTO can address inherent challenges of the collective impact model in its future work. Benefits include shared leadership, common agenda, reinforcing activities and continuous communication while challenges include the approach feeling top-down, difficulty with setting a common agenda, shared measurement and uneven contribution and follow-through from members. Future efforts of ISTO to address the challenges of collective impact include developing opportunities for participants to contribute to coalition building, developing opportunities for social justice initiatives and increasing funding for ISTO. Finally, Mattila provides recommendations to similar groups seeking to develop coalitions.

 

Participatory Research

 

“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

Jamie Marshall, Brendon Ferrier, Philip B. Ward, and Russell Martindale

 

Building on previous research led by Marshall, Marshall and colleagues used a grounded theory approach to better understand the experience of eighteen military veterans with physical and/or mental health challenges who participated in the Jimmy Miller Memorial Foundation one-day ocean therapy program in California, USA. Five prevalent categories emerged, two related to the nature of the surf therapy intervention and three related to individual participant experience. Tackling a challenge at one’s own pace and a familial non-judgmental safe space emerged as categories relevant to how the surf therapy program was organized. Respite, social connectedness and personal accomplishment emerged as categories connected to the experience of being a participant in the surf therapy program. Marshall and colleagues discuss these findings in relation to both flow and self-determination theories. Additionally, they discuss how the findings of this study build on previous grounded theory research in this area.

 

Surfing and the Senses: Using Body Mapping to Understand the Embodied and Therapeutic Experiences of Young Surfers with Autism

Easkey Britton, Gesche Kindermann, and Caitriona Carlin

 

In Donegal, Ireland, Britton and colleagues utilized participatory community research in their work with the Liquid Boardriders Club, a surf therapy program serving youth with disabilities. The program consisted of two-hour weekly surf therapy sessions over eight weeks. The Boardriders Club places a special focus on mind-body, self-other and self-nature connections. Largely informed by somatic studies, body mapping is used as an intervention and research method to encourage the communication of physical and emotional feelings of participants before and after surf therapy. Britton and colleagues utilized three methods of body mapping with twelve participants. The body mapping process was conducted before and after surfing to provide visual representations of the body-mind-environment capturing physical and emotional states of participants. They found that body mapping facilitated increased communication about complex emotions through visual representations. Body map themes after surf therapy expressed feelings of happiness, freedom, and being weird or silly. Parents reported that after surf therapy sessions their children felt happy, relaxed and more confident. Britton and colleagues discuss the implications of body mapping as an intervention and research tool for youth with disabilities.

 

Program Evaluation

 

Effects of PTSD and MDD Comorbidity on Psychological Changes during Surf Therapy Sessions for Active Duty Service Members

Nicholas P. Otis, Kristen H. Walter, Lisa H. Glassman, Travis N. Ray,

Betty Michalewicz-Kragh, and Cynthia J. Thomsen

 

Psychological conditions commonly co-occur in individuals, which is known as psychological comorbidity. In order to determine the impact of psychological comorbidity on surf therapy outcomes, Otis and colleagues explored whether surf therapy session outcomes differed among 47 U.S. active duty service members with probable posttraumatic stress disorder (PTSD) or major depressive disorder (MDD), or both. This study was conducted in collaboration with the Surf Therapy Program at the Naval Medical Center San Diego (NMCSD). The NMCSD Surf Therapy Program occurs once per week for six weeks, with each session lasting approximately 3-4 hours. In order to examine the effects of each surf therapy session, brief self-report assessments were completed before and after each session. The study found statistically significant increased positive affect and decreased depression and anxiety within surf therapy sessions for both groups, with greater effects observed for participants with both PTSD and MDD. These findings indicate that surf therapy can improve symptoms and affect within sessions among service members if they have probable PTSD or MDD, and particularly if they have both. Furthermore, study results suggested that surf therapy may have more global effects on symptom and functioning, rather than specific effects for particular disorders.

 

Emerging Hope: Outcomes of a One-Day Surf Therapy Program with Youth At-Promise

Gregor V. Sarkisian, Chloe Curtis, and Carly M. Rogers

 

Sarkisian and colleagues report on a two-year program evaluation of the Jimmy Miller Memorial Foundation one-day ocean therapy program in California, USA. In addition to surf instruction, the program includes talking circles to provide participants and surf instructors with the opportunity to share stories of resilience and coping in an inclusive and socially supportive environment. The program serves youth at-promise with opportunities to try something new (surfing), have fun, and enjoy a day of respite at the beach and in the ocean. Sarkisian and colleagues use a mixed-method design that included measuring hope before and after surfing (n=152), one month after surfing (n=50), and, rated drawings and related text of participants’ experience of the day (N=157). They found a statistically significant increase in mean scores on the Children’s Hope scale after surf therapy. One-month follow-up mean scores for a subsample of 50 participants were also observed to be significantly higher than pre-surf therapy means. While the results are promising, Sarkisian and colleagues discuss the limits of the observational design in attributing the cause of change in scores and limits to generalizability.

 

SURF.ART in Portugal: Daring, Accomplishing and Transforming Portuguese Youth and their Communities

Paulo Gomes, Nuno Fazenda, Diego Gomez-Baya, Mary Elizabeth Rauktis, and Grace Provost

 

Gomes and colleagues conducted an evaluation of SURF.ART, a surf therapy program in Cascais, Portugal, that works with vulnerable youth using a social-ecological approach through engaging with parents, providing psychoeducational workshops, support for crises and surf instruction and practice for youth participants. Participants of SURF.ART engage in weekly 4-hour surf sessions over three years with the opportunity to serve as a mentor after program completion. Using an observational pretest-posttest design with 69 participants using the Strengths and Difficulties questionnaire (SDQ), Gomes and colleagues found a statistically significant decrease in difficulties and a statistically significant increase in prosocial behavior. While a significant decrease in difficulties was observed for all years of participation, there was a greater effect for youth who participated for two years. And, while a significant increase in prosocial behaviors was observed for all years of participation, there was a greater effect size for youth who participated for one year only. This is one of the first studies to explore dosage of surf therapy in the context of benefits to participants. The SURF.ART film, No Mar Somos Todos Iquals (At sea we are all the same), is a feature video in this Special Issue.

 

The Wave Project: Evidencing Surf Therapy for Young People in the U.K.

Hannah Devine-Wright and Cath Godfrey

 

Devine-Wright and Godfrey conducted a three-phase evaluation over five years with the Wave Project in the United Kingdom. The Wave Project is a six-week, strengths-based program delivered over six weekends with opportunities to continue participation after program completion as a mentor. The Wave Project provides vulnerable youth with opportunities to learn how to surf in a non-competitive, supportive, and accepting social environment. Devine-Wright and Godfrey utilized a mixed-methods approach that included interviews, focus groups, Word Cloud and observational pretest-posttest measures.

 

Using subscales from several standardized measures, they found a statistically significant increase in measures of wellbeing among the 84 participants after surfing that persisted up to three months after program completion. Through semi-structured interviews with ten participants to better understand program effects in participants own words and long-term benefits of the program up to three years after completion, four overlapping theme clusters associated with wellbeing emerged – (1) shifts in coping, positive emotion, empathy and self-management; (2) increased trust, motivation, engagement and confidence; (3) changes in social identity and self-perception; and (4) a positive influence on family and community. Among 347 participants, Devine-Wright and Godfrey used a modified version of the Sterling Child Wellbeing Scale (SCWBS) – positive outlook subscale, and, a word association task post-surf therapy to generate a Word Cloud. They found a statistically significant increase in mean scores on the modified SCWBS positive outlook subscale and 833 words were generated through the word association task related to me and surfing with Fun being the most commonly reported word. Devine-Wright and Godfrey discuss the implications of their five-year, three-phase evaluation as it relates to the positive impact on vulnerable youth over time.

 

Positive Effects of Surfing on Psychological Wellbeing of Children with Developmental Difficulties

Hanneke van Ewijk, Marjolein Wansink-Lokerman, Andreas Lamerz, and Suzanne van den Broek

 

Van Ewijk and colleagues evaluated the Surf Project in the Netherlands, serving youth with disabilities. The Surf Project consists of a Surf Academy that includes three two-hour surf lessons over three weeks and a Surf Club that includes 3-6 additional surf sessions after the conclusion of the Surf Academy. Youth are able to participate in the Surf Club each year until 18 years of age. The curriculum of the Surf Project was developed to facilitate a safe and positive experience for participants through a structured curriculum, protocol-adherent preparation, and a personalized approach through one-on-one mentoring. Using an observational pretest-posttest design, 149 parents (of 84 youth) completed the KIDSCREEN-27, which measures five domains of quality of life, before and after the three surf therapy sessions. They found statistically significant increases in three KIDSCREEN domains, psychological wellbeing, social support and peers and school. Autonomy and parental relation approached statistical significance whilst there was no statistically significant change in physical wellbeing. Van Ewijk and colleagues also collected data using a customized evaluation questionnaire and found that the general program experience, surf lessons, and mentoring were all experienced by parents as very positive for their children and young adults. The Surf Project (The Netherlands) video is included in this Special Issue.

 

More than Surfing: Inclusive Surf Therapy Informed by the Voices of South African Children with Autism Spectrum Disorder

Nicci van der Merwe and Paula Yarrow

 

Using an exploratory case study design, Van der Merwe and Yarrow evaluated the process of adapting the Waves for Change surf therapy program, developed for neuro-typical vulnerable youth, to serve neuro-diverse vulnerable youth populations in South Africa. Neuro-typical refers to the typical development of intellectual and cognitive abilities while neuro-diverse refers to developmental differences commonly associated with Autism Spectrum Disorder (ASD). Through surf therapy and psychoeducation, Waves for Change works to build opportunities for youth to develop skills to regulate behavior and emotions, cope with community trauma, and develop their sense of purpose. For this pilot program, 45 youth with ASD participated in two, 16-week, weekly 3-hour surf therapy sessions. Focus groups were conducted with 10 parents/caregivers, 6 teachers/occupational therapists, and, Makaton symbols were used to provide visual stimuli on emotions participants were experiencing pre, mid and post surf sessions. Makaton symbols include six visual symbols representing emotions – frightened, sad, angry, happy, calm, brave.

 

Makaton symbols were analyzed using Word Clouds to illustrate change in emotions during the course of surf therapy sessions with most common words pre-surf therapy session being Nothing, mid-surf therapy session being Happy and post-surf therapy session being Brave. From the focus groups with parents/caregivers and teachers/occupational therapists, four major themes emerged in terms of benefits: Increased confidence and sense of identity; strengthened peer and adult relationships; increased communication initiation; and, increased verbal output. Van der Merwe and Yarrow discuss four areas in which they had to adapt the Waves for Change program in serving neuro-diverse participants – (1) Integrating visual communication; (2) embedding routine and structure into the regular program operations; (3) a decreased ratio of facilitator to participants (1:2 vs. 1:10); and, (4) increased training for facilitators on how to interact positively with youth who have ASD. A video outlining the program is included in this Special Issue– Autism is My Superpower.

 

Community Tool - Surf Therapy Program Planning

 

Intervention Mapping: Using Theory and Evidence to Inform the Ocean Mind Surf Therapy Program for Improving Youth Mental Health

Lisa Olive, Rachel Parker, Madeleine Dober, Cameron Drake, Michael Keith, and Rohan Telford

 

Olive and colleagues share Intervention Mapping, a protocol they used to replicate the U.K. based Wave Project surf therapy program for use in Australia as the Ocean Mind surf therapy program. Both programs serve vulnerable youth, however the contexts in which the programs work vary in cultural, environmental and social circumstances. They describe how they applied the six steps of Intervention Mapping as a planning tool for surf therapy program development, implementation and evaluation – (1) Needs assessment; (2) Formation of change objectives; (3) Selection of theory-based methods and practical strategies; (4) Intervention development; (5) Adoption and implementation plan; and, (6) Evaluation planning. Olive and colleagues describe how they navigated each step of the planning process and provide detailed examples of how intervention mapping works to plan a surf therapy program. One major limitation they experienced was a lack of resources which limited the scope of planning and resulted in an intervention that was focused on individuals. To expand the reach of interventions to larger social contexts, Olive and colleagues recommend collaboration with local community organizations and groups during the planning process to expand the reach of surf therapy programs from an individual to a community level.

 

Videos

 

In addition to the videos highlighted above, the Special Issue includes a video from the Warrior Surf Foundation (WSF), based in South Carolina, USA. A surf therapy program delivered by veterans for veterans, the WSF serves veterans active duty military service members and their families through a 12-week surf therapy clinic with opportunities for participants who complete the clinic to serve as mentors and continue participation indefinitely (http://www.warriorsurf.org):

 

Founded on Folly Beach, South Carolina in May 2015 by American combat veterans and surfers, the Warrior Surf Foundation addresses post-service transition challenges such as post-traumatic stress, moral injury, survivor’s guilt and traumatic brain injury.

 

The WSF has recently partnered with faculty from local universities to begin program evaluation efforts.

 

Guest Editors

 

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

Kristen H. Walter, Gregor V. Sarkisian, Giovanni Martinez and Philip B. Ward

 

In the concluding article, Walter and colleagues synthesize the collective work in this Special Issue and discuss implications pertaining to future practice, research, and coalition building in the surf therapy sector. Though there is variability among surf therapy programs, intervention components, and populations served, there are core competencies and common elements that may contribute to the positive outcomes reported by surf therapy participants. These aspects and processes by which they may occur are discussed. Additionally, each of the articles in this Special Issue assists in furthering the knowledge base of surf therapy in unique ways; however, recommendations and considerations for future surf therapy studies are presented as to encourage the continued scientific evolution of surf therapy. Lastly, this compilation of articles reflects the mission and values of the International Surf Therapy Organization (ISTO). The initiatives of ISTO and how they are informed by the current state of science and practice are presented to pave the way for the future of the surf therapy sector.

 

References

 

Dalton, J. & Wolfe, S. (2012). Joint Column: Education Connection and the Community Practitioner. Competencies for community psychology practice: Draft for review. The Community Psychologist, 45(4), 7-14.

 

Disclaimer

 

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. Government.

 

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Author(s)

Gregor V. Sarkisian, Kristien H. Walter, Giovanni Martinez, & Philip B. Ward

Gregor V. Sarkisian, Professor, has taught in the Applied Community Psychology specialization within the M.A. in clinical psychology program at Antioch University Los Angeles since 2005. Dr. Sarkisian began working with the Jimmy Miller Memorial Foundation (JMMF) in 2015 and 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.

 

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.

 

Giovanni Martinez, is a license Clinical Psychologist in Puerto Rico and the Founder/Executive Director of the 501 (c) (3) non-profit organization Surf4DEM, Inc. 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. 

 

Philip 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 Organisation, and a board director of the Waves of Wellness Foundation.

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