The following article is Part 3 of an excerpt from Cash Lambert's book Surf Therapy: The Evidence-Based Science for Physical, Mental and Emotional Well-Being, published by Hatherleigh Press and Penguin Random House in 2024.
You can read Part 1 "Did Native Hawaiians Use Surf Therapy" here and Part 2 "Blind Children Surf" here.
In 2017, something happened that would serve as the catalyst for the surf therapy sector to grow. Waves for Change, a surf therapy organization based in Cape Town, South Africa, had received a grant to grow not just their program, but the sector as a whole.
Eight organizations from around the world sent practitioners to Cape Town. From the outside, it may not have looked like much—a group of surfers talking about surf therapy—but it was the most significant meeting in the history of the surf therapy sector to date.
One person present was Kris Primacio, an energetic and sweet woman with Native Hawaiian roots who, at the time, served as the Program Manager for The Jimmy Miller Memorial Foundation. Kris understood the power of surf therapy firsthand.
After Kris Primacio learned how therapeutic surfing could be firsthand, she knew it could help others. Photo courtesy Kris Primacio
She began surfing in 2011, six months after her father was diagnosed with cancer.
“I sought the ocean’s healing powers to turn off the heartache of watching my father endure the relentless stages of terminal cancer,” she told me. “The ocean, God bless her, embraced my heartache like nothing else could have. I discovered what so many people already knew—surfing gets you into a flow state. During that time, mixing my saltwater tears with the saltwater in the ocean was extremely comforting. The ocean healed me, and it’s a place where I still find refuge. It feels like a hug when you’re immersed in the arms of the ocean.”
For five days, the group, including Kris, shared, brainstormed, laughed, cried, and differed on how to grow the sector.
The result was the creation of an international body that would serve as the meeting point for all surf therapy organizations, from past to present and future: the International Surf Therapy Organization (ISTO).
The goal of ISTO is simple: bring together surf therapy organizations, share methods, facilitate research, and promote better practices so more people can safely and inclusively experience the healing powers of surfing.
A mere nine months later, in 2018, 35 individuals representing 15 surf therapy organizations gathered in Jeffrey’s Bay for the second annual ISTO conference.
One of the main discussion points was the organization’s growth — which required someone at the helm. Kris was chosen.
“One year after we officially launched, I was appointed CEO of ISTO. It was exciting and intimidating all at once,” Kris said. “By harnessing the power of partnership, we know we can make bigger waves. We are expanding surf therapy awareness worldwide by increasing the research, [as well as] developing and sharing our practices.”
According to Kris, ISTO exists “to provide access to resources and connect practitioners in meaningful ways to learn from one another.” Through this, new practitioners have unlimited help and inspira tion through online monthly working groups, quarterly webinars, and annual conferences—none of which existed before ISTO.
Collectively, ISTO decided upon the theme of “Go Far Go Together,” a shortened version of an African proverb.
“What we found is that very few organizations spoke to one another or even knew other organizations existed,” Kris told me. “It felt like we were better together.”
In 2019, ISTO hosted a conference that showed just how far they had grown in just two years: 50 surf therapy organizations, 40 guest speakers (myself included to discuss Waves of Healing), and, in total, a little under 300 people.
Author Cash Lambert speaking on a panel alongside Eddie Donnellan, Tim Gras, and Mark Sawyer Chu about how surf therapy can impact lives. Photo courtesy Christina Cernik
To be a member of ISTO, you must do two things: first, contribute to surf therapy, and second, contribute to data around surf therapy.
One of ISTO’s most significant achievements to date is the latter.
“Evidence and exposure bring validation,” Kris says. “Our vision is universal acceptance through prescription. We can’t do that with out data.”
Before ISTO, less than 20 surf therapy publications had been published.
More than 300 people packed ISTO's surf therapy symposium in 2019, with many putting their words to action with a surf therapy event alongside the Jimmy Miller Memorial Foundation. Photo courtesy Christina Cernik
In 2020, the Global Journal of Community Psychology Practice released the First-Ever Special Issue Dedicated to Surf Therapy Research Around the World.
The Special Issue featured eight-peer reviewed articles, including 39 authors, researchers, scholars, students, practitioners, clinicians, and ISTO contributing members.
The idea to collectively submit research articles to an academic journal was made during the ISTO 2018 conference in Jeffrey’s Bay by ISTO Advisor Gregor Sarkisian.
The issue also included a comprehensive scoping review yielding 29 papers.
“This Special Focus Issue on Surf Therapy Around the Globe includes the most comprehensive collection of research on surf therapy,” said Gregor Sarkisian, Ph.D., who teaches psychology at Antioch University in Los Angeles. “It includes empirical research on eight surf therapy programs delivered across six countries—Ireland, the Nether lands, 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.”
“That journal alone tripled the research in surf therapy,” Kris told me. “I am stoked about the growing amount of data in the surf therapy industry and feel fortunate to be a witness to it all. I believe that surf therapy will become widely recognized and appreciated. It’s exciting to think that we will have been a part of its early development.”
Some of the study’s findings included:
• Surf therapy resulted in improvements in physical fitness, self confidence, social development, behavior and sleep, and reduced levels of anxiety for youth with disabilities.
• Surf therapy improved self-concept, emotional regulation and social competencies of children and youth in need of social and emotional support. In addition to this, participants also experienced re-engagement with school, and decreases in behavioral problems reported post-intervention.
• Surf therapy helped active-duty military service members decrease their symptoms of depression, anxiety, and PTSD. In addition to this, an active-duty military service member, surfing was found to have the ability to provide an alternative form of pain management.
• Surf therapy provided respite from the symptoms of PTSD, in addition to decreased stress levels, depressive symptoms and use of narcotics, and an increase in feelings of self-efficacy for a population of military veterans.
• Surf therapy improved the body image, self-esteem, and self compassion of a young adult population of cancer survivors. In addition, the participants reported decreases in self-reported depressive symptoms/depression as well as decreased feelings of alienation.
• Many more surprising, data-proven findings on the results of surf therapy.
"This recognition validates our efforts to bring together a level of collaboration and medical legitimacy that hasn’t been seen before in surf therapy,” Kris told me. “Data is the new healthcare currency. Protecting and growing it is vital for systematic change, so we have prioritized advancing research.”
While practitioners like Kris know that surf therapy works per sonally and amongst others, this never-before-seen collection of data helped further validate surf therapy’s effectiveness to academia.
What has also helped grow surf therapy’s presence in academia is the first-ever Ph.D. in surf therapy—an impressive title held by Scotsman Dr. Jamie Marshall, Research Fellow at Edinburgh Napier University.
Like many key players in the industry, Jamie first experienced how therapeutic surfing could be—and wanted to share it with others.
“When I look back on my life, a career in surf therapy seems inevitable,” he told me. “When I was at school, I struggled with some significant bullying which definitely affected my own mental health. When I was about 15, I got invited on a trip through the school and experienced surfing for the first time. I paddled into that first wave and all of that washed away. All the anecdotes you hear about surfing being therapeutic was true for me in that moment. Surfing gave me an identity and a feeling that no bully could take away.”
The man who laid claim to the first surf therapy PhD: Jamie Marshall. Photo courtesy Jamie Marshall
Jamie was asked to volunteer with the Wave Project, a UK based surf therapy program founded in 2010, and for the first time, he saw the effects that surfing had on participants with autism.
“Seeing the joy these guys and girls had, it was just infectious,” he said.
Witnessing how surfing was therapeutic for himself and others made Jamie curious. “Seeing these big changes that happen to young people, to veterans…when you say it out loud it’s unbelievable… people speaking again after going mute or being free from flashbacks. I was really struck by this when I was running the program [the Wave Project’s Scotland program], I wanted to know what was going on.”
One of the volunteers Jamie worked with was a lecturer at the University of Edinburgh in Scotland, and the person recommended Jamie to a Masters program where he could study physical activity’s impact on mental health, if not surfing specifically.
Jamie said that his Masters research led to “some theories” about surfing’s therapeutic properties, but he needed to go deeper—the impetus behind beginning his PhD.
“I’ve experienced people saying that surf therapy wasn’t evidence based, and that mirrors what other surf therapy practitioners have experienced…‘You aren’t serious about helping people, you just want to go surfing.’ The ultimate response to that is that I surfed less during the write up of my PhD than any other point in my surfing life! It was complete irony.”
Jamie examined a range of populations around the world, including “military veterans in the USA, youth in post conflict Liberia, and youth at-risk-of or with mental health diagnosis in Australia.”
He compiled his findings in A Global Exploration of Programme Theory within Surf Therapy. In the abstract, Jamie summarized his conclusions by noting the growing understanding and evidence behind surf therapy:
“The findings from the current research programme have pre sented 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, pre scribed, and standard means of care in supporting global mental health.”
Today, Jamie remains the pioneer of a doctorate in surf therapy— leading the way for other academic studies to follow. In addition, as a board member for ISTO, he is in constant contact with surf therapy practitioners from around the world—a community that has recently grown even larger.
ISTO’s growth has reached new heights up to the present time. As of 2023, they are engaged with 133 surf therapy organizations around the world—more than a 1550 percent growth in surf therapy programs.
ISTO's 2023 global conference was bigger than ever. Photo courtesy ISTO
Regarding where ISTO is headed, they’re promoting surf therapy with a goal—“Inclusive access to evidence-based, safe surf therapy worldwide.” Kris told me.
She referenced the Wave Project—a UK based surf therapy organization that has several programs within its organization that is funded by the National Health Service (NHS) and, therefore, the first surf therapy program recognized financially by a healthcare institution.
“If more institutions acknowledge the effective ness of surf therapy and provide funding, it can lead to the creation of more programs. This, in turn, can ensure that more people in need have access to this beneficial form of therapy. Here in the US, we need more RCTs (randomized controlled trials). Programming must go through all the checks and balances. Surf therapy will undoubtedly be added to the list of alternative treatment methods for mental health, but we have a long way to go.”
Today, ISTO and its global coalition of surf therapy organizations have one goal with surf therapy, and it’s the same goal that Ted Silverberg and his friends had in the 1980s, and the same goal that Hi’iaka had in The Epic Tale of Hi’ikaikapoliopele: to use surfing as a means of healing.