A Global Exploration of Programme Theory within Surf Therapy

Mental health problems have been estimated as the biggest challenge facing global health in recent years (Vigo et al., 2016) and has been further exacerbated by the COVID-19 pandemic (Usher et al., 2020). One novel approach to addressing this mental health crisis is the emergent ‘surf therapy’ paradigm which combines surf instruction/surfing and structured individual and/or group activities to promote psychological and physical well-being (International Surf Therapy Organisation, 2019). While surf therapy has been associated with a positive impact on mental health across many populations, a recent scoping review prioritised empirical understanding of surf therapy programme theory as a key priority for future research (Benninger et al., 2020). To address this knowledge gap, this programme of study conducted a qualitative investigation into surf therapy programme theory for a range of populations (military veterans in the USA, youth in post conflict Liberia, and youth at-risk-of or with mental health diagnosis in Australia). Findings from these studies had practical implications for optimisation of surf therapy delivery and were then compared to identify generalisable theoretical mediators. Physical and Emotional Safe Spaces, Positive Social Connections, Respite from Negative Emotions / Symptoms, and Transferable Mastery emerged in multiple studies. The consistent identification of the importance of safe spaces within intervention structures presents a learning of significance for mental health provision both for and out with the surf therapy paradigm. Alongside this the identification of the potential symptom reliving impact of ‘flow’ states (Csikszentmihalyi, 2002) as experienced within surf therapy provide a novel research priority for the future. Subsequently a Delphi style consultation with a different population (emergency service/healthcare workers in Scotland) built upon these findings to provide a framework for a novel surf therapy intervention with this population and an example of contextual adaption of theoretical mediators. The findings from the current research programme have presented an original and significant contribution to knowledge around programme theory within surf therapy and mental health. Taken together, all these conclusions make significant contributions to surf therapy’s aim of becoming a trusted, prescribed, and standard means of care in supporting global mental health (International Surf Therapy Organisation, 2018)