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Go Far, Go Together: The Story Behind the International Surf Therapy Organization

Updated: Apr 22

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.

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.  


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